Advice for Gastric Band Patients
The gastric band
is a remarkably safe device and serious complications are unusual. It’s helpful to consider problems occurring in the immediate post-operative period and those occurring later.
Immediate problems (within a week of surgery)
Left shoulder pain
This is common in the first few days after surgery and can persist for a week or more in some cases. It is referred pain from the diaphragm and from the gas (CO2) put into the abdominal cavity during surgery. You can take the usual painkillers (co-codamol or paracetamol) and you may also find that a hot-water bottle helps.
A sensation of being slightly short of breath is common after laparoscopic (keyhole) abdominal surgery and is usually due to pain which makes the patient take small breaths. It’s nothing to be concerned about and will improve with time, analgesics and mobilization. It does not usually persist beyond a day or two.
Another cause of breathlessness is potentially more serious: a blood clot on the lung (pulmonary embolus or PE). After surgery you will have been prescribed medication (usually clexane) to inject under the skin along with compression stockings – please ensure that you wear these. Together, these reduce the risk of a blood clot but may not entirely eliminate it.
Blood clots on the lung often start with a clot in the leg, usually the calf. The typical sequence of events is pain and swelling in the calf a few days after surgery, followed by breathlessness and chest pain on taking a deep breath. So the key symptoms are:
- Pleuritic chest pain (sharp pain on taking a deep breath)
- Breathlessness at rest
- Possibly pain, swelling, heat and redness in the calf muscle
Caution: If you have TWO or more of these symptoms you should go immediately to your nearest Accident and Emergency Department or Walk-In Centre for investigations and pain relief
Wound pain and infection
Some wound discomfort after surgery is inevitable, but it’s usually managed successfully with simple pain-killers. Infections are uncommon. Some redness, bruising and swelling around the sutures is quite normal and does not mean infection.
The characteristics of a real infection are redness, heat, discharge (pale yellow/green) and pain. You may also feel generally unwell and have a temperature. You will need antibiotic treatment and we will advise you how to go about organizing this.
Retching and pain
This is not uncommon immediately after surgery and is usually due to eating too quickly and eating the wrong foods. If you eat or drink too quickly you will get pain behind the breastbone and you may have to bring the food back.
- Remember to follow the post-operative regime of fluids for 2-weeks, pureed foods for 2-weeks and then small quantities of normal food
- If you are at the fluid stage, make sure liquids are smooth with no lumps and sip SLOWLY
- If you have moved to the solid stage, there are certain foods you may find problematic – especially bread, meat, chips and similar foods.
- You MUST slow down your eating and chew the food well. Use your Band Timer.
In RARE cases, you may be retching liquids and solids because of post-operative swelling around the band. In this case you may need the small amount of fluid left in the band after surgery removed.
The main problem occurring after the immediate post-operative period is retching/vomiting which may be accompanied by abdominal pain. This is always abnormal, though usually not serious. There are various possible causes for these symptoms but the immediate treatment for all causes is outlined below:
Inflammation of the pouch
There are lots of things that can cause inflammation in the pouch above the band, including recent infections (colds, chest infection etc) and vomiting as a result of food poisoning. Some forms of medication can also cause inflammation in the pouch including steroids and anti-inflammatory medications such as brufen etc.
What seems to happen in all these cases is that the lining of the pouch becomes inflamed and swollen, making it very difficult for food and liquid to pass through the band into the main part of the stomach. This results in retching, cramping, pain behind the breastbone and heart burn.
If the band is too tight you may become intolerant of some foods and liquids. Follow the general advice below and contact HWC to arrange to have some fluid removed.
Most cases of retching and food intolerance are due to simple causes as indicated above and will resolve in 24-hours or so. If your symptoms do not resolve the there is a possibility that the band may have slipped. Slippage also presents with regurgitation, retching, pain behind the breastbone and heartburn. However, these symptoms do not usually come on suddenly. Instead they tend to start gradually and become worse over a period of weeks or even months. So if your symptoms have started suddenly, it is unlikely that you have a slippage.
If, on the other hand, you have had symptoms for a while but they have become suddenly worse, then a slippage is a real possibility and you will need to contact HWC as soon as possible to arrange for an X-Ray barium study. Note that abdominal pain is NOT generally a feature of an early slippage. If you have severe abdominal pain, there are several possible explanations, including slippage and gallstones. But you will need to be investigated as a matter of urgency.
Advice if you are retching, have heartburn or finding it difficult to eat and drink
- Stop eating and drinking immediately – take nothing by mouth for the next 12 hours
- If you feel thirsty, you can suck some ice-cubes
- Lie quietly
If you have developed severe upper abdominal pain together with intolerance of liquids, you must go immediately to your nearest Accident and Emergency Department for pain management, re-hydration and investigations. Call the Emergency Helpline at 7am the next day
Advice if you feel like there may be something “stuck”
This happens quite often and can be quite unpleasant. Follow the general advice below and you may suddenly feel the food slip through. The food will invariably dissolve and the symptoms will improve, but it may take a few hours
- Try small sips of pineapple juice or Coca Cola (don’t worry if this comes back initially). There is an enzyme in pineapple juice that helps to dissolve food remnants
- Walk around
- Raise your arms above your head several times per minute
Caution: Contact Healthier Weight Emergency Number tomorrow morning – you may need to have some fluid removed from the band