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FAQ's

Gastric Banding

Can I be considered a candidate for surgery even though I have no health conditions (co-morbidities) related to my weight problem?

You may be considered a candidate for weight loss surgery if your BMI is in excess of 35 even though you present no co-morbidity symptoms.

What if I don't belong to a health fund?

The health fund waiting period for gastric banding surgery (item number 30511) is 12 months as obesity is considered a pre-existing condition. However there may be other options available to you. For further information please contact us.

Should I expect a lot of vomiting/regurgitation?

Usually there is no vomiting at all. This procedure should place a gentle restriction on your eating. If you find that you are vomiting, either there is something wrong with your band adjustments or there is something wrong with your following the rules of eating with the band (see Nutritionist Handouts). This is important as vomiting could lead to the shifting of the stomach within the band and this could then compromise your outcome.

Ideally there should be no vomiting at all. There may be some regurgitation experienced while adjusting to your new eating behaviour, i.e., from over eating, eating too quickly. This can be minimised by altering your eating habits as outlined in the Circle of Care Program.

Will I get constipated?

Constipation

You will have less bowel movements after surgery because you will be eating less food. There is no need to be concerned nor to take anything for it if you are comfortable. “Not going” does not mean you are constipated.

Symptoms

  • A feeling of density or heaviness in the lower abdomen
  • Increased wind (this can happen post surgery for other reasons too)
  • Incomplete bowel motion
  • Pellet like stools that are difficult to pass, requiring more pressure

Untreated constipation can lead to:

  • Bad breath (different from the bad breath of rapid weight loss)
  • Nausea & reluctance to eat
  • Compaction – like you are sitting on a hard, dry mass
  • Blood in the toilet bowl due to excessive straining

Causes

  • Inadequate fluid intake – aim for 1500ml+ per day
  • Inadequate fibre intake – add a high fibre cereal (8g+ dietary fibre/100g) and 2 slices of high fibre bread each day (2g+ per slice)
  • Not enough exercise
  • Stress
  • Some medications

Treatment

It is prudent to treat constipation in the first 24 hours with 30ml prune juice twice per day. If that does not work, use a laxative. See your pharmacist or GP ASAP if symptoms have progressed or your treatment fails to work. There is little value on adding a bulking agent such as Benefibre or Metamucil or eating extra fibre if you are already blocked up. It will just sit on top.

Prevention

See causes and do the opposite. A bulking agent such as Benefibre can help things running smoothly. When you are not eating much, the goal is a bowel movement every 2 or 3 days without straining and possibly less often on the fluid diet.

For more information:
www.medicinenet.com/constipation/article.htm

Can I burp after the gastric band placement?

This is not done so easily. As we eat we swallow air and normally this is brought up without conscious effort. The band interferes with the easy bringing up of wind. In the first weeks after surgery, people notice difficulty with bloating and feeling like they want to burp but cannot.

This is NORMAL, but usually subsides as the months go by. Presumably the stomach below the band changes shapes enough to reduce the problem, and does not seem to be troublesome.

Do I need to take multivitamins?

Yes, our Nutritionist should have already gone through supplements in your first or second visit.

What about my other medications?

Continue your medications prescribed as needed. If they are in the form of a bulky tablet, it is best to break them up to help with swallowing and prevent blockage. Capsules should be ok, these are designed to soften and melt in the body.

What should happen if I develop another illness?

If you have another illness, which makes the restriction of food inappropriate, then we can easily remove the fluid. Once you have recovered from the illness then the fluid can be placed back into the band.

What happens if I become pregnant?

The band should not interfere with your pregnancy. The likelihood of falling pregnant is greater, having lost the weight; your periods should now become more regular. Fluid can be removed from the band during pregnancy and this is usually done if you become nauseous as a result of the pregnancy. The band can be adjusted after the birth if you need to lose more weight.

Can I still dine out?

Meal sizes should be kept to entrée size due to your limited capacity now. Eat slowly! Maybe if you are going out to dinner at a friend's house, maybe advise them that you can only eat a small amount of food to save any embarrassment.

Is the silicone dangerous to me?

