Having a Gastric Band

Transcription

1 Having a Gastric Band Nutrition and Dietetic Department Information for Patients Small stomach pouch Larger stomach portion i Gastric band Port University Hospitals of Leicester NHS Trust

2 Introduction This information booklet is for people who are having, or thinking about having, an operation to fit a gastric band. This is usually done by Keyhole or Laparoscopic Surgery. This booklet is designed to give you and your family information and advice about your operation. You are advised to read this information before you come into hospital and to make a note of any questions you would like to ask. There is some space provided at the end of this booklet for you to write your questions. What is Gastric Banding? Gastric Banding is a type of weight loss surgery. The size of your stomach is reduced using a band so only small meals can be eaten and you feel fuller sooner. Most patients will go home the day after their operation. Your surgeon will explain the benefits and risks of having a gastric band fitted and will also discuss alternative options to the operation. It is important to remember your care may be different from how it is described here because it is adapted to meet your individual needs. We have learned that many potential problems after the surgery are related to the diet and most can be avoided by following some simple rules. Information is provided in a separate booklet to help you get the maximum benefit from the surgery. What is Severe Obesity? Severe Obesity is the medical term for unhealthy excess weight. It means you may be at risk of developing other diseases or conditions which may be life threatening such as sleep apnoea, type 2 diabetes, high blood pressure, heart disease, arthritis and cancer. 2

3 What are the benefits of losing weight? For people who are obese, losing weight can significantly improve health problems which are directly linked to being overweight. For instance, approximately one in three people who are obese have problems controlling their blood sugar (including type 2 diabetes). Having a lower weight in the longer term also reduces the risk of a range of future health problems. As a result, the risk of a premature death due to obesity is greatly reduced. There are benefits of being able to get about more easily and enjoying physical activity. Losing weight can also improve your self confidence and can generally make you feel happier about your appearance. People considering weight loss surgery need to be committed to making permanent changes to their eating habits and lifestyle. The operation is very much the start of the treatment. Who is suitable for an operation? Whether or not you are suitable for an operation can only be decided after a careful discussion with a surgeon who specialises in treating obesity. At University Hospitals of Leicester NHS Trust, surgery may be an option for a person who: has a BMI of 40 kg/m 2 or more has a BMI of kg/m 2, and a medical condition that would be improved by losing weight has made serious prolonged attempts to lose weight by other means which have not been successful is aged 18 or older does not have medical or psychological factors that make them unsuitable for an operation is fit enough for an operation and a general anaesthetic is committed to long term follow up (you will be asked to sign a contract to demonstrate this) does not smoke (we do not offer weight loss surgery to people who smoke) 3

4 The Digestive System The digestive system is the group of organs that breaks down food into chemical components so the body can absorb and use these for energy for building and repairing cells and tissues. Right is a simplified picture of the digestive system. Oesophagus Stomach Liver Gallbladder Duodenum Small intestine Large intestine Navel What does the operation involve? This is a keyhole operation to insert a band around the top of your stomach. It is performed under a general anaesthetic and usually takes between minutes depending on your individual circumstances. Gastric Banding involves placing an adjustable band around the upper part of your stomach to create a pouch. As the pouch is small, it fills up very quickly and the food passes slowly through the band into the rest of your stomach. The food then passes normally through the rest of your digestive system. Your digestion is not affected by this operation. The operation is performed through small cuts made in your abdomen (tummy). One of these will be in the region of your tummy button. Four other cuts are made on your abdomen. These cuts are called portsites. Carbon dioxide gas is used to inflate your abdomen to allow the surgeon to see whilst they are operating. Hollow tubes are placed into the cuts and through these your surgeon passes instruments to perform the operation. The operation is viewed on a large television screen. The wounds left after this operation may be closed with a special stitch which dissolves when it is no longer needed (or skin staples which will need to be removed at a later stage). 4

