What is gastric restrictive surgery?

Gastric restrictive surgery is a type of bariatric surgery or weight loss surgery and limits the amount of food you can eat. This surgery may be used to treat severe obesity when diet, exercise and medicine have failed. In this procedure, the normal digestive process stays intact; none of the gastrointestinal tracts is bypassed.

There are two types of gastric restrictive surgery operations:

  • One separates the stomach into two parts with a small pouch that can hold only about one ounce.
  • The second removes about 80% of the stomach, leaving the remaining stomach much smaller.

Because the size of the stomach is reduced so much, these bariatric surgery procedures are called “restrictive.”

After having a restrictive procedure, you can only eat about 3/4 to a cup of well-chewed food; eating more than the stomach pouch can hold may cause nausea and vomiting.

Restrictive procedures have fewer risks than gastric bypass procedures, but they may be less successful because continuous overeating can stretch the pouch so that it holds more food.

Types of gastric restrictive procedures

  • Laparoscopic adjustable gastric banding (LAGB)

    This weight loss procedure involves your surgeon attaching an inflatable band around the top part of your stomach; the band is tightened like a belt.

    It separates the stomach into a small pouch and now serves as a new, much smaller stomach; the rest of the stomach is below the band.

    The band creates a narrow channel between the two parts of the stomach, slowing the movement of the food from the upper small pouch to the lower stomach.

    After the procedure, the band can be adjusted as needed by your physician by adding or removing saline; no staples are used.

  • Vertical sleeve gastrectomy (VSG)

    VSG is a newer procedure that uses staples to remove about 80% of the stomach.

    The remaining stomach, which is shaped like a “sleeve” will hold about 1/4 cup of liquid. Over time, the stomach can expand to hold 1 cup of food.

    You can potentially lose 1/3 to 1/2 of your excess body weight at one year after surgery.

    Since the rest of the stomach has been removed, this procedure is not reversible.

LAGB is most often done using a laparoscope rather than through an open incision, using a few small incisions for the laparoscopic tools to reach the inside of the stomach. The surgeon does the surgery while looking at a TV monitor.

Laparoscopic gastric surgery usually reduces the length of the hospital stay and the amount of scarring and often results in quicker recovery than an “open” or standard method.

Am I a candidate for gastric restrictive surgery?

Bariatric surgery is currently the best choice for weight loss in people who are severely obese when nonsurgical methods of weight loss have not worked. Potential candidates for bariatric surgery include:

  • People with a body mass index (BMI) greater than 40
  • Men who are 100 pounds over their ideal body weight
  • Women who are 80 pounds over their ideal body weight
  • People who have a BMI of 35 or more who have another serious weight-related condition such as:
    • Type 2 diabetes
    • Sleep apnea
    • Heart disease
    • High blood pressure
    • Osteoarthritis

People with a BMI of 60 or more or those who have already had some type of stomach surgery may not be able to have laparoscopic surgery.

There may be other reasons for your physician to advise a gastric banding procedure.

Health benefits of restrictive gastric surgery

Because the surgery can have serious side effects, the long-term health benefits must be greater than the risks.

Surgery for weight loss is not for everybody, but these procedures can be highly effective in people who are motivated to follow their physician’s guidelines for nutrition and exercise after the surgery.

Although not all risks are fully known, the bariatric surgery does help many people reduce or get rid of some obesity-related health problems. It may help to:

  • Lower blood sugar
  • Lower blood pressure
  • Reduce or eliminated sleep apnea
  • Decrease the workload of the heart
  • Lower cholesterol levels
  • Minimize further worsening of osteoarthritis of the lower backs, hips, and knees

Risks of gastric restrictive surgery

As with any surgery, complications may happen and may include:

  • Infection
  • Blood clots
  • Pneumonia
  • Bleeding ulcer
  • Gallstones
  • Obstruction or nausea when food is not well-chewed
  • Poor eating habits
  • Nutritional deficiencies
  • Scarring inside the stomach
  • Vomiting due to eating more than the stomach pouch can hold, not chewing food well enough or eating food too fast

There may be other risks based on your specific health condition; be sure to discuss any concerns with your healthcare provider before the procedure.

LAGB vs laparoscopic banding

In LAGB, the band can erode into the stomach clip which can block the flow of food through the band. Rarely, the stomach juices may leak into the stomach and emergency surgery may be needed. The most common long-term complication with LAGB is that the stomach pouch enlarges.

Laparoscopic banding procedure has fewer risks because there is no incision made into the stomach wall.

