Surgical Procedures:

Gastric Banding

What is gastric banding?

Gastric banding is a surgical technique which involves the placement of an inflatable silicone band around the upper part of the stomach. This partitions the stomach into two smaller compartments joined by a narrow opening. Weight reduction is achieved by reducing the amount of food that is able to be eaten and also slowing down the emptying of the stomach. This results in feeling full by eating less food. Additionally, due to the decreased emptying of food through the new stomach compartment, patients feel fuller for longer.

What does gastric banding involve?

Gastric banding requires admission into hospital and a full general anaesthetic.

Once the patient is anaesthetised, a fine tube is placed via the nose into the stomach to empty the stomach.

The procedure is done with keyhole surgery. Five small (5mm) incisions are made on the abdomen and the normally collapsed abdomen is inflated with carbon dioxide to enable visualisation of the stomach.

The stomach and lower oesophagus are then mobilised or freed away from their attached structures to allow the gastric band to fit around the stomach.

The gastric band is then manipulated around the upper part of the stomach and secured with stitches. This is done using specialised laparoscopic instruments. The inflating and deflating devise is then secured just below the skin above the belly button. The band is left deflated at the end of the procedure.

What risks are associated with the procedure?

Serious problems due to gastric banding are rare and are usually associated with pre-existing medical problems due to obesity. Due to this, thorough anaesthetic assessment prior to surgery is routine at St Vincent's Hospital.

Complications from the surgical procedure itself are uncommon, but include

1. Injury Due to Trochar Placement
   To allow the smooth insertion and removal of laparoscopic instruments in and out of the abdominal cavity , short, hollow ports are used. Insertion of these ports is done under vision, but rarely injury to blood vessels or underlying bowel may occur which require repair.
2. Bleeding/Infection
   Significant bleeding during or following the operation is rare. Post operative infection within the abdomen or wound infection are also rare complications. These complications are reduced by the administration of a single dose of antibiotic at the time of operation.
3. Conversion to Open Operation
   In less than 1% of cases, the procedure is unable to be completed laparoscopically (keyhole surgery). In these cases, open surgery is performed. The most common reason for conversion is due to scar tissue present in patients who have had previous operations.
4. Oesophageal Perforation
   As the stomach and oesophagus are attached to the back of the abdominal cavity, placement of the gastric band requires these structure to be mobilised. Rarely, perforation of the oesophagus can result. Even in these rare cases, the perforation usually heals without any treatment. Very occasionally, re operation is required.
5. Migration of band
   The band is routinely secured in position with stitches to the stomach by Dr Fenton-Lee. This prevents displacement of the band which would lead to the procedure being less effective.

What will i be like after the operation?

Keyhole (laparoscopic) surgery has revolutionised many surgical procedures. The greatest advantage of laparoscopic surgery is significantly reduced post operative pain and quicker recovery time. Following the procedure, a drip to administer fluids will remain as well as the tube into the stomach via the nose.

The following day, a special X-ray test is performed to ensure there has been no damage to the stomach or oesophagus. Once this has been cleared, the stomach tube is removed and a diet is slowly introduced.

Mobilisation is encouraged early with the aid of pain medications. Disharge is achieved once patients are mobilising independently, pain control is achieved with oral medications and they are tolerating a diet. This is generally achieved between one and three days following the operation.

Following discharge follow up with Dr Fenton-Lee is crucial to ensure success of the operation. Adjustments to the gastric band are then performed to optimise weight loss. This does not require an operation, it simply involves injecting saline into the reservoir to make the band tighter or looser according to the degree of weight loss required. It is usually done in the x-ray department to ensure the accurate placement of fluid into the reservoir.

Additionally, close follow-up with a nutritionist to monitor weight loss and to ensure it is done safely is organised.

To learn if you are potentially a candidate for gastric banding and how well it works, click here.

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