A Patient Guide to Laparoscopic Gastric Banding Surgery

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1 A Patient Guide to Laparoscopic Gastric Banding Surgery

2 Morbid Obesity Facts Morbid Obesity is a serious disease which substantially increases health risks. Approximately 2-3 % of the population in western countries of the world can be considered Morbidly Obese. The WHO (World Health Organisation) considers Mobid Obesity to be an epidemic disease of the future. The consequences of morbid obesity are serious. They can result in various diseases described as co-morbidities and a shortened life expectancy compared with normal weight people. Co-morbidities of Obesity include: Diabetes Heart disease High blood pressure Sleep apnoea and other breathing problems Joint problems Certain cancers Morbid Obesity is life threatening for patients and it is an economic issue for society. The treatment of diseases induced by Morbid Obesity is very costly and a growing threat to all healthcare systems around the world. Apart from the medical and economic issues with obesity, there are also social implications for obese people. They often experience social pressure which results in social isolation, low self esteem and depression. After all other methods of losing weight have failed surgery may be considered.

3 Body Mass Index Body Mass Index (BMI) is an international scale health professionals use to determine a persons weight status. It is calculated by dividing weight in kilograms by height in metres squared. Weight (kg) Height (m) 2 Underweight: BMI 18.5 and less Normal weight: BMI 18.5 to 25 Overweight: BMI 25 to 30 Obese: BMI 30 to 35 Severe Obesity: BMI 35 to 40 Morbid Obesity: BMI 40 and higher BMI is a major indicator of whether surgery should be considered as a treatment for Morbid Obesity along with associated diseases. Patients will be considered for surgery if they have a BMI over 40 or a BMI over 35 with co-morbidities. Obesity Surgery Options What kind of help can a surgeon offer? Your surgeon will help identify the best possible treatment for you personally. There are a number of surgical options available to support you in your effort to lose weight. Today the most popular techniques are gastric bypass and gastric banding surgery. Gastric Bypass This is also called stomach stapling surgery. There are a number of ways of performing this procedure, but the most popular is the Roux-en-Y gastric bypass (RYGBP). This involves creating a small upper stomach, then connecting a limb of the small intestine to this upper stomach. The remaining stomach and first segment of the small intestine are bypassed. It is mainly a restrictive procedure but also malabsorptive (which means not all food is absorbed). The RYGBP can be performed as open surgery or laparoscopic surgery. It is a major operation with associated risks, but it is an effective procedure for achieving weight loss.

4 Gastric Banding A soft inflatable silicone band is placed around the upper portion of your stomach and closed to form a ring. This divides the stomach into a very small upper portion and a larger lower portion. A reservoir that is attached to the band sits beneath your skin on your upper abdomen or lower chest wall. Injecting fluid into the port allows the band to be tightened after surgery. Fluid can also be removed if the band is too tight. Gastric banding is usually performed laparoscopically (keyhole surgery) which is minimally invasive. This means big incisions on the abdomen are avoided. Benefits of laparoscopic surgery include faster and less painful post operative recovery for patients. The gastric band procedure is performed under general anaesthesia. You are usually admitted the day of surgery and will generally spend one or two nights in hospital afterwards. AMI Soft Gastric Band There are a number of gastric bands available in New Zealand. All bands work on the same principle. One of the popular gastric bands is the AMI soft gastric band (AMI SGB). The AMI SGB is made from a silicone inflatable ring which is attached via tubing to a titanium port. Benefits of Gastric Banding over other Surgical Techniques It is a relatively fast and safe procedure compared with gastric bypass with a lower serious complication rate. It is usually performed laparoscopically which means no large incisions and a quicker recovery. It is adjustable to suit your weight loss. The inner diameter of the restriction can be increased or decreased by inserting or removing fluid via a fine needle through the reservoir. The procedure is reversible. There is no stapling, resection or shortening of the stomach so the anatomy of the gastrointestinal tract remains unchanged. It provides a less drastic, but stable weight loss. The total weight loss is usually achieved after 24 months.

5 How does Gastric Banding Work? The gastric band induces an early feeling of being full. When you are full you should stop eating. This reduces food intake and leads to weight loss. When weight loss reaches a plateau the band can be tightened by inserting fluid into the reservoir, enabling weight loss to continue. The procedure does not work for liquid calories, so all liquids consumed need to be very low or zero calorie content such as water, tea and coffee (without sugar) and low calorie fruit flavoured fluids. Liquid will pass straight through the band and not have any effect on feeling full. It is also important to avoid liquids at meal times or it will speed up the emptying of the upper stomach and reduce the feeling of being full. For the surgery to work you must change your diet and lifestyle. Recommendations Eat slowly and thoroughly chew every bite Eat three small meals a day Eat good quality foods; protein, fruits and vegetables high in vitamins and minerals Eat low fat, low calorie foods; avoid high fat and high sugar foods Avoid fluid at meal times drink 30 minutes after meals and 10 minutes before meals Don t eat between meals End a meal as soon as you feel full Exercise 30 mins per day Complications With any surgery there are always possible complications. These will be discussed with you in more detail by your surgeon. Every attempt will be made by your surgical team to minimise these risks. Complications of surgery include infection either around the stomach and band, at the reservoir, or the small laparoscopic wounds. Clots can form in the legs and pass to the lung. Vomiting may occur when a new eating phase is being established if a patient eats too much or too quickly. It is not ideal to ever vomit with a gastric band, particularly soon after surgery, as it can displace the band. The band can slip further down the stomach and the pouch above the band can become too large (band slippage). It is also possible for the band to erode from the outside of the stomach into the inside (band erosion). Both are rare events but result in re-operation. It is possible for the band or the tubing to leak. This would be very unusual but if it occurs the band can be replaced.

