Frequently Asked Questions
[+] What do I do with the gastric band if I’m going overseas?
If you are going overseas we normally advise to have all the fluid taken out of the gastric band first. This is to avoid the potentially dangerous situation of having food stuck in the band or an acute slip causing obstruction when you are away from medical care.
Depending on where you are going there may be little or no understanding of gastric banding surgery in the local medical centres. We can often give you details before you go of surgeons who we know can look after gastric bands properly in a variety of different countries.
When you return from your trip, come back to the clinic and we can re-fill your band if it has been emptied prior to leaving.
[+] How do I manage at restaurants with the gastric band?
You should not have to avoid eating out just because you have a gastric band! But restaurants can provide a challenge due to lack of control of portion size and food types. It is also socially embarrassing to have to run to the bathroom and vomit or regurgitate food that you have eaten too quickly or too much of.
A useful approach is to limit your order to an entree size order only. Discuss with your waiter in order to avoid foods that are difficult – ask for variations such as smaller serves, altered cooking times, pureed options etc. Ensure you eat slowly and remember you have a gastric band inside!
[+] Will I be able to eat normal foods afterwards?
The main change you have to make with the gastric band is not so much the kind of food you eat but rather how you eat it. In theory there should be no particular food restrictions with the band, but foods need to be in smaller portions, chopped carefully and chewed well. It is important to slow your rate of eating so that food does not accumulate in the oesophagus above the band during your meal. This leads to vomiting and regurgitation. You will need to learn to pause between each mouthful to allow the last quantity of food to start moving beyond the gastric band.
Sometimes you will need to alter the textures of some of the foods that you like to eat. For example, minced meat is usually easier than a standard cut of meat and casseroled dishes tend to be more easily tolerated. Bread, rice and meat products tend to be the most difficult to eat but it is important to continue with these products in your diet – just reduce the quantities that you consume.
[+] Will I be vomiting all the time?
It is not normal to be vomiting with the gastric band, although an occasional vomit here and there is not unusual. Frequent vomiting, particularly of liquids, may indicate a mechanical problem with the band. This might be simply due to the fact that the gastric band has been adjusted too tight for your needs or the band may have slipped out of position.
Putting technical issues aside, frequent vomiting is usually due to eating too much too quickly and poor food choices. If you eat correctly textured foods in a slow, measured manner, chewing mouthfuls carefully there should be minimal vomiting with the band.
[+] How do I know which gastric band is for me?
The two most commonly used gastric bands in Australia are the LAP-BAND® adjustable gastric banding system (Allergan – Lap Band) and the Swedish Adjustable Gastric Band (Ethicon – SAGB). Other brands include MidBandTM and Helioscopie. The Lap Band comes in two sizes: small (APS) and large (APL). Both the Lap Band and Swedish Bands have been used for around two decades and have an excellent track record and safety profile. Both the Lap Band access port and the SAGB access port have metal claws underneath to attach the port to the underlying muscle. The locking systems on the gastric band itself are slightly different but this is of no practical concern to the patient.
The Lap Band system has had more publications regarding outcomes but both Lap Band and Swedish Band have been well studied over the years and are found to give essentially equivalent outcomes. At North Eastern Weight Loss Surgery we usually use Swedish Bands by default but are happy to place the Lap Band instead if requested by the patient. The Lap Band has recently been approved by the Food and Drug Administration of America for placement in patients with BMI between 30 and 34.9 kg/m2 in selected patients.
[+] Is it better to have a sleeve gastrectomy or a bypass than a gastric band?
Which operation is best for your circumstances is a very individual thing.
Both sleeve gastrectomy and gastric bypass surgery tend to be associated on average with more weight loss and a lower failure rate overall than gastric banding. This is at the cost of higher upfront complication rates and more stringent requirements for nutritional supplementation.
These are some of the important questions which will help determine the best operation for you:
- What is your weight and BMI? (very heavy patients may sometimes elect to have sleeve or bypass surgery)
- What are my weight loss goals?
