Gastric restrictive surgery is a type of bariatric surgery or weight-loss surgery. It limits the amount of food you can eat. This surgery may be used to treat severe obesity when diet, exercise, and medicine have failed.

The normal digestive process stays intact in gastric restrictive procedures. None of the gastrointestinal tract is bypassed. There are two types of operations:

• One separates the stomach into two parts. One is a very small pouch that can hold only about 1 ounce.
• The second type removes about 80% of the stomach. The remaining stomach is much smaller.

These procedures are called “restrictive” because the size of the stomach is reduced so much.

You can only eat about 3/4 to 1 cup of well-chewed food after having a restrictive procedure. 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. That's because continuous overeating can stretch the pouch so that it holds more food.

The types of gastric restrictive procedures are:

• Laparoscopic adjustable gastric banding (LAGB). In this method, your doctor attaches an inflatable band around the top part of your stomach. The band is tightened like a belt. This turns the upper part of the stomach into a small pouch. This pouch serves as a new, much smaller stomach. The rest of the stomach is below the band. The band creates a narrow channel between these two parts of the stomach. This slows the movement of food from the upper small pouch to the lower stomach. The band can be adjusted by your doctor, as needed, after the procedure. This is done by adding or removing saline (salt water) to an attached port. This is underneath the skin. No staples are used. This is because usually no part of the stomach is removed. Like other restrictive procedures, LAGB may not help you reach significant weight loss.
• Vertical sleeve gastrectomy. This newer procedure uses staples to remove about 80% of the stomach. The remaining stomach is shaped like a "sleeve." You can potentially lose 1/3 to 1/2 of your excess body weight by 1 year after surgery. This procedure is not reversible since the rest of the stomach has been removed.

LAGB is almost always done using a laparoscope rather than through an open cut (incision). This method uses 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 or by using a surgical robot. Laparoscopic gastric surgery usually reduces how long you'll need to stay in the hospital. It also reduces the amount of scarring, lowers the amount of pain after surgery, and often results in quicker recovery than an "open" method.

Bariatric surgery is currently the best choice for lasting weight loss in people who have severe obesity, after nonsurgical methods of weight loss have been tried but have not worked.

Potential candidates for bariatric surgery include:

• People who have a body mass index (BMI) greater than 35.
• People who have a BMI of 30 or more who have another serious weight-related condition, such as type 2 diabetes, sleep apnea, heart disease, high blood pressure, or osteoarthritis.

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

People who have 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.

Although not all risks are fully known, 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 eliminate sleep apnea.
• Decrease the workload of the heart.
• Lower cholesterol levels.
• Reduce the chances of osteoarthritis of the lower back, hips, and knees getting worse.

Surgery for weight loss is not for everybody. But these procedures can be highly effective in people who are motivated to follow their doctor's guidelines for nutrition and exercise after surgery.

There may be other reasons for your doctor to advise a restrictive gastric procedure.

As with any surgery, problems may happen. They include:

• Infection.
• Blood clots.
• Pneumonia.
• A bleeding ulcer.
• Gallstones.
• Obstruction or nausea when food is not well-chewed.
• Poor eating habits.
• Nutritional deficiencies.
• Scarring and adhesions in the belly (abdomen). These can lead to bowel blockage.
• Vomiting because of eating more than the stomach pouch can hold, not chewing food well enough, or eating food too fast.
• Heart attack or heart rhythm problems (arrhythmias).
• Stroke.
• Death.

In LAGB, the band can erode into the stomach or slip. This can block the flow of food under the band. Rarely, stomach juices may leak into the abdomen and emergency surgery may be needed. A common long-term problem with LAGB is that the stomach pouch enlarges.

After a sleeve gastrectomy, there may be heartburn or reflux. This usually is managed with medicines, but sometimes additional surgery is needed.

There may be other risks based on your specific health condition. Before the procedure, be sure to discuss any concerns with your doctor.

• Your doctor 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. It also gives your doctor permission to do the procedure. Read the form carefully and ask questions if something isn't clear.
• You'll have a physical exam to make sure you're 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 8 hours before the procedure, generally after midnight.
• If you're pregnant or think you might be, tell your doctor.
• Tell your doctor if you are sensitive to or allergic to any medicines, latex, iodine, tape, or anesthesia.
• Tell your doctor what medicines (prescription and over-the-counter) and herbal supplements you take.
• Tell your doctor if you have a history of bleeding problems. Also tell them if you are taking any anticoagulant (blood-thinning) medicines. These include warfarin, aspirin, ibuprofen, naproxen, or other medicines that affect blood-clotting. You may need to stop these medicines before the procedure.
• You may be asked to start exercising and change your diet a few weeks before the surgery.
• It's important to not become pregnant in the first year after this surgery, so you may get birth control counseling. Rapid weight loss during pregnancy can harm the fetus.
• You may be given a sedative before the procedure to help you relax.
• Based on your medical condition, your doctor may have other preparation instructions for you.

