Mclean, Laparscopic Vertical Banded Gastroplasty

Laparoscopic Vertical banded Gastroplasty (Mclean method)

The following information is for people who are having or thinking of having Vertical banded Gastroplasty (Mclean method) surgery. Your care may differ from what is described below as surgery is adapted to meet your individual needs, therefore it is important to follow your surgeon and his teams advice. For information regarding the surgeon and hospital, please click on Belgium under the destinations page Tab which is on he right side of this page.

Why a Vertical Banded Gastroplasty (Mclean method)

VGB also known as the Mclean Method is a type of weight loss surgery that works by making your stomach smaller The McLean method is one of the most stable and effective procedures for long-term weight loss. McLean Surgery sections off a small portion of the stomach to restrict food intake. A small outlet is left at the bottom of the stomach. Since the outlet is small, food stays in the pouch longer and you also feel full for a longer time.

The operation is done under general anaesthesia. This means you will be asleep during the procedure.

Depending on the surgical technique used, you will need to stay in hospital three days for the laparoscopic procedure and up to five days if open surgery is required.

Your surgeon will explain the benefits and risks of having a VGB (Mcleans), and will also discuss the alternatives to the procedure.

It is a trouble free procedure that requires little aftercare and maintenance. Once “fitted” it can be forgotten and the candidate has an easier time losing weight.

This method is purely restrictive, meaning that it is an operation simple in concept, which produces a small pouch within the stomach with a banded opening leading into the remainder of the stomach. Solid food makes the person feel full, whereas liquids tend to pass through much more easily.

Unfortunately, this operation does not produce as much weight loss as the Gastric Bypass, there tends to be a late weight gain and a common problem is vomiting because food does not pass easily through this small opening and therefore backs up. In addition, it has been found that another possible complication is a disruption or opening up of the staple line, so that food empties into the main stomach without passing through the banded opening.
Pre operatively

Prior to surgery you will need to complete a pre-admission medical history questionnaire. Your answers help the surgeon & hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment as well as evaluating your suitability for surgery. 

The day prior to surgery you will have your consultation with the surgeon, dietician and undergo all required pre-operative tests such as bloods, ECG if required etc. This is the time to ask any questions you have.

If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your surgeon specifically tells you not to. If you are unsure about taking your medication, please contact us or the surgeon. Please note that any tablets that thin the blood such as asprin should be stopped two weeks prior to surgery, it s good practice to speak to your GP as well as the surgeon prior to surgery regarding your medication.

On surgery day, you will be asked to follow some instructions.

• Have a bath or shower at the hotel on the day of your admission.
• Remove any make-up, nail varnish and jewellery. Typically, you must not eat or drink for six hours before general anaesthesia.
• You may be asked to wear compression stockings to help maintain circulation and prevent blood clots forming in the veins of your legs (deep vein thrombosis, DVT). You may also be given an injection of a blood thinning drug called heparin before surgery.
  Your surgeon and anaesthetist will visit you before the operation. This is a good time to ask any unanswered questions.

The operation

The surgeon sections off a small portion of the stomach to restrict food intake. A small outlet is left at the bottom of the stomach. Since the outlet is small, food stays in the pouch longer and you also feel full for a longer time.

Keyhole surgery

About five small cuts (one to two centimetres long) are made on your abdomen and chest. Your surgeon will insert a tube-like telescopic camera to view the area either by looking directly through this, or at pictures it sends to a video screen. Afterwards, the skin cuts are closed with two or three stitches.

Open surgery

A single cut (about 15 to 25 centimetres long) is made on your upper abdomen. Afterwards, the skin cut is closed using stitches and staples.

 
Post Operatively

Following your surgery you will be taken from the operating theatre to the recovery room, here you will come round from the anaesthesia under close supervision of the nursing staff.
After this, you will be taken back to your room or ward, where a nurse will monitor your blood pressure and heart rate at regular intervals.

You will need to rest until the effects of the anaesthesia have passed. If you are sore, you may need painkillers. Please inform one of the nursing staff of any discomfort you may feel.
For the first 24 hours you will only be allowed to drink clear fluids. After this your surgeon or dietician may start you on a liquid diet for several days, your dietician will go over this with you prior to surgery.

If you had open surgery, you may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from the wound. These drain fluid into another bag and are usually removed after a day or two.

You may have an intermittent compression pump attached to special pads on your lower legs. By inflating the pads, the pump encourages healthy blood flow and helps to prevent DVT.
You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs. You may also have a heparin injection to prevent blood clots.

Your surgeon will visit you to assess your progress and answer any questions you have about the operation.

You will need to make lifelong changes and follow a strict diet after the banding operation. Your dietician will have discussed this pre-operatively with you however she is available to give you more advice post operatively. Depending upon the aftercare package you have chosen back in the UK you will also have access to a dietician at home.     

Back at the hotel

Before you leave hospital, your nurse will give you advice about caring for the healing wound(s), hygiene and bathing. You will receive nursing care at your hotel until you return home.
After you return home

If you need them, continue taking painkillers as advised by the hospital. Remember to book your after care on your return, alternatively ensure that you have regular check ups with your GP to ensure your blood levels, i.e. vitamin and mineral levels are as they should be, you will be provided with a letter for your GP regarding your surgery before your return to the UK.

The risks and making a decision to have a VGB Mcleans surgery:

A  VGB is a major operation, for most people, the benefits in terms of losing excess weight are much greater than any disadvantages. However, the operation carries an element of risk. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful treatment. Afterwards, you are likely to have some bruising, pain and swelling of the skin around the healing wound(s) for a few days.

You may feel or be sick after eating, especially if you try to eat too much. If you eat sugary foods it can make you feel faint and sweaty.

Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any surgery include an unexpected reaction to the anaesthesia or excessive bleeding during or soon after surgery. A blood transfusion may be required to replace the lost blood.

Some of the complications specific to a VGB are listed here.

• Wound infection. Antibiotics are given during surgery to help prevent this.
• For up to six weeks after the operation, it is possible to develop a blood clot (DVT) in the veins in the leg. This clot can break off and cause a blockage in the lungs. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings, intermittent compression pumps and blood-thinning injections are used to help prevent DVT.
• During the operation other organs in the abdomen may be accidentally damaged. The points at which the intestine is re-joined could leak in the first few days. These complications are rare, but may need further surgery. 
• It is possible you may fail to lose sufficient weight or regain weight, and the operation may need to be repeated.
• Vomiting
• If you lose weight rapidly, there is a risk of developing gallstones in your gallbladder. These can be painful. Your surgeon may remove your gallbladder during surgery.

Your surgeon will explain how these risks apply to you. The exact risks will differ for every person.