Your age (for example, we are less likely to recommend sleeve gastrectomy on younger people) - What are your medical conditions? (if you have very poorly controlled diabetes for example, and other co-morbidities we may recommend bypass or sleeve gastrectomy due to the extra reliability of the weight loss)
- Do I live a long way from medical care? (it is harder to succeed with gastric banding without the availability of intensive follow-up)
For more information regarding
sleeve gastrectomy or
gastric bypass surgery click here.
[+] What if my BMI is under 35? Do I qualify for banding?
The classic guidelines for bariatric surgery do not include the range BMI 30 – 34.9. However these guidelines were originally penned in 1991 when most surgery was performed open rather than keyhole and gastric bypass surgery was primarily used for outcome analysis. These days we can perform most weight loss surgery laparoscopically and the safety and knowledge regarding these operations has improved.
In 2010 a meeting of medical and surgical experts released a consensus statement after a conference in Rome, Italy. This statement related to poorly controlled diabetics with BMI 30-34.9 and was supportive of a role for weight loss surgery in selected patients in this range. The FDA of America in 2011 approved the Lap Band system for use of in selected patients with BMI between 30 and 34.9.
In practice, if your BMI is less than 35, selection is individualised rather than guaranteed. You will need to demonstrate a strong understanding of the pros and cons and basic rationale for surgery to be considered in our clinic. The responsibility for the decision for surgery is more in your hands as the overall metabolic benefits of weight loss in this group is likely to be less than those with BMI > 40 for instance.
[+] Will my body reject the gastric band?
The gastric band is made of silicone and does not stimulate the body’s immune system, so there should be no concerns regarding rejection of the band. The gastric band may become infected (rarely) but this is a different problem. Apart from mechanical and technical issues which may rise, such as band slippage, the gastric band is a safe device which will co-exist harmlessly inside your body.
[+] What is a gastric band erosion?
Because the gastric band is made of material foreign to the human body it does not always behave in an harmonious manner inside ourselves. In about 1% of cases the silicone band can eat its way through the wall of the stomach and reside partly or fully inside the stomach. This is called a band erosion.
Symptoms of gastric band erosion include abdominal pain, weight regain, fevers and port infection. Access port infection is often associated with gastric band erosions, presumably due to the connection between the band and the port.
Gastric bands which have eroded should be removed surgically to prevent further infective complications. This can be done laparoscopically or sometimes with a gastroscope (through the mouth) with a special cutting device. The operation to remove an eroded gastric band can be challenging and there is always a small risk of ongoing leak/infection after the band has been removed.
Options after a gastric band erosion include re-banding (this has been associated with a high re-erosion rate), gastric bypass, sleeve gastrectomy or nothing at all.
[+] What is a gastric band slip?
The gastric band is placed around the top of the stomach and usually stitched into place. In up to 5% of cases, the band will slip out of position and end up further down the stomach. Usually the symptoms of this will be difficulties tolerating foods that were previously ok, increase in reflux symptoms and vomiting. It can occur any time after the original gastric band placement.
Graphic: Gastric Band Slip
In the worst case scenario the pressure within the slipped band gets so high that the blood flow to the stomach is compromised. In this situation it is impossible for the patient even to keep fluids down as the gastric band is completely obstructed. If there is a delay to surgery in this case it could lead to death of part of the stomach which is a very serious and even life-threatening condition.
Key Point: If you are unable to tolerate fluids with the gastric band you should seek urgent medical attention
In ordinary circumstances, however, band slips are not dangerous and can be fixed with further surgery. Revision surgery may involve simply re-positioning the gastric band back into the correct position, placing a new band in the correct position or removing the band altogether. If the condition of the entrapped stomach is poor, temporary removal of the band may be the safest choice.
Click here to
watch a video of re-positioning a slipped gastric band
[+] Why aren’t I losing any more weight with my gastric band?
