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Below you will find many questions about what you can expect with the
Lap-Band®. Use the following links to access questions about:
If you don't see the answers to your questions here, write them down and bring to
our next seminar. We will be glad to answer them personally.
Q: How is the Lap-Band® different from gastric bypass surgery?
A: The Lap-Band® is a silicone band that is placed around the stomach, creating a
small upper stomach pouch that prevents a patient from eating excessively. It is
only a restrictive device (not a malabsorptive one), and can be adjusted and/or
removed, if necessary. The procedure to place the band is done laparoscopically on
an outpatient basis, so our patients go home the same day as surgery in most cases.
Recovery is relatively quick - with patients returning to work and/or most normal
activities within 4-5 days. It is currently the least invasive form of bariatric surgery,
with a relatively low complication rate compared to alternate obesity surgeries.
(Read more about the Lap-Band® procedure) Gastric bypass surgery involves
permanently changing the shape of the stomach by surgically reducing (cutting or
stapling) its size to an egg-sized pouch, and then bypassing a portion of the
digestive tract with the new smaller stomach. This type of surgery has both a
restrictive and a malabsorptive effect, and unlike the
Lap-Band®, it is essentially
irreversible. Generally, gastric bypass patients stay in the hospital 3-4 days
following surgery, and recovery takes approximately 2-4 weeks. Due to the nature
of the procedure, gastric bypass surgery has a higher rate of severe complications
following surgery and a significant mortality rate.
Q: How overweight do I need to be to consider the Lap-Band®?
A: You should be at least 40-100 pounds overweight to consider the Lap-Band®
System. A better measure for determining your eligibility, however, is your BMI
(Body Mass Index), a calculation based on your height and weight (Click here to
calculate your BMI) The Lap-Band® is generally recommended for patients with a BMI of 35-60.
Q: Is the Lap-Band® surgery safe?
A: Yes. The Lap-Band® procedure is considered the least invasive bariatric surgery
available - offering fewer complications, less pain, less scarring, and a quicker
recovery than any other form of obesity surgery. However, you should discuss this
directly with your surgeon.
Q: Is this surgery performed using minimally invasive surgical techniques?
A: The Lap-Band® procedure is performed laparoscopically. The cameras and
instruments our surgeon uses offer superior visibility and access for precise
dissection of tissues and associated blood vessels. The operation is completed in a
relatively short period of time (approximately 1 hour) and with minimal blood loss.
The benefits of using these minimally invasive methods are that patients
experience less pain, easier breathing, minimal scarring and a quicker recovery.
However, any operation has associated risks, and complications can occur whether
the procedure is done "open" or laparoscopically.
Q: How many times have your surgeons performed the Lap-Band® procedure?
A: Our surgeons at Texas Gastric Banding are part of the American Institute of
Gastric Banding, and are very experienced laparoscopic surgeons. As a network,
they have performed thousands of laparoscopic procedures, hundreds of Lap-Band®
procedures and are all FDA-approved for Lap-Band® surgery.
Q: What is the average excess weight loss and improvement of related health
conditions for patients?
A: On average, Lap-Band® patients have lost about 50% of their excess weight
within the first year after surgery. Most of patients' associated medical problems,
such as diabetes, sleep apnea, arthropathy, or high blood pressure, have improved
or disappeared completely after their Lap-Band® procedure. Potential results and
weight loss expectations can be discussed in further detail with you during your
initial consultation.
Q: Do you have patients who are willing to share their Lap-Band® surgery
experiences, both positive and negative?
A: Yes, we encourage you to come to one of our FREE Informational Seminars where
you will be able to ask other Lap-Band® patients questions about their experience
with the surgery and our program, or we can provide you with some names and
phone numbers of patients who would be willing to talk to you about their surgery.
Q: How long will it take to recover after surgery?
A: If Lap-Band® surgery is performed laparoscopically at a day surgery facility such
as the Physicians SurgiCenter of Houston, patients typically spend less than 8-10
hours at the facility. It takes most patients 2-3 days to return to work and
approximately 2-3 weeks to resume all normal activities.
Q: What type of exercise do you recommend post-operatively?
A: Walking is great exercise to start out with following your surgery. After 6 weeks
you may do any exercise you would like - aerobics, bicycling, running, strength
conditioning, etc. Exercise is an important part of your post-surgery regimen, as it
will facilitate weight loss and contribute to your overall health and well-being.
