- The
Adjustable Gastric Band System
- How
does the band work?
- Advantages
of adjustable Gastric Band
- Weight
loss after Adjustable Gastric Banding
- Adjustments
- Risks
Specific to Laparoscopic Adjustable Gastric Band
- Frequently
Asked Questions
Developed to aid
in long-term weight loss, the Adjustable Gastric Band System ha
s
been used by leading laparoscopic surgeons worldwide to
overcome severe obesity. Sustained weight loss with the Gastric
Band is achieved by reducing the capacity of the stomach
Frequently Asked Questions
| 1) Who
is a Good Candidate for Adjustable Gastric Banding? |
| A. You may be eligible for the lap band system surgery if : |
- Your BMI is ≥40, or you
weigh twice your ideal weight or are at least 100 pounds
(45Kgs.) more than your ideal weight.
- You have been overweight for more than
5 years
- Your serious weight loss attempts have
had only short-term success.
- You are not suffering from any other
diseases that may have caused your obesity.
- You are prepared to make substantial
changes in your eating habits and lifestyle.
- You do not drink alcohol in excess.
- You are willing to continue being
monitored by the specialist treating you
|
2)
Is Weight loss surgery risky?
A. Any surgery has a degree of risk and should not
be taken lightly. However Laparoscopic Adjustable Gastric
Banding is the safest of all weight loss surgery with lowest
complications because no cutting, stapling or rerouting of
intestine is involved. When you weigh the risks involved with
surgery against the risks of the co-morbidities that accompany
being over weight, the surgery is usually far less risky.
3) How
much weight will I lose?
A. This is not
predictable; most of the patients will never be skinny people.
But the majority can and do achieve a normal, healthy weight
for their height and bone structure. Success after bariatric
surgery is defined as losing 50 percentage of excess body
weight. After a Laparoscopic Adjustable Gastric Banding, one
loses an average 60 percentage of excess body weight at 18
months.
| 4) What are the main differences between the
Adjustable Gastric Band and the gastric bypass? |
| A. |
Lap-Band |
Gastric Bypass |
| |
|
|
Complexity |
Simple |
Moderate |
Reversibility |
Easier in general |
Reversible but moderately difficult |
Laparoscopic |
Yes |
Yes |
Relative Early Risk |
Lower |
Moderate |
Expected hospital stay |
1 night |
3-4 nights |
Mortality |
0.1% |
0.4% |
Statistical Average
Weight
Loss (2 years) |
50-60% of Excess weight |
70 -75% of Excess weight |
Possible Late-Term Risks |
Band slippage, port
complications, erosions, Lap-Band infection, esophageal
dilatation |
Ulcers, anemia, stricture, vitamin/
calcium / iron defeciencies, intestinal obstruction |
Risk of Malnutrition |
Minimal |
Low |
5)
With both these options, how do I choose the right one?
A. After educating yourself to all the
aspects of these operations you can decide with your surgeon
which is the best operation. Both the operations can be
performed laparoscopically in almost everyone.
The
Lap-Band requires significant post-operative manipulation, has
a re-operative rate that is high, but is the simplest
procedure to perform. The Lap-Band probably has the lowest
average weight loss and is a much slower weight loss than the
other operations. The operative mortality is the lowest of all
the procedures. There are occasional patients that do not lose
significant weight after this operation
The gastric bypass is the most
studied of all the bariatric operations. It is generally a
safe and effective operation. There is a higher early
complication rate than the Lap-Band.
6)
I have failed at so many other diet methods. Am I going to
fail at this?
A. Although we cannot make guarantees, unlike dieting where it
has been proven that 95% of people will regain any weight
lost, bariatric surgery has a long track record of success.
The Gastric Bypass achieves a similar weight loss of about
70-75 percent of excess weight. That means a women, who weighs
420lbs and has an ideal body weight of 120lbs would be
expected on average to lose 240lbs. Certainly some patients
will lose more. Other may only reach a weight loss of 150lb
(50% of excess).The Lap-Band has slightly less overall weight
loss at 55 percent, further, this weight loss occurs over a
slower period than the gastric bypass. However, the Lap-Band
is a more simple operation with less initial operative risks.
There are rare patients that do not achieve successful weight
loss.
