Gastric Bypass (Malabsorptive) Surgery

(Malabsorptive Procedure, Roux-en-Y Gastric Bypass, Biliopancreatic Diversion)

What is gastric bypass surgery?

Gastric bypass surgery, a type of bariatric surgery (weight loss surgery), is a surgical procedure that alters the process of digestion. Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.

There are several types of gastric bypass procedures, but all of them involve bypassing part of the small bowel by greater or lesser degrees. For this reason, procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small intestine that absorbs nutrients.

Some of these procedures also involve stapling the stomach to create a small pouch that serves as the “new” stomach or surgically removing part of the stomach.

Although a gastric bypass procedure is malabsorptive, it may also be restrictive because the size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach. While malabsorptive procedures are more effective in causing excess weight to be lost than procedures that are solely restrictive, they also carry more risk for nutritional deficiencies.

Types of gastric bypass, or malabsorptive, surgical procedures include:

• Roux-en-Y gastric bypass (RGB). Roux-en-Y gastric bypass, the most commonly performed bariatric procedure, is both malabsorptive and restrictive. This surgery can result in two-thirds of extra weight loss within two years. The procedure involves stapling the stomach to create a small pouch that holds less food and then shaping a portion of the small intestine into a “Y”. The “Y” portion of intestine is then connected to the stomach pouch so that when food is being digested it travels directly into the lower part of the small intestine, bypassing the first part of the small intestine (called the duodenum) and the first part of the second section of the small intestine (called the jejunum). The effect of bypassing these sections of the intestine is to restrict the amount of calories and nutrients that are absorbed into the body.
  
  The Roux-en-Y gastric bypass may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes--small thin tubes with video cameras attached--to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. Persons with a Body Mass Index (BMI) of 60 or more or those who have already had some type of abdominal surgery are usually not considered for this technique. A laparoscopic method allows the doctor to make a series of much smaller incisions. Laparoscopic gastric bypass usually reduces the length of hospital stay, the amount of scarring, and results in quicker recovery than an open procedure.

• Biliopancreatic diversion (BPD). A biliopancreatic diversion is both restrictive and malabsorptive, and is a more complicated procedure than the Roux-en-Y procedure. In this procedure a large part of the lower stomach is removed. The small part of stomach that is left is connected directly to the last part of the small intestine. As food is digested, it completely bypasses the duodenum and the jejunum. Because this procedure may result in nutritional deficiencies, it is not as commonly performed.
  
  A variation of the biliopancreatic diversion is a procedure called the duodenal switch (BPD-DS). More of the stomach is retained, including the valve that controls the release of food into the small intestine. A small part of the duodenum is also retained.

The digestive system

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine. The digestive tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

The stomach is where the three mechanical tasks of storing, mixing, and emptying occur.

Normally, this is what happens:

• First, the stomach stores the swallowed food and liquid, which requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material.

• Second, the lower part of the stomach mixes up the food, liquid, and digestive juices produced by the stomach by muscle action.

• Third, the stomach empties the contents into the small intestine.

The food is then digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine, and the contents of the intestine are mixed and pushed forward to allow further digestion.

Malabsorptive procedures alter this process in different ways depending on the type of procedure.

Reasons for the procedure

Bariatric surgery is performed because it is currently the best treatment option for producing lasting weight loss in obese patients for whom nonsurgical methods of weight loss have failed.

Potential candidates for bariatric surgery include:

• Persons with a Body Mass Index (BMI) greater than 40

• Men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight

• Persons with a BMI between 35 and 40 who have another condition such as obesity-related type 2 diabetes, sleep apnea, or heart disease

Because the surgery can have serious side effects, the long-term health benefits must be considered and found greater than the risk. Despite the fact that some surgical techniques can be done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.

Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems. It may help to:

• Lower blood sugar

• Lower blood pressure

• Reduce or eliminate sleep apnea

• Decrease the workload of the heart

• Lower cholesterol levels

Surgery for weight loss is not a universal remedy, but these procedures can be highly effective in people who are motivated after surgery to follow their doctor’s guidelines for nutrition and exercise and to take nutritional supplements.

There may be other reasons for your doctor to recommend a gastric bypass procedure.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

• Infection

• Blood clots

• Pneumonia

• Bleeding ulcer

• Development of gallstones

With Roux-en-Y gastric bypass procedures, malabsorptive symptoms may be more serious with an increased risk of anemia and loss of fat-soluble vitamins (vitamins A, D, E, and K). Adequate amounts of iron, calcium, and vitamin B12 may not be absorbed. This can cause metabolic bone disease and osteoporosis.