5 What is band adjustment? Inside the Gastric Band there is a balloon which is adjusted to give more or less restriction. More restriction means more fluid in the balloon, less space available for food to pass through, so you can eat less food. Adjustment is done through a tube that runs from the band to a port which is placed under the skin on your abdomen. The band will initially be adjusted under x-ray guidance to make sure it is angled correctly. This is done approximately six weeks after the operation, leaving time for the swelling to go down. What happens during band assessment/adjustment? You will be asked to remove your clothing from your top half. You will be given a drink containing barium which can be seen on x-ray. This will show the radiologist (x-ray doctor) how food passes through the band. The doctor then uses a special needle to inject fluid (saline) into the band via the port. You will be given a drink before you leave the clinic to check that the level of restriction is right for you. You may need further band assessments, for example if you are having difficulty eating or if you can eat too much. If you think you need a band assessment, speak to your Dietitian or Nurse. They will provide advice and will arrange a band assessment appointment if required, however further adjustments may be performed without x-ray guidance. The diagram below shows the adjustable gastric band after the operation. Oesophagus Stomach band port 5

6 Weight loss after the operation Weight loss after the operation is initially quite rapid but this will settle down after the first few weeks. It is important not to compare your weight loss with any other patient as it is very individual. There may be some weeks in which your weight loss slows down or stops and this is perfectly normal. On average, people can lose approximately 50% of their excess weight in the first two years after having a gastric band operation. Excess body weight is all the weight you carry above what is normal for your height a body mass index (BMI) of 25. Ask your Dietitian or Surgeon to calculate how much you can expect to lose. Are there any risks associated with the operation? Gastric Banding is generally a safe procedure. For most people, the benefits in terms of losing weight are much greater than any of the disadvantages. Any major operation carries an element of risk. In order for you to give your consent to this operation, you need to be aware of the possible side effects and complications that can occur. Side effects you may experience after your operation can include bruising, pain and swelling around your healing wounds. You may feel sick or be sick after eating, especially if you eat too much and/or eat too quickly. Your restricted diet may cause some shortage of nutrients so you will need to take multivitamins. More information is provided in a separate booklet. Complications associated with this operation Complications can occur during or after the operation. The possible complications of any operation include: A reaction to the anaesthetic Excessive bleeding 6

7 Complications associated with this operation (continued) Other complications can include: A very small risk of death during or soon after the operation (approximately 1 in 2000 patients) Wound Infection A blood clot (DVT) in the veins in the leg. This clot can break off and cause a blockage in the lungs. In most cases this is treatable, but it can be a life-threatening condition. Damage to some of the organs in your abdomen The band may slip out of place, break, or erode through the stomach wall. This may require a further operation or removal of the band. In some people (approximately 1 in 50) the food pipe (gullet) dilates above the stomach pouch. If this happens the band may need to be removed Failure to lose sufficient weight or weight regain If you lose weight rapidly, there is a risk of developing gallstones in your gallbladder It is important that your surgeon explains these risks to you. The exact risks will be different for each person. Preparing for your admission You may be asked to see an anaesthetist. This is to ensure you are fully prepared for your anaesthetic and to make sure you do not need any further tests before your operation. They will also discuss the risks of the operation which are relevant to you. Before your operation you will be seen in the Pre-Assessment Clinic. This appointment will usually be two weeks before your operation. It is very important that you attend. If you do not attend, your operation may be postponed or cancelled. At this clinic a member of the nursing team will see you. They will check that you are fit for your operation. They will also be able to explain details about the operation and answer any questions you may have. You may also be seen by a doctor who will examine you and may organise for you to have some tests. You will also be given a diet to follow before the operation (included in the separate diet booklet). This helps to shrink the size of your liver, making it easier for your surgeon to perform the operation. If you do not follow this diet your surgeon may not be able to carry out the operation. Before your admission you will also be contacted by the dietitian to answer any questions you may have about the pre and post-operative diet. If you take tablets or insulin for diabetes you may need to reduce the dose when you start your pre-operative diet to avoid low blood sugar. Please speak to your GP or Diabetes Nurse if you need help with this. 7

