Ask the expert: Gastric Band Surgery

Mr Paul Super is a consultant Upper Gastrointestinal and Bariatric Surgeon with special interests in keyhole stomach operations for both weight loss and for acid reflux. He has a busy NHS practice which covers these areas and also is the surgical lead for the Heart of England NHS trust obesity surgery program, one of the largest NHS providers of this service.

Mr Super's speciality is laparoscopic gastric band insertion for morbid obesity which throughout the world is the safest of all weight loss surgery operations, and has now become the most popular. This surgery forms a large part of his clinical research activities and he regularly presents his research work at national and international meetings. He is a member of the Association of Upper GI Surgeons as well as a member of the British Obesity and Metabolic Surgical Society. He works closely with industry in the development of new techniques and is a regularly invited international speaker at Obesity surgery meetings around the world.

How do I know I would be suitable for gastric band surgery?
If you are morbidly obese with a BMI of at least 35, and your obesity causes at least one health problem, you could be suitable for this surgery as long as you have already made good attempts at alternative weight loss strategies. If your BMI is greater than this, you may be suitable even if there are no health problems.

What are these health problems in order for me to be suitable?
Obesity causes many problems such as bone and joint pains (backache, knee and hip pains). Other problems include blood pressure, diabetes, heartburn, sleep apnoea and hormonal problems such as polycystic ovarian syndrome.

What is a gastric band?
A gastric band is a silicone ring which is placed around the top of the stomach and works by decreasing appetite.  Patients feel much less hungry. In addition the band produces a feeling of fullness as the food passes through the band. The combined effect is to be less hungry and at the same time find it easier to feel full.

What does the operation involve?
Firstly this is not just an operation which will work in isolation. A gastric band is a tool which makes dieting easier and as such this still involves regular attendance with dieticians and other members of the weight loss surgery team. he operation is part of a program. The operation is performed by keyhole (laparoscopic) surgery and there are 5 cuts in total measuring between 15mm and 5 mm each. The procedure takes 30 minutes to complete and patients can usually go home 6 hours later. You are advised to take it easy for 2-3 days and then to go out walking for 1 hour per day from 3 days after you get home. After that you may drive a car and people go back to work within one week.

Can I eat normally after this operation?
It is impossible to eat entirely normal food but in general liquids and soft food goes down easier and solid food produces fullness after one or two mouthfuls. The tightness of the band can be adjusted by an injection into a small valve device placed under the skin at the top of your tummy. This is required perhaps 2-3 times in the first year and occasionally in the second year.

What sort of weight loss is expected?
This varies from patient to patient, but on average just over half of your excess weight (over weight problem) goes away after one year.

What problems can develop?
This operation is safe to perform and problems having the surgery are unusual. There can be bad bruising and very rarely infections (each about 0.3%) but the main problem is slippage of the band some years later caused by over-eating in that high pressure from eating mouthfuls of food can push on the band. The risk of this is between 2 and 4%.

Do these bands last forever?
They may well last for a long time since they have been inserted since 1982. Over the years since then band materials have improved as have the surgical techniques to reduce problems later on.

Will I have lots of loose skin?
This may be the case if you are very large to start with, older than 50, and get an above average weight loss result, especially if you become thin. For most patients this is not a problem.

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