After your gastric banding

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1 After your gastric banding Exceptional healthcare, personally delivered

2 2 Please call J Ward at Southmead Hospital on if you have any questions or concerns soon after discharge. You may be advised to return to the ward or to contact your GP for assessment. Call particularly if you experience any of the following: Shortness of breath. Fever greater than 38 C. Rapid pulse. Pus draining from incisions. Redness around incisions bigger than 50 pence. Difficulty with swallowing fluids. Pain Control It is not unusual to have some shoulder pain after surgery. The pain is from irritation to the diaphragm during the surgery. This pain will gradually subside over several days. Walking and mobilising is also known to improve this discomfort. For the first three days, please take the pain killers that have been prescribed by your surgeon. Take these as indicated but be aware not to exceed the recommended dose within a 24 hour period. After three days the pain should be easily managed by an occasional paracetamol as needed. Your surgeon will have discussed this with you. Take paracetamol with fluid or food and make sure that you drink plenty of water. If taking soluble pain relief allow the bubbles to go down before drinking. If you have trouble swallowing pills, you can use an equivalent amount of liquid paracetamol (ask your Pharmacist) or take in dispersible form. Suppositories for pain relief may be available. You should not take aspirin, ibuprofen, voltarol (or equivalent non steroidal anti inflammatory drugs), even in suppository form, unless advised to do so by your surgeon. After your gastric banding

3 Dressings and stitches You have dissolving sutures (stitches) that do not need to be removed. The wounds may also be closed with small adhesive tapes (steristrips) and/or clear plastic dressings. Do not soak in a bath as these will be loosened but you will be able to take a shower as long as the dressings are not soaked. The dressings and tapes can be peeled off after 5 days like normal sticking plasters. Until the wounds are fully healed do not rub them vigorously with a flannel. Blot the wounds dry with a clean towel after a shower. Bleeding from incisions It is common and normal for the small incisions to ooze blood and clear, yellow fluid for several days after surgery. Consequently, you may see some bruising around the incisions which will resolve on its own. If blood is continuously dripping out of an incision, apply firm pressure to it with a gauze or paper towel for five minutes and it should stop. If in doubt, please seek medical advice. Wound infection Although some oozing is normal until the wounds are healed, please contact the ward or your GP straight away if the wounds become red, hot, increasingly painful and start to leak pus. If you have a gastric band it is particularly important to treat any infection quickly with antibiotics to avoid the risk of infection in the band, which would mean band removal. Vomiting Vomiting must be avoided as it increases the possibility of gastric band slippage and other problems such as hernia after gastric bypass. We will give you a supply of anti-sickness tables to take home. If you are vomiting after eating too much food then change your eating habits to smaller amounts of softer food. After your gastric banding 3

4 Activity It is very important to perform some physical exercise every day, particularly soon after surgery when you are at slightly increased risk of blood clots in your legs. Start out slowly and build up gradually. A simple walking programme is a good place to start if you have not been physically active before surgery. Try to avoid sitting down for long periods of time. We will give you more information about becoming physically active at the support group meetings. Most people go back to work within 5 days, depending on the type of job they have. You can resume sexual activity whenever you feel ready and you can begin exercising more vigorously after a week or 10 days, although the wounds may feel a little uncomfortable at first. There are no restrictions on lifting, but take it easy for a week or two or you will cause more pain in the incisions. Swimming is not recommended until the wounds have healed. Post-operative diet The Nutritionist/Dietician will give you an advice sheet prior to your discharge from hospital and it is VERY important that you follow this advice if you want to reduce the risk of complications. It is extremely important to chew your food well. Stop eating at the first sign of fullness and avoid vomiting as much as possible. You must never drink fizzy or carbonated drinks if you have a gastric band. These will distend your stomach and might increase the risk of band slippage. It is not uncommon for people to experience violent vomiting following drinking carbonated drinks. Daily vitamin and mineral supplements have been recommended by the Dietician and should be taken long term. This is essential for those who have had gastric bypass. 4 After your gastric banding

5 Constipation Constipation is not uncommon following weight loss surgery. This is due partly to the fact that your food intake will have been significantly decreased. It is important that you drink enough fluid each day to result in your urine being clear. Choose your foods carefully and include such items that contain fibre e.g. Oat So Simple a glass of prune juice and stewed fruit. Ideally you should be aiming to drink 2 litres of fluid a day outside of mealtimes. ideally leave a gap of 10 minutes before and 30 minutes after eating food before drinking. Should your constipation not be improved by natural methods, then over the counter solutions are available to buy. If in any doubt you need to consult your GP or the team involved in your care. Appointments You will be seen in clinic about 6 weeks after your operation. For those with a gastric band you are likely to need your first band adjustment 6-8 weeks after surgery. This is not always the case as some people have sufficient restriction for some time longer than 8 weeks before needing their first band adjustment. Further appointments will be booked at that time. It is highly recommended that you attend or are in contact with patient support groups in your area. If this is not possible, there are several excellent web based support groups who can provide valuable advice on living with a gastric band or gastric bypass. This is the beginning of your journey. You will have up days and down days. Please try and keep in contact with others who have had surgery as they can provide valuable support in addition to the medical advice you will be receiving. Band Inflation You will probably start thinking about having another inflation if you: Have stopped losing weight. Are starting to feel hungry. Are able to eat larger portions. After your gastric banding 5

