[Watch above video which illustrates the text below]
The gastric band is placed around the upper part of the stomach (see video)
Following band placement, in conjuction with band adjustment, inflation or fill, after the band is adjusted or filled, the resulting constriction of the stomach is achieved at the level of band placement. This constriction slows the passage of food to the stomach below - in the same way as sand flows through an hourglass.
When wound around the top of the stomach to create a small pouch, the band exerts very mild pressure after it has been inflated, or adjusted with saline.
Above the area of band placement a small ‘pouch’ is formed, and it is thought that for this reason the person with a well adjusted gastric band, is less likely to experience the sensation of hunger. Band adjustment allows the diameter through which the food passes to be widened or narrowed as clinically indicated.
It will also be evident, that swallowing insufficiently chewed food will lead to difficulties, and patients with a gastric band in place will need to carefully chew their food very well, and also eat smaller portions of food.
When the pouch is full, the patient also will have the feeling that their whole stomach is full- they feel satiated
It is in this way that the band will begin to exert its effect, and so lead to weight loss.
Bariatric or weight loss surgery, is undertaken to help morbidly obese patients lose weight, because an obese person is more likely to suffer from physical and psychological illness than a person of normal weight.
Weight loss surgery is to be considered when standard methods of weight loss such as dieting, exercise regimes and prescribed medication, fail to achieve results.
In particular, overweight and obese patients are more at risk of heart disease, diabetes, high blood pressure, high cholesterol, heart attacks or stroke, sleep apnoea, depression, and osteoarthritis.
Losing weight has been shown to reverse or reduce the severity of these conditions.
All of Mr Horner’s referred patients usually are required to fulfill the NICE criteria for bariatric obesity surgery.
- Morbid obesity, BMI of more than 35 with co-morbidities, or a
- BMI of more than 40 without co-morbidities
- Super morbid obesity - BMI more than 50
- Most patients should have attempted to lose weight by diet and lifestyle changes, and also where indicated, have been prescribed appropriate obesity medication such as Reductil and Xenical.
- Where a BMI is in excess of 50, patients can be immediately referred for obesity surgery.
Sadly, because weight loss by dieting, drugs and exercise, and most importantly, maintaining weight loss by these means, so often fails in up to 95% of cases, obesity/weight loss surgery remains the only alternative.
After a full and careful explanation to his patients the reasons and indications for advising weight loss surgery, Mr Horner will ensure that his patients are referred to experienced colleagues in his Multi Disciplinary Team(MDT) in Metabolic Medicine and Dietetics (dietician). When considered necessary, referral to a Clinical Psychologist for a review may also be considered.
- The Metabolic Physician will ensure that all metabolic and medical issues, which may affect the outcome of surgery are assessed, especially the presence of previously diagnosed and undiagnosed conditions such as diabetes and heart disease, which can then be monitored afterwards.
- The dietician will be able review the patient pre-operatively, and offer advice and support, both in the build up for surgery, but also in the postoperative period, with regard to food preparation.
- The psychologist’s review, considered by NICE when necessary, may be an integral part of the assessment of a patient undergoing bariatric surgery, and allows patients to understand the pressures they may face after surgery, and to enable them to come to terms more readily to their "new life".
Most patients should have attempted to lose weight by diet and lifestyle changes, and also where indicated, have been prescribed appropriate obesity medication. However if these attempts have failed, weight loss surgery is the only viable alternative.
The operation is performed under general anaesthesia, and the entire procedure usually takes approximately one hour. The laparoscopic or keyhole method is always used. (see video)
Mr Horner will make several small cuts in the upper abdomen. He will place surgical instruments, along with a telescope, inside the abdomen in order to perform the operation. Mr Horner will then create a small tunnel behind the upper stomach, and will pass the band around the stomach and secure it. This creates a smaller pouch in the stomach.
The small incisions are closed with skin glue and waterproof dressings. The dressings can be removed by the patient themselves, 7 – 8 days after surgery.
A return to full and normal activity is usually possible after 10 to 12 days.
Mr Horner uses local anesthesia in all the small skin incisions, so that postoperative discomfort is kept to a minimum.
- Band too tight
- Band too loose (able to eat anything with no restriction)
- Band slippage
- Band erosion
- Inability to swallow anything – even liquids
- Oesophageal reflux
- Failure to loose weight
- General advice with band management
Occasionally, patients who have had their bands fitted elsewhere in the UK, in Europe or indeed elsewhere in the world, develop problems or concerns with their band; or they may have moved within the UK, far from their original banding unit, and it would be very inconvenient to travel long distances for further band adjustments.
With the passage of time, they may have lost contact with the original surgeon or unit where they will have had their surgery.
They may even have lost confidence in their previous banding service or surgeon, and feel the need for reassurance or intervention, to maintain the function and performance of their band.
Rarely, and for reasons described above, they may have developed a complication from their band and require rapid expert opinion in what can be done to manage the problem.
Sadly and very rarely, some post banded patients may have been left to fend for themselves after their first year follow–up has expired, and do not know where to turn to for support.
Mr Horner will be personally pleased to see any such patients for the necessary investigations, if required, arrange for specialist dietician input, propose and undertake appropriate treatment after full consultation and discussion as to the nature of the problem.
Mr Horner will personally take charge of all follow up visits, and any concerns or difficulties should be reported immediately to his secretary, who will pass on all messages to him.
Where necessary, a simple telephone response by Mr Horner is often sufficient, but if not, an out patient visit will be arranged.
- A special dietary regime will be given to you at the time of the first consultation, and after your discharge.
- This will set out what you should and should not eat in during the next 3 to 4 weeks.
- Your first band adjustment will take place between 6 and 8 weeks after your operation, by Mr Horner in the X-Ray department with the aid of a barium swallow.
This is not a painful procedure, and will take approximately 10 minutes.
- After this first band fill, you will for the first time begin to experience the physical effect of the restricting band. It is now very important that you adhere to the chewing, eating and dietary instructions you will have previously been given.
- Your next outpatient follow up appointment to see Mr Horner personally, will be arranged for 3 months later.
Your band is a life long experience, and often after 1 or 2 years have passed since your operation, you may have lost contact with your original bariatric team.
You may have had your band inserted in Europe or elsewhere in the UK or the world, and are experiencing problems with the band.
You are unhappy with your follow-up care program, and would like to change.
- You need a band adjustment
- Your band may be to loose, and you are beginning to put on weight
- You are able to eat more freely than you would like or have been previously able to do
- You have never lost a significant amount of weight after the band was inserted
- Your band is to tight, and you can hardly eat any solid food
- You are “sliming”, or regurgitating saliva
- You are experiencing heartburn or reflux
- You are feeling generally unhappy with your band and need advice
If you are having any of these concerns, you may wish to contact Mr Horner for a consultation to discuss these matters pleasec contact us
