Gastric band or gastroplasty in Tunisia

How it works?

From the first bites, the pocket above the gastric band is full, since it can only contain about 15 to 20 cc. A feeling of satiety is then felt.
Solid foods must be very conscientiously chewed. Once the first mouthfuls have been swallowed, you must wait patiently until they have passed through the ring otherwise they will accumulate in the esophagus and regurgitations. For this, it is essential to arrange your daily schedule to be able to make meals spread over 30 or 45 minutes, although in small quantities and above all as much as possible outside of stress, under penalty of spasms which make then impossible food. We can possibly replace the meal taken at work with 2 or 3 small snacks. .You must be particularly vigilant at the start of a meal, do not forget the instructions to chew well and start slowly. Avoid drinking while eating. It can be done shortly before a meal or between meals. Carbonated and of course sugary drinks, even "light" are not recommended. The ring is inflatable, causing more or less significant discomfort. Overtightening is undesirable. The occurrence of vomiting is not normal and should be consulted The volume of food intake during each meal is very small, reducing caloric intake accordingly. in calories. If the dietary recommendations are respected, however, there will be no protein or vitamin deficiency. The fat mass of the body will decrease and the muscle mass will increase, especially as physical activity can develop with weight loss, the resumption of walking, in particular, is strongly recommended every day, as often as possible. It is desirable to play sports once a week but contact sports should be avoided because of the presence of the box on the abdominal wall. Scuba diving with bottles is contraindicated.

The gastroplasty is an adjustable intervention, because the ring will be inflated one month after its placement (time required for it to be fixed in place by healing) The surgeon punctures the subcutaneous box with rigorous aseptic precautions and injects a liquid which will allow the inflation to be adjusted in several stages.

Gastric banding or gastroplasty is a simply restrictive mechanism, with no malabsorptive consequences, like other interventions, which are "mutilating". It is also a reversible method: it is possible to deflate the band, by example during pregnancy or in the event of incarceration of unmasticated food. and who is more exposed to parietal, respiratory and decubitus complications.

Who is affected by gastroplasty?

Social security pays for gastroplasty for a BMI > 40. However, the figure of 35 can be retained when there is already a comorbidity (disease resulting from obesity). The installation of a ring can therefore only be proposed for an already considerable overweight (for example 115 kg for 1.70 m or 100 kg for 1.60 m).Operative complications, although rare, exist and it is certainly not necessary to operate someone who would only have to lose 10 kg or 15 kg.It is the patient herself who must make his decision, take responsibility for himself and immature behaviors are to be ruled out, as well as intellectual deficiencies, alcoholism, drug addiction, severe depression and psychoses. This decision must never be taken quickly but must be the result of a long personal reflection for the candidate who will have to become aware of the abandonment that she will impose on herself from the immediate oral satisfaction. It is necessary to explain the food constraint which will result. Contacts with former operated are desirable, meetings are organized for this purpose (cf. patient space). The ring requires eating slowly and chewing very well and this every day. rule out compulsive eaters unable not to throw themselves on food in certain frustrating situations. Those who, during anxiety attacks, have bulimic behavior cannot reasonably consider gastroplasty, unless the start of psychotherapy succeeds in correcting this behavior. ring placed and are not a contraindication, but swallowing small quantities all day remains mechanically possible with the ring. Finally, certain strong personalities will not accept the constraint of monitoring, believing they can manage it alone and will expose themselves to a failure. In fact, it is difficult in one or a few interviews to identify people's personalities. It is important to have the opinion of the psychologist and the dietician, to also contact the family doctor who knows the candidate for a long time. It must be understood that the "miraculous" installation of the ring is not suitable for so much to erase the difficulties of life. Obesity is often the symptom of a psycho-affective disturbance: we "console" ourselves by eating when we feel frustration or an existential void. an error because after the eating behavior can no longer be the same. It is necessary to know how to start a work of introspection to try to look at reality differently, to accept it and not to suffer it by eating as soon as an annoyance arises, and to do this know how to postpone the date of the intervention.

Gastroplasty and pregnancy

A pregnancy is perfectly possible with a ring, while conversely obesity is sometimes a factor of sterility. But it is necessary to loosen the ring from the beginning of pregnancy for fear that vomiting will displace it and to avoid possible deficiencies. For this reason, pregnancy is not recommended during the initial period of weight loss.

How is it going?

This is an operation performed under laparoscopy which consists of inflating the abdomen under general anesthesia with a gas to introduce an optical device through a 1 cm orifice, connected to a camera which transmits the image to a screen. he intervention takes place using fine instruments introduced through 5 or 10 mm orifices. It generally lasts a little less than an hour. Although laparoscopy allows very simple follow-ups, comparable to those of removal of the gallbladder, this surgery should not be trivialized for all that. The difficulty of the gesture is very much a function of the degree of hepatic steatosis (and therefore of the volume and fragility of the liver). It should be noted that the risks of instrumental perforation exist, although exceptional, which can have serious consequences. Mortality is estimated at 1/1000 but mainly related to cardiovascular problems in patients who already have coronary heart disease.

The postoperative

Postoperative pain is minimal. They decrease over a week, when the sutures will be removed. The work stoppage is 2 to 4 weeks. The first inflation will take place, at the earliest, only after one month. The first 15 days, a soft and mixed diet is recommended, then the bites to chew are gradually reintroduced with caution, so as not to risk move the ring while it is not yet fixed by healing. You have to see the dietician again around the 15th day. After a month, it is the surgeon who will decide whether or not the first inflation with a specific product that you will have obtained in pharmacy. The inflation must be done by the surgeon himself in the radiology room so that he can appreciate on the screen the passage of a sip of opaque product. Indeed, an optimal adjustment can only be obtained if it is done by the same person who follows you and questions you on the difficulties encountered. is a simple puncture with a fine needle through the skin in the membrane of the injection box of the ring and it is not very painful.

