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Dr.Weight // BEFORE and AFTER bariatric operation - practical guidelines // Grand questions after gastric banding

After gastric banding

Grand questions after gastric banding

Bariatric Surgery - DoctorWeight.com 2008

When and how is the bandage inflated?

The modern gastric bandage is finely adjustable to individual requirements. The first adjustment is usually performed 2 months after the operation, when the bandage becomes firmly secured in the surrounding tissue. The adjustment is made by inflating the bandage with saline solution into the hydraulic system or by aspirating fluid from it, both of which are done by means of a simple syringe fine-needle puncture. This generally takes 3-5 minutes. Afterwards the patient should adhere to eating guidelines.

Only seldom does one adjustment suffice (2-10 is normal), and the second follows a week or two after the first. The silicone ring presses away the fat pad around the stomach, and the lumen of the stomach begins to dilate again. Gradually the fat pad beneath the band disappears, and the ring becomes properly mounted on the stomach wall. A patient noticing cessation of weight loss may come to the clinic for another adjustment, in which case a doctor adds fluid to the system and weight loss resumes.

If the patient has difficulty drinking and vomits after a small amount of water, it is necessary to remove some fluid from the system, enlarging the opening between the smaller and larger stomachs. Best results require an average of 5 adjustments during the 1-year period.

Eating guidelines

The operation is only the first step towards changing your way of life. New eating habits must follow.

  • Chew food very thoroughly before swallowing.
  • Do not eat and drink at the same time, as the water could wash away the swallowed food and the feeling of satiety disappear. It is better to drink BEFORE eating and 1-2 hours after. There are no limits as to volume, but drink at least 1.52 litres of water per day and pay close attention to the caloric content of any other drinks.
  • Lying down after eating could provoke a reflux from the stomach into the oesophagus, causing heartburn.
  • Eat 5 times a day. This regimen of frequent feeding is important for adequate nutrition and can reduce hunger.
  • Most importantly, avoid food such as ice-cream, milk shakes, chocolate, cream and cakes, which turn into high-caloric liquid in the mouth cavity and pass into the bigger stomach without difficulty, significantly increasing caloric intake. Similarly, avoid Coke, Pepsi, Sprite and other high-sugar drinks; at the very least, substitute them with diet versions (which use sugar substitute aspartame).

Some foods can be badly tolerated after gastric banding, e.g.:

  • Tough meat
  • Tough pasta
  • Fruits and vegetables with peel (corn, asparagus, apples, pears, grapes etc.)
  • Mushrooms
  • Sausage and ham
  • Sparkling beverages

Temporary postoperative problems

Sometimes patients after gastric banding suffer vomiting and epigastric pain after meals. These problems could be caused by incorrect diet or by overinflation. Eat slowly and carefully, and listen to your new stomach.

Constipation is also possible owing to the marked reduction in the amount of food eaten. If after some time bowel function does not return to normal, mild laxatives such as Guttalax may be taken.

Potential problems after gastric banding

Fortunately, problems that can occur after gastric banding are usually not life-threatening.

Leakage of hydraulic system

This takes place in 0.5% of cases, even though the materials of which the system is produced are of the highest quality. This most often takes place in the connection between the adjustment port and the tube, a weak point of the system as the movements of the patient cause increased mechanic stress in this area. In such a case a port inspection is necessary, requiring a day in hospital and local anaesthesia. The port is opened, and the disconnected tube reconnected.

Leakage of the bandages cuff is possible but extremely rare. This form of leakage necessitates the replacement of the whole system and laparoscopy under general anaesthesia.

Infection of the port

The adjustment port is made of titanium and, being foreign body implanted to a region with bad blood circulation (subcutaneous fat), can provoke infection. In this event it is necessary to remove the port and after a few months to implant it elsewhere.

Migration of the bandage into the stomach

This occurs when the bandage causes degeneration of the gastric wall in the weakest place. Previously, when surgeons used tough bandages, this took place in 1% of all cases; now, with new generation of soft bands, it has all but disappeared. Nevertheless, it remains theoretically possible and would require removal of the band by upper GI endoscopy.

Slippage of the bandage

Now that most surgeons in the world use a new pars flaccida technique of band implantation, this has become rare. This complication essentially constitutes slippage of the bandage down along the stomach, resulting in increased volume of the small stomach and undoing of the effect of the operation. To reduce the possibility of this, bandage inflation is usually carried out 2 months after surgery when it is already firmly secured by scar connective tissue. As another precaution, the bandage is sutured to the stomach during the operation. Even so, the possibility remains; this too could only be corrected by another laparoscopy.