Restrictive gastric surgery sometimes means you'll have a stay in the hospital. Procedures may vary based on the type of procedure done and your doctor.

These operations need you to be asleep under general anesthesia. Your doctor will discuss this with you before surgery.

Generally, the following process happens:

1. You'll be asked to remove clothing, and you'll be given a gown to wear.
2. An I.V. (intravenous) line will be started in your arm or hand.
3. You'll be positioned lying on your back on the operating table.
4. If there is excessive hair at the surgical site, it may be shaved off.
5. The anesthesiologist will keep track of your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
6. The skin over the surgical site will be cleaned.
7. For a laparoscopic procedure, a series of small incisions (usually ½ to 1 inch long) will be made. For an open procedure, the surgeon will make a single larger incision in the stomach area. Carbon dioxide gas will be pumped into the belly (abdomen). This inflates the abdominal cavity so that the stomach and intestines can easily be seen.
8. For a laparoscopic adjustable gastric band procedure, a band is placed around the top end of the stomach, encircling it to create the small pouch. A narrow passage through the band will connect to the rest of the stomach. The band will be inflated with a salt solution.
9. 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.
10. Incisions will be closed with stitches or surgical staples.
11. A clean bandage or dressing will be applied, or skin glue may be used.

After the procedure, you'll be taken to the postanesthesia care unit to be closely watched as you wake up from anesthesia. You'll be taken to your hospital room after your blood pressure, pulse, and breathing are stable and you are alert.

You'll get pain medicine as needed. This will be either from a nurse or by giving it to yourself through a preprogrammed pump device connected to your I.V. line.

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

At first, you'll get fluids through an I.V. If you have a band, you might go home later that same day. That evening or the next day, you'll be given liquids, such as broth or clear juice to drink. As you are able to take liquids, you may be given thicker liquids, such as pudding, milk, or cream soup. This is followed by foods that you don't have to chew, such as hot cereal or pureed foods. Some surgeons recommend a liquid diet for 1 to 2 weeks. Your doctor will instruct you about how long to stay on a liquid diet and when it's time to progress to eat pureed foods after surgery. By 4 to 6 weeks after your procedure, you may be eating solid foods.

Pay attention to the size of the portions. Follow your surgeon's or dietitian's advice on what to eat, how much to eat, and how often. This will help you to lose extra weight.

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

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

Contact your doctor immediately if you have:

• Fever or chills.
• Redness, swelling, or bleeding or other drainage from the incision site.
• Increased pain around the incision site.
• Chest pain or trouble breathing.

After surgery, your doctor may give you other instructions, depending on your situation.

After you are back at home, it will be important to keep the surgical area clean and dry. Your doctor will give you bathing instructions. The stitches or surgical staples will be removed during a follow-up visit in a week or so.

Your incision and stomach muscles may ache, especially with deep breathing, coughing, and exertion. Take a pain reliever for soreness as advised by your doctor. Aspirin or certain other pain medicines called nonsteroidal anti-inflammatory drugs may increase the chance of bleeding and for ulcers to form in the stomach. Take only recommended medicines.

To prevent lung infections, keep up the breathing exercises used in the hospital.

Gradually increase your physical activity as you are able. It may take several weeks or months to return to your previous level of activity.

You may be told to stay away from lifting heavy items for a few weeks to months, depending on whether the operation was done laparoscopically or with an open method. This will help prevent strain on your stomach muscles and surgical incision.

Weight-loss surgery can be emotionally difficult because you'll be adjusting to new dietary habits and a body in the process of change. If your feelings are serious enough to interfere with daily functions, consider getting short-term counseling. Your surgical team can suggest resources.

You may feel especially tired during the first 4 to 6 weeks after surgery. Following the prescribed post-surgery exercise program and going to a support group may be helpful at this time.

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• What the possible side effects or problems are.
• When and where you are to have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What would happen if you did not have the test or procedure.
• Any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you will have to pay for the test or procedure.