MR ADAM SKIDMORE
MBBS, FRACS
Upper Gastrointestinal and General Surgeon
Patient’s Name: (Affix Patient Label)
CONSENT FORM FOR REMOVAL OF GASTRIC BAND
You have agreed to have your gastric band removed. This will involve removing the band itself and the
stitches that anchor the band to the stomach. These stitches usually go from the pouch above the band
onto the normal stomach. The operation is generally done laparoscopically or through keyhole
surgery. At least five small incisions will be made. You will require removal of the port which will
require a 15 to 20 mm incision. This will be the largest incision. Most patients who have this
operation will be able to go home the following day and suffer from no complications. You can generally
eat and drink the next day and return to normal activity within seven to fourteen days.
There are instances, though, when these bands can cause intense inflammatory reaction around the
stomach and also cause intense scarring. This can result in difficulty removing the band. Sometimes
we can recognize when there has been damage to the stomach when we remove the band at the time
of the first laparoscopy and if this is the case, we will be able to place some stitches in the hole or
perhaps remove the part of the stomach that has the hole. This will be decided on the day. If this is to
occur, there is very little that needs to be done post operatively and you will follow the same clinical
course as someone who has no complication during the surgery. There are, of course, risks of bleeding
at the time of surgery and if this was the case, the worst case scenario would be an open operation. You
may require a blood transfusion as well.
The worst case scenario is an unidentified perforation or hole in the stomach. If this was to occur, it
would usually result in a return to the operating theatre either very early or after your first operation.
This would be to wash out the abdomen with sterile saline. We would then place a drain tube adjacent
to the perforation. If we can see the perforation, we can then stitch it or perhaps place a stapler across
it. This will, of course, mean that your recovery will be a little bit slower but in general if repeat
laparoscopy is done early, there is a good chance you will be able to leave hospital within three to four
days. In some instances, the damage may be so bad that an open operation may be required. This is
called laparotomy. This will obviously keep you in hospital longer and is more of a significant problem.
If we have to perform open operation or laparotomy, we will do this whilst you are under the general
anaesthetic and inform your family after the case has been performed. Some cases will need to go to
the intensive care unit.
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CONSENT FORM FOR REMOVAL OF GASTRIC BAND
Any surgery can be complicated by very severe complications including pneumonia, clots in the lung and
the leg and severe bleeding. All of these may require you to be placed into the intensive care
department. Sometimes a breathing tube is required to help you recover. In some instances, there
may be delayed perforation of the stomach which can occur up to a week later. This may be due to
adhesions or perhaps to lack of blood supply to a portion of the stomach. If this is the case, it will
require either radiological drainage of any fluid collections around the stomach or perhaps repeat
surgery. This is a very difficult time to operate and we will obviously try not to do this.
All in all these operations generally go very smoothly and very well and the recovery time is very quick.
Most patients are back to normal eating behaviours very quickly, however, there is the very small
chance and I would quote a figure of approximately one in two hundred cases that can go badly. This is
the same with any operation where we operate on previously operated organs.
If you have any further questions regarding removal of your gastric band, please make another
appointment to see me. If you are happy to proceed, please sign below.
Signed ………………………………………………………………………………
Date ………………………………………………….