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The principle behind the gastric ring is to reduce the stomach's capacity and slow down the movement of food through the rest of the digestive tract, thereby leading the patient to feel full sooner.
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The ring is proposed in most cases as a first intention. This operation, as carried out by our team has a very low rate of post-operative complication..
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The success rate is around 70% and the patients' satisfaction rate greater than 90%. It is because the gastric ring is a low-risk solution with very favourable results that our team proposes it as a first intention treatment for obesity.
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- Oesophago-gastrofiberscopy : this examination involves viewing the inside of the stomach to check for ulcers or hiatus hernia. It is usually performed under general anaesthetic as it is not generally well tolerated by the patient.
- Abdominal ultrasound: a painless examination to establish whether the liver is free from excess fat and whether there are gall stones in the gall bladder.
- A blood sample.
- In certain cases, after assessment by the anaesthetist, a consultation with a cardiologist may be requested.
All these examinations may be performed the day before the operation.
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The patient goes into hospital the day before the operation.
Surgical preparation:
- Antiseptic shower.
- Anti-thrombosis stockings to be worn.
- An anticoagulant injection to prevent the risk of phlebitis on the morning of the operation.
- The abdomen wall is prepared with an antiseptic solution.
- Premedication.
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This is performed the day after the patient enters hospital.
For patients who have never had their stomach operated on, the operation lasts 15 minutes. For patients who have had their stomach operated on, it may last up to an hour.
It is performed under general anaesthetic using keyhole surgery, i.e. with 5 small openings.
After the operation, the patient remains in the recovery room for about 2 hours.
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The patient gets up a few hours after the operation.
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In the evening, he/she is allowed to drink and take a liquid snack.
Pain is generally minimal after the operation and can be perfectly well controlled using simple pain-killers.
On the day after the operation, an X-ray known as an oeso-gastro-duodenal transit examination is performed. A liquid must be drunk during this examination which may cause a brief bout of diarrhoea. The purpose of the examination is to check whether the ring is properly in place.
The nutritionist visits the patient to give him/her final information before he/she leaves.
Once this examination has been performed, the patient can leave the clinic.
On leaving, the patient is prescribed the following:
- A few days of pain-killers and medicine to protect the stomach.
- Anticoagulants only if the patient has a history of thrombosis or is at very high risk.
- 1 to 3 weeks off work. In practice, it is possible to go back to work after one week if physical work is not involved.
- A consultation with a radiologist two months after the operation in order to adjust the ring.
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Complications relating to the gastric ring |
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Complications arising during the operation
These are the same as with any form of surgery. Phlebitis, pulmonary embolism, haemorrhage and infection may occur. During the operation, it may in exceptional circumstances be necessary to open the abdomen to control haemorrhaging, par exemple..
Of complications specific to fitting the gastric ring, the following may be encountered:
- Gastric perforation : highly unusual for experienced teams. The ring is not fitted in such cases.
- Total food intolerance. This is due to excess grease around the stomach. In general it can be cured by medication, but requires a few days longer in hospital.
- Inability to fit the ring: this may be due to the liver being too large or to a particular anatomy. This failure is often resented by the patient, but is a sign of caution on the part of the team.
These complications are nevertheless unusual for our team.
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Complications arising after the operation |
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Gastric erosion
These generally occur 2 years after fitting the ring. The ring enters the stomach, progressively moving through the stomach wall.
It is extremely rarely painful. The only clinical sign is that patient puts weight back on, with sometimes pain felt between the shoulders.
This complication is treated by laparascopy and requires the ring to be removed and a stay of 5 days in hospital. A further operation for obesity cannot be attempted for 3 months..
This complication occurs in less than 1% of cases with the rings that we now use.
Slipping and dilatations
This complication is more frequent (from 1.7% to over 10% depending on the type of ring). it can be prevented by avoiding vomiting and fizzy drinks.
It means that the patient cannot drink liquids and suffers from refluxes at night. If pain is felt, an emergency consultation is necessary to deflate the ring.
The treatment first involves deflating the ring. If it goes back into position, which can happen more easily with low-pressure rings, it can be carefully re-inflated and the patient must at all costs avoid vomiting.
If the ring does not go back into position, it is preferable to remove it and consider a different procedure to combat obesity.
Ring failure
This is caused by bursting of the catheter linking the ring to the inflation device or leaks on the ring itself. In both cases, the patient starts to put weight back on. If the catheter is completely broken it can cause pain in the pelvic region through irritation.
Such failure always requires another operation to replace the defective part.
These complications are related to the type of ring used.
To sum up, the ring causes very few complications during the operation itself. Complications occur above all with time and can be avoided with a few precautions.
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Follow-up after this type of operation is highly recommended. This is a moral undertaking between the patient and the medical team. The patient is of course free to choose to change surgical teams for his follow-up.
The patient remains in control of his/her weight loss, but is guided in this by the medical team.
The recommendations are:
Consult a nutritionist if possible every three months and at least every 6 months. The purpose of this consultation is to remind the patient of the rules governing how he should eat with the ring in place. and to detect any complications.
Have the ring adjusted when indicated by the x-ray examination with a doctor.
Call the clinic in the event of any problem, especially if there is pain or significant vomiting.
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The goal is to get as close to the ideal weight as possible, while eating a balanced diet and enjoying a normal social life. The ring is not an end in itself but an aid. It must be considered as a crutch to help you relearn how to eat!
The danger is to fall into a state of under-nutrition and extreme thinness.
The last few kilograms are usually lost through regular physical exercise. It is advisable to begin to take exercise as soon as the ring is fitted.. We realise that it is impossible to ask someone to take up a sport when he is 50 kilos overweight, but this activity be undertaken progressively by, for example, using the stairs instead of the lift or asking oneself if it really is a good idea to use the car when the journey can be made on foot. The weight will eventually become compatible with a more intense physical activity.
When the ideal weight has been attained, the ring can be deflated, but only if the patient agrees to this. The aim is to progressively wean the patient away from the ring and above all to avoid any complications such as dilatation or slipping. Exceptionally, the ultimate goal of removing the ring from a patient who is in proper control of his weight is obtained..
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