If your weight loss has slowed or stopped with the gastric band, there are a number of possible reasons:
• You may have reached your plateau weight. The average weight loss with the band is 50% of your excess weight (above BMI 25). If you have reached around this point, it may be as far as you are going to go without making some further significant changes to your lifestyle. If you and your dietician are happy with your eating choices and habits, increasing your exercise and activity levels may improve and maintain your weight loss at this point.
- You may need a further fill of your band. If your gastric band is not restricting your portion size and inducing satiety it may be too loose.
- You may be choosing high calorie foods and liquids which are not easily prevented by the band. For example soft drinks, cordials, fruit juices, milkshakes, crackers, cheese, lollies, chocolate and so forth. If you are having trouble avoiding these foods or are a frequent comfort eater you might consider consulting a psychologist for advice on behavioural intervention strategies.
- You may have a technical problem with the band. If you have a gastric band erosion or a leak from the system you will not be getting the restrictive effects that you need from the band. Your surgeon can investigate for these problems if need be.
- The gastric band may not be suitable for your weight loss needs. Some people simply do not manage to lose the desired amount of weight despite prolonged attempts with the band. It may be worth discussing revisional surgery (i.e. revision to gastric bypass or sleeve gastrectomy) with your surgeon if you are interested in pursuing things further.
Click here for more information regarding
revisional surgery after gastric banding.
[+] Should I have the gastric band removed once I’ve lost the weight?
It is a common misconception with gastric banding surgery that one can lose the weight then have the band reversed (removed) and all will be well. It is well understood that having the gastric band removed leads to weight regain in almost every circumstance. Those who have had success with the band are never interested in having the band removed!
[+] Will I become vitamin deficient after gastric banding surgery?
Many individuals seeking weight loss surgery are Vitamin D deficient, which mostly reflects the situation in our community at large. We frequently supplement our patients with vitamin D as well as prescribing a suitable multivitamin for anyone undergoing gastric banding surgery. It is unusual for gastric band patients to become severely deficient in protein, iron, calcium or other nutrients.
As a routine we order pre-operative and yearly nutrition profiles (blood test) to check these levels and can supplement as required. Patients undergoing sleeve gastrectomy and, in particular, gastric bypass are usually subject to higher levels of nutritional deficiencies over time.
[+] How much weight will I lose with the gastric band?
Weight loss success with the gastric band is quite variable. For some individuals the key seems to fit the lock and the weight comes off very easily. Others have a constant struggle with food choices, food portions, eating style and suffer frequent vomiting. It is not easy to predict who will succeed with the band and who will not.
Most studies suggest that the average excess weight loss with the gastric band is about 50%. This means that if you start out 120kg and your ideal weight is 70kg (if your BMI was 25) then you would expect to lose about 25kg all together. Many people do manage to lose more than 50% of excess weight with the band, but many do not even lose this much. Over a period of time, the chance of an individual losing 50% of their excess is itself about 50%. This variability in outcomes with the gastric band is key reason why some individuals prefer to look at gastric bypass or sleeve gastrectomy which tend to bestow a greater reliability of success.
Weight loss with the band is a slow and steady process and can take up to 18 months to complete.
[+] Will my diabetes improve after weight loss surgery?
Successful weight loss surgery is a potent weapon against type 2 diabetes. Depending on the weight loss a diabetic may expect to be able to discontinue medications and improve blood tests back to normal in about 50-75% of cases. (Ref: Am J Med 2009 Mar;122(3):248-256.e5) If you have been diabetic for many, many years it may be more difficult to get off your medications than if you have only recently been diagnosed.
Those who have glucose intolerance or “pre-diabetes” are likely to avoid diabetes altogether by having gastric banding.
For type I diabetics who are dependent on insulin, there may be a benefit in terms of reduction in insulin dosage but these patients will still require ongoing medication. Late onset diabetics are sometimes found to have an “auto-immune” component to their diabetes (antibodies attack the body’s own insulin-producing cells). These diabetics may not receive the same benefits from weight loss as standard type 2 diabetics.