6 It is advisable to try not to have a further inflation for as long as possible for 2 reasons: 1. Patients with a slower rate of band inflation seem to do better than patients inflated to their maximum inflation level quickly. 2. If you are overfilled you risk having problems and/or damaging the band. Is the band ever deflated? It is fairly common for the band to be deflated, especially when patients have over-filled. Patients may also be deflated if they continue to lose weight after reaching their goal, during pregnancy or for certain medical treatments. How do I know if my band is over-inflated? If you are over-inflated you will experience the following symptoms within 1-2 days of having an inflation: Difficulty keeping food and liquids down. Reflux. Awareness of swallowing. Being over-inflated not only means that you have difficulty maintaining a healthy diet but can also result in pouch dilation or band slippage which will compromise the effectiveness of the band. If you experience excessive vomiting or reflux immediately after an adjustment it is vital that you make contact with the team via the contact number with which you have been provided. It is likely that you will need fluid taken out to relieve your symptoms. 6 After your gastric banding

7 Your adjustment Please do not eat for 4-6 hours before an adjustment. Following your adjustment please do not immediately go out and test the band to see if it is working. By increasing your food intake at this stage you may experience some swelling of the band, which may result in difficulty in swallowing liquid. Take it easy it is not a race! This weight loss journey is your journey. Please try not to compare yourself too closely with others. For some, weight loss prior to first adjustment is achieved, for others a weight gain can occur prior to the first fill. Some patients only require insertion of 2 mls; others require 4 mls or none! Eat when you are hungry, follow the basic rules of small portions and chew, chew, chew! Be patient and believe in yourself - even when you think you are losing weight too slowly. Slow weight loss is more likely to be safe, successful and sustained! What are inflations, adjustments or fills? Inflations, adjustments and fills are the terms used to describe the procedure during which fluid is injected into, or removed from, the band through the port located near the surface of the skin. When will I have my first inflation? Most people have their first inflation 6-8 weeks after surgery. This is to ensure that all healing has taken place and you have recovered fully from the operation. What can I expect at a consultation and adjustment appointment? If you have diabetes, high blood pressure etc. your condition will be reviewed carefully and your medications adjusted as necessary. After your gastric banding 7

8 You will usually discuss your eating, exercise and weight loss since your last appointment and decide whether inflation is necessary. If an adjustment is necessary, the port site is located by feel or occasionally X-ray. A fine needle is used to inject the appropriate amount of fluid via the port. Once the band has been adjusted you may be asked to wait in the waiting room and have a drink. This is to make sure that you are not going to have any significant problems swallowing liquid following your adjustment. What fluid is injected into the band? This is dependent on the make and type of band but it will usually be a fluid called Niopam, which shows up on X-rays. How much fluid is injected into the band at each inflation? The MIDband holds a maximum of 9 mls of fluid. The first adjustment will be no more than 4 mls for women and not more than 3 mls for men. A tight band does not always mean good weight loss. Does it hurt? Adjustments, inflations, or fills, are basically painless. Some patients report feeling a small pricking sensation similar to that experienced when giving blood. If you have a needle phobia you can ask your GP to prescribe some anaesthetic cream EMLA cream. This is spread on the skin over your port area and covered with a clear elastoplast to hold the cream in place. This must be done a minimum of 1 hour prior to your adjustment appointment. What can I expect after an inflation? For a day or two following adjustment, you may find it more difficult to swallow solid foods. You should, therefore, take only clear fluids for 24 hours followed by a liquid or puree diet for 2 or 3 days to let your stomach adjust to its new size. You can then slowly reintroduce solid foods. 8 After your gastric banding

9 You may find that you cannot manage foods that you were able to eat prior to the adjustment. You will discover what you can and cannot eat after the adjustment by trial and error. When can I expect to have my second inflation? The timing of the second inflation varies from patient to patient and depends on your weight loss, food intake and exercise patterns. How many adjustments will I need? No one knows for certain. The amount of fluid injected at each inflation, the rate of inflation and the total number of inflations varies considerably between individuals. Most people will have between 2 and 5 adjustments over the first twelve months. How do I know when I need another adjustment? It can be very difficult to determine when you need a further inflation. NHS Constitution. Information on your rights and responsibilities. Available at [Last Accessed March 2010] After your gastric banding 9

10 How to contact us: Co-ordinator Tel who will then put you in touch with the appropriate team member If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. First Published October This third edition July NBT002228

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