FREQUENTLY ASKED QUESTIONS (FAQ)

Lap Band Surgery

Q: What is required prior to surgery?

A: I will organize a series of blood tests to check for diabetes, vitamin D and iron levels, as well as liver, thyroid and kidney function. If you do not already see an endocrinologist, I will arrange for you to be assessed by one to ensure that your health is optimal prior to surgery.

For 2 weeks before the operation I want you to adhere to an Optifast liquid meal replacement diet. This will result in severl kilograms weight loss, which is a good start. However, most importantly the early weight is lost from the liver and inside the abdomen. This can make surgical access to insert the LapBand much easier. It is very important that you adhere to this diet. Failure to do so could result in a need to convert from laparoscopic to open surgery.

Q: Is it always possible to insert the LapBand with keyhole surgery?

A: No. With any laparoscopic operation there is always the possibility that conversion to open surgery is required. Extreme obesity, enlarged liver or adhesions from previous surgery increase the chances of this occurring.

Q: Will I be sick a lot after the operation?

A: 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. 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.

Q: How long will it take to recover after surgery?

A: If LAP-BAND surgery is performed laparoscopically, patients typically spend less than 48hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.

Q: How much weight will I lose?

A: 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 correctly adjusted, and you need to be committed to your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the kilos won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of up to a kilo a week in the first year after the operation is possible, but slightly less than this is more likely. 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. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity. The aim is to keep the weight off.

Most people will lose 50-60% of their excess weight. Some lose less, some more. In my experience, the people who lose most are those who also adopt an exercise program, once the weight starts to come down. Those who lose less are generally people who have not attended regularly for band adjustments and who consume liquid calories.

Q: How do the weight-loss results with the LAP-BAND compare to those with the gastric bypass?

A: The results from Lap Band surgery are very similar to those from gastric bypass operations. The weight loss with a LapBand is slower, but there is little difference in the long term. The LapBand is safer than bypass surgery.

Biliopancreatic Diversion procedures (Duodenal Switch and Scopinaro operations) result in greater weight loss than a LapBand, but the risk of the surgery is higher.

Q: Does the LAP-BAND require frequent office visits after surgery?

A: Regular attendance for follow up is a very important part of the LAP-BAND System follow-up. The band needs to be adjusted to achieve the appropriate control of hunger. Regular advice on food choices and exercise is given. Having a LapBand involves a major life change and it is not possible to achieve this quickly. Poor eating habits and food choices, developed over many years have to be changed.

In general I will see you at 2weeks after the operation, then every 3 to 6 weeks for the next 6 months. The time interval between appointments then increases, depending on your progress.

Q: Does the LAP-BAND limit any physical activity?

A: The LAP-BAND does not affect or hamper physical activity including aerobics, stretching and strenuous exercise.

Q: How is the band adjusted?

A: Most times it is possible to adjust the band in my office. Sometimes it is not possible to feel the reservoir initially and adjustments will be done in the X-Ray Department. The reservoir has a “target” on it that can be seen under an X-Ray machine. It is important that all adjustments are done with a special needle which minimizes the chances of the reservoir leaking.

After the adjustment you will be given a drink of water to ensure that the band is not too tight. After the band has been tightened it is important to be extra careful about choosing small food portions, eating slowly and chewing your food well.

Q: Do I have to be careful with the access port just underneath my skin?

A: There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should cause little, if any 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.

Q: Can the band be removed?

A: Although the LAP-BAND System is not meant to be removed, it can be. In most cases this can be done laparoscopically. The stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight or even gain more. Unfortunately, experience tells us that weight gain is almost invariable when any weight loss procedure is reversed, no matter how long it is since the original surgery.

Q: Will I need plastic surgery for the surplus skin when I have lost a lot of weight?

A: That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin shrinks back and the appearance is quite satisfactory. You should give the skin the time it needs to adjust before you decide to have more surgery. If you do end up with unsightly loose skin, I will refer you to an accredited Plastic Surgeon if you wish to have it dealt with.

Q: Is it true that the LAP-BAND seems "tighter" in the morning?

A: 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. Some women have also noticed that the LAP-BAND feels tighter during menstruation.

Q: Will I feel hungry or deprived with the LAP-BAND?

A: 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 full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the LAP-BAND is a tool to help you change your eating habits.

Q: What will happen if I become ill?

A: 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. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.

Q: What about pregnancy?

A: Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band may be made tighter again, and you can resume losing weight. If you are trying to become pregnant, make sure you are taking a vitamin supplement before you conceive. Ideally, see your General Practitioner or come back to see me so that you can have your iron and folate levels checked.

Q: Will I need to take vitamin supplements?

A: I generally recommend this. It's possible you may not get enough vitamins from three small meals a day. A multivitamin in a small gel capsule such as Vitabdeck, Myadec or Pluravit is recommended. Completely soluble vitamins generally do not contain the full range of nutrients. Larger, non gelatine capsules, may get stuck in the band.

Q: What about other medication?

A: You should be able to take prescribed medication. You may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this. Remember to tell any doctor who is prescribing medicine for you that you have a LapBand so that smaller tablets, soluble drugs or syrups can be chosen.

Q: What if I go out to eat?

A: Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much. If you are at a restaurant, look at vegetarian options as these generally are unlikely to cause obstructions. Alternatively ask the kitchen to make you an omlette.

Q: What about alcohol?

A: Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.

Q: Can I eat anything in moderation?

A:  In the first two weeks after the operation only fluids are consumed. This is to ensure that nothing gets stuck in the band, making you vomit. Thereafter, you will gradually increase the consistency of the foods until all calorie containing foods are solids. Because you can only eat a little, it is important to include foods high in nutrition. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the LAP-BAND will be greatly reduced.

It is important that you consume adequate protein, fibre and vitamins. Calories are not really required as the whole aim is to force your body to burn the existing fat stores. It will only do this if there is no alternative calorie source for it to use. The body always prefers to burn carbohydrates and these should be consumed in very limited amounts. I recommend that you eliminate sugar, pasta, potatoes, rice and bread from your diet. Essentially I advocate a low fat, low carb diet. The difference is that long term adherence to such a diet is much easier when you have a properly adjusted LapBand as you will be much less hungry.

There are other foods that need to be avoided because they are likely to cause obstructions. Bread will nearly always cause a problem. Red meat or chicken will often be problematic unless it is first minced and then cooked as a small hamburger , meatball etc.

There is no question that having a LapBand significantly restricts your food choices. You need to be organized. You should drink prior to eating. You will probably find it difficult to eat and chat at the same time.

If you think that you could not cope with these restrictions , then it may be better to choose an alternative weight loss procedure.

Q: Will I suffer from constipation?

A: There may be some reduction in the volume of your stools, which is normal after a
decrease in food intake because you eat less fibre. This should not cause you severe
problems. If you are experiencing a tendency to constipation, I suggest a drink of Metamucil each morning.