These produce a small stomach pouch of 15-30cc connected to the lower pan of the stomach by a narrow opening or ‘stoma’. The effect of these procedures is to limit the patient to a very small meal which empties only slowly through the narrow stoma producing a feeling of satiety lasting 3-4 hours. Total daily food intake is, therefore, vastly reduced.

In order to achieve a good weight reduction with these procedures, patients must be prepared to make sacrifices and to be disciplined in the way in which they eat. This is not an easy way out and the patient must be strongly motivated to lose weight otherwise they may not feel that the sacrifices are worth while. They must:

• Adhere to a diet of easily masticated foodstuffs such as cereals, vegetables and white meats. Red meat is difficult to eat and the diet can seem boring.

• Measure food volumes and eat no more than 5 dessertspoons of food per meal. To eat more may cause vomiting and may stretch the pouch.

• Chew each small mouthful of food to a pulp before swallowing otherwise the food pieces may block the stoma causing vomiting and pain.

• Avoid high calorie semi-liquid foods such as chocolate and ice cream as these liquefy and pass rapidly through the stoma, causing weight regain or preventing weight loss.

• Avoid solids when rushed or upset as vorniting is more likely in this situation.

• Take daily multivitamins and occasionally take iron if required.

With discipline, excellent weight reduction can be achieved with the average loss being 35kg and some patients losing much more. Two common methods used are ‘stapling’ and ‘banding’.

*212\186\4*