If you have any questions or concerns about your illness or your treatment, please contact your medical team.

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1 This booklet is designed to give you information about your operation. We hope it will answer some of the questions that you or those who care for you may have at this time. This booklet is not meant to replace the discussion between you and your medical team, but helps you to understand more about what is discussed. If you have any questions or concerns about your illness or your treatment, please contact your medical team. A gastric band is an inflatable silicone ring which can be used to control the amount of food passing from the stomach into the digestive tract. The operation is done as keyhole surgery while you are under a general anaesthetic. When the ring is placed around the upper part of the stomach, it creates a small pouch at the top of the stomach with a small opening, or channel, to the rest of the stomach (see picture below). The size of the pouch and the channel both depend upon how much the ring is inflated. During a meal, food enters the pouch before passing through the opening into the main part of the stomach. The rate at which food passes through depends on the size of the channel between the p.1

2 pouch and the main part of the stomach. The more the ring is inflated, the smaller the opening and therefore the food passes through more slowly. There is a small port attached by thin tubing to the band. This port is placed just under the skin, allowing the band to be adjusted as necessary. There is some fluid present inside the band which controls its size, i.e. this fluid can then be injected or withdrawn to adjust the size of the opening between the upper and lower parts of the stomach. This enables you to feel full sooner and for longer. This method of surgery is recommended for patients with a BMI (body mass index) of 35 and over. On average, patients tend to lose 20% of their total body weight in the first year after surgery. 1. Feeling full quicker and for longer than before the procedure 2. The procedure is less invasive and easier to reverse than other surgical techniques designed to help with weight loss. 3. The band is adjustable, so we can vary the size of the opening between the pouch and the main part of the stomach if necessary. 4. Shorter stay in hospital and shorter recovery time compared to having a gastric bypass operation. Specific to this operation, there is a 10% risk of complications, which can include the band slipping or band erosion (band moving into the stomach), an increase in the size of the stomach or gullet (oesophagus), rupture of the ring or infection of the port. This may result in the band or port needing to be removed, repositioned, replaced or converted to a different procedure. These patients will need further surgery for these or other complications. There is also a risk of: Wound hernias Even though the scars are very small, you may develop a small lump in the wound which may need further treatment. Chest infection You can help by practising deep breathing exercises and following the instructions of the physiotherapist. If you smoke, we strongly advise you to stop. Wound infection You may be prescribed antibiotics to treat this if it occurs Deep vein thrombosis (blood clot in the leg), also known as DVT Major surgery carries a risk of clot formation in the leg. A small dose of heparin (blood thinning medication) will be injected once or twice daily until you go home. You can help by moving around as much as you are able and in particular regularly exercising your legs. You may also be fitted p.2

3 with some support stockings for the duration of your stay in hospital. If you smoke, we strongly advise you to stop. Pulmonary embolism (blood clot in the lungs) Rarely a blood clot from the leg can break off and become lodged in the lungs. This is treated with anticoagulant (blood thinning or clot dissolving) medication. Your surgeon will explain more if this rare event occurs. Bleeding A blood transfusion may be needed. Very rarely, further surgery may be required. If you are unable to receive blood products, please discuss this with your surgeon. Please note that there is a 1 in 1,000 risk of death caused by having this surgery. Lifestyle management Drug treatment Gastric bypass surgery Sleeve gastrectomy Your surgeon will discuss other options with you if appropriate. A few weeks before your operation, we will ask you to attend the pre-admission assessment clinic. This appointment is to check your current health and the factors that may affect your surgery, and that you fully understand the information about your admission, treatment and discharge home. You may also have investigations such as blood tests, ECG (recording of your heart) or a chest x-ray if not done already. You will be assessed by a surgeon and an anaesthetist. Anaesthesia means loss of sensation. Medications that cause anaesthesia are called anaesthetics. Anaesthetics are used for pain relief during tests or surgical operations so that you do not feel pain or touch. You will be asked for your consent before the hospital staff begin your treatment. Your doctor and/or clinical nurse specialist/key worker will carefully explain the procedure, but details will vary according to each individual case. No medical treatment can be given without your written consent. If you do not understand what you have been told, let the staff know straight away, so they can explain again. You may also find it useful to write a list of questions before your appointment and to have a relative or friend with you to help you remember the discussion when the treatment is explained. p.3

4 You will receive a copy of all communications sent to your GP. Please let us know if you prefer not to receive this. Please follow the pre-operative diet sheet for bariatic surgery before your operation. Your surgeon will advise the duration for this. This is primarily to shrink the size of your liver. It is important you follow this diet carefully as if your liver has not reduced in size enough your operation may have to be cancelled Make sure you go for a 30 minute walk every day, as this is good cardiovascular exercise. This will help reduce the risk of complications after surgery, as well as help you lose some weight before your surgery. You should also do your breathing exercises as discussed with you in clinic, while you are having your 30 minute walk each day. If you take blood-thinning medications (such as warfarin, aspirin or clopidogrel) and/or you are allergic to any medications, please contact the ward or the bariatric team for advice before you come in to hospital. Generally, these will have to be stopped for 7-10 days before your surgery. If you are a smoker, you must stop smoking at least six weeks before your operation. Stopping smoking will improve your chances of a good result. It will also improve wound healing. All infections (such as coughs and colds) must be cleared up before you have your operation. Please do not eat anything (not even sweets or chewing gum) six hours before surgery. You may sip only water until two hours before your surgery. If you regularly take medicines in the morning, you should take them before 7:00am, with a small sip of water if necessary. If you have diabetes, you must not take your insulin or diabetic tablets on the morning of your operation. You will be admitted to the ward on the day of your operation. Your temperature, blood pressure, breathing rate, height, weight and urine will be measured. We will measure you for special stockings (sometimes known as TEDS ) to prevent blood clots (DVT) from forming in your legs after surgery. We may also start you on anti-coagulant (blood-thinning) injections to help minimise this risk. All make-up, nail varnish, jewellery (except wedding rings, which can be taped into place), body piercings and dentures must be removed. One of the nurses will then come and prepare you for the operating theatre. p.4

