Firstly your general fitness for operation is assessed. Normally you are admitted to hospital on the day of your surgery. The operation is performed under a general anaesthetic and takes about one hour. It is performed laparoscopically, that is, a telescope is introduced into the abdominal cavity through a small puncture wound above the umbilicus. If the initial examination confirms that there are no problems, such as adhesions resulting from previous surgery that would make the laparoscopic procedure unsuitable, other small puncture wounds are made to pass instruments into the abdomen.
The band is placed around the top of the stomach, creating a small pouch above the band. The band is connected by a tube to a reservoir which is placed under the skin on the abdominal wall. This requires an incision approximately 4 cm. long in the centre of the upper abdomen. This reservoir is accessed by a needle passed through the skin to introduce or remove fluid from the balloon inside the band. This is the way the band is adjusted. The balloon is left empty at the time of operation and fluid is not introduced until 4 - 6 weeks after operation. After the operation an X-ray is performed to check the position of the band. Patients are normally discharged from hospital following this X-ray.
If the operation cannot be performed safely by laparoscopic means it is then necessary to proceed to an ordinary abdominal incision to place the band.
The band placement is identical; however, your hospital stay may be extended by a day or two. Following the laparoscopic procedure, although there is no major abdominal incision there is some discomfort and you will be given adequate analgesia to keep you comfortable. There can also be a period of post anaesthetic fatigue which may last for up to two weeks.
Immediately after the operation, it is very important to adhere to the postoperative eating and drinking instructions to allow your internal stitches to heal properly. It is also important in the early stages not to stretch your stomach pouch by eating too much. For this reason you will be advised to follow a liquid or pureed diet (the consistency of baby food or apple sauce) for the first four weeks, before progressing to mashed food, and then a solid diet. This ensures that healing is complete, the band is set firmly into place, and the pouch above your band does not become dilated. Comprehensive guidance and education on foods and meals choices will be given to you prior to your operation.
Approximately four to six weeks after surgery the first fill of the band is done. This is performed with a syringe and needle through the access port and is not a painful procedure. This is repeated at regular intervals until you reach your individual “sweet spot” where your band restriction is sufficient to still enable you to eat enough food so you are not hungry and adequately nourished, but reducing your calorie intake to ensure you are losing weight at a steady, gentle pace (½ - 1 kilogram per week is ideal).
It is anticipated that you will have a gradual reduction in weight over a period of twelve to eighteen months and in general, the aim is for you to lose two thirds of your excess weight over this period. Your excess body weight is the amount of weight you were carrying above what is regarded as a healthy normal weight for someone of your height. For example, if you weigh 120 kg. and your ideal body weight is 70 kg., your excess weight would be 50 kg., and two thirds of this would be 33 kg.