Weight Loss Surgery

Gastroplasty

GastroplastieThe gastroplasty procedure consists in putting a silicon ring, whose gauge can easily be modified, around the higher part of the stomach.

 

The stomach is a pouch located between the oesophagus and the small intestine from approximately 1 liter. Gastroplasty will separate your stomach in two pouches (see diagram): A higher pouch from 15 to 25 Cm3 (3 to 4 spoons) and a lower pouch.

 

Your stomach is transformed in a sand glass, the food will pass slowly through the gastric ring.

 

When you swallow a small quantity of food, chewed well, it will go down in the higher pouch, located over of the gastric band.

 

This pouch will dilate, which will stimulate the center of satiety located at the level of the brain.

 

After having introduced a small quantity of food, you will not be any more hungry.

 

The gastric band can be tightened or loosened thanks to a small case located under the skin (in general on the level of the abdomen, a few cm under the left coasts). This case is connected to the gastric band by a small pipe.

 

After a local anaesthesia of the skin by patch, some cc of liquid can be injected into the case, which will inflate the gastric band and will decrease its gauge, the food will pass then more slowly.

 

The gastroplasty acts by restrictive effect : it decreases the volume of the stomach and it slows down the passage of food.

 

The gastroplasty gives no modification of the digestion of food.

 

The principal interest of the gastroplasty is to restore the sentation of satiety, which was decreased because of all the modes that you made.

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  • The gastroplasty is a relatively simple procedure,, with a 2 or 3 days hospitalization.
  • The gastroplasty causes loss weight from 2 to 4 kgs per month..
    The maximum of weight loss is obtained the first 2 years. It is rather advised for BMI lower than 45. According to the scientific data, the gastroplasty makes lose - on average - more half of weight excess after 2 years.
  • Denutrition and vitamin deficiencies are rare.
    No oral supplementation is necessary. A biological assessment after a weight loss from 25 to 30 kgs is carried out. Sometimes it shows small vitamin deficits which are easily made up by oral way.
  • This method is completely reversible.
    The band can be easily loosened, it can be withdrawn with a new coelioscopy.
  • Nibbling and ingestion of sodas or icecreams represent the principal factor of failure of the method.
    They must be completely proscribed ; if not, you will lose little or not.
  • Alimentary comfort is decreased.
    If you eat too much, too quickly, of too large pieces, you will vomit.
  • Food practices must be completely modified.
    3 meals and possibly 2 collations.
  • A regular follow-up by a disciplinary multi team is obligatory.
    The gauge of the band must be modified, usually 2 times the first year. A radiologic control of the gastroplasty is necessary - at least - once per year.

 

The D day

  • Hospitalisation at 5 PM.
  • You can eat normally.
  • No food, no drink since midnight. However, if your procedure is programmed after midday, a light breakfast is possible.
  • The procedure requires a general anesthesia, lasts approximately 1 hour and is always achieved by coelioscopy.
  • After the procedure, you will spend a few hours in recovery room, before you return in your room.
  • Drugs against pain will be managed to you by venous way.
  • The evening : emply stomach.

D1

  • Drugs against pain will be managed to you by venous way.
  • A kinesitherapist will help you to raise and walk.
  • The evening, liquid food.

D2

  • You will be able to leave the establishment at 11 am.
  • A presciption will be given to you for scar cares, and a seak leave from one to two weeks, according to your job painfulness.

Scarcs

You have usually 4 or 5 small scars on the abdomen, which are closed by fasten, of wire (which it is necessary to make withdraw) or of resorbable wire (which only leave all).
The bandages can be changed one day out of 2.
I advise you to use tight bandages, you will be able to take showers easyly.
You can make withdraw wire or fasten between D12 and D15.
It is not necessary to put bandages.
You can take showers, clean the scars with household soap, without rubbing.
Still await ten day before taking baths.

Food

The intervention is still very close, the band is not well fixed. 

It is essential not "to force" the system, which could compromise its effectiveness in the following months.

 

I propose the following procedure : the 3 days rule.
Your hospitalization lasted 3 days
At your exit, you must eat liquid for 3 days (water, tea, soup...)
Then you must eat crushed food for 3 days.
Then you can everything, while chewing food well. I advise you to crush meat for one month.
.
No stress, there is no reason food does not pass.

The first month

The first month will enable you to adapt to your gastic band. 

The effectiveness of the system is not maximum, because it is not yet inflated.
The capacities of taking food remain broad, except for large mouthfuls.

 

You must however take the good practices which will be useful when the device is inflated.

 

Split the food catches in 3 meals plus 2 collations, do not drink water during the meals, mix or crush ham, meat or fish in order to obtain a semi-fluid or "tender” consistency.

 

After the first month

The inflation of the gastric band usually takes place at the end of the first month.

It should be known that the inflation is not obligatory: if the weight loss is suitable (2 to 4 kgs), and if the feeling of satiety is good, the band can be tightened at the end of 2 or 3 months, or later.

When your band is tightened, the feeling of satiety must occur quickly, but the risk of vomiting increases.
Continue to select your food and eliminate all the mets with high caloric value.
You will be probably obliged to grope at the beginning on various food, their volume, their size.

Eat in calm at regular hour.

