What is adjustable gastric banding surgery?

Adjustable gastric banding is surgery to help people lose weight. It makes the stomach smaller and limits how much food it can hold. This helps you eat less and feel full sooner.

You will be asleep during the surgery. The doctor will make several small cuts in your belly. These cuts are called incisions. Then the doctor puts special tools and a camera through the incisions. Next, the doctor wraps a silicone band around the upper part of your stomach to make a small pouch. Then the incisions are closed with stitches. They will leave scars that fade with time.

The small size of the stomach pouch means you will feel full after you eat a small amount of food. The doctor can adjust the size of the band by inflating or deflating it. This controls how quickly food goes from the new pouch into the lower part of the stomach.

You probably will stay in the hospital for 1 or 2 days after the surgery. Most people can go back to work or their usual routine in about 2 to 4 weeks.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Until your doctor says it is okay, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Hold a pillow over your incisions when you cough or take deep breaths. This will support your belly and decrease your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You will probably need to take 2 to 4 weeks off from work. It depends on the type of work you do and how you feel.
• You may shower, if your doctor okays it. Pat the incisions dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
• Ask your doctor when it is okay for you to have sex.

Diet

• Your doctor will give you specific instructions about what to eat after the surgery. For the first 2 weeks, you will need to follow a liquid or soft diet. Bit by bit, you will be able to add solid foods back into your diet.
• Your doctor may recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements from now on.
• At first you may feel full after just a few sips of water or other liquid. It is important to try to sip water throughout the day to avoid becoming dehydrated.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incisions, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Weight loss is usually slower and less with adjustable gastric banding than with gastric bypass.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to follow a clear liquid diet for several days before surgery. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Here are some risks common to all surgeries for weight loss:

• You could get an infection in the incision.
• You could get a blood clot in your legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism).
• You may not get enough of certain vitamins and minerals. This can lead to problems such as anemia and osteoporosis.
• Some people get gallstones.
• Some people get kidney stones.
• You may gain the weight back a few years after surgery if you don't follow your eating and lifestyle plan.

Adjustable gastric banding is the least invasive of the weight-loss surgeries. But some problems can occur. They include:

Obstruction.

The band can cause something (usually food) to block the opening from the upper part of the stomach to the lower part of the stomach. This can cause pain, nausea, and vomiting.

Band slippage.

The band can slip out of place. Symptoms might include belly pain or heartburn (acid reflux). This may be treated by removing the fluid from the band. Or you may need a second surgery.

Access port problems.

You could get an infection around the access port. Or the access port could disconnect or leak. The tube that leads from the band to the access port could also become blocked.

GERD.

You could develop esophagitis or gastroesophageal reflux disease (GERD).

Esophageal dilation.

If the band is too tight, or if you eat too much, your esophagus could expand. This can make it hard for you to swallow, which could cause food to get stuck in your throat. If it isn't fixed, you could get pneumonia.

After surgery, you may need pain medicine to help with discomfort and soreness. You'll be encouraged to start moving around to help your body heal. You may have an X-ray the day after surgery to see that everything is working correctly.

Most people need 2 to 4 weeks before they are ready to get back to their usual routine.

Your doctor will give you specific instructions about what to eat after the surgery. You'll start with only small amounts of soft foods and liquids. Bit by bit, you will be able to add solid foods back into your diet. Your doctor may advise you to work with a dietitian. This will help you learn how to get enough protein, vitamins, and minerals while you lose weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements from now on.

After you can eat solid food again, your doctor will adjust the band around your stomach by inserting saline into your port. This will inflate the band and cause it to tighten. You will probably have many adjustments to the band in the first year to find the right size that helps you lose weight, feel full at the right time, and not vomit. You'll need to see the doctor each time you need the band adjusted.

Weight loss

After this surgery, weight loss is usually gradual but steady. You will have regular visits with your doctor to check how you are doing. The doctor can adjust the band if you aren't losing weight as expected or if you have problems with the band. Some people lose weight for up to 3 years after surgery.

Emotions

It's common to have many emotions after this surgery. You may feel happy or excited as you start to lose weight. But you may also feel overwhelmed or frustrated by the changes that you have to make in your diet, activity, and lifestyle. Talk with your doctor if you have concerns or questions.

Think of bariatric surgery as a tool to help you lose weight. It isn’t an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

Your doctor will give you specific instructions about what to eat after the surgery. For the first 2 weeks, your stomach can only handle small amounts of liquids while you are healing. Some people feel full after just a few sips of water or other liquid. Other people won't notice much difference. It's important to try to sip water all day long to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to. That's because you will feel full after eating much less food than you are used to eating. If you don't chew your food well or don't stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit.

Your doctor may recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements from now on.

Adjustable gastric banding is surgery to make the stomach smaller. It is done to help people lose weight. The surgery limits the amount of food the stomach can hold. This helps you eat less and feel full sooner.

The cuts (incisions) the doctor made in your belly will probably be sore for a few days after the surgery. If you have stitches, the doctor will take these out at your follow-up visit.

After this surgery, weight loss is usually gradual but steady. You will have regular appointments with your doctor to check how you are doing. The doctor can adjust the band if you are not losing weight as expected, or if you have problems with the band. Some people keep losing weight for 4 or 5 years after surgery.

It's important to think of this surgery as a tool to help you lose weight. It's not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

It's common to have many different emotions after this surgery. You may feel happy or excited as you begin to lose weight. But you may also feel overwhelmed or frustrated by the changes that you have to make in your diet, activity, and lifestyle. Talk with your doctor if you have concerns or questions.

Weight-loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.

Surgery is typically considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight.

It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 1 hour.