At present there is no sufficient evidence to support this. The band is made of solid silicone. This cannot leak into the tissues in the way that liquid silicone can, therefore we would expect that the likelihood of problems to be less. If the information of problems becomes available in the future, which is relevant to this question, we would inform you of it.

How long will the band last?

There is no answer to this question. There had been similar products in use in excess of ten years and show no signs of failure. However we do expect that down the track there will be failure of the adjusting balloon in particular and if this should occur, the band would need to be replaced. This will be determined as necessary.

Can the band be removed?

Yes, however it is not our intention to have the band removed. For whatever reason we can remove the band if appropriate, under keyhole surgery.  The stomach is expected to go back to its usual configuration after the band has been removed.  If the band is removed you need to be aware that you may regain the weight.

What about alcohol?

Alcohol is high in calorie content and is therefore not recommended. There are some health advantages with modest alcohol intake, particularly wine. Occasionally a glass of wine is not really going to compromise your outcome, just try to avoid this occurring more than once a week.

Can I speak to someone who has had the surgery?

Of course, we have many delightful patients who are happy to speak to you about their experience.

What information can you give me to help family and friends better understand this surgery?

We encourage a friend or family member accompany you on your consultation with the surgeon.

You may bring as many as you like to our information sessions.

Will I have a lot of pain?

Usually there is minimal pain after surgery, every attempt is made to control pain to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Several drug options are used to help manage your post-surgery pain if required.

Will I need plastic surgery for excess skin folds once I have lost the weight?

A quarter of our patients need to get some help with excess skin folds. Removal of the abdominal apron is the most common. Plastic surgery is not usually considered for some months after reaching your goal weight. The skin usually has enough elasticity in the skin to take up the slack, and this is assessed before considering reconstructive surgery.

We have specialist plastic surgeons available that has expertise in body contouring required after massive weight loss.

Is this cosmetic surgery?

NO, it definitely is not. Obesity is potentially a severe and a life threatening disease. It is recognised by health funds and Medicare. Item number 30511 is the item number that you should quote to your fund if you are considering this surgery.

How much weight can I expect to lose?

If your band is in the correct position and if you are following the program regarding eating and exercise then, we should expect that you should be able to lose a substantial amount of excess weight.

Generally we find that people lose more than half their excess weight. Your weight should decrease slowly and gently over 12-18 month period. We are not aiming for a rapid weight loss, which can be potentially harmful and may be associated with vomiting which we want to avoid. Weight loss should be between 0.5-1kg per week early on, and then gets less as you get towards the 2 year period.

What about follow up care after I have finished my Circle of Care Program?

Patients who have a gastric band insitu are required to be followed up every six to twelve months with all practitioners, for the rest of your and your bands life. We will place you on a recall system to remind you.

Contraindications

The following is a list of conditions in which it is inadvisable to perform gastric banding:

  • Inflammatory diseases of the GI tract, including severe intractable oesophagitis, gastric ulceration, duodenal ulceration, or specific inflammation such as Crohn's disease that has been active within the past 10 yrs
  • Barret's oesophagus, oesphageal or gastric varices, or congenital or acquired intestinal telangiectases
  • Severe cardiopulmonary diseases, or other severe organic diseases that may make them poor surgical candidates
  • Portal hypertension, cirrhosis, chronic pancreatitis
  • Congenital or acquired anomalies of the GI tract such as atresias or stenoses
  • Patients who have experienced an intraoperative gastric injury during the implantation procedure, such as a gastric perforation at or near the location of the intended gastric band placement
  • Localised or systemic infection anywhere in their body
  • Receiving oral or parenteral administered steroids for more than 15 days
  • Patients who are know to have ,or suspected to have, an allergic reaction to materials contained in the band or accessories used with the band, or who have exhibited a pain intolerance to implanted devices
  • Known diagnosis or pre-existing symptoms or autoimmune connective tissue disease such as SLE or scleroderma
  • Who are or may be pregnant. Patients who become pregnant after band placement may require deflation of their band.
  • Patients who are unwilling to comply with dietary restrictions, which are required by this procedure eg: sweet eaters.
  • Patients who are emotionally unstable or who exhibit psychological characteristics that, in the opinion of the surgeon , would make follow-up impossible or gastric band surgery inappropriate in general

What are the risks?