[+] Will my sleep apnoea improve after weight loss surgery?
Obstructive sleep apnoea is commonly related to overweight or obesity. Successful weight loss surgery will usually lead to significant improvements in sleep apnoea symptoms. Often the CPAP mask prescribed for established sleep apnoea will no longer be required once weight loss has occurred.
Chart: Review of studies showing improvements in sleep apnoea after bariatric surgery. Ref: Am J Med. 122(6), June 2009
It is worthwhile consulting with your sleep physician before ceasing CPAP therapy during weight loss in order to ensure that the condition remains adequately treated.
[+] Will I live longer with gastric banding surgery?
Improved health is the goal of many people seeking gastric banding surgery.
There is evidence from a handful of studies that in the long term successful weight loss surgery will likely lead to improved overall lifespan.
Graph showing increasing deaths over time in morbidly obese patients who did not undergo bariatric surgery compared to those who did. Ref: New England Journal of Medicine. 357(8):741-52, 2007 Aug 23
This graph from the Swedish Obese Subjects Study shows death rates over time in a series of morbidly obese patients. Half of these patients underwent weight loss surgery and half did not. After around ten years of follow-up the patients who had not undergone surgery appear to be dying more frequently than those who did have surgery.
Of course, the older you are when you undergo bariatric surgery, the less likely you will be to find improvements in longevity from improved metabolic health. In addition to this there are other conditions independent of weight which occur more frequently in the older decades, including cancer and Alzheimer’s disease.
[+] Is it normal to be able to feel my access port?
Whether you can feel your access port depends on a number of factors including the surgeon’s choice of port position and how much fat you have between the skin and the muscle layers. If you try hard enough you can almost always locate your port in the upper abdomen as a small firm lump deep underneath the skin.
Occasionally ports cause discomfort during usual activities of life, such as at work, playing sport or even during sex. If the sensation of the port is excessively uncomfortable, it is possible to place the port underneath the muscle of the abdominal wall which will make it much more difficult to feel or see. The downside of this port position is that needle access to the port tends to be a little more difficult and painful.
Graphic: Gastric band port placed underneath the muscle
[+] Does it hurt to have a gastric band adjustment?
This is different for everyone but mostly people do not feel much pain with a gastric band adjustment. Sometimes there may be an uncomfortable feeling related to the sensation of the needle hitting parts of the port but usually this is very tolerable. When ports are difficult to access (e.g. very deep) or placed under the muscle there may be a little more discomfort involved.
Generally it is not useful to use local anaesthetic to numb the skin as the anaesthetic itself causes a degree of pain and discomfort when infected.
[+] Why does my friend have more fluid in their gastric band than me?
The amount of fluid required to produce the correct degree of restriction and satiety is highly variable between individuals. There are also differences between the types of gastric band, for example, the Lap Band APS system has a maximum of 10ml, whereas the Lap Band APL has up to 14ml. The old style Lap Band is smaller and only takes around 4ml altogether.
Differences in restriction from filling the band may also related to the size of your stomach or other anatomical factors. Generally speaking it is best to get by on as little fluid as possible in the gastric band to minimise vomiting and poor food choices.
Key Point: The amount of fluid required in your gastric band is highly variable between individuals
[+] What do I do about the loose skin on my body after I’ve lost weight?
After significant weight loss it is common to find that the skin in parts of your body has become redundant and will hang down to various degrees causing discomfort and embarrassment. This most commonly occurs in the lower abdomen but also in the upper arms, breasts, buttocks and thighs. The amount of loose skin you have depends on the total weight loss you have had, your age and your general body habitus.
Surgery is available to remove loose skin from these areas, although usually the trade-off is a permanent scar where the resection was done. Plastic surgeons and some weight loss surgeons perform these procedures but the amount your insurance company will cover will vary depending on the procedure.
Click here for more information about
abdominoplasty surgery for redundant abdominal skin.