8 Medication If you are taking any tablets at the time of your pre-assessment appointment, please bring them with you. You may need to stop some of your tablets before your operation and you will be advised which tablets to stop if necessary. If you are taking any tablets to thin your blood, such as Aspirin, Warfarin or Clopidogrel it is important that you tell us as soon as possible. Please remember to bring your tablets into hospital with you when you are admitted. Sleep apnoea If you suffer with sleep apnoea (a breathing condition where during sleep the throat repeatedly narrows or closes) you may have a CPAP machine. It is important that you continue to use your machine every night as it is an essential part of your treatment and preparation for surgery. If you do not use your CPAP machine as recommended and attend the sleep clinic as required, your operation may be cancelled. It is important you bring this machine into hospital with you. Preparing for your operation We will send you a letter confirming the date of your admission and details of where you will be admitted to. You will also be advised when you should stop eating and drinking before your operation. If you are unsure please ask during your pre-assessment appointment. The following points should be noted before coming into hospital: Ensure you follow your diet prior to coming into hospital Do not bring any valuables into hospital, as we cannot be held responsible for any loss or damage Please remove all jewellery (except a wedding ring) Please bring in some night clothes, day clothes and wash items Take a bath or shower before coming into hospital There is no need to shave the operation area. If necessary this will be done in the operating theatre. Please have a contact number for the person who is going to take you home. You must have a responsible adult at home with you for the first 24 hours after you are sent home. If you live alone you should make arrangements for someone to stay with you. 8

9 What happens when I am put to sleep? When you go to theatre for the operation, you will be put to sleep in the operating theatre itself, not in the anaesthetic room. We have found it is safer for overweight patients to move themselves onto the operating table rather than being moved whilst they are asleep. After your Operation You will be taken from the operating theatre to the theatre recovery area where you will be closely monitored. You will be connected to machines that monitor the activity of your heart and other body systems. You will usually stay in theatre recovery for about four hours and then be transferred back to the surgical unit. This is different for everybody. Some people need to stay in theatre recovery for longer or they may require a stay in the High Dependency Unit (HDU). During the operation you will have a tube (nasogastric) passing through your nose into your stomach. This drains air and fluid from your stomach to stop you feeling sick and bloated. This tube is usually removed at the end of your operation You may be given oxygen until you are fully awake. This is given through a mask which is placed over your nose and mouth. You may have a tube (drip giving you fluid into your vein) going into the back of your hand. This is normal and only temporary until you are drinking enough fluid. Occasionally people have a tube (urinary catheter) placed into the bladder during the operation. This will be removed as soon as possible, to encourage you to get out of bed. Occasionally people have one or two tubes (wound drains) coming out of small holes in the abdomen. These are also connected to separate bags and drain fluid from your abdomen. You will be encouraged to get out of bed and move around on the day of your operation. You will then be encouraged to get out of bed the morning after your operation. It is important you get up and walk around the ward every hour during the day. This helps prevent chest infections and blood clots in your legs. You will have some special stockings on your legs and you will be given an injection in your tummy. Both of these help stop blood clots forming. You will need to follow a strict diet after the gastric band operation. You will need to have a liquid diet for the first four weeks. This allows the band to settle in place. Your surgeon, nurse and dietitian will give you more advice about this. A copy of this diet will be given to you in a separate booklet. 9

