Gastric band surgery is a type of weight
loss, or bariatric, surgery.
Gastric banding surgery is an operation
that takes about 1 to 2 hours to perform under full general anesthesia.
It is done using a technique of
laparoscopy.
The patient is placed on the operating the table in a supine position and the surgeon team will stand on the right side of
the patient with monitors arranged at the head on both sides.
An optic view trocar which is like a
channel for passing instruments is placed. Four numbers of ports are made to
access the stomach varying from 5 mm to 18 mm in length. Through a 5 mm long
skin incision, a Nathanson liver retractor is inserted to move away from the
liver from the vision of the surgeon. The left hepatic lobe is retracted and
curved up.
Between the greater curvature of the
stomach and the spleen, an atraumatic grasper is placed in the groove which is
as long as
45
cm. with the help of this instrument the tissues covering the region called the angle of His (the angle formed
Between stomach and esophagus,) is swept
inferiorly. Another long atraumatic
grasper is positioned by the surgeon via the right lateral port and a diathermy
hook is placed through the port that measures 15 mm.
The angle of His is exposed further by the
grasper as it pulls the fundus region inferiorly. Lateral to the
gastroesophageal angle the peritoneum is existent laterally, this gets incised
and swept posteriorly. The above step allows the fundus part of the stomach to get
freed from the diaphragm sheet.
The almost transparent pars flaccida is
incised by retracting the stomach to the left. The right crus which can be
visualized in the inferomedial position to the caudate lobe of the liver is now
visible after the incision of the right crus. It curves to the right and
disappears in the retroperitoneal fat. Now with the right crus identified the
next incision is made on the peritoneum just medial to the crus.
The grasper is next cautiously inserted
into the space medial to crus and behind the esophagus, the food pipe via the
scored peritoneum. Without exerting any force, the grasper is made to pass to
the left and then allowed to emerge through the angle of His that was kept
dissected earlier. The length of the
path traversed by the grasper is as short as 3-4 cm only.
Now the end tag of the gastric band is made
to progress up and meet the now retro gastric grasper and is pulled slowly
allowing the stomach to get encircled.
Gastric to gastric sutures are employed to
close the ends of the stomach and the stomach is approximated on either side of
the band without experiencing any undue tension.
Gastric banding side effects and
complications are rare, but one must be aware so that before things get worse,
they are taken care of by gastric banding surgeons.
- Blood clots
- Problems in a band like erosion, in such case it must be removed
- The stomach may slip up through the band
- Change in bowel functions and perforations
- Gallstones
- Food getting trapped
- Dilation in the esophagus
- GERD or Gastroesophageal reflux disease