Laparoscopic Adjustable Gastric Band

Definition

This procedure is done to treat obesity . Keyhole incisions are made in the abdomen. An adjustable band is placed around the stomach with the aid of a laparoscope (a tiny tool with a camera on it). The surgery causes weight loss by decreasing the amount of food that can pass into your stomach.

Adjustable Gastric Banding

Reasons for Procedure

This surgery treats severe obesity. Doctors use a calculation called body mass index (BMI) to determine how overweight or obese you are. A normal BMI is 18.5-25.

This surgery is a weight loss option for people with:

BMI greater than 40
BMI 35-39.9 and a life-threatening condition (eg, heart disease, diabetes )
BMI 35-39.9 and severe physical limitations that affect employment, mobility, and family life

The success of this surgery depends on your commitment and follow-up with your doctor. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:

Weight reduction
Improvement in many obesity-related conditions (eg, glucose intolerance, diabetes, sleep apnea , high blood pressure , high cholesterol , arthritis, poor exercise tolerance)
Improved mobility and stamina
Enhanced mood, self-esteem, and quality of life
Reduced risk of dying from cardiovascular disease (eg, heart attack , stroke ) and other causes

Possible Complications

If you are planning to have this procedure, your doctor will review a list of possible complications, which may include:

Vitamin deficiencies—You will take a daily multivitamin for the rest of your life.
Bleeding
Infection
Blood clots
Vomiting
Slipping or wearing away of the band
Erosion of the band into the stomach (may require open surgical repair)
Injury to other organs
Irritation of the throat due to acid reflux
Complications of general anesthesia
Death (occurs in less than 0.5% of patients)

Factors that may increase the risk of complications include:

Smoking
Recent or chronic illness (eg, kidney disease)
Diabetes
Old age
Heart or lung disease
Bleeding or clotting disorders

Keep in mind that staying obese is a risk factor for many conditions.

What to Expect

Prior to Procedure

Each bariatric surgery program has specific requirements. Your program will likely include:

Thorough physical exam and review of your medical history
Mental health evaluation and counseling
Ongoing consultations with a registered dietitian
Program to help you lose weight through diet and exercise
Smoking cessation program

Leading up to your procedure:

Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as warfarin (Coumadin)
- Clopidogrel (Plavix)
Do not start any new medicines, herbs, or supplements without talking to your doctor.
Arrange for a ride to and from the hospital. Also, arrange for help at home.
If advised by your doctor, take antibiotics.
The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor. You may be given laxatives and/or an enema to clear your intestines.
Shower or bathe the morning of your surgery.

Anesthesia

General anesthesia will be used. You will be asleep for the surgery.

Description of the Procedure

To prepare you for surgery, a nurse will place an IV line in your arm. You may receive fluids and medicines through this line during the procedure. The doctor will place a breathing tube through your mouth and into your windpipe. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.

The doctor will make several small (keyhole) cuts in the abdomen. Gas will be pumped in to inflate your abdomen. This will make it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor in the operating room. Your doctor will operate while viewing the area on this monitor.

An adjustable round band is placed around the top of the stomach and fastened into place. This creates a smaller stomach area for food. Tubing is placed from the band to an access port in the abdominal wall. The band can later be adjusted with a special saline solution and needle syringe. The incisions will be closed with staples or stitches.

Immediately After Procedure

The breathing tube will be removed. You will be taken to the recovery area while the anesthesia wears off.

How Long Will It Take?

30-60 minutes

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. You may have pain and soreness at the incision site. Your doctor will give you pain medicine to relieve discomfort.

Average Hospital Stay

The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if needed.

Post-procedure Care

At the Hospital

While you are recovering at the hospital:

Pain medicine will be given as needed.
On the day after the surgery, x-rays will be taken to make sure the band is in place. If everything looks fine, you will be given fluids, then progress to pureed food.
You may be asked to do the following:
- Use an incentive spirometer to take deep breaths every hour. This is to prevent breathing problems.
- Wear elastic surgical stockings or boots. This is to promote blood flow in your legs.
- Get up and walk.

At Home

Be sure to follow your doctor’s instructions. You will need to practice lifelong healthy eating and exercising habits. Keep in mind after your surgery:

It will take 2-4 weeks to fully recover. You may be out of work for several days after surgery.
Do not drive or lift anything heavy until your doctor tells you it is safe. This may take two weeks or more.
Walk as soon as you are able. Exercise lightly every day.
Meet regularly with your healthcare team for monitoring and support.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Follow your doctor’s instructions on driving limitations.
You may have emotional ups and downs after this surgery. Talk to your doctor about your feelings.

Your new stomach pouch will be the size of a small egg. It will be slow to empty. This will make you feel full quickly. Nutritional guidelines include:

Eat very small amounts and eat very slowly. You will begin with 4-6 small meals per day. A meal is two ounces of food.
For the first 4-6 weeks, all food must be pureed. Once you move to solid foods, food must be well-chewed. When making food choices, ensure that you are getting enough protein.
Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.
This procedure does not cause nausea and diarrhea if sweet or fatty foods are eaten. In fact, some people gain back weight because they continue to eat high-calorie foods. To promote ongoing weight loss, you will need to eat healthy foods.
Follow your doctor’s instructions.

You may need to take medicines, as directed by your doctor, which may include:

Antacids
Pain medicine (eg, acetaminophen )
Vitamin and mineral supplements

Ask your doctor if you are able to take medicine in pill form. You may need to crush your medicine or switch to liquid forms.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
Pain that you cannot control with the medicines you have been given
Blood in the stool
Constipation that lasts more than two days
Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
Persistent nausea and/or vomiting
Pain and/or swelling in your feet, calves, or legs
Cough
Any other concerning symptoms

Call for medical help or go to the emergency room right away if you have:

Shortness of breath
Chest pain

If you think you have an emergency, call for medical help right away.

RESOURCES

American Family Physician http://www.aafp.org/

American Gastroenterological Association http://www.gastro.org/

CANADIAN RESOURCES

Canadian Association of Gastroenterology http://www.cag-acg.org/

Health Canada http://www.hc-sc.gc.ca/index-eng.php

References

Bariatric surgery. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 2009. Accessed January 27, 2010.

Gastric band operation. The British United Provident Association website. Available at: http://hcd2.bupa.co.uk/fact%5Fsheets/html/gastric%5Fband.html#4 . Published September 2008. Accessed January 27, 2010.

Kassel K. Vertical banded gastroplasty surgery. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated December 2009. Accessed January 27, 2010.

LapBand surgery information. Center for the Treatment of Obesity, University of California San Diego Medical Center website. Available at: http://health.ucsd.edu/specialties/lapband/faq/ . Accessed January 27, 2010.

Weight Loss Surgery Center, Beth Israel Deaconess Medical Center website. Available at: http://www.bidmc.org/wls . Accessed January 27, 2010.

6/24/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487. Maciejewski ML, Livingston EH, Smith VA, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.

Revision Information

Reviewer: Marcin Chwistek, MD
Review Date: 03/2013 -
Update Date: 00/31/2013 -

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