10 Will I be in pain? Some pain after your operation is normal. You will be given pain relief whilst you are asleep, and you should wake up feeling reasonably comfortable. If you have pain, please inform the nurse looking after you. You can then be given pain relief at regular intervals throughout the day. Do not wait until your pain is unbearable before you ask for medication. You will be given painkillers to take home with you. Following the instructions, make sure you take these when you need them. Wound Care You will have dressings over your wounds, which you may remove five to seven days after your operation, providing your wounds are clean and dry. It is not uncommon for some clear pinkish fluid to leak from your wound. This will usually dry up on it s own but it is best to keep the wound covered. Once your wounds are dry you may choose not to cover them, although you can apply clean dressings to protect your clothes from the wounds. You may have a shower when you are at home. It is perfectly safe for water to splash onto the wounds when in the shower. If you take a bath ensure the water is shallow. Afterwards, gently pat the skin dry around your wounds, with a clean towel. Your wounds may itch and there may be bruising. This is quite normal and will settle in the same way as any other bruising. A small number of people develop a wound infection after the operation. The signs of infection are: redness, swelling, heat, leaking fluid, smell or tenderness around the wound edges. If you think your wounds are infected, please contact your GP as you may need a short course of antibiotics. Occasionally, the pus has to be released from an infected area by a further operation. If you have skin stitches or staples that need to be removed, this will be arranged before you leave hospital. They will need to be removed days after your operation. You will need to arrange an appointment with your GP practice to get these removed. The hospital will give you some staple removers to take home. 10

11 Getting up and about When you go home you should continue to walk around doing a little bit more each day. Once you have left hospital, if you experience any of the following symptoms please contact us (details are provided on page 14 of this booklet) as soon as possible: A temperature or fever Severe abdominal pain A swollen or distended abdomen Severe or uncontrolled vomiting General Advice Most people are ready to go home the day after the operation. Please remember everyone is different and this timescale is only a guide. If you have a long journey home and are travelling by car, stop every hour or so and stretch your legs to prevent you becoming too uncomfortable. It may be more comfortable for you to place a folded towel between your tummy and your seat belt. Once you have been discharged from hospital, it is important you do not compare your recovery with other people who have had the same operation. We are all different and recover at different rates. Diet: Before you leave hospital, the dietitian or nurse specialist will ensure you understand the strict diet that you need to follow. It is important if you have lost your diet sheet or do not understand anything, then please ask. The dietitian may also visit you prior to you going home. They will also be in close contact with you once you are at home. Tiredness: Most people feel tired for several days, sometimes weeks after their operation. Do not fight the tiredness, rest if you can. Do not expect too much too soon. Work: You may return to work when you feel able to perform your job to the best of your abilities. This may be as little as three to four weeks after your operation or it may be longer. It depends on the nature of your job. You need to avoid heavy lifting for about six to eight weeks. If you require a sick note then please ask a member of the ward staff before you are sent home. Driving: You should not drive for a week after a general anaesthetic (you should be able to perform an emergency stop). The first time you drive have somebody in the car with you in case you feel unwell. It is also advisable to check with your insurance company, to ensure your insurance is still valid. Alcohol: Remember alcohol is rich in calories and although you can drink after the operation, it should be done in moderation. You will be eating small amounts meaning alcohol will be absorbed very quickly after the operation, making you more susceptible to its intoxicating effects. Please remember to be sensible. 11

