Part III - Gastric Band Text

September 21, 2011

OBGYN.net Broadcasting presents Part III of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op.

 

This is Mark Smith again with just a couple of quick bits of information for everyone. We're going to describe and show you what the band actually looks like. I'm sure most of you have questions about this thing called a 'lap band' that everyone is talking about. So let me give you some description of what they'll actually be inserting into Roberta today. This is a picture of the type of band that will be used. This part actually goes around the stomach, or slips around part of the top of the stomach, and then it's closed, like so, and it constricts the stomach. This portion goes out to the abdominal wall beneath the skin, where it can be injected with fluid. When it's injected with fluid, it thickens this band and narrows the inner diameter of the band. This is a picture of the lap band as it actually goes around the stomach, like so, and this is the esophagus coming in from above. It goes around the stomach like so, and then constricts it. We then have an overall picture, here - this is what it does to the stomach, making a tiny reservoir in this area, and then by different degrees of constriction of the band, we can allow food to go through at different rates and much more slowly. The patient feels full much more quickly, and continuing to over-eat at this point can actually cause nausea and vomiting. Thus, the overall food and caloric intake is reduced on a day-to-day basis and leads to a gradual loss of body weight.

Next Dr. Weiner is discussing with me the pre-operative X-rays of Roberta. An upper G.I. is done on every patient prior to the procedure to determine the exact anatomy of the stomach and esophagus, and to insure that there are no contra-indications to the procedure. As will be seen later, Roberta does have a small hiatal hernia. Dr. Weiner also demonstrates the band itself, and note the clear balloon on the inner surface of the ring. It holds a maximum of 5 cc of fluid, so the secondary fills, if required, are critical as to the volume that is injected.

Roberta is now being brought into the operating room. The sequence for surgery is different in Europe from that in the United States. The patient is first anesthetized in an outer or separate room, and then brought into the operating room already asleep and placed on the operating room table. This is different from the U.S. where the general anesthesia is induced in the operating room itself. Roberta is placed on the table, her abdomen is washed with a sterile solution, and sterile drapes are used to cover her.

At this point Dr. Wiener describes the type of trocars and entry technique he utilizes. He uses the InnerDyne® trocars with their step system of entry as he feels this significantly reduces the chances of injury to the patient, and thus makes the surgery much safer. First he demonstrates how he places the smaller trocar and insufflates the abdomen with carbon dioxide (CO2) to elevate the abdominal wall to afford visualization. He then uses that trocar to initiate the step system of placement, using the same incision and smaller initial trocar to place the larger one in a step-like fashion. Once the larger trocar is placed through the umbilicus safely, the camera is inserted and the intra-abdominal cavity inspected to ensure its proper placement and the absence of any intra-abdominal abnormalities. Then the other trocars are placed in a similar fashion, and again note the non-cutting end of the secondary trocars as they are placed, resulting in a safe insertion. Dr, Weiner next shows the outside of the abdomen and the location of the placement of the trocars.

Dr. Wiener demonstrates the instrument that was designed and developed by Richard Wolf instruments with the collaboration of Dr. Weiner. This is utilized for the dissection behind the stomach and the placement of the band. He then inserts the band through the trocar into the abdominal cavity to have it readily available once the dissection is completed. He inserts all his instruments for the surgery, and the last part of this video is Dr. Weiner arranging all the instruments and utilizing retraction of the organs inside the abdomen. As every good surgeon knows, the hallmark of good surgical technique is proper exposure before the surgery is initiated. Dr. Wiener is taking his time to achieve this, and is understandably quiet during this time as he is working. Once done, it is time to move on to the surgery, and this will be the topic of the next part of the series in the subsequent video.

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At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: http://www.inamed.com/contact/bio_patient.cgi.  Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails. See Professor Rudolf Weiner's website about Weight Loss Surgery to see if this option is right for you. Visit www.profweiner.com.