Gastric banding surgery in Kuwait, which is controllable, is considered one of the operations that has gained great popularity in Europe, and later in America, due to its ease of being performed by laparoscopy and the low complications and risks associated with it. In addition to its good results, although they are less effective than other surgeries in the long term, such as sleeve gastrectomy or gastric bypass.

Details of the gastric banding procedure in Kuwait:

• Laparoscopic surgery has played a big role in the spread of gastric banding in Kuwait due to its ease on the patient in terms of pain and quick return to normal activity after the operation.
• Through four incisions (or one incision), the laparoscope is inserted, which is connected to a wire that leads to a television screen showing the intestines, stomach, and other organs.
• Through small incisions (half to one centimeter), telescopes and surgical clamps are inserted into the abdominal cavity and are displayed on the screen along with the stomach and other organs.
• The abdominal cavity is inflated with a needle as in any usual laparoscopic surgery, lifting the abdominal wall and making it like a ceiling, while the intestines and stomach remain.
• The gastric band is removed longitudinally outside the abdomen and its balloons are empty. Then, it is inserted and its tube into the abdominal cavity through one of the incisions or holes.
• The upper part of the stomach is surrounded by the band (gastric banding).
• The band is secured in place (so it does not slip down) by sewing a part of the stomach wall below and above the band together as shown in the figure.
• The end of the tube connected to the gastric band is carefully pulled out of the abdominal cavity through one of the incisions.
• Now outside the abdomen, the end of the tube is securely connected to the reservoir.
• The reservoir is fixed with the end of the tube under the skin, and the skin is closed above it.

The location of the reservoir installation differs from one surgeon to another. It may be located under the left breast, under the left rib edge, in the front of the abdomen, or in the area around the navel. This reservoir is injected with a special solution using a needle (after several weeks). The solution passes through a tube to the ring balloon that is fixed around the stomach, pressing on the stomach wall to narrow the opening or passage between the upper and lower parts of the stomach.

Through this injection or solution withdrawal process, we can narrow or widen the opening between the two parts of the stomach. The injection and withdrawal process is simple and takes place in the clinic without any anesthesia, and it is the basis of the entire procedure (external control). When the ring is wrapped around the stomach, the balloon is empty, so the opening between the upper and lower parts is large, and food does not stay in the small upper part for long.

However, when the reservoir is injected repeatedly, the balloon swells, and the opening becomes smaller, retaining the food in the upper part. When solid or semi-solid food is consumed, the upper part of the stomach, which receives the food, fills up quickly and with a small amount, causing the person to feel full or satisfied, and this feeling stops the person from eating, as the wall of the small stomach stretches, sending signals through the stomach nerves to the satiety center in the brain.

The small stomach then contracts and digests the food over the following hours before emptying the food in liquid form through the opening into the lower part of the stomach and then into the intestines. This prevents overeating or rapid consumption of food, which reduces the amount of food consumed daily and leads to weight loss.

Store injection dates:
There are multiple injection schedules after the operation, including a small injection every month for several months, up to 10 injections

To ensure patient commitment and follow-up, including the most practical, which is an initial injection three weeks after the operation, then every two weeks for three or four injections.

Follow-up program: –
The gastric band device is designed to improve the method and system of eating and does not work alone to achieve results, but the method of food and exercise must be observed. Therefore, the follow-up is continuous as long as it is intended to maintain good results, and it continues as long as the patient is carrying the device. The patient must follow up continuously and not fail to review or neglect so that continuous good results can be obtained.

During the operation, the belt is not mobilized and tightened so that the stomach wall can adapt to the new position. The first injection of the belt tank takes place 3-4 weeks after the operation, and then every two weeks or monthly, where 4 cm of sterile saline solution is injected to narrow the food passage gradually so as to give the stomach wall enough time to restore the blood supply. We may need about 4 sessions to reach the required degree, and then the follow-up will be every 3-6 months to follow up the weight loss and make sure of the style and quality of eating, and here the follow-up will be by this medical team in addition to a nutritionist.

And the patient must stay in constant contact with the doctor in the event that new medical information becomes available

or in the event of a medical complaint.

Its risks and complications:
Perhaps one of the most important complications of this process is the patient’s lack of understanding of its nature and what he has to adapt to

If he fails to do so, it is expected that the ring will fail to lose weight.

First: immediately after the operation

Like any operation, complications may occur from anesthesia or during the operation, such as stomach perforation, spleen or liver injury, or bleeding

But it is very small compared to other operations such as gastric bypass or diverting bile and pancreatic juices.

Second: in the long run

Nausea, vomiting, difficulty swallowing, and choking: as a result of eating a hard bite, a lot of fiber, or a large amount, or not chewing well, or drinking liquids while eating.

And sometimes as a result of taking medications that lead to minor infections in the stomach wall, and if it continues violently, it may be a result of the slipped ring, which are rare cases.

– The ring slipping into the lower part of the stomach, which leads to a blockage of the food passage and the need to perform an operation to lift or remove the ring, and often an easy operation.

Expansion of the upper part of the stomach and an increase in the amount of food, usually as a result of consuming large amounts of food after feeling full.

– Expansion of the esophagus, which is the result of repeated vomiting.

– Entering the ring into the stomach after a long period, which are very rare cases and can be removed without complications.

– Leakage of the solution from the storage or the tube connected to it under the skin and can be easily changed.

– The possibility of needing another operation for between 5 to 35% of cases.

The success of the gastric band operation in Kuwait:-
It is when the patient loses more than half of the excess weight from his ideal weight and maintaining it depends on:

– The person’s insistence on changing the style and method of feeding and literally adhering to the instructions.

Exercising daily on a regular basis.

advice:-
Not to narrow the loop dramatically or to the end. And to rely on the regulation of eating and the method of chewing more than restriction.

Advantages of gastric band surgery:
. A relatively easy process in which the natural physiological course of food does not change

. It does not involve the removal or cutting of any part of the stomach or intestines

. The ring can be removed when needed and most of the time easily

– In the event of the need for any future operation in the abdomen, this operation will not be an obstacle to it.

. – It is possible to control from the outside the hole between the two parts of the stomach and thus control the weight loss

– The possibility of performing it from a single hole in the abdomen and thus be better from an aesthetic point of view.

Disadvantages of gastric band surgery:
– The main drawback on the stomach ring is the increase in the number of people whose weight begins to increase after the third year, which made the process of balancing it with other operations with complications critical and accurate.

Some patients do not accept it as a result of their incompatibility with the slow (homeopathic) eating method that they should follow, and thus frequent vomiting, difficulty swallowing and recurrent choking occur.

– The possibility of performing another operation either for complications (albeit few) or to remove them and perform another operation, and this possibility reaches in some studies from 5-35% of cases.

What we found in a nutshell:
We started to perform gastric bypass surgery in the late 1990s, and since no laparoscopic obesity surgery was available,

And others, we conducted it for all large weights and body mass indexes that exceed fifty and sixty, and therefore we have a large number

(More than half of those we operated on) gained weight after 4 or 5 years of the operation, and you find that today not a week goes by without us performing an operation or two to remove the ring and make a skip or reduce my length.