  • Split your food catches in three meals (and, possibly, one or two collations).
  • Vary your food.
  • Eat only small pieces.
  • You must chew lengthily, and swallow several times.
  • Take time to appreciate your meal. Do not forget that digestion starts in your mouth.
  • Never drink during your meal, and avoid drinking up to 30 minutes before or after the meal.
  • With the appearance of a feeling of satiety, imperatively cease eating.
  • Supervise your teeth.

One coffee spoon moreover could make you vomit. You have only a mini gastric pouch, do not forget it.

If you vomit, Try to understand why :

  • You eat too much.
  • You eat too quickly.
  • You eat too large pieces.
  • You do not chew enough.
  • You swallow too quickly.

Beetween meals

Avoid sweetened drinks and, in theory, aerated beverages.
Often Drink apart from the meals, by small quantity, even without thirst. 

 

Take again a regular physical activity, leisures and endurance.
The simplest regular physical activity is walking : walk of a good step but at your own rythm, the ideal being 3 times 30 to 40 minutes per week. A kinesitherapist may help you.
After the first month, you can practise any sport activity.

 

Respect sufficient hours of sleep.
Possibly make you accompany on the level '' management of stress ''.

A regular follow up by your general practitionar is important.

Sometimes your doctor will incite you to optimize your food in the direction of a better contribution out of Iron, Calcium, some vitamins, particularly B Vitamins (possibly after a biology of these elements). Sometimes a specific supplementation should be considerated. 

 

You must be also careful with a possible proteinic denutrition. If you do not eat sufficient proteins, you will lose on your muscular masses, whereas it would be preferable to lose on your fat or water of your body.
In worst case, you can undergo a protéin denutrition, with fall of immunizing defenses and a tiredness, an anaemia, a increased sensitivity to infections.

When to insuflate the gastric band ?

Ideally, you must decide when to make insuflate your gastric band. 

If the weight loss (2 to 4 kgs per month) is insufficient, if the feeling of satiety decreases. In short, if the gastroplasty appears definitely less effective to you, it is time to make tighten your band.
Contact quickly your surgeon.

 

On the other hand, if the food does not pass well, if vomiting appears, if the weight loss is higher than 4 kgs per month, also contact your surgeon.
A radiography of the gastric pouch is necessary, and possibly the surgeon will make the decision to loosen the band.

 

The number and the importance of inflations are very variable. Some patients do not make tighten the band the first year and lose 2 to 4 kgs per month. For some others, it is necessary to tighten the band 3 or 4 times to obtain a good result.

 

Do not forget that maximum weight loss is obtained in the first two years after the procedure.

 

Good luck and enjoy your life !

The complications of gastroplasty are fortunately rare, but important to know.

 

It is essential to evaluate the operational risk compared to the anticipated profits of gastric banding, before taking the decision to have an operation.

 

This risk is related to your medical history (cardiac, pulmonary…) and with the procedure (surgery and anaesthesia).

 

First week

Operational complications are possible, they can bring to stop the procedure : perforation, haemorrhage, impossibility of intubation of the trachea.
They are serious complications, with a vital pronostic.
The phlebitis and pulmonary embolisms are prevented by the use of anticoagulant drugs with low dose and the port of special socks.

First month

An infection on the level of a small scar, the reversal of the case are possible.

After the first month

Dilation of the pouch is a serious problem.

This dilation initially involves a major reduction in the system effectiveness and then a difficulty of feeding.
Not detected in time, it will require the ablation of the gastric band by a new coelioscopy.

 

The dilation of the pouch is prevented by a very rigorous procedure : precise passage of the ring behind the stomach, calibration of the pouch from 15 to 25 cc, fixing of the band by hiding on the level of the left part of the stomach.

 

The dilation of the pouch is supported by the vomiting and a too important thightening of th band.
To avoid dilation, it is important to eat in moderated quantity, slowly.

 

If theband is well tightened, that you vomit and that your weight loss is not important and constant, it is because you eat too much by ratios with the possibilities that you leaves the gastric band, you "force” the system.

 

It is necessary to make a radiography, to study your mode of food well to correct it and possibly loosen the band.

 

Migration of the band into the stomach is rare.

It occurs in less than 1% of the cases. The band will migrate slowly through the wall of the stomach.
It results in an inefficiency of the system, with disappearance of satiety.

 

Its diagnosis is confirmed by a gastric fibroscopy.
The treatment is not yet completely codified : often ablation of the band by coelioscopy, sometimes makes an attempt that the band passes completely inside the stomach and ablation of the band by a fibroscopy.

 

Failure of gastroplasty

  • Seldom the failure is complete : no weight loss, ingestion in large quantity of liquid foods (soups, ice creams…) who pass the band without involving easily satiety, or nibbling all the day. These food behavioral problems are often - but not always - detectable during the assessment before the intervention.
  • These people should not have been operated, or should have profited from a food rehabilitation during several months before the surgical procedure.
  • In other case, one speaks about failure when :
    • The weight loss is lower than 50% of the weight excess.
    • The patient is unhappy with his gastroplasty : decreased food comfort, too rigorous dietetic rules, too demanding follow-up.

These failures stress the importance of the assessment before the intervention, the good knowledge of the food constraints and the anticipated results of gastroplasty.

Last update 19 August 2015