12 General Advice (continued) Exercise: Whilst the skin around your wound edges heals very quickly, the muscles take longer and for the first six to eight weeks it is important to avoid straining or lifting heavy objects. Any activity where you hold your breath to brace your muscles is too much during this time. It is however very important to stay mobile throughout this period. After this time, gradually increase your activity levels. Sex: You may resume normal sexual activity as soon as you feel comfortable. Pregnancy: Many overweight female patients are infertile and once they start to lose weight, ovulation normally starts again. It is important you use some form of contraception. In general, we advise you not to become pregnant whilst you are losing weight. You should avoid becoming pregnant for at least two years after your weight loss surgery. If you do become pregnant it is important you inform your surgeon and dietitian as soon as possible. Medication: When you first go home you will need to give yourself a daily injection called Dalteparin. This thins your blood and prevents blood clots forming. It is the same injection you will be given while you are in hospital. The nursing staff will teach you how to do this before you are sent home. If you are not happy to give yourself the injection, a district nurse or a relative can do this for you. Please let the nursing staff know if you do not want to give this injection yourself. You will need to have this injection every day for two weeks once you are at home. You will also be given a tablet called Lansoprazole which dissolves in a small amount of water or on your tongue. This stops the stomach from making too much acid. You will have to take this for the first two months following your operation. If you take tablets on a daily basis, these may be converted to a liquid or soluble form before you are sent home. This is because there is a small risk of your tablets not passing through the band. Other medical conditions: The surgery often has a major impact on other medical conditions you may have. If you are diabetic you may be seen by the diabetic nursing team before you are sent home. They will advise you on any changes to your medication. High blood pressure also responds well to surgery. It is important to have your blood pressure checked every month after the operation especially if you take tablets for blood pressure. As you start to lose weight your blood pressure may also reduce. If you take tablets for an underactive thyroid, your GP should check your thyroxine levels regularly. The dose of your tablets may need to be reduced. Excess skin: The appearance of loose skin can be improved by exercising which will tighten up the underlying muscles. Operations to remove excess skin are not available on the NHS. 12

13 General Advice (continued) Follow-up: You will receive a telephone call from the nurse specialist within the first week of you leaving hospital. This is to ensure that you are recovering after your operation and also to answer any questions that you may have. Please write these down on a piece of paper so that you can ask the nurse. The dietitian will also contact you to ensure that you are following your diet and that again you have no problems or questions. If you have any concerns do not wait for the nurse or dietitian to ring you. You can contact them at any time (the numbers are at the end of this booklet). An outpatient appointment will also be arranged. This will be for you to return to the hospital to see the nurse and the dietitian. The appointment will be sent through the post after you leave hospital. It is important you attend this appointment and every other follow up appointment that is made for you. If you are unable to attend please ring the clinic co-coordinator (the number will be on your appointment letter). Please do not waste your outpatient appointment. Follow-up should be life-long and the majority of this follow up is carried out by the dietitian. This will ensure you keep healthy and your diet remains balanced and will promote good weight loss and weight maintenance in the longer term. You will be encouraged to attend up to four appointments in the first year after your operation, two in the second year and an annual review thereafter once your weight has stabilised. After two years you will be discharged back to your GP for follow up. It is also important your GP knows that you have had weight loss surgery so they can take into account the possibility of nutritional causes for any symptoms you may develop. You will be given a letter to take to your GP. It is important you deliver this as soon as possible after leaving hospital. 13

14 Advice after your operation If you are concerned about any symptom or problem at any time after you are sent home you should try and contact your GP. Alternatively, you can contact: Laparoscopic Nurse Specialist The specialist nurse is available Monday to Friday from 7am 3pm. If you need help or advice regarding your diet, please contact: Jane Calow Specialist Dietitian Bariatric Surgery Jane is available Wednesday to Friday from 8.30am 4.30pm If the Nurse Specialist or Dietitian are unavailable, please contact the ward you were discharged from and ask to speak to the nurse in charge: Kinmonth Unit Ward It would be helpful if you are able to tell them: The name of your consultant The operation that you had The date of your surgery Your hospital number Please also make a note of the name of the person that you speak to for advice. 14

15 Further Information British Obesity Surgery Patients Association (BOSPA) Association for the study of Obesity (ASO) Weight Loss Surgery *This website links to an online patient forum. It is free to join and can provide you with useful support and advice from other patients. Sources Gastric Bypass Health Fact sheet Illustrations courtesy of UHL Medical Illustration. My Questions Comments and Suggestions We review our information leaflets on a regular basis. If you have any comments about how we can improve this information please speak to a member of staff. 15

16 Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on Produced by Jane Calow Specialist Dietitian and Joseph Lee Specialist Nurse Printed: February 2015 Review Date: February 2018 (Mort/Calow) SUR