Presentation

• A band made from biocompatible material and placed around the top part of the stomach, creating a small sized gastric pouch.
• The band is then tightened (1 to 2 months after surgery) by injecting saline solution into a reservoir which is implanted under the skin and connected to the band by a tube.
• The band can be tightened or loosened by increasing or decreasing the quantity of saline solution in the reservoir.
• When the patient eats, the gastric pouch rapidly fills with solid food and empties slowly.
• The restricted passage creates food discomfort (dysphagia) where you feel blocked-up, which can be painful or provoke vomiting if there is too much food (hyperphagia).

Advantages

The technique of the gastric band is easier to carry out than the Gastric Bypass of the Sleeve Gastrectomy. It is characterised by a rate of immediate post-operative complications close to zero.

• Gastric banding is carried out by keyhole surgery.
• This means that time in hospital is short: the patient can be discharged from the clinic the day after surgery.
• Recuperation is quicker: furthermore, the patient can generally go back to work after one week.
• One of the main advantages of the gastric band is that it can be tightened or loosened relative to the individual needs of the patient (for example: loosen the band in the case of a pregnancy and allow a varied, complete and more abundant diet).

Results

After the gastric band is put in pace, the patient can expect weight-loss to be around 40 to 50% of excess weight (%EWL) after a period of two years. But some patients regain the weight they have lost.

Others are incapable of adapting their eating habits and cannot achieve their desired weight-loss target.

Although this operation is strictly restrictive, and leads to weight loss for nearly all patients, it is less effective in terms of long-term weight loss than a Sleeve Gastrectomy and other restriction/malabsorption operations such as the  Gastric Bypass.

Clinical and Dietary follow-up

The quantity of food you can eat at each meal can vary, depending on how the band is regulated, how stressed you are, and the time of day (nothing in the morning, more in the evening).

However, foods considered « difficult to digest » will help you feel fuller.

Some advice:

• You should eat very, very slowly. You should respect this eating practice even if it means that to eat only a small volume will take you 45 minutes.
• You should masticate a lot.
• Gassy drinks (water, soft drinks, …) and effervescent medicines are strictly prohibited. The bubbles contained in these liquids will expand your small stomach, which will, again, become a large stomach: your gastric band will be of no use!
• You should avoid drinking at meal times, if not the volume drunk during the meal adds to the volume of food you eat. It will be too much for your small stomach and may cause vomiting.
• Cut your food into small pieces before eating. The volume of each mouthful should be small: about a teaspoon full.
  Once in your mouth, you should chew the food well before slowly swallowing.
• Think about checking the state of your teeth. You must be able to chew efficiently
• As soon as you feel full, you must stop eating.
  One spoonful too much and you may vomit (or feel pain at the level of the gastric band and stretch your small stomach).
• Twice a week, take physical exercise adapted to your capacities and what you enjoy (examples: acquagym, cycling, walking, dancing).

Dietary errors to absolutely avoid:

• Eating too much.
• Eating too quickly.
• Not chewing/masticating enough.
• Swallowing too quickly.
• Drinking liquids during the meal.

Possible complications

Immediate complications:

The number of immediate complications is very low. There is risk of a Gastric perforation (a tear in the stomach wall) during or after the procedure.

Early complications:

Dysphagia = blockage of food and/or liquids.

Medium/Long term complications with a gastric band:

• Infection of the reservoir under your skin.
• Any movement or tipping of the reservoir.
• The tube disconnects from the reservoir.
• Movement of the gastric band.
• Sliding of the gastric band.
• Dilation of the oesophagus
• Gastro-oesophageal reflux and oesophagitis.

All surgical interventions have underlying risks, particularly for people with morbid obesity.

You must talk with your surgeon so that you will be ready to  make a considered and informed choice, aware of the advantages and potential risks of the surgery, the constraints and inconveniences of this technique.