Bariatric Surgery in USA

The gastric band in ten questions

The gastric band, what is it?

How it works ?

How does it arise?

What are the benefits of gastric banding?

What are the risks after the installation of a ring?

When should I be worried?

What course before the ring?

How do I live with my ring?

Will my ring be taken away from me one day?

Ethics and regulations in France?

The gastric band, what is it?

It is a silicone ring, whose diameter is changeable, which is surgically placed around the upper part of the stomach, creating a small pocket (gastric pouch) above it.

It is connected by tubing (a flexible tube) to a housing placed under the skin. Water can thus be injected into the housing, by a simple puncture through the skin, to tighten or loosen the ring if necessary. This adjustment can be made under radiological control for optimal inflation.

How it works ?

This is a so-called restrictive technique, which reduces the useful volume of the stomach. The ring acts like an hourglass, slowing down the passage of food, causing it to stagnate in the gastric pouch.

During a meal, the feeling of hunger decreases quickly because little food is needed to fill the gastric pouch (about 15 to 20 cl, the equivalent of a briquette of fruit juice).

With the installation of the gastric band, neither the digestion nor the absorption of food is disturbed. The risk of vitamin and micronutrient deficiency is therefore very low and does not require replacement tablets to be taken for life, which is different from other types of bariatric surgery.

However, the ring is only one element within an overall care. It does not dispense with following the proposed dietary rules or setting up regular adapted physical activity.

It is not a “miracle” product and it justifies a long multidisciplinary follow-up, total involvement and adherence of the teenager and his family to the course offered to him.

How does it arise?

Placing the gastric band requires an operation. This takes about an hour and is performed under general anesthesia. It is done laparoscopically, that is to say that the surgeon operates using a camera and instruments that he introduces into the abdominal cavity (the belly) through small incisions (5 mm). Then, he operates by following his gestures on a screen.

If the surgeon encounters difficulties – for example a too large liver -, he will then operate in the traditional way and make a classic incision (laparotomy).

To allow good tissue healing, the band is always placed deflated. The first inflation will take place in consultation approximately 6 weeks after the intervention, after application of an anesthetic cream on the skin next to the box.

What are the benefits of gastric banding?

On weight loss:

Weight loss is expressed in different ways:

Weight loss in kilograms

Loss of excess weight

Loss of excess weight percentage

Lower BMI

The average loss that can be expected is 40-60% of excess weight.

Excess weight is the difference between the actual weight and the ideal weight (weight corresponding to a BMI of 24.9 Kg/m2).

“Let’s take the example of a person of average height (1.76m), weighing 119 Kg (BMI of 40kg/m²). His ideal weight (for a BMI of 24.9 Kg/m2) is 73 Kg. His excess weight is therefore 44 kg. She can therefore hope to lose between 20 and 25 kg approximately thanks to the ring, i.e. a final weight of around 96 kg.

ATTENTION: The weight loss begins in the first days after the intervention, but it is very gradual, and reaches its maximum peak in approximately 18 to 24 months.

It will be optimal if we respect the advice of food hygiene as well as possible and that we practice regular daily physical activity.

On associated disorders (comorbidities)?

The gastric band is very quickly effective on all the complications associated with obesity: high blood pressure, menstrual disorders, sleep apnea, type 2 diabetes, hypercholesterolemia,… It can improve them or even make them disappear completely as soon as the first six months after installation.

What are the risks after the installation of a ring?

Like any other surgical procedure, the placement of a gastric band exposes you to a certain number of risks (or complications). But, of all bariatric surgery procedures, it is the technique with the least risk of serious complications. Is bariatric surgery for me?

Sometimes surgery can lead to:

A perforation of the stomach. It’s rare (less than 1% of cases) and it fixes itself.

Pulmonary embolism or venous thrombosis after the operation. It is a clot that forms in a blood vessel, and can travel up into the vessels of the lungs. This is possible after any surgery and is often linked to prolonged bed rest. It is avoided by getting up early, wearing compression stockings and taking medication.

Bleeding around the stomach or at the scars.

An infection in the scars.

There are complications that can occur after the operation, sometimes very long after:

The “slippage”: it is the slippage of the stomach through the band, which causes the impossibility of eating and drinking. It justifies a new intervention quickly.

