What is the Laparascopic Adjustable Gastric Band, and how does it work? PLEASE READ – IMPORTANT!
The Adjustable gastric band is one of the least complicated weight loss surgeries. We recommend it in the following cases:
- For patients who are hoping to lose weight steadily and permanently and who are willing to learn to work with this tool to get the best results. The band, because of its adjustable nature can be filled and adjusted to allow the weight loss to take place at a pace to suit the patient. When the patient reaches a weight which is comfortable, the amount of saline in the band can be reduced to enable the weight to be easily maintained.
- For patients at the “lower” end of the BMI scale of acceptability for surgery, the band is a good choice, though patients must learn new eating techniques – chewing food very thoroughly and not eating and drinking together, and weight loss will not be rapid until the patient achieves the ideal restriction by gradual tightening (filling) the band until it reaches the optimum level. This can take several months.
- A Band is designed and engineered to last for life, but because the procedure is reversible and the band can be removed at a later date – there is no cutting or removal of parts of the stomach, it ihas been the preferred choice of the majority of patients. It is a relatively simple surgical procedure which has shown proven weight loss results over many years. However we believe the Gastric Wrap (Laparoscopic Greater Curvature Plication) will soon replace the band as the most popular reversible simple weight loss surgery procedure.
- Psychologically, many patients feel more comfortable with the knowledge that these two procedures are both reversible.
The laparoscopic adjustable gastric band is placed around the upper part of your stomach. This creates a new small stomach pouch and leaves the larger part of the stomach below the band. This small pouch acts as a smaller stomach with less storage area. The adjustable band is a silicone hollow ring filled with saline. The flow of food from the pouch to the lower stomach is controlled (and restricted) by the size of the ring. This, together with the pressure from the band on the vagal nerve branches, makes you feel full sooner and for longer periods of time. Most patients report fewer feelings of hunger even in the mornings when the stomach is empty. The band also controls the stomach outlet (called the stoma) between the two parts of the stomach. The size of the stoma regulates the flow of the food from the upper to the lower part of the stomach. The band is connected by a tube to a small container – an access port that is placed beneath your skin during surgery , just below your ribs.
Later, it is possible to control the diameter of the band by inserting a fine needle through the skin into the port and adding or extracting saline solution and inflating or drflating the ring inside the band. If you are not losing enough weight, saline is added, reducing the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, and causes you problems when eating the band can be deflated by removing some of the saline.
The operation to fit the band will take place laparoscopically, normally with only five tiny incisions under a general anaesthetic. The band is considered to be tone of he least invasive surgical options for weight loss because there is no intestinal re-routing, no cutting or stapling of the stomach wall or bowel, only small incisions, and minimal scarring. You will be able to resume your normal life very quickly after surgery. Dr Cierny favours the use of the Johnson & Johnson (Ethicon-Endicon) band in most circumstances. He positions the band and the port in such a way as to minimise the risk of movement of the band and the port.
Many patients favour the band because it is adjustable, allowing them to regulate the rate of weight loss. The adjustments are performed without additional surgery, and are completed quickly. The operation is reversible, and the band can be removed at any time if necessary.
Since this operation does not involve any “rerouting” or reconnecting of the intestines, and therefore no “malapsorption” (inability to absorb nutrients in the small intestine) there is little likelihood of becoming malnourished after a band has been fitted, provided you follow a healthy sensible diet in the long term after the operation. Because your food intake is restricted, we do suggest to all our patients that they take daily vitamin supplements – simply to ensure they are getting the recommended daily allowance. You will receive lots of detailed dietary and nutritional advice from us after surgery.
After you have a band fitted, you must be very careful not to have it adjusted too tight, with too much saline solution in it. This can be very dangerous, as it prevents you from being able to keep down solid food, and can result in frequent vomiting/regurgitation. An over-filled band can lead to permanent damage to the stomach or oesophagus. This may lead to the band slipping or eroding its way through the stomach wall, If this were to happen, the band would certainly have to be removed as otherwise it could result in possible peritonitis or even death. As the band is a mechanical device, there is also the (low) possibility of mechanical failure of the band itself or problems with the access port, again requiring a further surgery to correct the defect or remove the band. This is why it is important not only to choose a surgeon who will fit the band correctly and safely, but also to choose a provider who will give you the right advice and guidance to make sure your band is properly maintained
The band is a very good tool to help you achieve sustained weight loss by limiting how much you can eat, reducing your appetite, and slowing digestion. Please remember that the band by itself will not solve morbid obesity, nor will it ensure that you reach your ideal weight.
