Gastric band, popularly known as gastric band, is one of the surgical methods used in the treatment of morbid obesity. This method, also known as gastric banding; It is the process of placing a band around the stomach, approximately 200 mm below the junction of the esophagus and stomach.

The band placed in the stomach is inflated step by step by injecting serum through a port under the skin, 1 month after the surgery. The biggest advantage of this application, as the name suggests, is that it can be adjusted after surgery. The band made of silicone divides the stomach into two compartments like an hourglass. Filling the upper small stomach pouch with food provides a feeling of early satiety. Thus, as a feeling of satiety occurs, food intake is directly reduced.

The basic principle of the gastric band method is to change the patient’s behavioral habits and eating style, as in other surgical methods.

What are the Types of Gastric Bands?

Nowadays, there are many gastric bands with FDA and CE approvals. The main differences between the bands in question are their filling amounts, some formal differences and port structures, especially their literature supports. While some bands have a maximum filling volume of 6 cc, some can reach 9 – 11 cc filling. The widths of the part of the band wrapped around the stomach vary. Some bands have a ‘shape memory’ feature that takes shape directly when passed behind the stomach.

Current gastric bands used in our country;

Lapband (Lap-Band/ Bioenterics Corp, USA),

Swedish Adjustable Band (Allergan – Obtech Medical AG of Switzerland),

Midband (Medical Innovation Development in Lyon, France)

A.M.I Soft Gastric Band Premium (A.M.I Agency of Medical Innovation, Austria) and

Heliogast Advanced (Helioscopie, Lyon, France).

How to Place a Gastric Band?

Gastric banding (clamp; adjustable gastric band; adjustable gastric band; laparoscopic adjustable gastric banding:LAGB) method is applied using laparoscopic interventions in many patients. Making very small incisions during the surgery allows the patient to return to daily life in a short time. The patient loses approximately 60 to 80 percent of his excess weight in the 12 to 24 months following the surgery. If there is no problem with the gastric band, these patients have no risk of gaining weight.

How is Gastric Clamp Surgery Performed?

Gastric band surgery is the method of attaching a silicone band 3 to 4 cm below the part where the esophagus and stomach meet. Since the upper part of the stomach will be smaller, the patient will feel full by consuming less food.
Patient Position: After the patient is placed supine on the operating table, his feet are bent 300° downwards. The operator works between the patient’s legs in the reverse Trendelenburg position.

Insufflation of the Abdomen with Gas: A special needle called Verres is entered through the incision above the navel. Or, if the surgeon has experience, a safer abdominal entry and insufflation is achieved by seeing the layers one by one with an optical trocar (visual trocar). First incision; It is performed approximately 6 fingers below and in the middle part of the breastbone. This incision, through which the optical camera will enter, is approximately 10 mm long. It is filled with carbon dioxide gas so that the intra-abdominal pressure is 15 mmHg. The purpose of this is to push the intestines and abdominal organs back and protect the organs from injuries.

Insertion of Trocars and Hand Instruments: A total of 5 trocars (cannulas through which the instruments will pass) are entered through the existing incisions.

Dissection: The anesthesiologist inserts a nasogastric tube with an inflatable balloon at the end into the stomach. The intragastric balloon is inflated with 2.5 cc of serum and withdrawn. In this way, the balloon is attached to the gastroesophageal junction. This bulge in the stomach also allows the surgeon to decide where to start dissection.

Dissection of the Lesser Curvature: This dissection should be performed as close to the stomach wall as possible, with utmost effort not to damage it, and the laterjet nerve should be protected.

Dissection of the Phrenogastric Ligament: The gastric fundus, that is, the upper part of the stomach, is grasped with a grasper by entering through the outermost trocar and pulled downwards. Thus, the connection between the stomach and the diaphragm, called the phrenogastric ligament, is stretched.

Retrogastric Tunnel: The Endograsp Roticulator or Articulating Dissector is entered through the trocar in the right upper quadrant and advanced through the retrogastric tunnel under direct vision. Then, the instrument is angled so that the phrenogastric ligament is visible in the dissection area, that is, on the opposite side.

Insertion and Placement of the Band: Generally, the tube part of the band is placed into the abdomen through the outermost 10 mm trocar. This end is attached with an endograsp roticulator and is passed behind the stomach at the level of the dissecting area. After the tube of the band is passed through the locking mechanism, the silicone band is placed around the stomach and tightened.

Adjusting the Band Position: The anesthesiologist performs oral g with 15 cc.

People’s daily protein intake should be monitored and blood levels should be measured regularly. Average energy intake should not exceed 1500 calories.

The best source of protein is meat. However, red meat can be difficult to chew and break down. Therefore, fish is easier to chew and many types of fish are much richer in protein. White meat is a food that is relatively easier to chew. Eggs, yogurt and cheese are excellent sources of protein. Apart from animal sources, protein can also be obtained from legumes. Half of the glass should be devoted to proteins, and the other half should consist of fruits or vegetables.

Natural foods that have undergone minimal processing should always be consumed. There is no harm in using spices to flavor foods.

When to Eat?

After stomach surgery, a patient should consume three or fewer meals a day. If the patient is in the green zone – which means his band is adjusted correctly – he will not feel the need to eat between meals. Therefore, patients should be warned not to snack between meals. If hunger is felt in the afternoon, they can have small amounts of high quality food. This could be a piece of vegetable or fruit. If the patient is not in the green zone, he should definitely visit his doctor.

How to Eat?

Food should be eaten in small bites and chewed well. Half a glass of food should be placed on a small plate. Small forks and spoons must be used. Each bite should be chewed for a minimum of 20 seconds. This will ensure that the food is adequately broken down. Patients should be motivated to enjoy eating. Foods should be swallowed only after chewing sufficiently.

Patients should wait until the first bite has completely passed through the band before taking another bite. Normally this requires two or six peristaltic contractions. This corresponds to approximately 1 minute. Therefore, the patient should be warned to chew well, swallow and wait at least 1 minute.

A meal should not take more than 20 minutes. This means 20 small bites, one minute at a time for each bite. The patient will probably not be able to finish half a glass of food during this time. In this case, the food left on the plate should be thrown away. Every patient who undergoes a gastric band should know that they can throw away the food left on their plate.

With optimal band filling and good eating habits, patients do not feel hungry after 20 or fewer bites. If hunger is not felt, eating should definitely be stopped. After having gastric band surgery, patients should not expect to feel bloated after eating. feeling bloated; It means that the food pauses on the belt and the most important part of the LECS is stretched. If this condition becomes chronic, it destroys the LECS mechanism.

If the patient still feels hungry after eating half a glass, this most likely means that he is not in the green zone and needs refilling.