Bariatric Surgery
A gastric band is a life changing operation. It is used to help people lose weight and improve their health.
Losing weight lowers the risk of developing medical problems associated with obesity, for example: high blood pressure, diabetes, arthritis, breathing problems and asthma.
How does it work
A gastric band is an inflatable silicone band which can be used to control the amount of food passing from the stomach into the digestive tract. The operation is done as a laparoscopic (‘keyhole’ surgery) procedure while you sleep under a general anaesthetic.
When the band is placed around the upper part of the stomach, it creates a small pouch at the top of the stomach with a small opening, or ‘channel’, to the rest of the stomach. The size of the pouch and the channel both depend upon how much the band is adjusted.
During a meal, food enters the pouch before passing through the opening into the main part of the stomach.
There is a small ‘port’ attached by thin tubing to the band. This port is placed just under the skin allowing the band to be adjusted as necessary. Fluid can then be injected or withdrawn to adjust the size of the opening between the upper and lower parts of the stomach. This enables you to feel full sooner and for longer.
Usually, 5mls of fluid will be injected into the port to inflate the band six weeks after the operation. You will then be monitored closely.
What are the advantages of having a gastric band?
- Feeling full quicker and for longer
- The procedure is less invasive than other surgical techniques designed to aid weight loss.
- The band is adjustable, so we can vary the size of the opening between the pouch and the main part of the stomach if necessary.
- Shorter stay in hospital and shorter recovery time compared to the other procedures.
How much weight can you expect to lose?
You can expect to lose between 40% and 65% of your excess weight in the first 12 to 24 months following surgery. However a greater excess weight loss is not uncommon in patients who do intensive exercising.
The amount of weight you are able to lose and keep off after surgery will depend also on the lifestyle changes that you make, such as increasing the amount of exercise you take and eating a healthy diet. It is important to remember that the operation will not stop you from craving certain foods or eating what you fancy.
Women of childbearing age must not become pregnant for at least two years following gastric band surgery. After two years: if you are planning a pregnancy, please contact your specialist bariatric nurse and dieticians for nutritional advice.
What are the risks of a gastric band?
As with all surgery, gastric band has some risks. These risks vary according to your age and other illnesses you may have.
The risk of death within the first 30 days after surgery is estimated to occur in less than 0.05% (or 1 in every 2000 patients) having this operation. This number does not reflect the experience of our surgeons but it is calculated on national and international averages on the base of large multicentre databases.
Other short term complications, listed below, happen in less than 5% of patients (or 1 of every 20 patients).
Complications that can occur soon after surgery
- Wound infection
This can usually be treated with a course of antibiotics and does not require hospital admission - Infection of the port or the band
This is usually treated with antibiotics. However, it may be required to remove the port or the band for clearing the infection. - Bleeding
Very rare after gastric band. You will be monitored carefully for signs of bleeding. If occurs, it can be often managed and occasionally it may require transfusions. - Blood clots in the legs or the lungs (DVT or PE)
To prevent blood clots from forming you will be given special stockings, and an injection to thin the blood. During and immediately after your operation you will also wear special boots to prevent clots from occurring. You need to continue to wear the stockings for few weeks after your operation.
Actively walking and moving around is an essential part of your care you will be expected to be mobile straight away after you operation and increase this each day as you are at risk of developing blood clots. Your specialist nurse and consultant will give you advice before you leave hospital on activity. Smoking significantly increases the risk of clotting, our policy is that we will not operate on patients that smoke - Vomiting or band intolerance
Very occasionally the stomach may respond to the surgery with frequent spasms and a temporary intolerance to food and even liquids. This is a rare and unpredictable event which usually does not last longer than few days. Exceptionally, it may require the band to be removed.
Long term complications after gastric band surgery
- Specific to this operation, there is a 10 to 20% risk of complications within the first five years. These can include the band slipping or moving into the stomach, an increase in the size of the stomach or gullet (oesophagus), rupture of the band. This may result in the band or port needing to be removed, repositioned or replaced
- One in five to ten patients will need further surgery within five years
- Hair loss or thinning in the first six months. This is a temporary side effect of the rapid weight loss and it will re-grow
- Gallstones
How should you prepare for the procedure?
Prepare a list of written questions for your surgeon
Read information on UK patients’ group websites such as Weight Loss info
Discuss the operation with your close friends and family
Meet other patients if possible
Make healthier changes to your lifestyle
Two weeks before the operation you will be required to follow a liver shrinkage diet
The day of the operation
You will usually be admitted to the hospital on the day of your operation. If you are diabetic, you may be admitted the day before surgery.
