Gastric Band Service

Gastric Banding

You need to understand the following before embarking on the placement of a gastric band (The MIDband® adjustable gastric band featured right):

• Adjustable gastric banding is not the right decision for everyone.
• To make the decision it is important that you make an informed choice and that you are happy with your choice.
• Gastric banding is not a 'quick fix' or magic wand. It needs to be medically managed and you will need support before and after the band has been placed.
• The band is a tool to help you re educate your eating habits.
• You have to be prepared to work with your band and not against it.
• If you are a suitable candidate for an adjustable gastric band your life style and eating pattern will change. You need to weigh up whether life style and eating habits that you may have had for years are worth saying goodbye to.
• You must be committed to post operative follow up care. Having the band placed is the easy bit - you will need experienced and professional support following surgery.
• Banding is a two way thing. Surgeons who operate on obese people know they are operating on higher risk patients - I'm ever grateful to my surgeon for doing so. I am committed to long term responsibility of living with my MIDband® in exchange for significant weight loss.
• All surgery has a risk factor - risk factors are increased because of obesity.

Is it for you?

It might be, but the final decision lies with your surgeon or Endocrinologist. Listed below are indications that you are suitable for gastric band placement:

• BMI (Body Mass Index) above 40 or between 35 to 40 in the presence of other associated diseases that may improve with weight loss - high blood pressure, diabetes, sleep apnoea, painful joint condition arthritis proven by x-ray
• Aged at least 18 years
• Stable obesity for more than five years
• Diet failure or weight loss drug therapy for more than one year
• Absence of glandular diseases such as hypothyroidism
• Full understanding of the procedure and compliance by you including your commitment to long term follow up care
• No dependency on alcohol or drugs
• No specific medical or psychological reasons why weight loss surgery should not be performed. If you are uncertain contact us and we will discuss this with you.

Not suitable for Laparoscopic Adjustable Gastric Band

Sometimes an adjustable gastric band is not suitable for you. Below are listed some conditions that may mean you are not suitable for band placement. Again, the final decision is a medical one.

• Gastrointestinal disease including: Ulcerative Colitis / Crohn's disease, gastric ulcers, duodenal ulcers, pyloric ulcer. Congenital abnormality of the Gastro intestinal tract that would affect surgical intervention - e.g. oesophagial atresia.
• Heart or Lung disease: severe heart or lung disease
• Blood disorders: clotting disorders, venous disease, congenital or acquired intestinal telangiectasia (dilation of a small blood vessel), portal hypertension.
• Auto immune disorders: e.g. lupus erythematosus or scleroderma
• Liver disease: e.g. cirrhosis
• Pregnancy - if you become pregnant following weight loss with the MIDband then it can be deflated and managed accordingly. Banding is not recommended if you are actively planning a family or intend to become pregnant immediately following band placement.
• Drug or alcohol addiction.
• Chronic infection: e.g. MRSA, VRE or other infections that may cause post operative infection.
• Steroids: long term steroid treatment
• Silicone allergy
• Significant psychological or psychiatric history

Risks

Any operation carries with it a risk factor and being obese increases the risk of complications. General anaesthesia alone has a risk factor if one is not obese and is increased if obesity is present.

Gastric banding is a swift procedure and because it is performed using laparoscopic surgery; the complication rate is less than with open or more radical weight loss surgery such as gastric bypass.

Less than 1 in 100 patients are diagnosed with complications such as: inflammation of the oesophagus, gall bladder, stomach and pancreas. Wound infection and pain associated with the operation. These can be treated without admission to hospital.

Some complications however do require immediate hospital admission and treatment. These would include:

• Severe dehydration (for example, due to a blockage)
• Band slippage
• Band erosion
• Band migration.

At the time of writing there have been no reported cases of MIDband® migration (2005).

Should there be indication for an AGB to be removed this may be done so by laparoscopic surgery and would require admission to hospital.

Further information - The MIDBand

The www.laparoscopic-surgeon.com/visu/anneau.php webpage is a great source for more detailed information on the MIDBand and how it functions. To see an animation you will need to click on the blue button on the right side of that page.

Further information - Pre-operative Gastroscopy

What is Gastroscopy?

The preoperative investigations for gastric banding surgery may include a gastroscopy. Gastroscopy is a procedure which enables the endoscopist to see inside your gullet, stomach and small intestine using a thin flexible tube with its own lens and light source. It is superior to x-ray because not only can the doctor see the surface areas, but they are also able to take samples for pathology.

Why is Gastroscopy done?

Gastroscopy is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract. It may also be used as part of a preoperative examination prior to gastric banding.

One possible cause of some of these symptoms can be a Peptic Ulcer; a gastroscopy can therefore help avoid an undiagnosed ulcer perforating once banded.

What preparation is required?

You should have nothing to eat or drink, including water, for approximately 6 hours before the examination.

What happens during the Endoscopy?

n some circumstances you will be given a light anaesthetic for this procedure (usual in France); otherwise your throat will be sprayed with a local anaesthetic before the test begins. A mouthguard is placed in your mouth, and you will be given a sedative anaesthetic to help you relax during the test. While you are in a comfortable position, the endoscope is passed through the mouth and then in turn through the oesophagus, stomach and duodenum. The endoscope does not interfere with your breathing during the test. Most patients consider the test to be slightly uncomfortable and many patients fall asleep during the procedure.

What are the possible complications of Gastroscopy?

Gastroscopy is generally safe. Complications are rare when doctors with specialised training and experience perform this procedure. Bleeding may occur from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires a blood transfusion. The sedation used can cause a localized irritation of the vein.

What happens after Gastroscopy?

After the test, you will be monitored in the recovery area until most of the effects of the medication have worn off. Your throat may be a little sore for a while, and you may feel bloated after the procedure due to the introduction of air into your stomach during the test. You will be able to resume your normal activities the following day unless you are instructed otherwise. You must not drive or operate machinery for the rest of the day. If you are not remaining in hospital for another procedure you must arrange for someone to take you home.

Is there any more information on this topic?

You may find following article useful:

Medicle article on Gastroscopy

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