Stomal stenosis occurs when there is a stricture (tightening) of the opening between the stomach and intestine after a Roux-en-Y procedure. When this occurs, vomiting after eating and sometimes after drinking may occur. Stomal stenosis can be treated easily, but should be treated immediately.

“Dumping syndrome” is also more likely to occur with these procedures because the food in the stomach moves to the intestines quickly. Symptoms include nausea, sweating, fainting, weakness, and diarrhea.

There is a risk that additional surgery may be necessary because of complications, including gallstones.

One of the most serious complications of gastric bypass is a stomach leak that can cause peritonitis to develop. Peritonitis is an inflammation of the peritoneum, the smooth membrane that lines the cavity of the abdomen.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your doctor permission to perform the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

• You will be asked to fast for eight hours before the procedure, generally after midnight.

• If you are pregnant or suspect that you are pregnant, you should notify your doctor.

• Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, or anesthetic agents (local and general).

• Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• You may be asked to begin exercising and alter your diet several weeks before surgery.

• If you are a woman of child-bearing age, you may receive birth control counseling so that you do not become pregnant in your first year after surgery due to the risk to the fetus from rapid weight loss.

• You may receive a sedative prior to the procedure to help you relax.

• The area around the surgical site may be shaved.

• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Gastric bypass surgery requires a stay in the hospital. Procedures may vary depending on which type of procedure is performed and your doctor’s practices.

Gastric bypass surgery will be performed while you are asleep under general anesthesia. Your doctor will discuss this with you in advance.

Generally, gastric bypass surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.

2. An intravenous (IV) line will be started in your arm or hand.

3. You will be positioned lying on your back on the operating table.

4. A urinary catheter may be inserted into your bladder.

5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

6. The skin over the surgical site will be cleansed with an antiseptic solution.

7. For an open procedure, the doctor will make a single large incision in the abdominal area. For a laparoscopic procedure, a series of small incisions in the abdomen will be made. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the appendix and other structures can easily be visualized with the laparoscope.

8. For an open procedure, the abdominal muscles will be separated and the abdominal cavity will be opened. For a laparoscopic procedure, the doctor will insert the laparoscope and other small instruments.

9. For a Roux-en-Y gastric bypass, the doctor will staple the stomach across the top to create a new small pouch for a stomach. The rest of the stomach will be separated from the new pouch and closed off by the staples; however, the remaining stomach will continue to produce digestive juices that will be used in digestion. A portion of the small intestine will be shaped like a “Y” and connected to the pouch.

10. For a biliopancreatic diversion, a large part of the lower stomach will be removed. The small part of stomach that is left is then connected directly to the last part of the small intestine. For a duodenal switch procedure, the doctor will retain more of the stomach, including the valve that controls the release of food into the small intestine. A small part of the duodenum will also be kept.

11. A drain may be placed in the incision site to remove fluid.

12. The incision will be closed with stitches or surgical staples.

13. A sterile bandage or dressing will be applied.

After the procedure

After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Malabsorptive stomach surgery usually requires an in-hospital stay of several days.

You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.

You will be encouraged to move around as tolerated while you are in bed, and then to get out of bed and walk around as your strength improves.

At first you will receive fluids through an IV. After a day or two you will be given liquids, such as broth or clear juice, to drink. As you are able to tolerate liquids, you will be given thicker liquids, such as pudding, milk, or cream soup, followed by foods that you do not have to chew, such as hot cereal or pureed foods. Your doctor will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods.

You will be instructed about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.

Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your doctor.

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up visit.

The incision and abdominal muscles may ache, especially with deep breathing, coughing, and exertion. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You should continue the breathing exercises used in the hospital.

You should gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina.

You may be instructed to avoid lifting heavy items for several months in order to prevent strain on your abdominal muscles and surgical incision.

Weight loss surgery can be emotionally difficult because you will be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. Exercise and attending a support group may be helpful at this time.

Notify your doctor to report any of the following:

• Fever and/or chills

• Redness, swelling, or bleeding or other drainage from the incision site

• Increased pain around the incision site

Following gastric bypass surgery, your doctor may give you additional or alternate instructions, depending on your particular situation.

