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Home Weight Loss Surgery FAQs

FAQIt is only natural to have questions and concerns regarding important decisions about your health. We have compiled these frequently asked questions to assist you in learning as much as possible about weight loss surgery.

 

GENERAL QUESTIONS

How do I get started?
You can get started by attending any of our free seminars. Our seminars are designed to enlighten all those interested or curious about obesity and surgery. This will help you decide if you should proceed with surgery or if you should take other steps to be fully prepared for surgery.

What can Dr. Eldridge and Dr. Holsaeter do for me?
We can give you the tools needed to make positive, healthy changes in your life. Our experience and expertise serve as the starting point for your journey toward a healthy and happy life.

POST-OPERATIVE QUESTIONS

Have there been any unsuccessful weight loss surgeries?
Each patient’s surgical experience is unique. The LAP-BAND® system requires effort from the patient to have proper exercise and diet habits as well as continuous monitoring by the attending physician. There have been cases where patients do not lose the weight expected but this is largely dependent on the person.

What will happen to my skin after significant weight-loss?
Many patients will experience excess, loose skin after experiencing significant weight loss. Each patient’s experience will vary. The factors that affect excess skin are:

1) Age: skin is typically more elastic in younger patients. A 30 year old female who is of child-bearing years, for example, may have less excess skin than that of a 50 year old female.
2) Amount of weight lost: a patient with 100 pounds lost may have skin that is better able to reshape itself than a patient who has lost 150 pounds.
3) Overall health of the skin: skin that has been well-maintained and properly cared for is more likely to return to original shape than skin that has been neglected.
4) It depends: any of the above factors can (and have) been proven wrong without evidence to the reason why. There are many 50 year old patients that have lost an extraordinary amount of weight that do not experience excess skin.

For those that do experience excess skin, they may choose to undergo reconstructive surgery to further tone and enhance their new figure.

 

FAQ – The LAP-BAND® System

Will I be nauseated or sick often after the operation?
The LAP-BAND® System limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. We consider vomiting as unacceptable. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation.

How long will it take to recover after surgery?
LAP-BAND® surgery is performed laparoscopically and patients typically spend less than 24 hours in the hospital. 95% of our patients go home on the day of surgery. We recommend that our patients take a week off from work, but most of our patients don’t. We have many patients that have surgery on Friday and go back to work on Monday. We have had several patients that underwent surgery and went back to work the next day, and even one patient that went back to work the same day, but this is against our recommendations. We recommend that patients do not resume exercise or strenuous activity for 4 to 6 weeks after surgery.

How much weight will I lose?
Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the pounds won’t come off by themselves. The LAP-BAND® is a tool to help you achieve weight loss and sustain that weight loss, but you have to use it to your advantage. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 1 to 3 pounds a week in the first year after the operation is what we aim for (4-12 pounds in a month). Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Losing weight faster often leads to a loss of muscle as well as fat. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.

How do the weight-loss results with the LAP-BAND® compare to those with the gastric bypass?
The studies involving the LAP-BAND® have shown that the results are exactly equal to that of the gastric bypass in terms of weight loss at about 3 years. With the gastric bypass, patients lose the majority of their weight in the first 18-24 months. Then they statistically gain 15% of the weight back, sometimes more (some gain all of the weight back). LAP-BAND® patients lose the majority of their weight in the first 3 years, but they do not gain any weight back unless they ask to have the saline removed from their band (deflate the band). You should focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health.

Does the LAP-BAND® require frequent office visits after surgery?
Check-ups are a normal and a very important part of the LAP-BAND® System follow-up. We see all patients in the office 1 week after surgery, then every 2 weeks for the first 6 weeks. Then all patients are seen on a monthly basis for the rest of the first year. When a patient is doing really well, we may let them go to 3 months. Then the patients are seen every 3-6 months for the second year (more if needed). Patients are then seen once a year for life (more if needed).

Does the LAP-BAND® limit any physical activity?
The LAP-BAND® does not affect or hamper physical activity including aerobics, stretching, strenuous exercise, or any other activity you choose.