Although the weight loss surgery procedures are minimally invasive 'keyhole' surgery, there are still risks and complications, especially if the patient suffers from a pre-existing illness, such as diabetes.

When considering surgery, it is important to realise that the potential benefits of weight control surgery outweigh the risks.
Some of risks and complications of gastric banding surgery are:

  • Anaesthetic risks: Anaesthesia is a long-practised and very safe technique. The risk of dying under anaesthetic is very low, about 1 in 40,000.
  • Infections are uncommon: All patients are given antibiotics during the operation. Infections may develop around the wounds or at the access port. This would require the patient to remain in hospital longer and have ongoing antibiotic treatment.
  • Swallowing difficulty and regurgitation: This may occur if the band is too tight. To ensure proper functioning, the Laparoscopic Adjustable Gastric Band (LAGB) can be adjusted to suit the needs of the individual patient. It is important that patient follow their eating plan to reduce the risk of swallowing difficulty and regurgitation.
  • Slippage: This occurs in less than 5% of cases. The band may slip down, leading to pouch dilatation, or the stomach might shift through the band leading to a blockage of the stomach. Slippage usually occurs because of vomiting or overeating. It is important to follow your eating instructions to avoid vomiting. Slippage can occur months or years after surgery, and usually requires further surgery to correct it.
  • Stomach pouch dilatation: Over-eating may stretch the small stomach pouch making it less effective.
  • Band erosion: In less than 1% of cases, the band works its way through the stomach wall. Erosion of the band requires it to be removed and the stomach repaired.
  • Acid reflux and oesophagitis: This may be treated with medications to reduce acid. In some cases, it may indicate that the pouch has dilated or the band has slipped.
  • Gallstones: Weight loss may predispose to gallstone formation.
  • Nutritional deficiencies are uncommon.
  • Disconnection or leakage: Disconnection of the tubing system, or leakage of the access port may occur, requiring re-operation and replacement.
  • Reaction to the band: The band is made of solid silicone. There are no known side effects of having it implanted in the body.
  • Re-operation: Further surgery may be required in 5% of gastric banding surgery. This may be necessary for band re-positioning, band removal, or port/tubing related issues.
  • Spleen complications: Bleeding or injury to the spleen may require conversion to an open surgical procedure. Injury to the spleen and other organs, including the stomach, during surgery is rare.
  • Deep Venous Thrombosis and pulmonary embolism: Blood clots may develop in the leg veins, which may travel to the lungs, thus causing death.
  • Death: The risk of dying during the operation is very small (about 0.5 in 1,000). Death may result from a heart attack or a blood clot passing into the lungs.

Potential Benefits and Results

'Success', following weight loss surgery, is measured in terms of:

  • Weight loss as a percentage of excess weight loss (%EWL) - e.g., a female who is 120kg before surgery (whose ideal weight is 60kg), has 60kg of excess weight. If she loses 40kg, then she has lost 66% of her excess weight.
  • Improvement and restoration of health to individuals suffering from obesity.

Studies have shown that following gastric banding, patients can expect:

  • An average of 50 - 60% excess weight loss gradually over 2 to 3 years.
  • Maintaining weight loss over the medium term, but no studies exist that span over 10 years.
  • Improvement in health, especially in relation to obesity-related diseases such as hypertension, diabetes, lipid disorders, asthma, sleep apnoea and arthritis.
  • Mortality risk reduced
  • Mobility and endurance levels improved
  • Self esteem and self confidence improved
  • Significant improvement in quality of life

It is important to realise that these are general expectation bases on published studies. No guarantee can be given for to any individual patient.

The ultimate goal of weight control surgery should be an improvement in health achieved by a sustainable weight loss that reduces life-threatening risk factors, and improves the patient's day-to-day quality of life.