7)
Will my medical problems improve after bariatric surgery?
| A. |
Disease |
Improved |
Resolved |
Arthritis |
47% |
41% |
High cholesterol |
33% |
63% |
Heartburn |
24% |
72% |
Hypertension |
18% |
70% |
Sleep apnea |
19% |
74% |
Depression |
47% |
8% |
Urinary incontinence |
39% |
44% |
Asthma |
69% |
13% |
Diabetes |
18% |
82% |
Headaches |
29% |
57% |
Gout |
14% |
72% |
|
So, your chances of losing significant
weight and improving your medical illnesses are very high.
8) What about my Quality of life?
A. person's quality of life is significantly
improved after weight loss. Aside from the medical
consequences of obesity, the social consequences are obvious
to anyone who is obese. Difficulty in sitting in seats
in airplanes, movie theaters and buses is embarassing.
Difficulties with simple acts such as tying shoes, and
difficulties with basic personal hygiene, are also common. The
most serious is the social stigmatization and prejudice
against obesity that is ubiquitous throughout almost every
society in the world. These consequences of obesity result in
difficulties in personal relationships and at work.
In one well-done study it was demonstrated that the
quality of life of patients who are severely obese is equal to
a person undergoing chemotherapy for cancer! Further, after
weight loss those patients' quality of life improved to the
level of the general population. Quality of life just three
months after weight loss surgery returns to normal!
9) Is it true that I'll never be able to enjoy
eating again if I have weight control surgery?
A. No. Patients who follow the guidelines to
eating after weight control surgery will become people who eat
food for quality and flavor, not for volume. They enjoy food
more after surgery than they did before surgery. They pay more
attention to what they are eating, are often pickier eaters,
and don't feel guilty about eating food.
10)
Are there foods I can no longer eat?
A. You will be on a liquid diet at first progressing to a soft
diet then to solids for the six week healing phase. When
properly adjusted, there are some foods that no longer are as
easy to eat but most of bandsters can eat anything, just very
small amounts. One can have trouble with soft mushy breads,
tough or dry meats, skins of certain fruits or vegetables such
as grapes, potatoes and tomatoes or very fibrous foods like
asparagus or pineapple.
11)
What should I be eating?
A. Protein and produce,
if it isn't one of those two items then it is something that
should not be part of your daily diet. Chicken and vegetables,
Beef and vegetables, Fish and vegetables, some fruit thrown in
there and a little dairy and you are good to go!.
12) What
happens if I overeat?
A. If
you overeat it will come out, it is just food so it isn’t
like being sick or vomiting. It is more like coughing up a
hairball. The experience teaches you to eat slowly, chew food
well and not to over eat.
13)
Why do I need to chew well?
A. Your stoma (the opening from the pouch to your stomach) is going
to be very small and large chunks of food, or poorly chewed food
could potentially plug the stoma. You will experience something
being stuck at one time or another. It is very uncomfortable but
not usually a dangerous situation. You will find yourself
salivating excessively as your body tries to dislodge the
offending material. There is a learning curve to being banded
and sometimes discomfort is necessary to the learning process.
14)
Can I drink alcohol or soda pop?
A. Alcohol is not a good idea because it is
a stomach irritant and is high in calories. It is always
better to consume solid food with daily 1200 calories rather
than drink them. However, one can have a drink occasionally.
Beer, soda pop or any carbonated beverage is not recommended
because of the potential to stretch your pouch. You may find
the carbonation very uncomfortable after you are properly
adjusted. However an occasional (once a week) drink may be
consumed in moderation.
15)
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.
16)
Will I be sick a lot after the operation?
A. The LAP-BAND System limits food intake.
If you feel nauseous or sick on a regular basis, it may mean
you are not chewing your food well. It could also mean you are
not following the diet rules properly. Another reason you
would feel sick may be that there is a problem with the
placement of the band. So you should contact your doctor.
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. That would
reduce the success of the operation. In some cases, it would
also require another operation.
17) Will I suffer from constipation?
A. There may be some reduction in the volume
of your stools. That's normal after a decrease in food intake,
because you eat less fiber. This should not cause severe
problems. It is suggested you take a mild laxative and drink
plenty of water for a while. Drinking plenty of water is a
good idea, anyway. Your needs will vary, but you should drink
at least 6-8 glasses of water a day.
18)
Will this operation cure my diabetes?