Motricity disorders of the esophagus above the ring which constitutes an obstacle, with the possibility of dilation of the esophagus or the gastric pouch. The ring must then be loosened.

Stomach damage caused by the ring. The risk is then a displacement of the ring inside the stomach. The ring must be removed.

“Malfunctions” in the tubing and housing: leaks in the tubing, mismatching of the tubing from the housing, infection of the housing, reversal of the housing. They require readjustment of the device.

When should I be worried?

If I am unable to absorb food or drink, if I vomit at every meal, if I feel significant pain in the upper part of my stomach…

I must then contact my surgeon immediately.

During the week, I can reach the pediatric surgery secretariat of the CHU d’Angers directly at 02.41.35.42.90

At night and on weekends, I can reach the on-call surgeon via the hospital switchboard 02.41.35.36.37

He will do a clinical assessment and a radiological examination to look for a mechanical obstacle to the passage of food. These are often dietary errors (I eat too quickly or too much), but they can reveal band complications such as dilated esophagus or gastric slippage. Depending on the case, this may require temporary deflation or reoperation to reposition or remove the ring.

What course before the ring?

The course of bariatric surgery for adolescents offered at the CHU d’Angers is based on the national recommendations of the High Authority for Health and international. Its goal is to modify your lifestyle habits (food, but also physical activity and socialization), in order to give the maximum chance of success for the surgery. For more information, download the booklets opposite.

The duration of the course is a minimum of 12 months, and the final decision of surgery will only be taken at the end of this period, during a summary meeting of the various stakeholders who will have followed you throughout along this route.

The dietary preparation will aim to correct your bad eating habits, such as snacking or a diet that is insufficiently varied and too high in calories. It will also prepare you for the more split feeding rhythm that is necessary to tolerate gastric banding well. It will be recommended that you start splitting your diet at least 1 month before surgery.

Starting a sports activity now allows you to get a taste for it long before the surgery, and is essential to maintain weight loss over the long term, and also to build muscle mass! Different activities adapted to overweight are offered in the region, so… it’s up to you to play according to your tastes and your desires!

The sports activities

Gateway workshops in Angers

Find a structure on Sport Health in Pays de la Loire

Ideas for sports activities on Attitude Prévention – Sport and physical activity and the French Federation Sport for all

Different meeting times with pediatricians are also offered: the nutritionist endocrinologist will provide regular updates on the progress made, and day hospitalization will be planned to carry out examinations in search of complications of obesity, but also to prepare for surgery. At the end of the course, a one-week multidisciplinary evaluation hospitalization will be organized in the unit of the Adolescent Clinic at the CHU d’Angers before any intervention decision. You will take part in many activities (talk groups), which will allow the entire medical and paramedical team to evaluate and assess your motivations, the psychological impact of your overweight…

You will also meet the surgeon several times, at the beginning of the course so that he explains to you everything you need to know about the gastric band before you decide for this intervention, then before the surgery to explain you a little more. in detail how the operation and hospitalization will take place, and to answer any questions you may have.

Child psychiatry follow-up is essential throughout this course and must continue after the intervention. You will meet a referral child psychiatrist in Angers, but more regular follow-up near your home is entirely possible and even recommended!

Finally, during this year, you may be offered a stay of one or three months at the Capucins center, in a group of about ten young people motivated by comprehensive management of your obesity. In this case, the surgery will take place soon after the end of the stay to help you continue to lose weight!

How do I live with my ring?

For the intervention, you will be hospitalized the morning of the intervention at the adolescent clinic of the CHU d’Angers. You will start to eat again the day after the operation, after having done an x-ray of the stomach, so that we can make sure that there is no problem with the band, in particular a leak , and that it is in a good position. The dietitian will be there to help you. You can go home 2 to 3 days after the operation, when you have fully understood the new way in which you should eat (fractionation). You will find many tips in the Information Booklet after gastric banding before your discharge.

You will not need a “lifetime” vitamin supplement, but if deficiencies are detected during regular blood tests, they will then be corrected on time.

You can start practicing sports again one month after the surgery, until your stomach muscles are well healed. No sport is formally contraindicated, but it is recommended to avoid violent sports, because knocks on the case could cause pain, or damage the ring.