Once your admission is complete you will see your surgeon and the anaesthetist, and a written informed consent will be signed. You will then walk to the theatre where the anaesthetist will put you to sleep. You will also be given an intravenous drip so you can have fluids during the operation..
What should you expect after the procedure?
You will wake up in a recovery room where nursing staff will monitor you for any complications. You will have a drip attached to your arm. You will also be wearing stockings and have a pumping device on your legs to prevent blood clots. As soon as you are fully awake and comfortable, you will be transferred to the surgical ward where your relatives can visit you.
You will receive painkillers to control any pain. Your surgeon will instruct you when you may start to drink water, it is important you do not have anything to drink until your surgeon feels it is appropriate for you to do so.
You will be encouraged to get out of bed as soon as possible on the day of surgery. This helps to reduce the chance of post operative complications such as blood clots in the legs or chest infections, when in bed you need to be sat upright.
The amount you may drink will be increased every couple of hours until you are able to take at least one glass of water every hour. Your drip will be removed when you are drinking enough to keep you hydrated.
You should start to feel better very quickly after the operation and will be able to move around on your own.
You need to drink one 125ml glass of smooth fluid every hour when you are awake. For example, you may have clear jelly, clear soup, tea, coffee and milky drinks.
At discharge
Pain and medication
Gastric band is usually not a painful procedure. You will be given a supply of soluble painkillers to take home with you; these should be taken regularly for the first few days.
If you have no pain gradually reduce the amount of pain relief you are taking. Allow soluble tablets to stop fizzing before you drink them.
You will also be prescribed an anti-acid tablet (lansoprazole) and multivitamins and minerals to be taken lifelong after your surgery. You will have lifelong blood-thinning injections daily for 10 days after your operation and the nurse will give you advice on how to do this before you are discharged.
If you have been taking medication to control your blood pressure or diabetes, these will be reviewed before your discharge. Please make sure you are clear about this before you leave the hospital.
Important
Do not take any large tablets for first four to six weeks as they may get stuck. All tablets must be crushed or taken in soluble form. If in doubt, please ask your surgeon or specialist nurse.
Wounds
Abdominal stitches will need removing by your practice nurse at 14 days after your operation.
Anti-emboli stockings
You should take them home with you and continue to wear them until you are walking about on a regular basis. We advise you not to fly within six weeks of your operation. If you fly soon after this, we advise you to wear stockings during the flight.
Eating and drinking
You will be given a diet information sheet. You should have this with you at all times so you know what to drink and eat and are familiar with the stages of food introduction in the next few weeks. In case of doubt you are advised to contact your dietician.
You are advised to drink at least two litres of fluid per day to help avoid dehydration and constipation, it is a good idea to obtain a water bottle so you can maintain this fluid intake whilst out of the house and overnight whilst in bed.
Washing
You can have a shower but, for at least a week after surgery, do not soak in the bath.
Driving
You may drive as soon as you can comfortably wear a seat belt and are able to perform an emergency stop (independently assessed by a close relative or a friend). You should check with your insurance company for their specific advice about driving after keyhole (laparoscopic) surgery.
Other activities
Straight after your surgery, you will be able to walk. Try to go for a walk every day, gradually increasing the distance as you feel able. You will need at least two weeks off work but please check with your surgeon. It is advisable to avoid heavy lifting for at least four to six weeks after abdominal surgery, if you are unsure discuss with your surgeon. You may resume sexual activity as soon as you feel comfortable.
Follow up appointment
You will be seen again at an outpatient clinic about six weeks after your operation
Contact details
- The James Cook University Hospital
Tel: 01642 854505 (available 24 hours) - The Bariatric Team
Tel: 01642 835724
Email: [email protected]
Further help and information
- Weight Concern
1-19 Torrington Place, London WC1E 6BT
Tel: 020 7679 1853 (not a helpline)
www.weightconcern.org.uk
Weight Concern is a registered charity, set up to tackle the rising problem of obesity. Weight Concern has shown how psychologists, dieticians and exercise specialists working together can help people make the lifestyle changes they want, to control their weight.
- WLS info (Weight Loss Surgery Information and Support)
Wessex House, Upper Market Street, Eastleigh, Hampshire SO50 9FD
Tel: 0151 222 4737
www.wlsinfo.org.uk
- British heart foundation
www.bhf.org.uk
- Diabetes UK
www.diabetes.org.uk
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]