Gastric Banding Step by Step

Key points about the gastric banding operation performed by keyhole surgery:

  • Anaesthetic: The surgery is performed under general anaesthetic. Local anaesthetic is infiltrated around the skin wounds.
  • Antibiotics: Prophylactic antibiotics are given intravenously to reduce risk of infections.
  • Anticoagulants: Anticoagulants or blood thinning agents are given subcutaneously and calf-compressing stockings are fitted to reduce the risk of blood clots in the legs.
  • Betadine: The abdomen is prepped with Betadine solution and sterile drapes applied.
  • Videoscope: A videoscope is inserted through a skin incision into the abdominal cavity.
  • Carbon dioxide: Carbon dioxide gas is pumped into the abdominal cavity to create a space in which to operate.
  • Incisions: Five small incisions are made to place instruments into the abdominal cavity.
  • Liver retraction: The liver is retracted out of the operative field.
  • Tunnel: Fine instruments are used to create a tunnel behind the upper aspect of the stomach.
  • Gastric band: The Laparoscopic Adjustable Gastric Band (LAGB) is wrapped around the upper part of the stomach after the integrity of the band is checked. This creates the small pouch which will be your new stomach. To hold it in place the lower stomach is stitched over the front of the band onto the upper pouch. The gastric band is then connected to the special reservoir or access port which is implanted in the abdominal wall under the skin through a 5 cm incision.
  • Inspection: The liver retractor is removed. The abdominal cavity is inspected for bleeding sites. The gas is evacuated.
  • Skin incisions: Skin incisions are closed with dissolvable sutures, and some local anaesthetic is placed near the wounds so you will be more comfortable when you wake up.
  • Duration: The operation takes about 60 minutes to complete.

In a minority of cases, the operation may not be able to be performed safely by laparoscopy and an open operation though a long incision may be necessary. This has not been necessary in over 800 operations. The band placement is the same and the results are similar. The length of stay in hospital will be longer.

'Keyhole' or Laparoscopic Surgical Procedure

Gastric banding is done with minimally invasive 'keyhole' surgery. This means there is:

  • Less pain and discomfort
  • Fewer complications
  • Shorter hospital stay
  • Earlier return to normal activities

Other laparoscopic procedures performed by our surgeons include:

  • Gallstone surgery (cholecystectomy)
  • Hernia repair
  • Anti-reflux surgery

Band adjustments

The inflatable inner balloon of the gastric band is connected via a thin tube to a special reservoir or access port which is implanted on the abdominal wall under the skin.

The band is only partially inflated at the operation, allowing the band to heal in position. The access port allows the band to be adjusted, by adding or removing fluid and thus increasing or decreasing the level of restriction.

  • First band adjustment is performed approximately 4 weeks after the operation. The doctor will access the port with a special needle through the skin. The band is filled with a small amount of saline. The patient is given a small amount of water to drink to ensure that the band is not too tight.
  • The second adjustment usually occurs at 5 to 8 weeks after the operation.
  • Subsequent adjustments then  occur periodically as deteremined by your clinic.
  • The amount of fluid placed in the band, and the frequency of the adjustments varies between individuals, and is determined by the doctor according to your weight loss requirements and feeling of fullness. Ongoing band adjustments are required for weight loss maintenance.
  • Most patients report minimal discomfort during adjustments.

How will I know if I need a band adjustment?

You will need a band adjustment if:

  • You don't feel full after eating a little bit of food
  • You have trouble keeping food down
  • You are not losing weight

Advantages of Laparoscopic Gastric Banding

The advantages include:

  • Minimally invasive using keyhole surgery
  • Normal anatomy and integrity of the digestive system is maintained (with no stapling, and no by-passing of portions of the stomach or intestines).
  • Fully adjustable to suit the individual needs of the patient. The tightness of the band around the stomach can be adjusted by inflating or deflating the inner balloon. This is done by injecting saline fluid through the skin into the access port. The tighter the band, the greater the stomach restriction and weight loss. If too tight, the band can be loosened by removing some of the fluid from the balloon.
  • Fully reversible. Although it is not recommended that the procedure be reversed, if unexpected complications do occur at any stage, it can be completely reversed with 'keyhole' surgery. The stomach will then return to normal capacity.
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