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Surgical Solutions : Laparoscopic Gastric Band Surgery (Lap Band)
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Here are the short-term side effects of the operation:
Vomiting
Most patients will once or twice feel pain or vomit after intake of food. This is in most cases caused by eating too much and too quick. If eating is slow and calm, patients will learn to listen to the signals from the stomach. Eating should be abandoned if the patient feels nauseated, have pain or vomits. Regular vomiting is a sign of warning. This can either be caused by wrong eating behavior or be caused by the outflow of the gastric pouch becoming too narrow. This means that the band may need to be adjusted through a tinny needle stick introduced into the reservoir under the skin. Regular vomiting should be discussed with the physician in charge and corrected.
Constipation
Many patients feel constipated after surgery. This is mainly caused by the fact that the reduced food intake leads to less feces and it is thus normal with fewer bowel movements. If laxatives become necessary, it is advisable to abstain from so called bulking agents and instead use liquid laxatives, such as lactulose or
Magnesium pills (500-1000 mg. at bedtime) which is an essential
mineral that is involved in 300 functions in the body and was found to be deficient in 70% of Americans.
Hair loss
Many patients report increased hair loss during the first six months after surgery. This is also caused by the relative starvation. This however never leads to baldness and normal hair growth will eventually return.
Serious complications are not common especially when the surgeon is experienced with this kind of surgery. At the Emirates Hospital in Dubai where I work, our team is headed by Dr. Christian De Bruyenne. He is a leading advanced laparoscopic surgeon in Europe. This surgery was approved in the USA in late 2003 and thus American surgeons who are more experienced in gastric bypass are less experienced in this operation than the Europeans.
Over the last eight years, Dr. Christian has performed more than 2,500 successful operations without a single mortality. Complications such as perforation of the bowel or stomach are encountered every two hundred cases in the hand of an experienced surgeon but are much more likely in the learning curve of less experienced surgeons. Should that happen, re-operation is required with a 2-3 week hospital stay. The operation is done under general anesthesia and lasts for about one hour and the patient usually goes home in 24 hours. The patient must follow the strict instructions in the two months period after surgery to minimize vomiting and complications and must follow up with our dietician.
One in 100 cases requires blood transfusion due to a perforation of a small blood vessel. Leakage of the port or rubber tube connecting the water reservoir to the band is seen in one out of thirty patients and is easily fixed with a minor revision usually under local anesthesia. Other rare complications may arise including slippage of the band, erosion and infection which may require repeat surgery. Most of the repeat surgeries are done with simple keyhole surgery.
Infection
An infection would require a prolonged hospital stay and may require re-operation and even removal of the band usually through the same previous openings. Infections are five times less common in surgical hospitals such as the Emirates hospital which by definition does not accept patients with chronic diseases or chronic infections than in general hospitals.
Band Problems
Although we use the latest improved FDA approved bands it must be pointed out that a definite guarantee against manufacturing defects can never be given.
Band Migration
Migration occurs when the band and balloon migrates through the stomach wall into the stomach lumen. These cases are outright failures and these patients have quickly regained their preoperative weight. The French band we use (Cousin) has been associated with much lower migration because it is a low pressure system compared to the old bands. Migration usually does not occur until 18-24 months after surgery. Patients who have their bands filled quickly and with high total volumes have an increased risk of migration. Filling must be slow and gradual. We try hard not to fill the band to its full (10 ml) capacity. By keeping the volume refill under 8 ml and following the patient regularly we are able to minimize the risks of erosion and of
esophageal dilitation. If these guidelines are observed the frequency of this type of complication will decrease.
Port Problems
There have been port problems in about 4% of the cases. There are two types of problems. The first is dislocation of the port. It may move around, turn up-side-down and can in this position not be injected. It is thus necessary to adjust it. This is a simple operation in local anesthesia but nevertheless a nuisance to the patient. The second problem is perforation of the connecting tube close to the port. Some patients have extra fat over the chest and it is therefore sometimes difficult to hit the” bulls eye” with the needle and the tube may be accidentally perforated. This leads to loss of fluid, widening of the opening and subsequent weight gain. This is also corrected in local anesthesia. The port is brought to the surface, a bit of the tube including the hole is cut off, and the remaining tube is reattached to the port and finally the port returned into position. The design of the system has because of this problem been changed. The distal 2 cm of the tube is now covered with a protective sleeve in order to avoid this problem.
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