Gastric Band – For Insured & Uninsured Patients

The Adjustable Gastric Banding System is one of the least invasive surgical treatments for obesity available today. Our Gastric Banding program uses a clinically tested gastric band in combination with diet and lifestyle changes in order to achieve and maintain weight loss. Our team will work with you to develop your individualised weight loss program and support you through it. You will receive expert guidance on:

  • Nutrition- with an Accredited Practising Dietician (APD)
  • Fitness- with a qualified personal trainer or exercise physiologist
  • Behaviour and habit changes- with a registered psychologist

You will also have access to patient support groups and extra counselling sessions with clinical staff if desired or deemed necessary.

Disclaimer: Results may vary from person to person.

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How Does it Work?

The gastric band works by restricting the capacity of the stomach, therefore reducing the amount of food that can be eaten at one time. This system is made up of a silicone band and a reservoir, with thin tubing (catheter) connecting the two parts.

Using Laparoscopic (keyhole) surgery, the band is placed around the upper stomach to create a small pouch. This creates a constriction at the level of the band, which slows down the passage of food through the stomach. Keyhole surgery means that there is no large incision; rather, 5 small ones are made, with the largest ones being 4 to 5cm for the placement of the reservoir.

What sort of weight loss can I expect with the Gastric Band?

Success is generally achieved by surgery however it does require dedication and assistance from the patient to achieve those ends. The aim is to assist in the loss of roughly two thirds of excess body weight reducing the BMI down to approximately 27. The target weight must be attainable and maintainable.

Disclaimer: Results may vary from person to person.

Think carefully, do you really want this surgery?

When a band is placed, the intention is to never have to remove it. If removal is foremost in your mind, or reversibility features high on your enquiry list, it is questionable whether you are an appropriate person for surgery.

Placing a band is a permanent procedure, a process of weight reduction and control for the rest of your life and to that end, the surgeon expects that you will return for review yearly, forever. If you cannot return for review you must contact us with your statistics annually. Removal once you reach your target weight is not really an option as it has been documented that the weight of that patient will IMMEDIATELY start to increase once more.

Is the Gastric Band system right for me?

Here are some of the things we will consider when evaluating your candidacy for obesity surgery. The gastric band system may be right for you if

  • You are at least 16 years old
  • Your BMI is 30 or higher or you weigh at least twice your ideal weight or you weigh at least 70 pounds (about 30 kg) more than your ideal weight
  • You have been overweight for more than 5 years
  • Your serious attempts to lose weight have had only short-term success
  • You do not have any other disease that may have caused your obesity
  • You are prepared to make substantial changes in your eating habits and lifestyle
  • You are willing to continue being monitored by the specialist who is treating you
  • You do not drink alcohol in excess
  • You are willing to add exercise to your daily regime
  • You are willing to make changes to your eating habits

If you do not meet the BMI or weight criteria, you still may be considered for an alternative weight loss procedure. Please consult our clinical staff for further information on other programs that we offer.

Contra-indications for the Gastric Band

Listed below are some contra-indications for the placement of a gastric band. If you have any of the following conditions, please discuss them with your physician during your initial consultation:

  • You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe oesophagitis, or Crohn’s disease
  • You have severe heart or lung disease that makes you a poor candidate for surgery
  • You have some other disease that makes you a poor candidate for surgery
  • You have a problem that could cause bleeding in the oesophagus or stomach. This might include oesophageal or gastric varices (a dilated vein). It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel)
  • You have portal hypertension
  • Your oesophagus, stomach, or intestine is not normal (congenital or acquired). For instance you might have a narrowed opening
  • You have or have experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement
  • You have cirrhosis
  • You have chronic pancreatitis
  • You are pregnant. (If you become pregnant after the gastric band has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.)
  • You are addicted to alcohol or drugs
  • You are under 16 years of age
  • You have an infection anywhere in your body or one that could contaminate the surgical area
  • You are on chronic, long-term steroid treatment
  • You cannot or do not want to follow the dietary rules that come with this procedure
  • You might be allergic to materials in the device
  • You cannot tolerate pain from an implanted device
  • You or someone in your family has an autoimmune connective tissue disease. such as systemic lupus erythematosus or scleroderma.

The same is true if you have symptoms of one of these diseases

If you do not meet the BMI or weight criteria, you still may be considered for an alternative weight loss procedure. Please consult our clinical staff for further information on other programs that we offer.

Removal of Gastric Band

Professor Memon also removes gastric bands for those patients who are experiencing any of the issues listed below.

While the vast majority of gastric banding procedures are very successful, there is a risk that the band may have to be removed in the future for one of the following reasons:

  • Leaking port, tubing or band
  • Band erosion
  • Symptoms such as vomiting, reflux, heartburn that are not subsiding despite investigation and treatment
  • Slipped band
  • Patient choice – the patient has reached their goal and feels they no longer need to have the band in place

Safe removal of a Gastric Band

Removal is performed using keyhole surgery and involves an overnight stay in hospital. The band is removed along with the tubing and the injection port that lies underneath the skin. Following this surgery the stomach returns to normal function.

Can another surgical weight loss method be implemented once the band is removed?

Yes, it is possible to explore sleeve gastrectomy or gastric bypass after gastric band removal, once the removal surgery scar heals and softens (but at least three months later).

Important points to remember:

  • Very often the band can be replaced at the same time as the band is removed
  • It is not a failure on your part if the band has to be removed

If you need to consider having your band removed or you need advice regarding the same, Professor Memon would be happy to discuss with you.

Risks associated with surgery

All surgeries have elements of risk and danger and modern surgeons are very familiar with the risk factors involved with their specialty. But obesity is also very risky! Obese patients tend to have considerable risks to their health and lives and a reduction in weight by surgery assists in reducing these risks.