How is the band adjusted?
Adjustments are performed in the office and in the X-ray department. They are done in the x-ray department for the first adjustment so that the access port and the relevant anatomy can be clearly seen. Adjustments are then performed in radiology when it has been 3 months since the last adjustment or if the patient is having any symptoms, such as reflux. Local anesthesia is used unless the patient requests that it not be used. A fine needle is passed through the skin into the access port to add or remove saline. This process most often takes only a few minutes. Most patients say it is nearly painless.

Do I have to be careful with the access port just underneath my skin?
There are no restrictions based on the access port. It is placed under the skin on top of the abdominal wall muscles, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.

Can the band be removed?
Although the LAP-BAND® System is intended to be permanent, it can be removed if necessary. In most cases this can be done laparoscopically. The stomach essentially returns to its original shape once the band is removed. After the removal, though, you may soon gain back your original weight or even gain more.

Will I need plastic surgery for extra skin when I have lost a lot of weight?
That is not always the case. As a rule, plastic surgery will not be considered until you are close to your goal weight (usually at a year or so after the operation). Sometimes the skin will conform back to its original tone. You should give your skin the time it needs to adjust before you decide to have more surgery. The real answer is that it depends. It typically depends on three things. First, it depends on how much weight you have to lose. If you weigh 500 pounds, there will just be too much skin and this skin will need to be surgically removed. Second, it depends on how old you are. The skin of people in their 20’s and 30’s simply has better skin tone and will often recover better than that of people in their 50’s and 60’s. And third, it depends on how quickly you lose the weight. If you lose the weight slowly and gradually, you give your skin the best chance of catching up and your skin is healthier. People who have gastric bypass or duodenal switch lose weight very quickly and their skin cannot keep up. Plus, they are losing weight so quickly (sometimes more than a pound per day in the beginning) that they are also losing muscle, not just fat so their skin has a tendency to hang. These patients are typically malnourished and their skin just isn’t healthy and therefore lacks normal skin tone.

Is it true that the LAP-BAND® seems “tighter” in the morning?
This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel “tighter” some of the time. Most patients do not have any problems at any time of the day. Some women have also noticed that the LAP-BAND® feels tighter during menstruation (their period).

Will I feel hungry or deprived with the LAP-BAND®?
The most important mechanism of how the band works is that it takes away hunger. The LAP-BAND® makes you eat less and feel full in two ways – by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel satisfied (not hungry). If the band is adjusted properly, you should feel full until your next meal. If you follow the nutrition guidelines when you choose your food and then chew it well, you will not feel hungry or deprived. Remember that the LAP-BAND® is a tool to help you change your eating habits.

What will happen if I become ill?
One of the major advantages of the LAP-BAND® System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. Without saline in the band, it is like it is not even there and people can eat whatever they want. When you have recovered from your illness and are ready to lose weight again, the band can be tightened again by increasing the amount of saline.

What about pregnancy?
If you have had problems with fertility, becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. The LAP-BAND® is the safest surgery to have if you are considering having children. If you need to eat more while you are pregnant, the band can be loosened (so that you can get adequate nutrition to the baby). After the pregnancy, the band may be made tighter again, and you can resume losing weight. It is not recommended that you become pregnant with any other weight loss surgery (gastric bypass, duodenal switch, VBG, or BPD) because there is no way to adjust these operations. Because you cannot take in enough nutrition to maintain yourself (losing weight), you cannot get enough nutrition to support a developing baby. Having any of these other surgeries places the pregnancy at “high risk.” There is a much higher risk of premature births, low birth weight, and birth defects.

Will I need to take vitamin supplements?
You do not need to take vitamins because your digestive system has not been altered physiologically (as in the gastric bypass). We do recommend that you take vitamins, however, because it is difficult to get the recommended daily allowances of vitamins with the typical American diet. At your regular check-ups, your primary care physician will evaluate whether you are getting enough vitamin B12, folic acid, and iron. [Please see nutritional guidelines in the program manual]

What about other medication?
You should be able to take prescribed medication. Most patients have no problems with taking medications, even a large number of pills. Rarely, some patients may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the band opening. You should always ask the doctor who prescribes the drugs about this. Please ask us if you have any questions.