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Last Modified Date: 2012-03-12T00:00:00-06:00
Created Date: 2007-03-30T00:00:00-06:00
Published Date: 2012-03-12T16:34:42.213-06:00
Copyright Date: 2012
Copyright Statement: © 2000-2012 Krames StayWell, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Gastric Stapling (Restrictive) Surgery Procedure

(Other terms that may be used include: Gastric Banding Surgery, Adjustable Gastric Banding, Vertical Banded Gastroplasty)

Procedure overview

What is gastric stapling (restrictive) surgery?

Gastric stapling surgery, also called gastric banding surgery, is a type of bariatric surgery (weight loss surgery) procedure performed to limit the amount of food a person can eat.  Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have not been effective.

In gastric banding surgery, no part of the stomach is removed and the digestive process remains intact. Either staples or a band are used to separate the stomach into two parts, one of which is a very small pouch that can hold about one ounce of food. The food from this "new" stomach empties into the closed-off portion of the stomach and then resumes the normal digestive process. Over time, the pouch can expand to hold two to three ounces of food. Because the size of the stomach is reduced so dramatically, this type of procedure is referred to as a restrictive procedure.

After gastric stapling or banding, a person can eat only about three-quarters to one cup of food. The food must be well-chewed. Eating more than the stomach pouch can hold may result in nausea and vomiting. Restrictive procedures pose fewer risks than gastric bypass procedures, but they are also less successful because continuous overeating can stretch the pouch so that it accommodates more food.

The types of gastric banding procedures include:

• Adjustable gastric banding (AGB). This procedure involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt to form a small pouch that serves as a new, much smaller stomach. After the procedure, the diameter of the band around the stomach can be adjusted by a doctor by adding or removing saline (salt water). No staples are used in this procedure, which is relatively new in the U.S.
  Like other restrictive procedures, AGB may not achieve significant weight loss. The U.S. Food and Drug Administration approved an AGB system in 2001 that can be put in place with a laparoscope (a small, thin tube with a video camera attached) rather than with an open incision for patients who are morbidly obese, as indicated by a Body Mass index (BMI) of 40 or more.

• Vertical banded gastroplasty (VBG). This procedure uses a combination of staples and a band to create the pouch. There is a dime-sized opening at the bottom of the "new" stomach that opens into the rest of the larger stomach. Plastic tissue or mesh is wrapped around the opening to help prevent the opening from stretching. Weight loss is about 50 to 60 percent of excess body weight at one year after the surgery.

• Vertical sleeve gastrectomy (VSG). This procedure uses staples to remove a large portion of the stomach; the remaining stomach "sleeve" will hold approximately one-quarter cup of liquid. Over time, the stomach can expand to hold one cup of food.
  This procedure was created as a first step of a two-step surgery (second step surgery involves changing the direction of food in the small intestine for a malabsorption). Many patients lose the desired amount of weight and do not have the second surgery. Weight loss can be 33 to 80 percent of excess body weight at one year after surgery. Since the rest of the stomach has been removed, this procedure is not reversible.

VBG and AGB may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes to visualize the inside of the abdomen during the operation. The doctor performs the surgery while looking at a TV monitor. Laparoscopic gastric surgery usually reduces the length of hospital stay and the amount of scarring, and often results in quicker recovery than an "open" or standard procedure.

Persons with a BMI of 60 or more or persons who have already had some type of abdominal surgery are usually not considered as a candidate for the laparoscopic technique.

The digestive system

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine. The digestive tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

The stomach is where the three mechanical tasks of storing, mixing, and emptying occur. Normally, this is what happens:

• First, the stomach stores the swallowed food and liquid, which requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material.

• Second, the lower part of the stomach mixes up the food, liquid, and digestive juices produced by the stomach by muscle action.

• Third, the stomach empties the contents into the small intestine.

The food is then digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine, and the contents of the intestine are mixed and pushed forward to allow further digestion.

Reasons for the procedure

Bariatric surgery is performed because it is currently the best treatment option for producing lasting weight loss in obese patients for whom nonsurgical methods of weight loss have not been effective.

Potential candidates for bariatric surgery include:

• Persons with a BMI greater than 40

• Men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight

• Persons with a BMI of 35 or more who have another condition such as obesity-related type 2 diabetes, sleep apnea, or heart disease

Because the surgery can have serious side effects, the long-term health benefits must be considered and found to be greater than the risk. Despite the fact that some surgical techniques can be done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.

Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems. It may help to:

• Lower blood sugar

• Lower blood pressure

• Reduce or eliminate sleep apnea

• Decrease the workload of the heart

• Lower cholesterol levels

Surgery for weight loss is not a universal remedy, but these procedures can be highly effective in people who are motivated after surgery to follow their doctor's guidelines for nutrition and exercise and to take nutritional supplements.

