The adjustable band is placed around the top part of the stomach, leaving a small section of stomach (about 25 ml) above the band; the main part of the stomach lies below the band. A small passage is left open through the section of stomach surrounded by the band, so that liquids and food can still flow through from the upper to the lower part of the stomach. This small opening is called the stoma.
The adjustable gastric band allows the surgeon to modify the width of the opening of the stoma (through which food passes), by injecting or removing liquid from the inflatable balloon that is fixed to the inside of the band. The balloon portion of the band is attached to a long tube that plugs into an injection port. The injection port is fixed to the stomach muscle during the operation, and can be localized by X-ray later.
The surgeon can remove or add liquid to the balloon of the band via the injection port, thus altering the inner diameter of the closed band: more liquid in the balloon will reduce the opening of the stoma, whereas by removing liquid from the balloon, the opening will increase, enabling more food to pass through into the stomach.
This procedure is ideal because adjustments can be made as frequently as necessary and according to each patient's need without a further surgery.
What are the advantages of the adjustable gastric band?
This method is:
1. less invasive surgical intervention available for the treatment of morbid obesity, as no alterations are made to the anatomy of the stomach or intestines.
2. the only method which enables a perfect calibration of the stoma diameter and pouch size (small part of the stomach which remains above the band).
3. the only method where the width of the stoma can be modified postoperatively without further surgery.
4. the only totally reversable method in obesity surgery, in which the anatomy of the stomach is entirely restored to its original form, after the band is removed.
Average weightloss achieved with the laparoscopic adjustable gastric band is 50-60% of excess body weight after 2 years.
It is of course essential that you comply with:
* medical advices
* dietary instructions
* follow-up controls
Who is suitable for a gastric band operation?
You must meet the following criteria :
1. You are at least 80% above your ideal weight (equivalent to approx. 45 kg or 100 lbs excess body weight or a Body Mass Index - BMI of 40 or greater)
2. You do not suffer from any other illness that cause obesity.
3. You are prepared to modify your lifestyle and attend follow-ups regularly. These are the basic criterias, but other requirements can be considered too, according to the results of the individual consultation.
The Adjustable Gastric Band (AGB) operation is the first step towards a major readjustment of the patient`s lifestyle. The patient has to learn new eating behaviours.
The following 6 rules are very important eating habits:
1. Only eat small quantities: The capacity of the stomach has changed. Also the amount of food intake has to change. Nevertheless it is not always easy to stop eating at the right time. What do we mean, if we say small quantities? For example one slice of bread for breakfast or
2 potatoes and a small piece of fish for lunch.
2. Chew well and swallow food only completely mashed: You need more time for chewing and also not all food is possible to chew well. The list of "unsuitable food" will show you the products which are usually not easy to chew.
3. Never eat and drink at the same time: The reduced capacity of the first part of the stomach will no longer permit to take in both: liquid and food at the same time. The usual amount of beverage, 2-3 litre liquid per day, are desirable. It´s better to drink between or before meals.
4. Do not lay down or rest after eating: because in a horizontal position reflux is more likely. The food also remains longer in the prestomach and leads to a very uncomfortable accumulation of mucus.
5. Eat five times a day: This is important, because if you only eat 2-3 times a day, it is not possible to have a great variety of food. Consequently, as you can only eat small amounts, you do not get enough proteins, minerals and vitamins. In addition, when eating 5 times daily, it is less likely that you are overpowered by sudden hunger attacks where you probably forget the new eating habits.
6. Watch for beverages rich in calories: In our experience, many people take in a lot of their calories with soft drinks, hot chocolate and milk shakes. This is also possible after the operation, so consider this before drinking high calorie liquids. The type of liquid should be varied and include tea or coffee, diluted fruit- or vegetable juice, light drink with artificial sugar, low fat variants of butter milk, mineral water without gas. Certain food are not easily tolerated and should be avoided unless they can be broken down into easily digestible alternatives. These are foods, that generally get stuck in the opening of the stomach and are therefore likely to cause obstruction, and include vomiting and fluid depletion.
Unsuitable food are:
* tough meet, especially beef
* pastas and noodles
* vegetables with shell or skin (beans, corn, peas, asparagus)
* sausages and bacon
* fruit with peel or skin e.g. grapes
* carbonic acid
It is, therefore, advisable to avoid eating meat in the beginning and only introduce this progressively into the diet. Much depends on how much fluid is injected into the AGB`s balloon as this affects the size of the aperture between the upper und lower part of the stomach. A small hole will allow greater weight loss, but will also require that patients are more careful about what they eat. With the balloon totally empty, the patient will be able to eat almost normally.