Restrictive operations make the stomach smaller. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat-including smaller portion sizes and different foods-in order to lose weight. The most common restrictive surgery is adjustable gastric banding.

Stomach stapling (vertical banded gastroplasty)
In stomach stapling (vertical banded gastroplasty), an incision is made in the abdomen. Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. This pouch is not completely closed off from the rest of the stomach. A small opening, about 0.25 in. across, allows the partially digested food to move into the rest of the stomach and then into the intestines. The size of the pouch is small enough that you can eat only 0.5 cup to 1 cup of food before feeling uncomfortable.

Gastric banding
Gastric banding was approved by the U.S. Food and Drug Administration (FDA) in 2001.
In this operation, a small band is placed around the upper part of the stomach, creating a small pouch. As with stomach stapling, the small size of the pouch means that you feel full sooner. But the band can be adjusted in size by inflating or deflating the band. This allows the health professional to adjust the size of the opening between the pouch and the stomach.

These procedures can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach).

What To Expect After Surgery

Open surgery for stomach stapling usually involves a 2- to 4-day hospital stay. Most people can return to their normal activities within 3 to 5 weeks.

Preliminary studies note that gastric banding is associated with a short hospital stay, rapid recovery, and little risk of complications.1 However, follow-up studies are needed.

After these operations, you will be able to eat only 1 cup or less of food at a time. You must be careful to chew food well and to stop eating when you feel full. This can take some adjustment, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the pouch may stretch. If the pouch stretches, you will not benefit from your surgery.

You may develop nutritional problems and need to take vitamins.

Why It Is Done

Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher. Surgery may also be performed when your BMI is 35 or higher and you have a life-threatening or disabling condition that is related to your weight.

Your doctor may only consider doing surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or at least considered:

• You have been obese for at least 5 years.
• You have no history of alcohol abuse.
• You do not have untreated depression or another major emotional disorder.
• You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.