The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and new eating habits. Some people lose more than others, and though you may never reach your ideal weight, the statistics show that those patients who have had the band fitted (and there are more than 300,000 of them worldwide) lose on average in excess of 40% of their excess weight in the first year. The weight loss generated by your band will assist you to achieve better overall health, and your self-image will improve, which in turn will encourage you to maintain a changed attitude to food. We have experience of our patients losing over 65kg (10.5 stone) within 2 years of band surgery, but we cannot overstress the fact that surgery itself is only the start of the journey through weight loss – the extent and speed of your weight loss will depend on your commitment to change, to improve eating habits with the aid of this tool you have been given, and to increase your levels of exercise and general health. It is a fact, though, that exercise becomes easier - and much more enjoyable!! - when the weight starts to come off.
A Note on BMI (Body Mass Index) and co-morbidities
Your BMI will help Dr Cierny to assess your suitability for surgery, but there are several other factors which influence his decision.
- You may be a yo-yo dieter, going through the “thinner” phase of your yo-yo effect now, but you can show your BMI has been substantially higher in the past.
- The way in which your excess weight is distributed around your body may make your obesity of greater risk to your overall health, that is why it is often useful for Dr Cierny to see photographs of you
- Your racial origin may make you more likely to develop some of the serious co-morbidities related to obesity at a lower BMI than others. There is research which suggests individuals of Asian origin are more likely to develop weight- related illnesses at a lower BMI.
- Co-morbidities. Our list of co-morbidities is not exhaustive, and some co-morbidities, such as Diabetes Mellitus (Type II Diabetes), can have more serious implications than others. There is a strong body of evidence for the link between sustained weight loss, achieved by Bariatric surgery, and improvements in Type II Diabetes
High Risk Patients
The risks involved in surgery for some patients are greater than for others. Statistically “higher risk” patients fall into one or more of the following categories:
- Age over 50 – As with most operative procedures, people older than 50 are known to be at higher risk during surgery
- BMI over 50 – those patients whose Body Mass Index is over 50 tend to be more at risk of peri-operative and post-operative complications
- Male Patients – Men are more likely than women to suffer from certain conditions that can increase surgical risk. These include diabetes, hypertension and metabolic syndrome (also known as syndrome X or insulin resistance syndrome), a condition characterized by a group of risk factors including hypertension, high triglyceride levels, low HDL levels and high blood sugar levels after fasting.
- High Blood Pressure (Hypertension) – People with high blood pressure (hypertension) often suffer from heart disease and/or chronic blood vessel inflammation, both of which increase the odds of serious surgery-related complications.
- Heart or circulatory problems or a history of ischemic heart disease, or disease of the heart valves
- History of Pulmonary embolism (blood clots in the lungs) – People who have previously had a blood clot in their lungs (pulmonary embolism) or legs, or who are genetically at risk for developing blood clots are at elevated surgical risk. All patients, regardless of their risk for clotting, are prescribed blood-thinning medications during the course of their stay in the clinic.
- A history of breathing problems, pulmonary and bronchial disease, asthma or chronic bronchopulmonal obstructive syndrome. People who have suffered from these problems are more likely to encounter difficulties during or after surgery and present a higher risk for anaesthesia
- A history of hiatal hernia, gastro-oesophagal reflux disease, stomach ulcers or a history of chronic diseases of the digestive tract (e.g.Chron’s disease, Barrett’s oesophagus)
- A previous open major abdominal surgery in the upper abdomen might also signal a higher probability of adhesions which would prolong the proceedure and make the operation technically more difficult.
If you fall into one or more of the higher risk groups Dr Cierny may well ask for additional medical reports/tests to be made available to him prior to making his decision on your approval for surgery.
Patients who are in High Risk categories usually require additional tests, treatments and medication at the hospital, either before or after their surgery to ensure maximum care and safety. This will generate additional costs for the hospital. If you are regarded as a high risk patient because you can be placed into one or more of the categories listed above, your medical questionnaire will be carefully evaluated by the team at the hospital (together with any further medical information you are asked to provide) and we will let you know into which Risk Band Dr Cierny and the team have placed you when providing your quotation. Extra charges for High Risk patients will either be £200.00 (Risk Band I), £390 (Risk Band II) or £760 (Risk Band III – the most vulnerable patients)
Further information on any complications and risks associated with Bariatric surgery can be found in the FAQ’s section of the website.