What is the follow-up after?

It is essential to see the surgeon regularly during the first months to allow the inflation to be adjusted and to monitor radiologically in his presence that the beginning of dilation does not set in. The ring does not act alone but through the regime it imposes. And this one cannot be invented, it must be supervised and reassessed regularly by the dietician. manage on their own afterwards. Some people know how to take advantage of the first contact with the psychologist to decide to start psychotherapeutic support which will allow a better acceptance of the constraints of the ring and therefore to use it in the best possible way successfully. It is not always easy to know in advance what will be the compliance of the candidates with this multidisciplinary follow-up, but it should be a key element of the operative decision. Once the weight loss has been obtained and has passed the first two years, a consultation remains necessary once a year with stomach x-ray.

What are the possible long-term complications?

The incarceration of food swallowed too quickly or poorly chewed, results in pain and vomiting.
If these persist for more than a day preventing any feeding, it is imperative to contact the surgeon quickly to temporarily deflate the ring and allow the incarcerated food to pass, under penalty of seeing a dilation set in which may even oblige if one waits too long, to remove the ring urgently by laparoscopy.

This is the most frequent complication.
It can result from an inappropriate eating behavior, in particular too fast, with insufficient chewing and frequent vomiting.
But, it is above all the consequence of excessive tightening. This is not necessarily very perceptible at the beginning, because we have become accustomed to significant discomfort when passing food and the dilation develops gradually at low noise.
The deflation of the ring is then necessary, even its ablation in emergency in certain cases of "strangulation" of the pocket which has become enormous.
The only way to avoid this is to properly submit to the requested follow-up.
Only radiography with ingestion of an opaque product in the presence of the surgeon can detect the premonitory signs which allow the ring to be partially deflated, out of caution.
It is therefore necessary to insist on the importance of respecting the appointments fixed to see the surgeon again, in particular after an inflation, even if everything seems to be going for the best, because once again, it is the x-ray which can, alone, raise the alarm early.
Similarly, if you are going through a difficult period, a source of a lot of anxiety, the ring becomes like a "knot in the stomach", forcing you to skip certain meals, causing vomiting and you must then know how to come back for a consultation to loosen it a little, even if it means reinflating it later.

Another rarer complication is mucosal ulceration in contact with the band, gradually leading to its "migration" into the digestive lumen and requiring laparoscopic removal.

Turning, disconnection of the tubing, infection, although less serious, however require surgery.

It should be noted that the percentage of reoperation for complications is far from negligible and that the long-term outcome is not yet well known:
The first rings were placed in the 80s but in small numbers (by laparotomy).
The spectacular development of the method (linked to laparoscopy) dates mainly from the years 1996/1997.

What results after the installation of a ring?

Weight loss is usually between 0.5 and 1 kg per week. Sometimes rapid the first month, it must then stabilize at around 500 grams to 1 kg per week. Too rapid weight loss is not desirable, often being done at the cost of vomiting, too severe a food constraint if the ring is too tight, and not allowing the psychological integration of the accomplished metamorphosis. The obese very quickly feels a clear improvement in his physical condition and his everyday life. His psyche often also evolves in a positive way. Shortness of breath and joint pain will also decrease. We gradually obtain the improvement, or even the disappearance of hypertension, diabetes, sleep apnea. The loss of weight is spread over 18 months to 2 years. It reaches 50% of the initial excess weight for 80% of the patients at 2 years (the excess weight being calculated in relation to an "ideal weight", corresponding to an BMI of 22.5). Once the loss of weight obtained, a rebound effect should not be feared, as with usual diets, because the ring remains there to cut off hunger. And if subsequent ablation remains possible, it is not recommended for this reason. There is no intolerance described to date for this material.

However, complications are not uncommon, which may lead to removal of the ring. But their frequency is considerably reduced when we take care of:
Select patients.
Prepare them and know how to postpone the date of the intervention for this.
Support them by offering them adequate follow-up.
This is why we must underline the fundamental role of the overall care of the obese person by a team that is not only concerned with the mechanical and surgical aspects, but also with the psychological and dietary aspects (making a link with “the scalpel cannot act alone).
In fact, two scenarios arise:
the patients who tolerated the ring well, knew how to adapt to it, respect the "instructions for use" and obtain satisfactory weight loss, above all do not want to see it removed, because for them it is a "safeguard" and they know that the pounds are likely to come back if it is taken away from them. Those, on the other hand, who cannot withstand the constraints of the ring, sooner or later expose themselves to problems of dilation which will force one day to withdraw it.

They vary greatly depending on age, degree of weight loss, skin texture and pregnancy history. Cosmetic surgery is often desirable, but it is a matter of personal desire. It is recommended to wait until you have reached a stable weight to achieve it, because if additional weight loss occurs later, it may in turn require surgical retouching.

What are your BMI and IMG indexes ?

Tests to do for gastric banding

Blood group. Full blood count. Serum Urea. serum creatinine. Protidemia and protein electrophoresis. Serum electrolytes. Calcemia. Cholesterol. Triglycerides. HDL, VLDL. Low cortisol at 7 a.m. Thyrostimulin T4. FSH. LH.
Osogastroduodenal endoscopy.
Electrocardiogram - Cardiac Ultrasound.
Abdominal ultrasound.