Preparing for gastric restrictive surgery

  • Your physician will explain the procedure to you and ask if you have any questions.
  • You’ll be asked to sign a consent form that shows that you understand the operation and its risks and also gives your physician permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • You’ll have a physical exam to make sure you are in good health before having the procedure; you may have blood or other tests such as an electrocardiogram for the heart and chest X-rays for the lungs. You may also meet with a dietitian and often a mental health counselor.
  • You’ll be asked to fast for eight hours before the procedure, generally before midnight.
  • If you are pregnant or think you might be, you should tell your physician.
  • Tell your physician if you are sensitive to or are allergic to any medications, latex, iodine, tape or anesthesia.
  • Tell your physician of all the medicines including prescription, over-the-counter medicines and herbal substances.
  • Tell your physician if have a history of bleeding problems and if you are taking any blood-thinning medicines including warfarin, aspirin, ibuprofen, naproxen or other medicines that affect blood clotting. You may need to stop taking these before the procedure.
  • You may be asked to start exercising and change your diet a few weeks before the surgery.
  • If you are a woman of childbearing age, you may get birth control counseling so that you do not become pregnant in your first year of surgery; rapid weight loss can harm the fetus.
  • You may be given a sedative before the procedure to help you relax.
  • Based on your medical condition, your physician may request other specific preparation.

What happens during gastric restrictive surgery?

Restrictive gastric surgery requires a stay in the hospital, and procedures may vary based on the type of surgery done.

These weight loss surgeries require you to be under general anesthesia; your physician will discuss this with you before your procedure.

  • General process for restrictive gastric surgery
    • You’ll be asked to remove clothing and will be given a gown to wear.
    • An IV will be inserted in your arm or hand.
    • You’ll be positioned lying on your back on the operating table
    • If there is excessive hair at the surgical site, it may be shaved off.
    • A urinary catheter may be inserted.
    • The anesthesiologist will monitor your heart rate, blood pressure and blood oxygen level during the surgery.
    • The skin over the surgical site will be cleansed.
    • Based on the type of surgery done, the actual surgical process will vary.
    • After surgery, a drain may be placed in the incision site to remove excess fluid.
    • The incision(s) may be closed with stitches or surgical staples.
    • A clean bandage or dressing will be applied.
  • For laparoscopic procedures

    For a laparoscopic procedure, a series of small incisions, usually ½ to 1 inch long, will be made.

  • For open procedures

    For an open procedure, the surgeon will make a single larger incision in the stomach area.

    Carbon dioxide gas is pumped into the stomach to inflate the stomach cavity so that the stomach and intestines can easily be seen.

  • For LAGB procedures

    For a laparoscopic adjustable gastric band procedure, a band is placed around the top end of the stomach encircling it to create a small pouch.

    A narrow passage through the band will connect to the rest of the stomach, and the band will be inflated with a salt solution.

  • For vertical sleeve gastrectomies

    For a vertical sleeve gastrectomy procedure, about 80% of the stomach will be removed, and a small sleeve of the stomach will be created with a line of staples.

After gastric restrictive surgery

After the gastric restrictive surgery procedure, you’ll be taken to the recovery room. Once your blood pressure, pulse and breathing are stable and you are alert, you’ll be taken to your hospital room. You may get pain medicine as needed, either by a nurse or by administering it yourself through a device connected to your IV.

You’ll be encouraged to move around while you’re in bed, and to get out of bed and walk around as your strength improves; it’s important to move around soon after your surgery to prevent blood clots. The first time you get up, ask the nurse to help you so you don’t fall or faint.

At first, you’ll get fluids through an IV; that evening or the next day, you’ll be given liquids such as broth or clear juice to drink. As you’re able to take liquids, you may be given thicker liquids such as pudding, milk, or cream soup; this is followed by foods that you do not have to chew such as hot cereal or pureed foods.

Some surgeons recommend a liquid diet for one to two weeks; your physician will instruct you about how long to stay on liquid until it is time to progress to eat pureed foods after surgery.

By four to six weeks after your procedure, you may be eating solid foods.

You’ll be instructed about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract, and you’ll be encouraged to maximize protein intake, often with protein drinks.

Before you are discharged from the hospital, follow-up visits are arranged.

If you start developing any of the following symptoms, call your physician immediately:

  • Fever and/or chills
  • Redness, swelling or bleeding or other drainages from the incision site
  • Increased pain around the incision site
  • Chest pain or difficulty breathing