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Q: How much weight should I expect to lose and how fast?
A: The amount of weight you lose and the rate at which you lose it dependent on a
number of factors in addition to the Lap-Band® itself, such as: your starting
weight, your post-operative diet, the amount of exercise you do, etc. On average,
however, patients have lost about 50% of their excess weight within the first year
of surgery. Most patients find they are losing between 5-10 pounds a month,
depending on their individual diet and exercise regimens. In general, it is not safe
to lose weight too quickly; a weight loss of 1 ½ to 2 pounds a week in the first
year after the procedure is possible.
Q: Will I still get hungry following surgery?
A: The Lap-Band® works best with solid foods to decrease hunger. Solid foods tend
to stay in the stomach pouch longer, giving you a greater sense of fullness and
satisfaction. Following surgery, you will begin by eating/drinking only liquid foods.
Therefore during this time you may feel hungry. However, most patients find that
they feel less hungry and more satisfied if they eat/drink the foods the
recommended number of times throughout the day. Once you begin to eat solid
foods you should feel very satisfied with significantly less food than you were
consuming before surgery. After 6-8 weeks post-operatively, if your weight loss
slows down to less than 1 pound a week, you may need to have a The Lap-Band®
Adjustment to tighten the band.
Q: What kind of post-operative medical care will I require and for how long?
A: You will be seen as often as necessary, of course, but we generally schedule you
for a post-operative follow-up appointment two weeks after surgery. Then you will
be seen at 1 month, 3 months, 6 months and 1 year post-operatively. In addition,
based on your rate of weight loss and your personal weight loss goals, your band
may require that you come in for band adjustments. Finally, we will have an
optional support group for Lap-Band® patients dealing with emotional and
psychological issues relating to body image, stress coping strategies, addictive
behaviors, etc.
Q: Will there be any medications that I can no longer take post-operatively or that I
will be unable to absorb properly?
A: No, you will be able to take any medication necessary. Unlike other bariatric
surgeries, the Lap-Band® will not affect your absorption so the effectiveness of
medication will not be diminished and/or affected.
Q: How many Lap-Band® adjustments will I need?
A: The number of adjustments (fills) you may need cannot be determined in
advance of your surgery. Some patients need one adjustment, while others need
two or three in the first year depending upon their individual response to the band
and the degree of weight loss desired. Generally, adjustments are not performed
until at least 6 weeks after your surgery.
Q: Are adjustments covered by my insurance company?
A: If you paid for your Lap-Band with cash, you have one year of adjustments
included in the cost of your Band. If your insurance paid for your procedure, we
will need to determine directly from your carrier as to their policy on payment for
adjustments. Typically, adjustments will only cost insurance patients their normal
co-pay, unless there is some exclusion in your policy that prohibits this type of
procedure. We will help you determine your particular scenario.
Q: How long will it take to have an adjustment?
A: The adjustment usually takes only a few minutes and you will be able to leave
the Center immediately following the procedure. You will be placed back on a
liquid diet for a few days following the adjustment in order to give your stomach
some time to adapt to the change.
Q: Will I be able to get pregnant after Lap-Band® surgery?
A: During the first year after surgery: A fast rate of weight loss during pregnancy is
thought to be harmful to the developing baby. Therefore, we would like for you to
use some form of contraception to avoid pregnancy during the first year following
surgery. If you become pregnant, however, during this first year, we will leave your
Lap-Band® in place without saline in order to ensure adequate nutrition for the
baby's growth. After the first year: Many women find it easier to conceive following
substantial weight loss. 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 can be made tighter again and you can go back to losing
weight.
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Q: What are the risks and complications involved with the Lap-Band® procedure?
A: Any gastric operation for obesity is major surgery and carries with it the risks
associated with any complex operation. And although the Lap-Band® procedure is
minimally invasive surgery, it is not without its own risks (laparoscopic surgery risks
include: spleen or liver damage, damage to major blood vessels, lung problems,
blood clots, rupture of the wound, esophagus/stomach perforation).
