Gastric band surgery

Gastric band surgery, also known as lap banding or gastric banding, is a type of weight loss surgery. It involves placing a band around the upper part of your stomach. Having a gastric band reduces the capacity of your stomach, which makes you feel full after eating a much smaller meal than usual. This can help you lose weight over time.  

When to consider gastric band surgery?

Living with obesity can increase your risk of several health conditions, including type 2 diabetes, cardiovascular disease, and osteoarthritis. It can make everyday activities more challenging and affect your physical and mental wellbeing. Losing and maintaining a healthy weight can have a wide range of benefits, such as:

• A lower risk of developing serious health conditions, like type 2 diabetes, heart disease and high blood pressure 
• Better mobility and joint health
• Higher energy and better sleep 
• Improved mood and mental wellbeing
• Increased life expectancy

Having a gastric band can lead to steady weight loss over 2 years. On average, people lose around 50% of their excess weight after 5 years. To achieve and maintain results, it’s important to follow your dietitian’s advice on eating habits and keep active with regular exercise. 

Gastric band surgery is not suitable for everyone, but it may be an option for you if: 

• You are severely obese with a body mass index (BMI) of 40 or over 
• You have a BMI of 35 to 40 and a health condition associated with an increased health risk, such as type 2 diabetes or high blood pressure
• You’ve tried to lose weight through diet and exercise, but haven’t lost enough weight
• You’re committed to making long-term lifestyle changes and attending regular follow-up appointments

Is gastric band surgery right for you?

Choosing to have a gastric band is a big decision. While it can support long-term weight loss, it also means committing to ongoing lifestyle changes. Here are some factors to consider when deciding if this treatment is right for you:

• You may need several appointments to adjust the band so it works effectively 
• You’ll need to change how you eat and drink 
• It may take a few months after surgery before you start losing weight
• Weight loss may be slow and results can vary from person to person
• You’ll need to take regular vitamins and minerals supplements 
• You’ll need regular check-ups throughout your life

Gastric band surgery can be reversed, if necessary, but this increases your chances of putting weight on and has a higher rate of risks and complications than the initial surgery. Your doctor will talk you through the potential benefits and risks to help you make a decision. 

Gastric band surgery is usually performed using keyhole (laparoscopic) techniques. This involves making several small cuts in your abdomen rather than one large incision. It’s carried out under general anaesthetic, so you won’t feel anything during the procedure. However, keyhole surgery may not be possible if you are morbidly obese ie have a BMI of 40 or higher.

A thin tube with a light camera is inserted through one of the cuts to guide the surgeon. An inflatable band — usually made of silicone — is placed around the upper part of your stomach and connected to a device called a port, which sits just under the skin of your abdomen. 

The band is left empty during surgery and is usually tightened around 4 to 6 weeks later by adding fluid through the port to inflate it. This helps control how full you feel after eating. The band can be adjusted over time by adding or removing fluid as needed.

The cuts are usually closed using dissolvable stitches that don’t need to be removed.  

Compared to traditional surgery, keyhole surgery typically leads to less pain, faster recovery and fewer complications.

How to prepare for surgery

Before your gastric band surgery, you’ll be asked to complete a preadmission form, covering your medical history, current medication and any allergies. You may also be invited to a preadmission clinic for tests, such as blood tests or X-rays.

On the day of surgery, you’ll have some basic checks, including heart rate, temperature and blood pressure. You’ll also meet your anaesthetist who will explain the type of anaesthetic you’ll have.

This is your opportunity to ask questions and make sure you’re fully informed. You’ll then be asked to sign a consent form for the procedure to go ahead.  

Before surgery, you’ll also need to:

• Stop eating and drinking for a set time — usually no food for 6 hours and no drinks for 2 hours before surgery (your admission letter will give full instructions) 
• Take a shower or bath on the morning before surgery
• Remove make-up and jewellery
• Change into a hospital gown and disposable underwear before going to theatre
• Have any hair near the surgery site removed — this is usually done in theatre, but you may be asked to use a hair removal cream the night before

Who will be involved?

Your consultant surgeon, anaesthetist and theatre team will be present during the procedure. Afterwards, you’ll be cared for in recovery by trained nurses.

The operation

The procedure typically lasts around an hour and is done under general anaesthesic, so you'll be fully asleep and won’t feel any pain. Your anaesthetist will use a combination of intravenous and inhaled medicines to keep you comfortable throughout.

What happens straight after surgery?

As the anaesthetic wears off, you’ll gradually wake up. It’s normal to feel some pain or discomfort around the small cuts on your abdomen. You’ll be given pain relief to manage this. Speak to the team if you’re still in pain, as your medication can be adjusted. Pain usually improves within a few days.