Likewise, travel abroad is allowed, but you will need to ensure that you can always be within 2-3 days of a hospital capable of taking care of you in the event of a gastric band-related problem, and this as long as your ring is in place.

Young women who have had bariatric surgery can have completely normal pregnancies. On the other hand, it is recommended to wait at least two years after the surgery to start a planned pregnancy, in order to avoid nutritional deficiencies in the future baby, and to ensure optimal follow-up from the desire for pregnancy by an obstetrician and a nutritionist specializing in the care of overweight women. Complications related to surgery can occur during pregnancy, but not more frequently than in normal times, that is to say, in the absence of pregnancy.

You’re going to have a lifetime following, at least as long as you have a ring. This lifelong follow-up is mandatory because it is necessary for your health, and you and your parents will agree to it by signing a consent form before the intervention

consent form about you

consent form for your parents

This follow-up will be ensured by the pediatric team, until the legal majority acquired or a little more. You will then be taken care of by the adult team, after a gradual and accompanied transition.

The post-operative follow-up is made of:

a post-operative consultation at 15 days and one month with the dietician and at 6 weeks with the pediatric surgeon who will inflate your ring for the first time.

follow-up with the dietitian every six weeks

regular follow-up with the child psychiatrist and the psychologist

day hospitalization at 3.6 and 12 months where you meet all the practitioners

follow-up every year after

Will my ring be taken away from me one day?

It’s possible :

Because it may be necessary:

Due to a complication related to the band (migration for example): it will then have to be removed and then put back on

Because some people do not tolerate the presence of the ring, which bothers them too much on a daily basis

Because you want to, if the ring hasn’t helped you lose weight after at least two years…

What will be done in case of “ring failure”?

The first thing is to appreciate and define what is called failure:

insufficiency of excess weight loss expected or rather hoped for? Be careful not to confuse…

The evaluation of the Quality of Life* questionnaires, completed throughout the course, seems to us to be the essential element in being able to speak of success or failure.

An assessment will then be made, to check that the ring is in place and correctly inflated (x-rays). If there is a mechanical problem, it will be corrected. Otherwise, the lack of weight loss is generally due to non-compliance with dietary guidelines and the lack of sufficient practice of physical activity. We will therefore encourage you to resume good habits!

We do not yet know if it will be possible to withdraw it “in principle” after a few years, considering that the habits of life and food hygiene are definitively acquired.

Ethics and regulations in France

Gastric banding, like all bariatric surgery in children, without being prohibited, is currently not expressly recommended in France, and never as first-line treatment. Therefore, you should think carefully before embarking on this process. You and your parents should take the time to get advice from your doctor. You must inform yourself about the techniques used and the recognized surgical teams.

In Angers, we made the choice of the gastric band, in adolescents, because its effectiveness on weight loss and the improvement of comorbidities have been proven in adults as well as in children. Above all, the installation of the ring is reversible and requires a great investment on your part: it is therefore included in an educational process.

Other surgical techniques, sleeve gastrectomy and gastric bypass, are also very effective. However, they are irreversible, technically more complex and can lead to more serious postoperative complications. In the long term, they can lead to deficiencies in vitamins and micronutrients

Our course of bariatric surgery for adolescents is based on international pediatric recommendations, – mainly American -, and on the French recommendations of the Haute Autorité de Santé. Our team has thus defined precise criteria to determine which adolescents can benefit from the surgery. It is with just as much rigor that it has defined the means necessary for the care of these children.

This treatment is part of the Specialized Adolescent Obesity Center of Maine et Loire, and has been validated by national experts in adult bariatric surgery, the Ethics Committee and members of the Management of the CHU d’Angers, the regional health authorities (ARS – Regional Health Agency) and the medical advisors of the Caisse Primaire d’Assurance Maladie (CPAM). Bariatric surgery is indeed subject to prior agreement, ie for the reimbursement of the intervention, the authorization to operate must be requested before the intervention from the CPAM. In addition, during the pre-surgery course, a request for 100% care coverage will also be made for ALD (long-term illnesses), in conjunction with the attending physician. It will allow the reimbursement by the CPAM of all the analyzes and all the care related to the management of the ob