What is a Gastric Band?
How does it work?
What are the risks?
Under general anaesthetic, using laparoscopic (keyhole) technique, a small silicone band (like a belt) with an adjustable component is placed around the upper part of the stomach and secured in place. It is connected to an access reservoir, which is placed under the skin in a discreet fashion to allow adjustment.
This reduces the amount of food that can be swallowed in each mouthful, and requires careful chewing. It takes longer to eat a meal. Hunger is reduced, meal size is reduced and this encourages weight loss.
As with any surgery to help weight loss, it is still important to choose healthy foods which are not calorie-dense, and exercise regularly.
The operation is one of the lowest risk operations performed in general surgery, and hospital stay is usually less than one day. During recovery, a “thin fluid” diet is required for two weeks while the body heals. Most people are surprised that they are not hungry during these two weeks. After that, soft foods are added and it usually takes another two weeks for solid food to be introduced again. However, after a month or two, most people return to eating normal foods. The pattern of eating is dramatically changed by the band: meals are chewed more carefully, eaten more slowly, and some foods are too difficult to swallow, such as soft white bread and stringy meats like steak.
We know that diet and exercise, supported by counselling, personal trainers, group work, hypnosis, acupuncture or medication are the key to weight loss, but only 5 % of people are able to lose more than 10 kg and keep it off for more than 6 months without the help of surgery.
The adjustable gastric band offers permanent loss of 50% of your excess weight (and more importantly, improvements in health and mobility) for 80% of people.
But what about the other 20%? They are important to us too. About half of those fail to lose as much weight as they would like because of ongoing lifestyle and dietary choices. The remaining 10% mostly struggle because of a slip.
About 10% of gastric bands slip, so that they are no longer in the right position on the stomach.
If they slip upwards, there is no longer any stomach above the band. In this position, the band does not restrict eating until it is very tight. Then it only causes pain when swallowing, and people with this kind of slip often find themselves living on a liquid diet, which is usually high in calories.
If the band slips down, the stomach pouch above the band is too large. This means that bigger meals are eaten before the hunger is quenched. Also, there is now more stomach in the band, making it tighter, and food gets stuck in it more often. With this kind of slip, many people suffer reflux and heartburn, especially at night. Some people even need to sleep in a chair.
Sadly, if the band has slipped, filling or emptying it using the access reservoir will not fix the problem. It requires another operation to put it back where it should be.
We feel that frequent vomiting increases the chance that the band will slip, and encourage our patients to come and have the band reviewed urgently if there are three or more vomits in one day. We would not expect people to bring food back up unless they are eating too quickly, or chewing insufficiently. If you have doubts, your Circle of Care team is happy to help review things.
Other problems, which are much less common include difficulty in using the access port for fills, or rarely, erosion of the band inside the stomach. While this sounds dramatic, it usually happens over many months, and is only recognised when a band which has been working well stops working, and the weight is re-gained. If a band is no longer working, it should be removed.
Risks of Surgery in General
- Insertion of the adjustable gastric band is one of the safest procedures we do (probably safer than taking out a gallbladder) but it does require a General Anaesthetic.
- Thromboembolism: the risk of deep vein clots in the leg which may dislodge and travel to the lungs is small, but it can be reduced by surgical stockings, blood thinners (heparin injections) and early walking.
- Atelectasis is collapse of the lower parts of the lungs and it can be reduced by conscientiously taking full breaths each hour after surgery and walking around. Try it now – take a deep breath while holding your hand on your belly. Only when your hand is pushed forward is your breath deep enough to reach the bottom of your lungs. It is important to use adequate pain relief.
- Bleeding is usually only minor, such as bruising at the wound sites. More severe damage to internal structures is very uncommon but there is rarely injury to the liver, spleen or bowel which may be severe enough to require open surgery.
Risks – Specific to the Gastric Band
- Infection of the band would require its removal. If you notice any sign of infection at a wound site (redness, swelling, heat, pain or fever) please notify us immediately. Early treatment may save the band.
- The access device can leak, twist, become mobile or cause discomfort. Surgery to correct these problems is usually simple.
- Injury to the stomach or esophagus is rare: 1 in 4000. Repair may be possible laparoscopically when recognised at the time of surgery or sometimes requires open operation. If the injury is not realised until after surgery, infection is inevitable and the band must be removed. If this does happen the infection is often severe enough to require admission to the intensive care unit and a prolonged stay in hospital.
Risks for the Long Term
- The band works only as long as food choices are appropriate: avoid foods which are dense in calories, or are basically liquid after you have chewed them.
- In some people, there are mechanical reasons for difficulty in eating and the band may need to be removed. Poor teeth or a weak swallow may cause these problems.
- After prolonged vomiting, the swelling in the stomach may cause a blockage. Always contact one of us if you vomit more than three times.
- The band may slip, as mentioned above. This causes vomiting, reflux, difficulty swallowing or increase in appetite. This may require removal, revision or repositioning of the band at another operation. If you have severe pain, this is a surgical emergency.
- The stomach (and band) may rarely slip into the chest. This would also require a revision operation.
- There are reports of erosion of the band into the stomach in about 1% of cases. This would cause increase in appetite, return of weight lost and require removal of the band.