Laparoscopic Adjustable Gastric Band

General information
The term “morbid obesity” is used to describe severe, abdominal and debilitating obesity. Individuals suffering with this condition are prone to develop different medical problems through their lives. The life expectancy of the severely obese person is decreased by 10 to 15 years, mainly because of increased incidence of heart attacks, strokes, hypertension and diabetes. Severely obese people also tend to develop severe arthritis in the joints of ankles, knees, hips and lower spine, due to excessive weight bearing. Self image is poor and depression may result.

Many supervised diet and exercise programs, behaviour modification programs, psychotherapy, hypnosis, group therapy and other modalities are in existence. However, some people cannot lose weight by dieting. Surgical procedures have been developed to help people who fail medically-controlled weight reduction programs. Obesity surgery is the only proven long – term effective treatment for morbid obesity.

The purpose of obesity surgery is to restrict food intake or decrease the absorption of nutrients. Surgical procedures include intestinal bypass, gastric bypass and gastroplasty. These procedures involve cutting, stapling and / or bypassing portions of the gastrointestinal tract. They produce permanent changes and are not easily reversed. Gastric banding is an alternate procedure that restricts the functional stomach volume, but avoids the use of stomach staples. A band is placed around the stomach to form a small pouch and a small opening to the rest of the stomach. It is easily reversed by simply removing the band.

The Laparoscopic Adjustable Band – Midband™
The Midband™ system was developed to improve the gastric banding procedure and to allow the procedure to be conducted through 5 small puncture wounds. This system results in less post operative pain, less complications and more rapid recovery.

The band can be adjusted easily without requiring further operation – it is performed in the Doctors rooms and is as simple as having an injection.

The Midband™ is a soft silicone “belt” that is placed around the upper portion of your stomach. It is an all in one construction and its inflatable “balloon” section is connected by tubing to a low profile titanium “injection reservoir”. The reservoir is placed just below the skin surface in the left mid section of the abdomen and is easily accessible to the Doctor for adjustments.

The band is placed around the upper portion of the stomach so as to divide it into two parts: a small 50ml capacity pouch is created above the band with the remaining stomach below the band. The diameter of the inner part of the band is adjusted according to your weight loss. The Midband™ induces a feeling of fullness very rapidly. It does not interfere in the absorption of nutrients by the digestive system. Weight loss is simply achieved by the reduction of food intake. Your Doctor can adjust the passage of food between the two chambers of your stomach by inserting a needle into the reservoir and either inject or remove saline.

Is it effective?
Patients who have had Midband™ gastric band surgery have lost an average of 80% of their excess weight in 2 years. Failure to lose weight can occur and is usually due to the inability of the patient to comply with their dietary instructions, or in some cases to intolerance. To achieve the very best results you need to follow the dietary rules that your Surgeon and Dietician explain to you.

80% of your weight loss is due to the effect of your gastric band. The device allows you to eat very little and not feel hungry. It is impossible to predict how much weight you will lose.

The gastric band is a weight loss aid, but alone it may not be sufficient to help you lose as much weight as you’d like. You need to accept a stabilized weight that is a good compromise between weight loss, nutritional and surgical complications and your personal comfort.

What are the risks?
Gastric banding is a major operation. There are risks which are common to any major operation which requires general anaesthesia. There is a 3 – 4% chance of complications after obesity surgery, most are minor. Serious complications are rare and include wound infection, oesophageal stomach perforation, bleeding from the stomach, injury to any internal organs, infection inside the abdomen, pneumonia, hernias in the wounds.

In the long term – the opening between the upper stomach pouch and the lower stomach may become too small, resulting in vomiting or reflux, or the opening can become to large which can result in weight gain. Adjustment of the bands via the reservoir may well correct these problems or you may need the band replaced or repositioned. The band could also move from where it was originally placed, could leak or erode into the stomach and these will require re-operation.

Gastric banding is a long term, but mostly a life long, commitment. It requires regular visits to dieticians and to your Doctor. Patient follow up is crucial and you should be prepared to return for regular visits. If you experience any problems then you need to contact your Doctor immediately.

Who can have Gastric Band Surgery?
In order to be considered for gastric band surgery, you should:

• Be more than 50% above your ideal weight;
• Be at least 16 years of age;
• Have been obese for at least 5 years;
• Have been unable to lose weight by any other non-surgical methods, such as supervised diet or behaviour modification programs;
• Have no medical problems that are causing your obesity;
• Be willing to accept significant changes in eating habits;
• Be willing to participate in post-operative follow-up visits at your Surgeons rooms and to have regular blood tests.

Ultimately your surgeon is responsible for your assessment of suitability regarding gastric band surgery.

Before deciding upon surgery
You should be convinced that you really want to make this significant change in your lifestyle. You must be sure that you will accept the extremely small meals necessary after your operation. The amount of food that you will be able to eat at any meal will be permanently reduced to very small volumes.

In the first 4 to 6 months, meals will be extremely small and you must learn to eat slowly and chew your food well. You may occasionally experience a bad day when you experience some vomiting – vomiting is usually related to improperly chewed food. Must have only 3 meals a day – avoid “high calorie” foods and fluids and continuous nibbling as it is still possible to “eat around” or “out eat” the purpose of the band.

Your recovery should be fast and smooth, providing you follow the dietary instructions.

Your surgeon will advise you on the length of time that you require to have off work – normally 15 to 21 days depending on your recovery phase and the type of work you do.

Medications

• Aspirin or other non-steroidal anti-inflammatory agents need to be avoided – if you currently take these or other medication please discuss this with your GP and with your surgeon.
• Arthritis medication – discuss this with your Doctors
• Some tablets may need to be crushed due to the size – Your GP may have to revise some of your medication if they can’t be crushed.
• Liquid form is available with some medications
• Panadol – is available in a dissolvable preparation

How quickly will you lose weight?
This varies among patients. Average weight loss is between 5 – 10kgs per month. When weight loss stabilizes your surgeon can adjust / inflate the band through the reservoir which will reduce the size of the opening and produce additional weight loss.

Diet needs to accompany exercise to gain optimum weight loss and health.

Should you become pregnant or very ill, and have a greater need for nutrition, the band can be deflated to enlarge the opening, allowing you to eat a little more.

Up to 80% reduction in weight loss can be expected.