Treatment of obesity
Obesity is the most common metabolic disease which shortens the life and worsens its duality. The frequency of overweight and obesity has been growing and the long term results of the conservative therapy have not been sufficient. In grade III obesity according to WHO classification and in failure of conservative psychological, dietary, exercise treatment and pharmacotherapy, the weight reduction surgery, so called "bariatric surgery" has been employed more and more frequently. The aim of the bariatric surgery is the reduction of health risks due to morbid obesity, as diabetes, hypertension, metabolic syndrome, sleep apnea and joints and backbone overloading.
in various modifications has been used for nearly 30 years in Europe, USA and Australia. We have been using the Laparoscopic adjustable gastric banding, the less invasive, safe and very reliable bariatric method with long-lasting effect. Neither the stomach nor any other part of the gastrointestinal tract is cut, resected, shortened or open during the operation and the risk of complications is minimalised. It is a restrictive operation with no malabsorption. The postoperative recovery is short as the abdominal wall has no long incision. Instead an inflation of CO2 gas through a special needle enables the surgeon to reach intraabdominal organs. Special thin and long laparoscopic Instruments enables a miniinvasive performance of the whole operation. Extremely rarely when this is not possible a 20 cm long incision has to be done to do the procedure in an open, traditional way. We use products from famous producers (SAGB - Ethicon Endo-Surgery Johnson and Johnson or A.M.I.) which are determined for a long years lasting implantation, yet not granting the life long effect.
Effect of the gastric banding
The main principal of the operation is in a surrounding of the utmost part of the stomach by a silicon band which has an inflatable balloon. The balloon is connected by a tube to a port which is located in the subcutaneous tissue of the chest wall, near the rib margin. During the later postoperative course a special Huber needle enables a doctor to regulate the inner diameter of the band.
The resulting effect of the Gastric band on the patient is a soon feeling of satiety with no intractable hunger resulting in weight reduction. Patients after gastric banding surgery together with those interested in weight loss surgery have their voluntary patient organization "Banding Club" offering the opportunity to share their experience and information to each other (www.bandingklub.cz).
International Indication criteria for Gastric banding
- Consensual indication by the surgeon, obesitologist and psychologist
- BMI 40 or more
- or BMI 35 and more in patients with comorbidities
- Conservative treatment failure, insuficiency
- Patient capable to stand an operation in general anaesthesia (lasting about 2 hours)
- No systemic disease
- No bulima, serious psyachiatric disease and abuse of grugs or alcohol
- The age of 60 years or more, or a short life expectancy for any reason
- Presumption of good a smoth cooperation, compliance of the patient.
The night after the operation is spent at the ICU, further one to four days lasts the hospitalization. The stitches extraction (10th- to 20th day) could be done either by a family doctor, GP or at surgical outpatient department. Further check-ups with optional adjustments use to be in the first year at postoperative months 3, 6, 9 and 12 , then twice a year for the next year and once a year further for life long. Immediate check-up is necessary anytime in ca se of problems.
Usually there are no major problems. Vomiting, emesis or sickness
- may be cased by an ingestion of a larger bite or in case of overfilled band. Pain - my be cased by the same reasons. Obstipation
- may be caused by decreased volume of the food together with decrease in drinking. Peroral drug medication
- may cause problem when large pills should be broken to pieces. Gravidity
- after banding and weight reduction the fertility usually improves, yet the term of conceive is advised to be postponed to the phase of weight stabilization. Then in pregnant the band should be emptied (totally or partially).
The most common complication seems to be bacterial contamination and infection
of the foreign material in the subcutaneous tissue. It may occur in less then 5% and requires usually explantation. To minimize the risk a broad-spectrum prophylactic dose of antibiotics is given preoperatively.
The most serious life threatening complication is a gastric perforation
, which requires an open operation and prolonged hospitalization. This occurs in less than 0.5% operations.
Late, rare yet serious complications are slippage, dilatation and erosion
. All of them need a band deflation. Reoperations are
required either for complications, or varios problems, yet the band is supposed to be left on stomac forever.
Instructions for international patients
For further information how to undergo this surgery in Czech republic, feel free to contact us. If you wish to receive a personalized opinion of a bariatric surgeon, please fill the following questionnaire.