What is Gastric Banding (Lap-Band) Surgery?

Adjustable Gastric Banding works by placing a band around the upper most part of the stomach, separating the stomach into one large and one small portion, which can hold about one ounce of food. The food from small pouch in the stomach empties into the closed-off portion of the stomach and then resumes the normal digestive process.

No staples are used in this procedure, and your physician can adjust the diameter of the band around the stomach by adding or removing saline (salt water). Over time, the pouch can expand to hold two to three ounces of food. Since no part of the stomach is removed, digestion remains normal.

This type of procedure is classified as restrictive because the size of the stomach is reduced so dramatically. Despite the lack of malabsorption, we still encourage daily vitamin intake as part of your healthy lifestyle.

Weight loss is slower and lesser with the lap band. You can expect to lose 50 percent of your excess weight at two years. Potentially, with continued adjustments of the band and better eating and exercise habits, you may lose more weight. Like gastric bypass, your effort will be critical to producing significant weight loss. Even with this operation, it’s possible for you to eat enough to maintain your pre-operative weight or to regain any weight you lose.

It will be critical that you begin and continue an exercise program for the rest of your life. This should include at least 30 minutes of exercise five to seven days a week. In addition, it’s critical that you maintain a diet for the rest of your life that consists of no sweets, very small amounts of carbohydrates, small volumes of food and high protein intake. You’ll need to eat 40-60 grams of protein a day and it’ll be very important for you to pay attention to food labels to make sure you get enough.

After the procedure, you’ll only be able to eat about three-quarters to one cup of food, and you have to chew the food thoroughly. Eating more than the stomach pouch can hold may result in nausea and vomiting. Restrictive procedures pose fewer risks than gastric bypass procedures, but they’re also less successful because continuous overeating can stretch the pouch so that it accommodates more food.

Because the surgery can have serious side effects, the long-term health benefits must be considered and found greater than the risk. Despite the fact that some surgical techniques can be done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.

Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems. It may help to:

  • lower blood sugar
  • lower blood pressure
  • reduce or eliminate sleep apnea
  • decrease the workload of the heart
  • lower cholesterol levels

Surgery for weight loss is not a universal remedy, but these procedures can be highly effective if you’re motivated after surgery to follow your physician’s guidelines for nutrition and exercise and to take nutritional supplements.

There may be other reasons for your physician to recommend a gastric banding procedure

Risks of the Procedure

As with any surgical procedure, complications may occur. Risks specific to vertical gastric banding include breakdown of the line of staples and erosion of the band. Rarely, stomach juices may leak into the abdomen and emergency surgery may be needed.

The most common complication that may develop with adjustable gastric band surgery is that the stomach pouch enlarges. Band slippage and saline leaks are also risks specific to adjustable gastric band surgery.

A laparoscopic banding procedure can reduce risk because there’s no incision in the stomach wall. There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

Prior to the procedure, you’ll be experience a large amount of prep work, both immediately before and in the weeks leading up to your surgery date. Here’s what to expect:

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your physician permission to perform the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • You will be asked to fast for eight hours before the procedure, generally after midnight.
  • If you are pregnant or suspect that you are pregnant, you should notify your physician.
  • Notify your physician if you are sensitive to or are allergic to any medications, latex, iodine, tape, or anesthetic agents (local and general).
  • Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
  • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • You may be asked to begin exercising and alter your diet several weeks before surgery.
  • If you are a woman of child-bearing age, you may receive birth control counseling so that you do not become pregnant in your first year after surgery due to the risk to the fetus from rapid weight loss.
  • You may receive a sedative prior to the procedure to help you relax.
  • The area around the surgical site may be shaved.
  • Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Gastric Banding is a 23 hour admission and almost all patients go home the same day. Procedures may vary depending on the type of procedure performed and your physician's practices. Gastric banding surgery will be performed while you are asleep under general anesthesia. Your physician will discuss this with you in advance. Generally, gastric banding surgery follows this process:

  1. You’ll be asked to remove clothing and change into a gown.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You’ll be positioned on your back on the operating table.
  4. A urinary catheter may be inserted.
  5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level during the surgery.
  6. The skin over the surgical site will be cleansed with an antiseptic solution.
  7. For a laparoscopic procedure, the surgeon will make a series of small incisions, then carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the appendix and other structures can easily be visualized.
  8. For an adjustable gastric band procedure, a hollow band will be placed around the top end of the stomach to create the small pouch that will serve as the new stomach. A narrow passage will connect to the rest of the stomach. The band will be inflated with a salt solution.
  9. A drain may be placed in the incision site to remove fluid.
  10. The incision(s) will be closed with stitches or surgical staples.
  11. A sterile bandage/dressing will be applied.

After the Procedure

After the procedure, you’ll be taken to the recovery room for observation. Once your blood pressure, pulse and breathing are stable and you are alert, you’ll be taken to your hospital room.

You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line. You’ll be encouraged to move around as much as you can while you’re in bed, and then to get out of bed and walk around as your strength improves.

At first you’ll receive fluids through an IV. After a day or two you’ll be given liquids, such as broth or clear juice, to drink. As you’re able to tolerate liquids, you’ll be given thicker liquids, such as pudding, milk or cream soup, followed by foods that you do not have to chew, such as hot cereal or pureed foods. Your physician will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods.

A nutritionist will instruct you about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract. Before you’re discharged from the hospital, we’ll schedule an appointment for a follow-up visit with your physician.

At Home

Once you’re home, it’ll be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions.

The incision and abdominal muscles may ache, especially with deep breathing, coughing and exertion. Take a pain reliever for soreness as recommended by your physician. Because aspirin or certain other pain medications can increase the chance of bleeding, be sure to take only recommended medications.

Continue the breathing exercises you began using in the hospital, and gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina. You may be instructed to avoid lifting heavy items for several months in order to prevent strain on your abdominal muscles and surgical incision.

Weight loss surgery can be emotionally difficult because you’ll be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. But once your body adjusts, you’ll start to feel better. Also, exercise and attending a support group can be helpful at this time.

Notify your physician to report any of the following:

  • fever and/or chills
  • redness, swelling, or bleeding or other drainage from the incision site
  • increased pain around the incision site

 

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