6 Before the Procedure You will be encouraged to get fit for surgery by starting an exercise program. Two weeks prior to surgery you will be put on a very low calorie diet. After the Procedure The operation will have a major impact on your life style. You will see your surgeon frequently during the first post operative year. This is when your surgeon will check your weight loss and if required adjust the gastric band according to your needs. For the first two weeks following surgery you will be on a fluid only diet. The fluid phase after surgery is very important to allow your body to heal. This is when the adhesions are formed to hold the gastric band in place for the future. Patients who eat solid or semi solid food soon after their operation run the risk of dislodging the band. At two - four weeks, puréed and blended soft foods will be introduced to your diet. Gradually you will be able to introduce soft and finally normal food. Some food will be difficult to eat and most will need to be chewed carefully. Fluid Phase thin liquids (that can pass through a straw) Water Complan or Sustagen Drinking yoghurt Fruit juice - diluted Optifast Low fat milk Tea/herb tea/coffee Vegetable juice Clear liquid soups, miso soup or stock Puree or Semi Liquid Phase Mushy food puréed in a blender Weetbix or cereal made mushy with milk Instant or rolled oats porridge Blended chicken or meat and vegetable casserole Blended tuna and cottage cheese Blended baked beans or lentils and vegetables Soup made with chicken or meat and vegetables Mashed ripe bananas, paw paw or mangos Yoghurt Scrambled eggs Pre-crushed frozen fruit Canned fruit Low fat custard or dairy snacks

7 Solid Foods Start with easy to eat foods such as chicken, pork and fish rather than red meat. Eat crispbread and crackers rather than doughy bread. Try porridge or cereal rather than toast. Eat slowly chewing every bite well. Drink plenty of fluids during the day but avoid fluid 10 minutes before eating and 30 minutes following food. Eat good quality food high in vitamins and minerals. Avoid high fat high sugar foods. Good Quality Foods High protein foods such as lean meat, chicken and fish with fat and skin trimmed off Eggs Low fat milk, soy milk and low fat yoghurt Vegetables and salad Fruit Wholegrain breads, cereals and grains Foods to Avoid High-calorie soft drinks, cordial and sports drinks Cakes, biscuits, sweets, chocolate Deep fried foods Pastries and pies Cream and ice-cream Drink alcohol in moderation

8 Exercise Aim for 30 minutes aerobic exercise per day (ie walking, running, swimming, cycling, aerobics, aqua jogging, rowing or racket sports). If you wear a heart rate monitor aim for bpm. If you wear a pedometer aim to exceed 10,000 steps per day. Exercise may be difficult at first due to your size but it will become easier with time. Start with brisk walking for 10 minutes. Take a one minute break then walk for another 10 minutes, take a minute break then walk for another 10 minutes (30 minutes brisk walking in total). Within two weeks aim to walk briskly the whole way without stopping, then start increasing the distance you are walking in that 30 minutes. As it gets easier you can add hill walking and even light jogging to your routine. You may decide to rent a walking, cycling or stepping machine to exercise in your own home. Increase the intensity you are exercising at every week as it gets easier for you ( ie increase the level on the machine. Vary it with interval or hill training). Once your fitness increases you can add some resistance training to your regime but it is best to get a programme from a trainer (ie lunges, squats, press ups and weight training exercises). It is important to continue 30 minutes of aerobic exercise a day. Aim to increase activity levels during the day Walk to the shop or with children to school rather than driving Walk up stairs rather than taking a lift or elevator Domestic tasks such as vacuuming, sweeping, painting, mowing the lawn or gardening is a great way of increasing daily activity levels Weight Loss after Surgery To make this procedure a success you need to follow dietary recommendations suggested by your surgeon and dietitian and undertake an exercise programme. Without following the guidelines provided the procedure may not result in the weight loss that you had hoped for. Weight loss is influenced by many factors. Your surgeon or physician and your dietitian will provide you with the right feedback on your loss of weight. The gastric band around your stomach can be adjusted to your personal needs and requirements. Most of the weight loss takes place during the first two years after surgery. Along with personal satisfaction and the social benefits of weight loss, many of the medical problems associated with morbid obesity will improve progressively with weight loss. Good luck! OBEX MEDICAL LIMITED Freephone Obex. Trust. Commitment. Knowledge

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