What if I go out to eat?
Order only a small amount of food, such as an appetizer. Or order a regular meal and ask for a take out box when you order. When the food comes, immediately put half (or more) of it into the take out box. Many patients state that they often get two or three meals out of every meal at a restaurant. Eat slowly. Finish at the same time as your table companions. Some patients will let the host or hostess know in advance that you cannot eat very much (this is a personal choice, but you will be given a card that states that you have had the surgery). Some patients have told us that some restaurants will make small portions for people that have had weight reduction surgery. Some patients have also told us that many of the buffet restaurants will give a discount for patients after surgery (because you can’t eat that much). You must learn to change your perspective. You shouldn’t concentrate on the food when you go to a restaurant. Rather you should spend more time concentrating on the people that you are with, enjoying their company. And you should spend time taking notice of the décor and enjoying the atmosphere of the restaurant. We have many more tips for going out to restaurants, please ask us.

What about alcohol?
There is no restriction on alcohol. Having said that, just remember that alcohol has a high number of empty calories. It also breaks down vitamins. A glass of wine or two, or other alcoholic beverage, however, is not considered harmful to weight loss1. Many patients state that they feel the effects of alcohol with much less consumed than they used to (so they become “cheap dates”).

Can I eat anything in moderation?
After your stomach has healed (the band has healed into place), you may eat most foods that don’t cause you discomfort. However, because you will be eating only a small amount, it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition manual you will be given and as you are advised by your surgeon and/or dietitian. If you eat foods that contain a great deal of sugar and/or fat, or you drink liquids full of “empty” calories (such as milkshakes), the effect of the LAP-BAND® and your weight loss efforts may be greatly reduced.

Will I suffer from constipation?
There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you any significant problems. If difficulties do arise, let us know as soon as possible. [Please click her for more information on constipation]

ANSWERS FROM GEORGE FIELDING, M.D., LAP-BAND® SURGEON AND LAP-BAND® PATIENT, NEW YORK UNIVERSITY

I want to get banded, what do I do now?
You will need to attend an informational meeting to make sure this is a choice for you. Then fill out the paperwork required for that particular Doctor and send it to his office/liaisons. After that, you make an appointment and go for it.

Does health insurance cover this procedure?
Many insurance companies now cover the LAP-BAND® procedure. However, even companies that routinely cover the surgery may have groups and individual policies that exclude coverage for the treatment of morbid obesity. Be sure to check with your insurance company to see if you have such an exclusion. If you should be denied coverage you can “appeal”. 

It has been a few days since my Doctor has filed and I keep calling the insurance company and they say they don’t have any paperwork what should I do now?
Chances are, the group you are calling and the group that received the paperwork are not the same group. Take a deep breath and relax. Give it a few weeks. Then call your Doctor’s office. Proceed to call every 2 weeks until you have an approval—not every day. You will drive them and yourself insane.

I am approved, but I must do a liquid diet before surgery. What if I can’t do it? What does it do?
A Liquid diet is required by most surgeons prior to surgery. It is believed to shrink the liver and make the surgery easier on you and your surgeon (we want everything easier on the surgeon—trust me). You CAN do it. If you can’t, what the heck are you having surgery for? It is 1 week out of your life—keep your eye on the prize and go for it!

What is the difference between the LAP-BAND® and the Swedish Band?
From a strictly scientific point of view, both the LAP-BAND® and the Swedish Band function in the same manner. Obviously, our preference is the LAP-BAND® for a number of reasons:
1). Because it is currently the only band permitted by law in the USA.
2). The Swedish Band has been taken over by Johnson & Johnson, and clinical trials are currently underway for FDA approval, which could be one to two years away.
3). Behind the reputation of the LAP-BAND® is a solid multi-national American company, Inamed.
4). Inherent problems with the “mesh overlay” in the initial design of the Swedish Band contributed to an unusual number of erosion issues, requiring subsequent band replacement surgeries.

