Gastric Band

The laparoscopic placement of a gastric band to combat obesity is a surgical technique that started being implemented in Europe in 1993 and is quite popular. With the help of gastric banding, thousands of people of all ages have found the solution to the problem of obesity.

The band is placed on the upper part of the stomach and embraces it like a belt on a pair of pants. This provides an hourglass shape to the stomach, with the difference being that the top part is much smaller than the bottom one. The food accumulates in the top part of the stomach, but since this is smaller, it fills up with less quantity of food. This quantity is enough for the patient to feel satiated. So after the gastric band procedure, the patient feels full although consuming less food and this feeling usually lasts for a few hours. Thus, the daily food intake is reduced and subsequently, the calorie intake is reduced, without the patient feeling hungry. The gastric band will help patient lose any excess weight, however, it is not a slimming device. For better results, patients will also have to adjust their nutritional habits (i.e. limit or avoid sweets and other high-calorie foods) and increase calorie burning (i.e. through physical activity and walking). This should be done because the stenosis does delay the passage of solid food, but allows the free passage of soft and liquid foods. Patients should avoid soft foods that are usually rich in sugar, fat and calories (e.g. juices, soft drinks, sweets, ice creams, etc), since they can be consumed without causing indigestion. On the other hand, solid and fibrous foods, such as meat and hydrophilic foods, which expand (e.g. bread, rice and pasta) are usually harder to digest, induce satiation quicker and serve the purposes of the procedure.

During the early stages following the procedure, bulimia does not diminish drastically, because the fundus of the stomach, which contains the ghrelin neuroreceptors, is not affected. Gradually, however, as patients lose weight, the level of bulimia diminishes. In the beginning, the appetite is not contained; however, patients cannot consume large quantities of solid food and are forced to adjust their dietary habits. Another major drawback of the procedure is the discomfort felt by patients due to indigestion. The feeling of a knot in the stomach is quite strong. This discomfort, though, differs from patient to patient, while it gradually disappears. Solid food that has not been chewed well may cause bowel obstruction and vomiting, that is why specific nutritional guidelines have to be followed. Liquid intake during meals is prohibited, as it facilitates stomach evacuation, which is contrary to the aims of the procedure. The main advantage of the technique is that it is considered minor surgery and hospitalization time is short. Therefore, under specific conditions (good doctor-patient communication), it produces very good results.

The procedure is easy and simple, with minimum injury to tissue, and does not have any side-effects, since the physiology of the peptic system remains unaltered. It does not last longer than 45 minutes and is performed with general anesthesia. Rarely does the patient need painkillers and on this occasion, only on the first day. Usually patients are discharged on the same day.

The most important thing for patients is to strictly adhere to the nutritional guidelines given to them after the gastric band has been placed.

Dietary guidelines following gastric banding

The surgery you have undergone will help your improve your life.

The laparoscopic placing of a gastric band to combat obesity is a surgical technique that started being implemented in Europe in 1993 and is quite popular. With the help of gastric banding, thousands of people of all ages have found the solution to the problem of obesity.

The band is placed on the upper part of the stomach and embraces it like a belt on a pair of pants. This provides an hourglass shape to the stomach, with the difference being that the top part is much smaller than the bottom one.

The food accumulates in the top part of the stomach, but since this is smaller, it fills up with less quantity of food. This quantity is enough for you to feel satiated. So after the gastric band procedure, you feel full although you consume less food, and this feeling usually lasts for a few hours. Thus, the daily food intake, and subsequently the calorie intake, is reduced, without you feeling hungry. The gastric band will help you lose any excess weight; however, it is not a slimming device per se. For better results, you will also have to adjust your nutritional habits (i.e. limit or avoid sweets and other high-calorie foods) and increase calorie burning (i.e. through physical activity and walking).

Postoperative dietary guidelines

The first three postoperative weeks is the time during which the body gradually adjusts and reinforces the area where the band has been placed. This reinforcement is achieved when the band adheres to the stomach wall.

This process protects the body from a possible complication known as “band slippage” (see below). Although this complication is observed in a very small percentage of patients, your eating habits during the first three weeks are very important for a smooth progress later on.

1st Postoperative Week

Liquid diet: water, tea, milk, coffee, fruit juice (bottled or freshly-squeezed) and soups.

Attention: Freshly-squeezed juices and soups have to be strained prior to consumption so that they do not contain any solid substances.

• Drink slowly, in small sips.
• Wait between sips.
• The total daily intake of liquids should be between 1-2 liters (2-4 pints).
• Each meal should not exceed 200 ml (0.5 pints), i.e. one cup, in quantity. (Exception: the maximum quantity on the first postoperative day should not exceed 100 ml (0.25 pints).
• You can consume as many meals as you like, depending on your appetite. However, you should wait half to one hour between meals.
• You can continue taking any medication you were on prior to the surgery, unless your doctor has advised you otherwise.