In rare cases, the Lap-Band® surgery cannot be performed using the less invasive
laparoscopic approach. For example, if unforeseen problems arise while attempting
to position the band, surgeons may have to switch to an open method. In addition,
there can be serious complications that may warrant the removal of the Lap-Band®
including:
* Slippage of additional stomach tissue under the band
* Erosion of the band into the stomach
* Infection and/or breakage of the injection port (rare)
* Gastric symptoms
While removal of the band can often be done laparoscopically, in some cases it may
require open surgery. Serious problems such as peritonitis, infection, leaks, and
long-term nutrition problems such as iron and vitamin deficiencies that are seen
with gastric bypass surgery do not occur with the Lap-Band®. Re-operation rates
for gastric bypass are significantly higher due to leaks, bowel blockages, outlet
scarring, ulcers, and bleeding.
Q: Does the Lap-Band® limit any physical activity?
A: The Lap-Band® does not hamper physical activity including aerobics, stretching
and strenuous exercise.
Q: How is the band adjusted?
A: Adjustments are preferably done with x-ray. They are done with x-ray so that
the access port can be clearly seen. Sometimes adjustments can be done in an
office, and local anesthesia may or may not be needed. A fine needle is passed
through the skin into the access port to add or subtract saline. The process most
often takes only a few minutes and most patients say it is painless.
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 not cause
discomfort or limit any physical exercise. The only sensation you may experience
from the port occurs when you go in for adjustments. If you feel persistent
discomfort in the port area, talk to your doctor.
Q: Can the band be removed?
A: Although the Lap-Band® System is not meant to be removed, it can be, in some
cases laparoscopically. Surgeons report that 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. You may also gain more.
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 as, sometimes the skin will mold itself
around the new body tissue. Give the skin the time it needs to adjust before you
decide to have more surgery. The slower weight loss associated with the Lap-Band®
makes skin removal less likely to be needed than with the gastric bypass.
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.
Q: Can I eat anything in moderation?
A: After your stomach has healed, you may eat most foods that don't cause you
discomfort. However, because you can only eat a little it is important to include
foods full of important vitamins and nutrients, as advised by your surgeon and/or
dietitian. 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® may be greatly
reduced or even cancelled.
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Q: What is expected of me if I decide to choose the Lap-Band® as a surgical
solution?
A: We expect that you will comply with each step of our program including the
pre-operative testing requirements, pre/post-operative diet and exercise
programs, band adjustments (as necessary) and follow-up medical appointments.
Q: Will my insurance pay for the Lap-Band®?
A: About 50% of insurance plans will cover the Lap-Band® procedure with a Letter
of Medical Necessity from our surgeon. However, you should check with your health
plan beforehand to find out if you are covered. Please read detailed information on
the insurance coverage process under "Insurance Information." Give them a call
and ask if they provide coverage for the "surgical treatment for morbid obesity
with a medical necessity." If your plan does not cover the Lap-Band® surgery, we
will be happy to discuss with you the more convenient "self-pay" option and the
financing programs available to help you manage the costs. Remember that even if
you pursue the self-pay option initially, you can still apply for insurance
coverage/reimbursement after you have had the surgery.
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Q: Does the Physicians SurgiCenter of Houston have gowns, beds and other
equipment large enough to accommodate me?
A: Yes, we perform the Lap-Band® procedure at the Physicians SurgiCenter of
Houston, a facility dedicated to the Lap-Band procedure. The facility is specially
designed, equipped and staffed to meet the needs of the Lap-Band patient.
Q: Are the anesthesiologists experienced with the unique needs of obese patients?
A: Absolutely! In keeping with our commitment to the highest quality care, our
surgery center only uses Board Certified anesthesiologists in the operating room,
all of whom are experienced in treating obese patints - never CNRAs / nurse
anesthetists.
Q: How long will I be in surgery?
A: Your operation will range anywhere from 45-90 minutes.
Q: Do you remove the gallbladder during surgery?
A: No, we do not remove the gallbladder on a routine basis unless we conduct a
gallbladder ultrasound and it indicates otherwise. Your surgeon will discuss this
with you further during your consultation.
Q: How soon and how often can I walk after my operation?
A: We encourage patients to walk as soon and as much as possible after their
surgery.
Q: How long will I need to stay at the Physicians SurgiCenter of Houston following
my surgery?
A: As the Lap-Band® surgery is performed on an outpatient basis, almost all
patients are released the same day as their surgery.
