Gastric Band and Beyond

Congratulations! You’ve made it through to the day of surgery. All those months of deliberating, appraising and accepting are over. You are probably feeling excited, stressed, nervous, hungry – all of these thoughts and feelings are to be expected and most importantly, are normal. I will explain in this chapter the course of events that will occur over the next 48hrs in order to allay your fears and reassure you that you are in very safe hands.

On the morning of surgery, you will be on a ward. You will be greeted by the team of doctors and nurses who will be looking after you and the first thing to realise is that they are experienced. You are not the first gastric band patient they have looked after and you won’t be the last so trust in them and let them do the worrying for you. After all the routine checks (blood pressure, pulse, temperature etc.) have been completed, you will be asked to sign a consent form. This is a very important legal document which highlights the risks and benefits of the surgery. It tells you what complications are possible, although unlikely. This information should not be new to you if the system has worked well as you should have been fully counselled on your journey up to this point. Don’t feel under pressure to sign this immediately as it is important that you have digested all the information and are ready to commit to the next phase of your journey. The likelihood though, is that you will be champing at the bit to get it signed.

Next comes the dress code – hospital gowns, net knickers and tight stockings – agreed not the most attractive of outfits but trust me, the stockings can be a life-saver. They encourage blood flow in the legs and help prevent deep vein thrombosis (DVT) – so don’t put up resistance when the sister insists you wear them. Do what you are told – remember they are looking after you now.

When it comes to the time for surgery, most places encourage you to walk to theatre. This is to empower you and make you feel less like a “patient” being wheeled on a trolley down long corridors. Its amazing the difference it makes and you should embrace this exercise as over the next few days you will most probably not feel like doing a great deal.

When you come through into the theatre complex you will arrive in the holding bay where you will be registered. Shortly you will go to the anaesthetic room where you will be re-united with the anaesthetic team (lovingly referred to as the “gas-board”). They will explain to you, again, what will happen as you drift off to sleep. Again, to empower you, you will be asked to walk into theatre and position yourself on the operating table. Now, the theatre can be a daunting place but actually most of the time, I find it a really special place to be. There are lots of people all with differing roles but more often than not these people are smiling , chatty and always ready to crack a joke. Theatres run like clockwork, everyone knows what they are doing so don’t be scared – feel privileged to be part of this team.

Next you will receive some drugs through the drip in your arm and you will calmly drift off to sleep. Almost certainly the anaesthetist will support your chin and hold an oxygen mask over your face as this is happening to ensure that your breathing is optimum. When you are asleep, they will then place a tube in your throat to help take over your breathing when you are asleep. Don’t worry, you will not be aware of this happening.

Next the surgeons take over. There will be a lead surgeon (usually the consultant) and several experienced assistants, all of whom are highly trained. They will take responsibility for your positioning on the table. You will be tilted to an angle of forty five degrees so that access to your stomach is made easier – gravity is the surgeon’s friend here. At all times, your dignity will be preserved. You will have discreetly placed towels over your bits and every effort will be made to ensure that you are treated with respect and humanity, as if you were awake.

Your tummy will then be “prepped” – painted with a golden brown antiseptic iodine based solution. Once this has been thoroughly done and rigorously checked, you will then be “draped” – putting sterile towels around the edges of the field of operating. Once this has been done, it’s lights, camera, action!

All equipment will have been checked and tested. The surgeon will then inflate your tummy with gas (carbon dioxide) to allow space for the key-hole instruments - the idea being that the abdominal muscle wall is lifted away from the organs by a cushion of gas. This is achieved using a long blunt needle (Verres needle) which is inserted just under the ribs on your left hand side. Once the tummy is inflated to the right pressure, the operating can start. Several “ports” are then inserted into abdominal muscle wall and these will allow various instruments, a camera and the gastric band to be passed in and out multiple times.

Once the ports are in place the operation can proceed. The liver is held out of the way to improve access to the stomach. This is where the yoghurt diet comes in and is so vital. This diet shrinks the size of the liver considerably to make surgery easier. In fact sometimes, surgery can’t proceed if the liver is too big. Remember, big on the outside, means big on the inside too. The liver accumulates and stores fat and will get bigger as weight increases so any pre-operative attempt to lose weight will be appreciated by your surgeon, trust me!

Next, once the liver is safely out of the way, a space is created around the top of the stomach just below where the food pipe joins the stomach. This is where the band will sit. Once this space has been created, it’s time to put in the band. This is a highly engineered, sophisticated bit of kit and the surgeon will take very good care of it during the procedure. Sterility will be of the utmost importance to keep germs out. The following picture shows a gastric band. The tube attached and the metal port are to allow inflation and deflation of the internal reservoir of the band to tighten or loosen it. This will become a very familiar process to you over the next few weeks, to months.

The band will be placed around the upper stomach and fastened in position. The band is often stitched in position by the surgeon but this is certainly not necessary and will be down to individual surgeon choice.

The tubing is brought out onto the surface of your abdominal wall and the metal port is attached. This is then buried in the fat of your abdominal wall or stitched to your muscle wall; again different techniques are practiced in different places but excellent results can be expected either way. This port needs to be accessible to your team, long into the future so that the band can be adjusted without further surgery.

The operation then finishes with a quick re-check inside to make sure that all is well and then the wounds from the ports are closed with dissolvable stitches. You will have up to six small key holes wounds in your upper abdomen which will fade quickly over the coming months.

After the operation, you will be tidied up and then taken to recovery, where you will be gently and calmly woken up from your deep sleep. You will feel drowsy and maybe a little disorientated but the nurses here, will constantly reassure you until you are “back in the room”.