5 You will wake up in the recovery room before you are taken back to the ward. Please tell us if you are in pain or feel sick. We have tablets/injections that we can give you as and when required, so that you remain comfortable and pain free as much as possible. You may feel light-headed or sleepy after the operation. This is due to the anaesthetic and may continue until the next morning. You may have a sore throat for two or three days after having a general anaesthetic. This sometimes happens because the anaesthetist has to pass a tube down your windpipe to give you the anaesthetic gases that keep you asleep during the operation. We will ask you to stand up and start moving around four hours after your operation. It is important that you move/walk about as much as possible, as this will reduce the risk of any complications and speed up your recovery. Please make sure that you do your breathing exercises using the inspirometer 10 times every hour (between 8.00am and 10.00pm) and walk around for 10 minutes every hour and every day that you are in hospital. Your wound will have been closed with surgical clips, which we will remove when you return for your first follow-up clinic appointment, seven to 10 days after surgery. You can remove the dressing covering your wound 24 hours after your operation and also have a shower at this stage, using a clean towel to pad the wounds dry. You will be allowed to start slowly sipping liquids such as water, tea, coffee, milk or squash as soon as you are fully awake after your operation. Days two to six after surgery, you will be on a liquid diet. After day seven, you can start having soft food then regular food as tolerated. For more information about the soft food diet, please refer to the diet sheet for gastric banding. After two weeks, you may feel ready to progress onto a normal textured diet. It is also possible that you may not feel ready, in which case you should carry on with the soft diet. For further details, please see the diet plan given to you before surgery by the dietitian. Provided you are well enough, you should be able to go home on the same day after your operation. Please arrange for someone to come and collect you by car on the day of your discharge home, as you will not be able to drive yourself or travel on public transport. It is important that you make the necessary plans as you will be expected to make your own arrangements for going home. p.5

6 You may feel different sensations in your wound such as tingling, itching or numbness. This is normal and is part of the healing process. However, if you experience a high temperature or fever, new or worsening stomach pains, constant vomiting or feel unwell in any way, please contact the bariatric team immediately. We will give you a list of emergency contact numbers before you go home. If you have any swelling, pain, discharge or excessive redness around the wound site, please contact your GP as you may have a wound infection. If you are unable to swallow or are having difficulties in swallowing, this may be because your band has slipped. Please contact your doctor or clinical nurse, using the numbers given to you before you go home. You should continue to walk for 30 minutes every day, as this is good cardiovascular exercise, for three weeks after surgery. It will reduce the risk of complications after surgery. You may still have some abdominal discomfort, which can be caused by excess wind, your wound or the reduced size of your stomach. You can take painkillers for this if necessary. You should be able to return to work. However, you should avoid doing any heavy lifting for the next six weeks. Make sure that you continue your breathing exercises three times a day. We will send you an appointment for the outpatient clinic. Your surgeon or clinical nurse specialist will make the first adjustment of your band if necessary. After each band adjustment, you will need to go back to a liquid diet for one to three days. You will have an appointment at various intervals during this period of time to see the clinical nurse specialist at the band adjustment clinic. You can also request to see the dietitian. You will be discharged back to the care of your GP. You should continue to see your GP yearly so that he/she can check your progress to see if you are eating correctly, that you are taking your medications and have all the vitamins and minerals that you need. Your GP will also ask you to have some blood tests. p.6

7 Please do not hesitate to contact one of the clinical nurse specialists if you have any questions or concerns, Monday-Friday (except bank holidays), Telephone: The website below provides information about weight loss surgery at our hospitals: Imperial Weight Centre These registered charities provide support and information to obese patients in the UK about weight loss surgery: British Obesity Surgery Patient Association (BOSPA) Weight Loss Surgery Info (WLSinfo) We aim to provide the best possible service and staff will be happy to answer any questions you may have. If you were pleased with your care and want to write to let us know we would appreciate your time in doing so. However, if your experience of our services does not meet your expectations and you would like to speak to someone other than staff caring for you, please contact the patient advice and liaison service (PALS) on for Charing Cross, Hammersmith, and Queen Charlotte s and Chelsea Hospitals or for St Mary s and Western Eye Hospitals. You can also PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and are often able to solve problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The chief executive Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on Bariatric surgery Published: Feb 2013 Review date: Feb 2016 Reference no: 2206T Imperial College Healthcare NHS Trust p.7