Q: Will I feel much pain after the procedure?
A: Patients are given pain medication for use at home following surgery. Most
individuals experience only mild discomfort, which is generally relieved by the pain
medicine.
Q: How long will I need to take off of work after my Lap-Band® surgery?
A: Usually about 4-5 days. Most patients feel some fatigue and weakness for 3-5
days but are able to return to normal functions after about 5-7 days. If you do
manual labor, you may wish to stay off of work a little longer.
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Q: Will I need to follow a post-operative diet after surgery? If so, for how long?
A: We will provide you with a post-operative diet and meal plan to follow for four
weeks after your Lap-Band® surgery. The diet will help decrease the initial
irritation and inflammation around the stomach and allow your band to "settle" into
place. At first, you will have only liquids in small amounts. Gradually, you will
progress from liquids to soft foods, eventually introducing solid foods back into
your diet. The transition to solids is slow and varies among patients. Eating must be
done slowly and should be stopped when you feel full. Only small portions at
intervals throughout the day are recommended. Eating too much at one sitting can
cause discomfort and/or vomiting. Our surgeon will meet with you before and after
the surgery to discuss the specific post-operative dietary restrictions and
recommendations in greater detail.
Q: Will my eating habits change after surgery?
A: Yes, your eating habits will change following Lap-Band® surgery. You will find
that you become full or satisfied after consuming a much smaller portion of food
than you did prior to surgery. It is important that you stop eating once you feel full,
as overeating can trigger pain and/or nausea. In addition, we recommend that you
eat slowly and chew your food carefully.
Q: Are there any specific foods or beverages that I should not eat post-operatively?
A: Before and after surgery, our nutritionist will review with you in detail the
post-operative diet you should follow as well as additional dietary
recommendations and restrictions, including: Food: Lap-Band® patients should NOT
eat any dried fruits, as they can swell in the stomach pouch and become stuck. It is
also recommended that patients avoid "fibrous" foods after surgery as they can also
get lodged in the small opening of the stomach pouch. Such foods include, but are
not limited to: asparagus, pineapple, rhubarb, corn (especially popcorn) and
grapes. Furthermore, nuts and seeds (walnuts, whole peanuts, almonds) appear to
be hard to digest for many patients. (Note: in general, Lap-Band® patients improve
their digestion if they learn to chew their food well, particularly meats.)
Beverages: Most liquids are fine, but patients should try to avoid carbonated
beverages as they can cause distension of the stomach pouch. In addition, patients
can help avoid feeling nauseated during the first 6 weeks post-operatively if they
avoid acidic juices (e.g., orange, grapefruit, lemon). Otherwise, we recommend
you eat a wide variety of foods and drink ten glasses of water every day.
Q: What nutritional supplements will I need to take post-operatively?
A: We recommend that our patients take a multivitamin with iron every day. In
addition, we suggest that our female patients also take a daily calcium
supplement. Because the Lap-Band® procedure is not a malabsorptive one, you
should enjoy the full nutritional benefits of the food that you eat post-surgery. The
volume of the food you eat will decrease, however, so you will need to be sure to
follow a nutritionally balanced meal plan.
Q: Will I get sick from eating sugar, natural or otherwise?
A: There are no problems with "dumping syndrome" after the Lap-Band® procedure
because your stomach and intestines have not been bypassed or significantly
altered. Gastric bypass patients, on the other hand, are instructed to avoid refined
sugar, which can cause dumping.
Q: What is the mortality rate for the Lap-Band® procedure?
A: The mortality rate is extremely low for Lap-Band® surgery, less than 0.1%.
Q: Have you ever had any patients die?
A: No, none of our patients have died.
Q: Will I need to have a blood transfusion during surgery?
A: No, most of the time blood loss is minimal.
Q: How will reflux / heartburn affect me after the surgery?
A: In recent studies, patient's reflux problems have improved after Lap-Band®
surgery. However, some patients may experience reflux during the early stages of
their recovery.
Q: Will I suffer any hair loss or other nutritional deficiencies commonly associated
with bariatric surgery?
A: No, unlike most other forms of bariatric surgery, the Lap-Band® is not a
malabsorptive procedure so your body's ability to metabolize vitamins and nutrients
will not be affected.
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