What are the advantages of the LAP-BAND® system over other bariatric surgery options?
o Minimally invasive surgery
o No cutting, stapling, and stitching like other surgeries
o Stomach stays intact
o Digestive process remains the same – food still passes through the lower stomach and the full length of the intestine (unlike gastric bypass surgery)
o Does not re-route the digestive tract
o Does not restrict the absorption of nutrients
o No “dumping syndrome” (sometimes seen with bypass surgery)
o Five tiny incisions in the abdomen (no large incisions)
o Band is adjustable – increases satiety and encourages patients to gradually eat less

What information is required to qualify as a candidate for LAP-BAND® surgery?
You must be age 18 or older (younger patients will be considered on a case-by-case basis), and at minimum 75 lbs. pounds overweight, or with a Body Mass Index (BMI) of 40+ to be eligible for this surgery (or a BMI of 35+ with significant co-morbidity). You should be in reasonably good health and your health information should include any current or past medical problems. Patients with severe and irreversible medical problems may be considered ineligible for this surgical procedure.

Does the LAP-BAND® system involve cutting, stapling, or stitching the stomach?
While other weight loss surgeries use cutting, stapling, and stitching to achieve their effect, the LAP-BAND® System procedure does not. No permanent changes are made to the body’s physiology. Instead, the surgeon wraps the band around the upper stomach to create a small pouch. The stomach stays intact, and the digestive process remains the same.

Can I have this procedure done having had prior gallbladder surgery?
Yes, providing pre-op tests do not reveal any other problems.

If I am allergic to medication, does this affect my eligibility?
Generally, being allergic to medication is not contra-indicative to surgery. But we should know what allergy it is.

What factors are key to successful weight loss with the LAP-BAND® System?
It is important that you have a good understanding of what is required from you with the LAP-BAND® System. We want you to have a thorough understanding of the procedure and care after the operation. Our experienced staff will assist you in learning about the procedure. Commitment to long-term dietary change is key to success with the LAP-BAND® procedure. You must be committed to following up with office visits according to the schedule set for you. You must be able and ready to follow your doctor’s advice on dietary changes.

What is the band inflated with?
Once in position, an adjustment is done by inflating or deflating the band with a sterile saline solution through the access port located just below the skin.

People have experienced stretching of a Gastroplasty or Roux-en-Y pouch, is this common with the LAP-BAND®?
It is not a common occurrence, and can be caught and remedied early on as long as you listen to your body, and have your adjustments done under fluoroscopy. With the LAP-BAND®, follow-up care is extremely important to monitor the band’s placement and position.

Can I expect post-operative problems with eating, or bowel movements?
After surgery, you will have to learn new dietary habits. While this new eating pattern is being established, you may expect some episodes of PB’ing (known as productive burping). You will be on a liquid diet for two weeks immediately following surgery, before more solid foods are reintroduced to your diet. Eating too much at one sitting, or eating improperly, can cause vomiting. Diarrhea is not uncommon during the first couple of weeks after surgery. While the anesthesia can often cause loose stools, the all-liquid diet for the first several weeks will generally result in diarrhea.

Is there any scarring after surgery?
Since laparoscopic surgery is minimally invasive, there is very little scarring. You will typically have 5 small incisions that usually heal quickly.

What are the risk factors during and immediately following LAP-BAND® surgery?
Any gastric operation for obesity is major surgery and carries with it the risks that would go with any complex operation. Although the LAP-BAND® procedure is minimally invasive surgery, it is not without its own risks. Infections can develop around the stomach band or at the site where the reservoir is placed under the skin. The access port or the band may leak and may need to be replaced (although this is very uncommon). While the risk of dying during the operation is small (about 1 in 10000), there is a slight risk because of either a heart attack or a life-threatening blood clot passing into the lungs (pulmonary embolism).

Will my heartburn or reflux get worse after the surgery?
Reflux usually reduces after weight loss surgery. Obesity can put extra pressure on muscles that lead to acid reflux. Losing weight may reduce reflux. Also, the position of the band can help prevent excessive stomach acid from reaching and irritating the lining of the esophagus, which can also help reduce the effects of reflux.

What are some of the complications from the LAP-BAND® System?
Complications are much less common than during the FDA clinical trials due to improved techniques. But the known complications include band slippage, band erosion, tubing leak, port infection, and esophageal dilation.

One final point:
It is important that you ask us any and all questions you have about obesity surgery and the LAP-BAND
® System.