Before you go home, your care team will check that you can move around and are able to eat and drink without any problems.

Your hospital stay

Most people need an overnight stay after gastric band surgery. During your stay, your care team, including specialist nurses and dietitians, will look after you and provide any support and advice you need.

When you are ready to be discharged, you will need to arrange for someone to take you home, as you won’t be able to drive.

Any pain or discomfort from your wounds should ease within 2 weeks after surgery. You should be able to go back to normal activities within one month. 

Short-term side effects

You may need oxygen after surgery, especially if you smoke or have chest problems. Feeling sick is common but usually passes within 24 hours. You’ll be offered medication to help. Pain around the small cuts is normal but you’ll be given pain relief to ease the pain.

The anaesthetic can make you feel drowsy, clumsy or forgetful for about 24 hours. During this time, you should avoid:

• Driving
• Making important decisions
• Using machinery 

Eating and drinking after surgery

You’ll need to follow a strict eating plan after your surgery. Your diet will usually follow 3 stages:

• Weeks 1–2 — liquid-only diet
• Weeks 3–4 — introduce pureed or soft foods
• Week 5 onwards — protein-rich, low-calorie meals with portion control

You’ll also need to take vitamin and mineral supplements for life, and some foods may become harder to tolerate.

Caring for yourself at home

It’s important to give your body time to heal. You can expect to feel tired during the first week, but most people return to their usual level of activity within 2 weeks. You can resume sexual activity when the wounds are healed and you feel comfortable — usually after a week or 2.

Looking after your wounds

Your wounds will be covered with dressings. You can remove them after 48 hours, although many people choose to keep them on for comfort. You can wash the area after 48 hours with soap and warm water. 

Pain relief

You will be given pain relief after surgery and should take it regularly for the first 48 hours to ensure you remain comfortable. You will also be provided with painkillers to take home, which will last for 2 weeks. This may be at an additional cost.

Smoking

Quitting smoking helps lower the risk of wound infections, poor wound healing and long-term coughing, which can put strain on your wound. 

Driving

You’ll need someone to take you home, as you won’t be able to drive straight after surgery. You can start driving again when you can comfortably wear a seatbelt and make an emergency stop without pain.

Time off work

Most people can return to work after2 weeks. If your job involves heavy lifting, you may need to wait up to 4 weeks.

What to do after gastric band surgery

• Follow your dietitian’s guidance carefully 
• Start moving around as soon as you can — gentle activity helps recovery
• Don’t drive until you can wear a seatbelt and make an emergency stop without pain
• Avoid heavy lifting for the first couple of weeks
• Stop smoking if you can 

If you have any concerns, make sure you contact your care team as soon as possible. A follow-up appointment will also have been arranged for you where your doctor can check on your recovery and, if needed, determine whether your gastric band needs to be adjusted.

Gastric band surgery is a common procedure. However, like all types of surgery, there are risks. Your consultant will explain these to you before you go ahead. Possible complications include:

• Band slippage or leakage
• Infection at the port site
• Nutritional deficiencies
• The need for band removal or revision surgery 
• Widening of the oesophagus (oesophageal dilation)

It’s important to seek medical advice straight away if you notice any of the following:

• A high temperature or chills
• Difficulty passing urine
• Increasing pain, redness, swelling, bleeding or discharge around your wound
• Sudden cough, chest pain or shortness of breath
• Swelling in your calf

There are several alternative treatments to a gastric band, including non-surgical and surgical options.

Lifestyle changes

An alternative to surgery is to continue making changes to your diet and lifestyle. This means following a healthy, balanced diet with a calorie deficit (consuming fewer calories than you burn) and getting regular exercise. Swapping processed foods and sugary drinks for healthier choices can make a big difference. Staying active can help you maintain your weight loss.

Weight management medications

A number of weight management medicines are available if diet and exercise haven’t been enough to support weight loss. Different medications work in different ways eg preventing fat absorption and reducing your appetite. You’ll still need to follow a reduced-calorie diet and get regular physical activity while you’re taking medication and after finishing your course of treatment.

Digestion-altering surgery

These are more complex procedures that involve rerouting your digestive tract so your body absorbs less food. They generally lead to greater weight loss than gastric band surgery, but they also carry higher risks. Digestion-altering surgeries include:

• Duodenal switch
• Gastric bypass (Roux-en-Y) 

Stomach reduction surgery

These procedures work by reducing the size of your stomach, helping you feel full more quickly so you eat smaller meals. They generally have lower risks than digestion-altering surgery but often result in more modest weight loss. Gastric band surgery falls into this category. Other stomach reduction surgeries include:

• Intra-gastric balloon 
• Sleeve gastrectomy
• Primary obesity surgery endoluminal (POSE)