Gastric
Stapling (Restrictive) Surgery
(Gastric
Banding Surgery, Adjustable Gastric Banding, Vertical
Banded Gastroplasty)
Gastric
stapling surgery, also called gastric banding
surgery, is a type of bariatric surgery (weight
loss surgery) procedure performed to limit the
amount of food a person can eat. Bariatric surgery
is the only option today that effectively treats
morbid obesity in people for whom more conservative
measures such as diet, exercise, and medication
have failed.
In gastric
banding surgery, no part of the stomach is removed
and the digestive process remains intact. Either
staples or a band are used to separate the stomach
into two parts, one of which is a very small pouch
that can hold about one ounce of food. The food
from this "new”\" stomach empties into the
closed-off portion of the stomach and then resumes
the normal digestive process. Over time, the pouch
can expand to hold two to three ounces of food.
Because the size of the stomach is reduced so
dramatically, this type of procedure is referred
to as a restrictive procedure.
After
gastric stapling or banding, a person can eat
only about three-quarters to one cup of food.
The food must be well-chewed. Eating more than
the stomach pouch can hold may result in nausea
and vomiting. Restrictive procedures pose fewer
risks than gastric bypass procedures, but they
are also less successful because continuous overeating
can stretch the pouch so that it accommodates
more food.
The
types of gastric banding procedures include:
- adjustable gastric
banding (AGB)
This procedure involves attaching an inflatable
band around the top portion of the stomach and
tightening it like a belt to form a small pouch
that serves as a new, much smaller stomach.
After the procedure, the diameter of the band
around the stomach can be adjusted by a physician
by adding or removing saline (salt water). No
staples are used in this procedure, which is
relatively new in the US.
Like other restrictive procedures, AGB may not
achieve significant weight loss. The US Food
and Drug Administration (FDA) approved an AGB
system in 2001 that can be put in place with
a laparoscope (a small thin tube with a video
camera attached) rather than with an open incision
for patients who are morbidly obese, as indicated
by a Body Mass Index (BMI) of 40 or more.
- vertical banded gastroplasty
(VBG)
This procedure uses a combination of staples
and a band to create the pouch. There is a dime-sized
opening at the bottom of the "new" stomach that
opens into the rest of the larger stomach. Plastic
tissue or mesh is wrapped around the opening
to help prevent the opening from stretching.
Weight loss is about 45 percent of extra body
weight at one year after the surgery.
VBG
and AGB may be performed with a laparoscope rather
than through an open incision in some patients.
This procedure uses several small incisions and
three or more laparoscopes - small thin tubes
with video cameras attached - to visualize the
inside of the abdomen during the operation. The
physician performs the surgery while looking at
a TV monitor. Laparoscopic gastric surgery usually
reduces the length of hospital stay and the amount
of scarring, and often results in quicker recovery
than an "open" or standard procedure.
Persons
with a BMI of 60 or more or persons who have already
had some type of abdominal surgery are usually
not considered as a candidate for the laparoscopic
technique.
Digestion
is the process by which food and liquid are broken
down into smaller parts so that the body can use
them to build and nourish cells. Digestion begins
in the mouth, where food and liquids are taken
in, and is completed in the small intestine. The
digestive tract is a series of hollow organs joined
in a long, twisting tube from the mouth to the
anus.
The
stomach is where the three mechanical tasks of
storing, mixing, and emptying occur.
Normally, this is what happens:
- First, the stomach
stores the swallowed food and liquid, which
requires the muscle of the upper part of the
stomach to relax and accept large volumes of
swallowed material.
- Second, the lower part
of the stomach mixes up the food, liquid, and
digestive juices produced by the stomach by
muscle action.
- Third, the stomach
empties the contents into the small intestine.
The
food is then digested in the small intestine and
dissolved by the juices from the pancreas, liver,
and intestine, and the contents of the intestine
are mixed and pushed forward to allow further
digestion.
Bariatric
surgery is performed because it is currently the
best treatment option for producing lasting weight
loss in obese patients for whom nonsurgical methods
of weight loss have failed.
Potential
candidates for bariatric surgery include:
- persons with a Body
Mass Index (BMI) greater than 40
- men who are 100 pounds
over their ideal body weight or women who are
80 pounds over their ideal body weight
- persons with a BMI
between 35 and 40 who have another condition
such as obesity-related type 2 diabetes, sleep
apnea, or heart disease
Because
the surgery can have serious side effects, the
long-term health benefits must be considered and
found greater than the risk. Despite the fact
that some surgical techniques can be done laparoscopically
with reduced risk, all bariatric surgery is considered
to be major surgery.
Although
not all risks with each procedure are fully known,
bariatric surgery does help many people to reduce
or eliminate some health-related obesity problems.
It may help to:
- lower blood sugar
- lower blood pressure
- reduce or eliminate
sleep apnea
- decrease the workload
of the heart
- lower cholesterol levels
Surgery
for weight loss is not a universal remedy, but
these procedures can be highly effective in people
who are motivated after surgery to follow their
physician's guidelines for nutrition and exercise
and to take nutritional supplements.
There
may be other reasons for your physician to recommend
a gastric banding procedure.
As with
any surgical procedure, complications may occur.
Some possible complications include, but are not
limited to, the following:
- infection
- blood clots
- pneumonia
- bleeding ulcer
- development of gallstones
- obstruction or nausea
can occur when food is not well-chewed
Risks
specific to vertical gastric banding include breakdown
of the line of staples and erosion of the band.