There may be other reasons for your doctor to recommend a gastric banding procedure.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

• Infection

• Blood clots

• Pneumonia

• Bleeding ulcer

• Development of gallstones

• Obstruction or nausea can occur when food is not well-chewed

• Poor nutrition

• Scarring inside the abdomen

• Vomiting due to eating more than the stomach pouch can hold

Risks specific to vertical gastric banding include breakdown of the line of staples and erosion of the band. Rarely, stomach juices may leak into the abdomen and emergency surgery may be needed. The most common complication that may develop with adjustable gastric band surgery is that the stomach pouch enlarges. Band slippage and saline leaks are also risks specific to adjustable gastric band surgery.

Risk is reduced with a laparoscopic banding procedure because there is no incision in the stomach wall.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your doctor permission to perform the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your health care provider may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

• You will be asked to fast for eight hours before the procedure, generally after midnight.

• If you are pregnant or suspect that you are pregnant, you should notify your doctor.

• Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, or anesthetic agents (local and general).

• Notify your health care provider of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen, naprosyn, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.

• You may be asked to begin exercising and alter your diet several weeks before surgery.

• If you are a woman of childbearing age, you may receive birth control counseling so that you do not become pregnant in your first year after surgery due to the risk to the fetus from rapid weight loss.

• You may receive a sedative prior to the procedure to help you relax.

• The area around the surgical site may be shaved.

• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Restrictive gastric banding surgery requires a stay in the hospital. Procedures may vary depending on the type of procedure performed and your doctor's practices.

Gastric banding surgery is generally performed while you are asleep under general anesthesia.

Generally, gastric banding surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.

2. An intravenous (IV) line may be started in your arm or hand.

3. You will be positioned lying on your back on the operating table.

4. A urinary catheter may be inserted.

5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

6. The skin over the surgical site will be cleansed with an antiseptic solution.

7. For an open procedure, the doctor will make a single large incision in the abdominal area. For a laparoscopic procedure, a series of small incisions will be made. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the stomach and other structures can easily be visualized.

8. For an adjustable gastric band procedure, a band with small reservoirs or balloons on the inside will be placed around the top end of the stomach to create the small pouch that will serve as the new stomach. A narrow passage will connect to the rest of the stomach. The band will be inflated with a salt solution.

9. For a vertical banded gastroplasty procedure, the pouch will be created with a line of staples.

10. A drain may be placed in the incision site to remove fluid.

11. The incision(s) will be closed with sutures or surgical staples.

12. A sterile bandage/dressing will be applied.

After the procedure

After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Weight loss surgery usually requires an in-hospital stay of several days.

You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.

You will be encouraged to move around as tolerated while you are in bed, and then to get out of bed and walk around as your strength improves. It is important for you to move around soon after y our surgery to prevent the formation of blood clots.

At first you will receive fluids through an IV. After a day or two you will be given liquids, such as broth or clear juice, to drink. As you are able to tolerate liquids, you will be given thicker liquids, such as pudding, milk, or cream soup, followed by foods that you do not have to chew, such as hot cereal or pureed foods. Your doctor will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods.

You will be instructed about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.

Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your doctor.

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up visit.

The incision and abdominal muscles may ache, especially with deep breathing, coughing, and exertion. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You should continue the breathing exercises used in the hospital.

You should gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina.

You may be instructed to avoid lifting heavy items for several months in order to prevent strain on your abdominal muscles and surgical incision.

Weight loss surgery can be emotionally difficult because you will be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. Exercise and attending a support group may be helpful at this time.

Notify your doctor to report any of the following:

• Fever and/or chills

• Redness, swelling, or bleeding or other drainage from the incision site

• Increased pain around the incision site

Following gastric banding surgery, your doctor may give you additional or alternate instructions, depending on your particular situation.

Last Modified Date: 2011-11-21T00:00:00-07:00
Created Date: 2007-03-30T00:00:00-06:00
Published Date: 2011-11-21T20:21:49.367-07:00
Copyright Date: 2012
Copyright Statement: © 2000-2012 Krames StayWell, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Gastric Banding Surgery for Teens

(Lap band surgery)

Gastric banding is a form of bariatric surgery. It is used to treat people with severe obesity who have trouble losing weight through diet or exercise alone.