A. Probably. Most patients lose enough weight that they
no longer require any treatment for diabetes. The effects of
the operation in control of diabetes are very rapid - even
before significant weight loss! People most likely to be
completely free of insulin are those who have been diabetics
for less than five years. If your diagnosis of diabetes
was more than 10 years ago, your chance of being cured is 50%
with the remaining patients having marked improvement. On
average, after a weight reduction surgery, diabetic patients
will have normal fasting blood glucose and normal HbA1C with a
very significant reduction, if not elimination of their
medications.
19) What
about my gallbladder?
A. We take out patient's gallbladder only when
at the time of surgery, the gallbladder contains stones since
the risk of gallbladder removal is lower that the chance of
developing significant symptoms from gallstones. For people who
have gallstones and no symptoms, it has been shown that there is
a one percent per year risk of developing problems related to
the gallstones. After significant weight loss, patients who did
not have pre-operative gallstones have a 30 percent chance of
developing stones. If you take Actigall (bile salts) for six
months, your risk for gallstones is only three percent.
20) Will I need to take vitamin supplements?
A. You
may. It's possible you may not get enough vitamins from three
small meals a day. You may be advised to take supplements.
21) What about other medication?
A. You
should be able to take prescribed medication. You may need to
use capsules or 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. You should avoid taking aspirin or other non-steroidal
anti-inflammatory pain relievers. That's because they may
irritate the stomach. The problems these drugs may cause could
mean the band would need to be removed.
22) why
is exercise so important?
A. We prefer to call it
increased physical activity as ‘excercise’
sounds like something one has to do in a gym. Increased physical
activity is cumulative, you don’t need to walk the dog
5 miles in a day, start with 15 minutes once a day and gradually
increase as you feel able to handle it. You can also park
farther out in the lot at work to increase the walking distance,
get up and switch the channels rather than use the remote, stack
wood, vacuum or anything that involves motion. Look for
opportunities to increase your motion; as you lose weight and it
becomes easier to move find activities you enjoy.
Being physically active, more than “exercise”,
is important for maintaining the lost weight. Regular exercise
is, of course, helpful in losing weight and improving your
health. Becoming more active as the weight is lost will help
you realize the benefits of a healthier weight and increase
your long-term success. Look at increased activity as one of
the rewards for being successful with weight control. Being
able to walk upstairs without your knees and back hurting, and
without getting severely short of breath, is a great thing -
enjoy it.
23) When
I reach my goal weight do I need to remove my band?
A. No, most of the patients
plateau with weight loss when they get close to a normal
weight and stop losing. If you continue to lose beyond your
ideal weight, some of the fluid may be removed from your band
to stabilize your weight. Most banded people regain most if
not all of their excess weight if the band is removed.
24) What
will happen if I become ill?
A. One of the major advantages of the Adjustable Gastric Band
is that it can be adjusted. If your illness requires you to
eat more, the band can be loosened. This can be done by
removing fluid from it. When you have recovered from your
illness and want to lose weight again, the band can be
tightened. This can be done by increasing the amount of fluid.
25) If
I get pregnant will I be able to get enough nutrition for my
baby?
A. Many patients have
become pregnant after both gastric bypass and the
Lap-Band procedure. In fact, several studies have demonstrated
that significant weight loss can improve fertility and one
recent, excellent study from Australia :country-region>showed
that weight loss after the Lap-Band improves fertility in
morbidly obese women. There is also a syndrome called
Polycystic Ovary Syndrome (PCOS),that can lead to infertility.
This syndrome involves excessive hair growth and hormonal
changes that generally resolve with dramatic weight loss after
bariatric surgery. As far as getting enough appropriate
nutrition to have a safe pregnancy, this has not been a
demonstrated problem with either the Lap-Band or the gastric
bypass. However, you are recommended to consult with your
bariatric program nutritionist to be safe if you do get
pregnant.
In fact, all bariatric operation often
cured obesity-related infertility. Pregnancy is one of our
most common "side-effects." We strongly discourage
all women NOT to get pregnant in the first year after the
operation. This may cause significant fetal problems, as your
body may not have enough vitamins and proteins stores for the
both of you. After the majority of weight is lost and you are
nutritionally stable, pregnancy has been shown to be very
safe. Overall, there is no difference in fetal outcome after
having bariatric surgery when compared to the general
population; however, follow-up is very important to
ensure your nutritional status is acceptable to have a child.
26)
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 will mold itself around the new
body tissue. You should give the skin the time it needs to
adjust before you decide to have more surgery. However people
who lose excessive weight may require loose skin to be
removed.