2nd Postoperative Week

Pureed food diet: In addition to the liquids mentioned in the first postoperative week, you may also consume pureed food. You can cook and then puree in a blender the following: meat, chicken, fish, vegetables and potatoes. Furthermore, you may also eat mashed potatoes or yoghurt, which, whoever, should not contain pieces of fruit.

• Drink slowly, in small sips.
• Eat the pureed food slowly, in small spoonfuls.
• Wait between sips or spoonfuls.
• Each meal should not exceed 200 ml (0.5 pints), i.e. one cup, in quantity.
• You can consume as many meals as you like, depending on your appetite. However, you should wait half to one hour between meals.
• The total daily intake of liquids should be between 1-2 liters (2-4 pints).
• You may consume liquids up to 15 minutes before your meal and then 30 minutes after it.
• Do not drink liquids (water, juice) with meals.

3rd Postoperative Week

Soft food diet: Apart from liquids and pureed food, you may also consume soft foods, such as: very well-boiled vegetables (without many fibers), potatoes, pasta, rice, ground meat, fish (except for shellfish and mollusks, such as octopus, squid, etc).

• Drink slowly, in small sips.
• Eat in small bites.
• Eat slowly and chew your food very well.
• Attention! You have to chew well from the very first bite.
• Concentrate on your food and eat leisurely.
• Each meal should not exceed 200 ml (0.5 pints), i.e. one cup, in quantity.
• You can consume as many meals as you like, depending on your appetite. However, you should wait half to one hour between meals.
• The total daily intake of liquids should be between 1-2 liters (2-4 pints).
• You may consume liquids up to 15 minutes before your meal and then 30 minutes after it.
• Do not drink liquids (water, juice) with meals.
• It is important that you also have one to two snacks between the main meals to avoid quick food intake and inadequate chewing due to the great hunger that you may be feeling.

4th Postoperative Week

The diet you have to follow this week does not differ much from that of the 3rd week. You may also gradually start eating chicken and meat, after having it cut up in very small pieces and chewing it well.

It is possible that your appetite will increase in the 4th week. If this happens, it is normal. The feeling of satiation will return after the first adjustment of the band.

After the first month, your diet will gradually return to normal, with regard to the type of food you may consume. However, the quantity that will make you feel full will be clearly less, especially after the first adjustment.

General Guidelines

• Chew you food well, for much longer than you used to before the surgery, and always eat leisurely.
• Eat small bites at a time and concentrate on your food from the very first bite.
• It is important to chew well and swallow slowly from the very first bite, so that the food does not get stuck.
• It is advisable to consume one or two low-calorie snacks between the main meals so that you are not forced to eat quickly because you are feeling hungry.
• Eat your food in a small plate (dessert plate).
• Stop eating when you feel full, even if just one bite remains in your plate.
• Get up from the table as soon as you have finished you meal and occupy yourself with something else.
• Drink as much water as you like daily, but remember, in small sips.
• Do not drink water with meals. Wait at least 30 minutes after you have finished.
• Limit soft drinks that contain carbon dioxide, including soda water, because they may induce satiation quickly when consumed with food and you may feel discomfort.
• Avoid consuming large quantities of sugar and sweets (cakes, ice creams, chocolates, etc), as they may be small in volume, but rich in calories and cannot be easily controlled by the band.
• Avoid consuming large quantities of alcohol, as it is rich in calories. Because it is in liquid form, the band cannot stop it from entering the stomach.
• You have to be aware that freshly-squeezed as well as bottled juices, even the ones in bottles that specify there is no added sugar, are rich in calories. That is why they have to be consumed wisely. The juice of two to three oranges is enough for 24 hours.
• Do not eat late at night and go to bed one to two hours after the last meal.

Food that you have to careful with

• Beef, because it is fibrous and usually cannot be chewed well.
• Shellfish and mollusks, such as octopus, squid, lobster, prawns, because they are tough, cannot be chewed well and are usually swallowed in large pieces.
• Bread, in some cases, may create problems because it is soft, can be eaten in large quantities, and as it travels towards the stomach, it bloats and may get stuck. The same applies for wholegrain cereals, as well as those with rough seeds.
• Foods that are made up of small pieces may accidentally be swallowed without having been chewed and may get stuck. These include mushrooms, beans, cherries, nuts, etc. When consuming this type of foods, only put a very small quantity in your mouth, and chew slowly and calmly.
• Mixed greens should be boiled very well and cut up in small pieces. Because they contain a lot of tough fibers, they have to be chewed very well. Other vegetables, such as broccoli and cabbage, can also get stuck for the same reason.

Basically, when you chew well and put small bites in your mouth, the possibility of the food getting stuck when swallowing is very small.