Rarely, stomach juices may leak into the abdomen
and emergency surgery may be needed. The most
common complication that may develop with adjustable
gastric band surgery is that the stomach pouch
enlarges. Band slippage and saline leaks are also
risks specific to adjustable gastric band surgery.
Risk
is reduced with a laparoscopic banding procedure
because there is no incision in the stomach wall.
There
may be other risks depending upon your specific
medical condition. Be sure to discuss any concerns
with your physician prior to the procedure.
- Your physician will
explain the procedure to you and offer you the
opportunity to ask any questions that you might
have about the procedure.>
- You will be asked to
sign a consent form that gives your physician
permission to perform the procedure. Read the
form carefully and ask questions if something
is not clear.
- In addition to a complete
medical history, your physician may perform
a complete physical examination to ensure you
are in good health before undergoing the procedure.
You may undergo blood tests or other diagnostic
tests.
- You will be asked to
fast for eight hours before the procedure, generally
after midnight.
- If you are pregnant
or suspect that you are pregnant, you should
notify your physician.
- Notify your physician
if you are sensitive to or are allergic to any
medications, latex, iodine, tape, or anesthetic
agents (local and general).
- Notify your physician
of all medications (prescription and over-the-counter)
and herbal supplements that you are taking.
- Notify your physician
if you have a history of bleeding disorders
or if you are taking any anticoagulant (blood-thinning)
medications, aspirin, or other medications that
affect blood clotting. It may be necessary for
you to stop these medications prior to the procedure.
- You may be asked to
begin exercising and alter your diet several
weeks before surgery.
- If you are a woman
of child-bearing age, you may receive birth
control counseling so that you do not become
pregnant in your first year after surgery due
to the risk to the fetus from rapid weight loss.
- You may receive a sedative
prior to the procedure to help you relax.
- The area around the
surgical site may be shaved.
- Based upon your medical
condition, your physician may request other
specific preparation.
Restrictive
gastric banding surgery requires a stay in the
hospital. Procedures may vary depending on the
type of procedure performed and your physician's
practices.
Gastric
banding surgery will be performed while you are
asleep under general anesthesia. Your physician
will discuss this with you in advance.
Generally,
gastric banding surgery follows this process:
- You will be asked to
remove clothing and will be given a gown to
wear.
- An intravenous (IV)
line may be started in your arm or hand.
- You will be positioned
lying on your back on the operating table.
- A urinary catheter
may be inserted.
- The anesthesiologist
will continuously monitor your heart rate, blood
pressure, breathing, and blood oxygen level
during the surgery.
- The skin over the surgical
site will be cleansed with an antiseptic solution.
- For an open procedure,
the physician will make a single large incision
in the abdominal area. For a laparoscopic procedure,
a series of small incisions will be made. Carbon
dioxide gas will be introduced into the abdomen
to inflate the abdominal cavity so that the
appendix and other structures can easily be
visualized.
- For an adjustable gastric
band procedure, a hollow band will be placed
around the top end of the stomach to create
the small pouch that will serve as the new stomach.
A narrow passage will connect to the rest of
the stomach. The band will be inflated with
a salt solution.
- For a vertical banded
gastroplasty procedure, the pouch will be created
with a line of staples.
- A drain may be placed
in the incision site to remove fluid.
- The incision(s) will
be closed with stitches or surgical staples.
- A sterile bandage/dressing
will be applied.
After
the procedure, you will be taken to the recovery
room for observation. Once your blood pressure,
pulse, and breathing are stable and you are alert,
you will be taken to your hospital room. Malabsorptive
stomach surgery usually requires an in-hospital
stay of several days.
You
may receive pain medication as needed, either
by a nurse or by administering it yourself through
a device connected to your intravenous line.
You
will be encouraged to move around as tolerated
while you are in bed, and then to get out of bed
and walk around as your strength improves.
At first
you will receive fluids through an IV. After a
day or two you will be given liquids, such as
broth or clear juice, to drink. As you are able
to tolerate liquids, you will be given thicker
liquids, such as pudding, milk, or cream soup,
followed by foods that you do not have to chew,
such as hot cereal or pureed foods. Your physician
will instruct you about how long to eat pureed
foods after surgery. By one month after your procedure,
you may be eating solid foods.
You
will be instructed about taking nutritional supplements
to replace the nutrients lost due to the reconstruction
of the digestive tract.
Before
you are discharged from the hospital, arrangements
will be made for a follow-up visit with your physician.
Once
you are home, it will be important to keep the
surgical area clean and dry. Your physician will
give you specific bathing instructions. The stitches
or surgical staples will be removed during a follow-up
visit.
The
incision and abdominal muscles may ache, especially
with deep breathing, coughing, and exertion. Take
a pain reliever for soreness as recommended by
your physician. Aspirin or certain other pain
medications may increase the chance of bleeding.
Be sure to take only recommended medications.
You
should continue the breathing exercises used in
the hospital.
You
should gradually increase your physical activity
as tolerated. It may take several weeks to return
to your previous levels of stamina.
You
may be instructed to avoid lifting heavy items
for several months in order to prevent strain
on your abdominal muscles and surgical incision.
Weight
loss surgery can be emotionally difficult because
you will be adjusting to new dietary habits and
a body in the process of change. You may feel
especially tired during the first month following
surgery. Exercise and attending a support group
may be helpful at this time.
Notify
your physician to report any of the following:
- fever and/or chills
- redness, swelling,
or bleeding or other drainage from the incision
site
- increased pain around
the incision site
Following
gastric bypass surgery, your physician may give
you additional or alternate instructions, depending
on your particular situation.
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