Procedure overview

Gastric banding involves putting a small, braceletlike band around the area near the top of the stomach, near to where the esophagus leads into it. The band reduces that part of the stomach to roughly the size of a golf ball. This, in turn, decreases the amount that the person can eat. A doctor can control the size of the opening by inflating or deflating a balloon that is present inside the band.

Weight-loss surgery and teens

Some studies suggest that bariatric or weight-loss surgery for extremely obese teens may improve both their weight and their health. By losing a significant amount of weight, your teen may avoid obesity-linked complications such as type 2 diabetes, sleep apnea, high blood pressure, and heart disease. After the operation, your teen may also escape the bullying, teasing, and social isolation that some overweight adolescents experience.

Experts are unsure, however, about the long-term consequences for a teen's developing body. Weight-loss surgery may weaken teens' bones, for example. A recent study found that teens who underwent weight-loss surgery experienced an average loss of 7.4 percent of their bone mass. Because the teen years mark the peak of bone development, the researchers urge that teens be carefully monitored after the surgery.

Like all operations, weight-loss surgery also involves some risk, including hernia, infection, internal bleeding, blood clots, and death. Your teen may also have to make permanent changes in his or her lifestyle, including eating only small portions of food and taking daily vitamin and mineral supplements—steps that impulsive teenagers may not be inclined to do.

When eating, the small pouch at the top of the stomach will fill up quickly. As a result, your teen will feel full after eating a small amount of food. The pouch then empties slowly into the bottom part of the stomach. Once the gastric band is in place, eating more than the pouch can handle can lead to vomiting and other problems. Your teenager may also experience problems if the gastric band erodes or slips out of place.

For these reasons, doctors will generally advise the surgery only if a teen has tried to lose weight for at least six months without success and has other health problems linked to obesity, such as type 2 diabetes. Because data on long-term studies are not yet in, the New England Journal of Medicine recommends that such surgeries for teens be approached with caution and used only for those who are "morbidly obese"—those who have a body mass index (BMI) of at least 40 with co-existing medical conditions, or a BMI of 50 or more. 

Other criteria your child should meet:

• Your teen should have reached physical maturity.

• Your teen should show evidence of mental and emotional maturity.

• Your teen should have a supportive family and not have an untreated eating disorder or psychiatric illness.

• The weight-loss procedure should be performed only in a bariatric center with adequate staffing.

Before the procedure:

• A gastric banding procedure is a major life change that patients need to take seriously. Your teen will likely be asked to take classes that explain what is involved with the procedure and what life will be like after the procedure, particularly as it pertains to diet.

• Your child will also need to have ultrasounds, blood tests, and other tests to ensure that he or she is healthy enough for surgery.

• Your teen may need to see a mental health counselor to make sure he or she is mentally ready for the surgery.

• Teens will also have to have a complete physical exam.

• The doctor may ask the teen to stop taking certain medications during the week leading up to the surgery.

• Be sure your teen does not eat or drink anything starting at midnight the night before the surgery.

Based upon your teen's medical condition, the doctor may request other specific preparations.

During the procedure

A gastric banding surgery usually requires a hospital stay of about 24 hours. Your teen may be asked to check in the day before or the morning of the procedure. Procedures may vary, depending on your teen's specific condition and the doctor's practices. Generally, a gastric banding surgery follows this process:

• Your teen will receive general anesthesia before the surgery, and he or she will be completely asleep during the procedure.

• The surgeon will make one to five small cuts in the abdomen.

• Through these small cuts, the surgeon will place instruments needed to perform the surgery, including small camera that allows the surgeon to see what he or she is doing during the surgery.

• Using these tools and camera, the surgeon will place a small, flexible band around the top portion of the stomach. This divides the stomach into a small pouch at the top and a larger lower portion.

• The procedure may take 30 to 60 minutes, depending on its complexity.

After the procedure

After gastric banding surgery, it's normal for your teen to feel some pain and discomfort. This is usually treated with general pain relievers. Your teen's health care team may also try to get him or her up and walking to assist in the recovery process.

On the day after surgery, your teen will probably have an X-ray to ensure that the gastric band is working properly. He or she may be asked to swallow a liquid that can be seen on the X-ray.

Eating will be much different after the surgery, and the counseling done before the surgery is meant to help prepare your teen for this. 

Last Modified Date:
Created Date: 2011-12-28T13:10:14.987-07:00
Published Date: 2012-05-10T15:23:32.923-06:00
Copyright Date: 2012
Copyright Statement: © 2000-2012 Krames StayWell, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.