What you need to do if you feel that the food has gotten stuck

• Stop eating immediately and wait a while for the food to pass through the band.
• Do not drink more than one to two sips of water.
• If the problem persists, get up from the table and take a few steps.
• Try to be more careful after that, chew your food better and for longer.
• If you still experience relative difficulty when swallowing, then the next few meals should be of a more liquid form.
• If you feel that not even liquids can be swallowed in the next few hours, you have to contact your doctor.

If the food gets stuck, or you experience vomiting or indigestion, you should pose the following questions to yourself in order to establish the reason why this happened and so avoid repeating it in future:

• Did I eat very quickly?
• Did I chew my food well enough?
• Did I eat a lot? Were the bites or spoonfuls too large?
• Did I drink liquids with my meal or very shortly after it?
• Did I lie down very quickly after my meal?

Band Adjustment

The adjustment of the band is a simple and quick procedure, and in most cases it is painless. It is performed by the doctor who operated on you, or an associate, at his practice.

The valve through which the adjustment is performed is placed under the skin, a little over the navel on the right.

The band is adjusted by inserting saline in the valve with a syringe that has a very small needle (that is why it is practically painless). This way, the band further constricts the stomach, and the more it constricts it, the less quantity of food is needed for you to feel full. Of course, the band is adjusted up to a limit.

During the surgery, the band is adjusted a bit more loosely for the first time, so that the body can adjust gradually and the band can be better stabilized in place.

With this first adjustment in surgery, little effort will be required to change your eating habits in the beginning.

However, this adjustment is not enough to reduce the food intake enough so as to lose the excess weight. That is why a few subsequent adjustments should also be performed.

The first adjustment of the band should be performed 25-30 days after the surgery.

The next few adjustments have to be performed after talking with your doctor.

It is natural that more than one adjustments will have to be performed in order to find the point where the reduction in food intake will help you lose weight, but will also be the one desired by your doctor.

When this point has been reached, the adjustments will stop, unless the quantity of food that makes you feel full increases substantially after a while.

No more than 3-4 adjustments will be needed in total to constrict the band. It is wrong to believe that the band should be adjusted constantly.

After each band adjustment, you will have to consume liquids for the first two days (i.e. follow the diet of the 1st postoperative week) and pureed food for another two days (i.e. follow the diet of the 2nd postoperative week). On the fifth day, you may start eating normally again.

Note that the band adjustment is directly related to the quantity of food you consume and not the weight you lose. That is why the doctor adjusts the band when the quantity of food has not been reduced or increased enough, and not when the quantity has been reduced, but you are not losing weight. In this case, you need to help your metabolism by increasing your calorie-burning activities.

You have to contact your doctor in case of:

• Repeated vomiting after meals.
• Pain in the area of the valve, accompanied by fever or trembling.
• Redness around the area of the valve.
• Sudden pain in the stomach along with vomiting.
• Repeated defecation with black, semisolid feces and intense smell.
• Being able to consume large quantities of food, without feeling satiated or constricted.

Band Slippage

It is a complication of the procedure that may even occur months or years after the surgery. The percentage of this complication appearing is very small: 3-5%.

The term “band slippage” is inexact, because it is not the band that slips, but a part of the stomach within the band. It is a process that occurs slowly and relates to the pressure exerted on the part of the stomach above the band. In order to reduce the possibility of this complication, you have to chew your food well, so that it does not get stuck often, to avoid drinking liquids with meals, and to avoid carbonate drinks (soft drinks, soda water).

Note that the band will in no way move due to the movements of the body, however vigorous they may be. In addition, there is no connection between band slippage and possible shifting of the adjustment valve, as the band and the valve are placed in independent, unconnected places. The adjustment valve may naturally shift slightly due to the weight loss, since the quantity of fat that surrounds it keeps lessening.

Epilogue

The pace at which excess weight is lost relates to and depends on a number of factors, such as initial weight, gender, age, type of food consumed and metabolism rate, which depends on the physical exercise in your everyday life. That is why you should not feel disappointed if you meet another patient with a gastric bad who has lost more weight than you. The excess weight is lost gradually, as initially you lose weight easier, while later on it becomes harder and takes longer. About 1 to 2 years have to go by before you reach your normal weight and the method is completely successful. There is also a small possibility of relative success, whereby someone might only lose 30-40% of the excess weight. To avoid this possibility, you should:

• Reduce the intake of high-calorie foods, such as ice-creams, cream, chocolate, sweets, alcohol, etc.
• Increase your daily physical activity (walking, jogging, swimming, cycling, sports, etc).

If, despite all this, you continue to find yourself dealing with relative success following the gastric banding procedure, you have to talk with your doctor and proceed, if this is deemed necessary, with some modified surgical procedure (sleeve gastrectomy) or laparoscopic biliopancreatic bypass (gastric bypass).