Consent: Gastric Band

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

A gastric band procedure primarily works via a restrictive mechanism.  The pars lucida and greater omentum are dissected and a restrictive band is placed around the stomach.

It is usually performed as day-case procedure. It is a lesser physiological insult than the other bariatric operations, and so its initial complications are less.

However, the degree of weight loss generated is believed to be less and a substantial proportion of patients develop band slippage or erosion, and may require further surgery (either band removal or conversion to sleeve / bypass).

Fig 1 – Gastric band works primarily via a restrictive mechanism.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage to any of the surrounding structures can cause significant haemorrhage.
Injury to surrounding structures including bowel, liver and spleen Damage can occur to any surrounding organ during the surgery.
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Infection Superficial wound infection or intra-abdominal collections are both possible as is chest infection due to the body habitus and reduced mobility of these patients. Early mobilisation, breathing exercise, or incentive spirometry can help
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer, and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery; the mortality risk is around 1 in 200

Late

Complication Description of Complication Potential Ways to Reduce Risk
Metabolic and endocrine disturbances This is potentially life-threatening. Changes to absorption and gastric secretions of the alimentary canal can affect nutrition considerable post-operatively The involvement of a specialist bariatric dietician in the management of bariatric patients is essential
Failure to lose weight or weight regain Sleeve gastrectomy is highly effective, but inevitably a minority of patients ultimately fail to lose or regain weight.
Band slippage (1 in 20) If the band position slips, this can become a surgical emergency as this can lead to ischaemia of the stomach; this often requires urgent surgical removal of the band.
Band erosion (up to 1 in 100) The band can erode into the stomach; treatment can involve simple laparoscopic excision of the band to laparotomy or even (rarely) partial gastrectomy.
Oesophageal dilatation (1 in 20) This occurs due to over-eating and occurs where the oesophagus dilates above the restriction. It can lead to oesophageal dysmotility and dysphagia. Initial treatment is by band deflation or removal
Injection port and tubing related problems (1 in 20) As with any foreign body, the tube and port can become infected.

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