Listed below are some potential risks of surgery and how we aim to minimise them:

  • Fasting before surgery dehydrates patients, they are asleep, and the patient is operated upon in a semi-sitting position using pressure of inert gas to allow enough space for the surgeon to view the stomach safely. All of these factors increase risk. An experienced surgeon will rehydrate a patient with an intravenous drip, inject a blood-thinning agent under the patient’s skin and use calf massaging stockings and early mobilization to reduce the risks of clotting in veins.
  • Pneumonia and breathing problems may occur. A respiratory implement called aTriflo, comprising three balls, will be provided to increase lung function, to diminish these problems.
  • Infection: antibiotics will be used intravenously during the operation and hospital stay to decrease the risk of infection, for all skin is potentially infected with a patient’s own skin bacteria and those bugs living in hair follicles, for example, can never be truly sterilized. Wherever possible, the surgeon will assess and reduce these risks. A foreign, though inert, material is being implanted about the stomach with the reservoir in the fatty tissue of the abdominal wall which may be at risk of local infection.
  • Bleeding within the abdominal cavity, technical problems with large fragile liver tissue, and previous surgery are common intra-operative problems. Further more obese patients are at a higher risk of suffering from heart and lung problems during and after surgery such as heart attacks or a need for assistance to breathe, requiring admission to the Intensive Care Unit.
  • The placement of the band requires dissection behind the stomach often almost a metre from the surface and damage can occasionally occur to the gullet or stomach wall during this. Such damage may lead to a need to change the operation to an open one, and for the repair of a perofration, which would negate the implanting of a band about the upper stomach.
  • The band is, by necessity, a little tight about the stomach and this varies with the size of the patient and the amount of fat about the upper stomach. Effort is made to make sure this is not too tight for this may induce early vomiting, which is not ideal. This may allow the stomach to slip up through the band, narrowing the passage so that the patient incessantly vomits. This is called slippage and can lead to further surgery to reposition the band in position.
  • The band might be able to be undone in some cases though it can also lead to the total replacement of the band. Whilst this slippage is more common early after surgery, before the band is cemented in place by scarring, it can occur years later if constant attention to the rule of eating, small volumes chewed well, are ignored.

All care is taken to avoid the problems mentioned but still they might occasionally occur. Surgery is a dangerous occupation and it is vital that you, the patient, understand the process of decision and choices that are available to you to lose weight. There is also a need to understand how to maintain that loss.

Post-Op Pointers

Here are some pointers for issues you may experience during the first few days after your gastric banding procedure:

  1. Shoulder tip pain after surgery

This is not uncommon after abdominal surgery as gas is sometimes left in the abdominal cavity despite the best efforts to remove it afterwards. This creates pressure under the diaphragm near the phrenic nerve causing irritation.

Adjustments

In order to determine whether your band fill needs to be adjusted, ask yourself the following questions:

  • Are you losing 500gms to 1 kg per week or are you struggling to lose weight?
  • Are you eating appropriate food portions i.e. <1 cup of food 3 times a day?
  • Are you choosing soft food because they go down easily, or worse – only managing fluids?
  • Are you grazing in between meals and looking for or eating junk food?
  • Are you gaining weight despite of eating the right foods and exercising?
  • Do you have any reflux or heart burn?
  • Do you have night coughs?
  • Are you regurgitating or vomiting?

If you are concerned about any of the above symptoms please contact us sooner rather than later. Your doctor will determine whether or not you require an adjustment (this can be either to add or remove fluid from your band)

Post Adjustment Rules

The following steps will tell you what to do after an adjustment to your band:

  • Before leaving surgery on the day of adjustment – one (1) tub of yoghurt should go down easily, that is, without pain, pressure or nausea, even if a little in doubt about how you feel, discuss with surgery staff
  • Day of adjustment – thick fluids only
  • Day 2 after adjustment – soups only
  • Day 3 after adjustment – normal diet, chew well – 25 to 30 times per mouth full. Eat slowly
  • If not able to take normal diet by the end of day 3, and no later – phone for re-adjustment to ease symptoms

If you do not follow these steps, you risk slippage!

Note: symptoms such as vomiting, inability to eat, drink or swallow, increasing reflux, difficulty sleeping, inability to lie down flat, coughing when lying down are all unacceptable. Action must be taken (a small amount of fluid must be taken out) – in other words, contact us immediately – do not wait and hope it goes away.

Nutrition & the Gastric Band

Good eating habits are vital to achieving and maintaining weight loss with the gastric band. The band is a tool which will assist you with losing weight but it does not lose weight for you. Therefore it is important to attend all your appointments with the dietician, as he/she will provide you with the knowledge and support required to develop good eating habits.

Common myths & misconceptions

The following is a list of myths and misconceptions regarding gastric banding. Click on each one to see how they are addressed.

Laparoscopic Adjustable Gastric Banding

  • Food still travels down normal anatomical pathway
  • Completely reversible
  • Safest of the operation, but there are possible ongoing complications as the band is present for life
  • Complications requiring surgery can nearly always be dealt with laparoscopically.
  • Some complications mean the band has to be removed.
  • Many patients are unable to eat certain foods, such as red meat and some vegetables and fruit
  • It does mean leaving a foreign body inside (although so do joint replacements, cataracts, tooth filling)
  • Weight loss is slower, so it will take longer to get to desired weight. However, this may give time for the skin to retract
  • It is strongly dependent on follow-up. Those who cannot commit to a minimum of monthly visits for the first 6 months should consider an alternative treatment
  • Top up may be required every few years as there is a slow loss of fluid out of the band, which leads to some weight regain if not replaced. This is a good way of keeping in touch about new developments.

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