Home Surgical Options Frequently Asked Q's The Medical Team

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What is New Weight Institute of Texas relationship with physicians I already see?
If your physicians have doubts about bariatric surgery we provide literature and attempt to educate them as to its merits. In any case we work with them to be sure that you are in the best shape you can be so that surgery may be safely done. Afterwards we send them a summary of your surgery and hospitalization with pertinent laboratory results and a letter describing your future needs as a gastric bypass patient.

How is laparoscopic gastric bypass different than open gastric bypass?
Laparoscopic gastric bypass is accomplished with 5 small incisions rather than one long incision. A camera is placed through one of the incisions and long instruments through the others. The operation is performed while watching a video screen. The actual operation on the stomach and intestine is the same with both approaches.

Is laparoscopic gastric bypass safe?
Many studies done by experienced laparoscopic bariatric surgeons have demonstrated laparoscopic gastric bypass to be safe. A study done by Dr. Oliak (see Description of Surgeries section) demonstrated the importance of surgeon experience. He found complication rates to be significantly higher during the "learning curve" for laparoscopic gastric bypass. Complication rates stabilize at a low rate after a surgeon completes approximately 75 laparoscopic gastric bypass operations.

How does laparoscopic gastric bypass compare to open gastric bypass?
Laparoscopic gastric bypass results in a shorter hospital stay, less pain, less scarring, and a quicker return to usual activities. Complications such as wound infections and wound hernias are nearly eliminated with the laparoscopic approach. The risk for serious complications (such as leak) is similar with both laparoscopic and open gastric bypass.

Why aren't all gastric bypasses done laparoscopically?
Laparoscopic gastric bypass is a difficult operation to learn to do safely. It also takes longer and is more expensive. The result is that most gastric bypasses in the United States are done open at this time. For most patients laparoscopic surgery is better (less pain, shorter hospital stay, less scarring, quicker return to usual activities). As more surgeons learn to do laparoscopic gastric bypass safely and patients demand it, more laparoscopic gastric bypasses will be done.

Is laparoscopic surgery right for me?
Laparoscopic surgery is a good choice for most people. People who have had previous bariatric surgery or surgery on the stomach are probably better candidates for the open approach. People with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.

Can the surgery be reversed?
Yes, but it would take another operation. No one, in my experience, has asked to have the surgery reversed.

What are the main risks of surgery?
Put simply the main risks are death and complications. Mortality risk is 0.5% or 1/200. The commonest causes for death are pulmonary emboli and infections. The commonest complications are wound infections, strictures, and hernias.

Are there long term risks after surgery?
Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur.

How long is the hospital stay?
About 3 days after laparoscopy and about 4 days after open bypass.

 
Is this surgery covered by insurance?
Many insurance companies cover this procedure, however, each insurance policy differs. Once it is established that you qualify for the procedure, our staff will work with your insurance carrier and submit all required information to expedite their approval process. This helps the patient in two ways. First, it eliminates the inconvenience of the patient having to deal with the insurance companies themselves. Secondly, the patient knows, in advance, what the insurance company will cover.

To discuss insurance or payment information, feel free to contact our office and speak with one of our knowledgeable staff members. Or, watch for our "Insurance/Payment Information" online page, coming soon. Unfortunately, many HMO's will not cover this procedure.

Will I have to count calories?
No, the diet is very simple. You eat animal protein with all meals in addition to vegetables and fruit.

Can I drink alcohol?
It is unadvisable to consume alcoholic beverages during the weight loss period, as alcohol digests to sugar. After goal weight is attained, you may drink moderately.

Will I ever be able to eat sweets again?
It varies. Most people have no difficulties, while others have a reaction to sweets.

Will I have a scar? Will vitamin E help?
Yes, there will be a scar. There is no scientific evidence that using Vitamin E will aide in healing scars, but some patients feel that it does help.

When can I swim?
You may resume swimming in 4-6 weeks.

What exactly is the 'program' after Adjustable Gastric Banding?
The program begins with the first call to our office. We know that people who are suffering with morbid obesity have gone through many "fad" programs, false promises, and 'diet industry' quackery, so we immediately want to dispel myths about morbid obesity and teach factual information about the realistic benefits and patient responsibilities related to choosing surgery for obesity. Our team has a high motivation for helping patients succeed post surgically. We define success as 80% of excess weight lost, with no major problems in quality of life and improved medical and psychological status.

So, the program actually begins before the surgery. We encourage our patients to become very involved in understanding the program, their personal commitment to have the Band, behavior and dietary choices BEFORE they are admitted in the hospital.

We strongly advise patients to attend our patient support groups before surgery, and we have a list of successful "veteran" patients with whom prospective patients can engage in private conversations. These pre-surgery steps help surgical candidates in many ways: the relationship between the patients and the clinical team is already under way and established on a sincere teamwork format, and the patient is more and more familiar with the surgery and the follow-up program. This later point is very important because with more understanding and trust, there is less fear for new patients and they are able to 'get' the necessary steps to improve their success following surgery.


The actual "Adjustable Gastric Banding", is generally basic, good health care strategies. You must follow a simple but consistent program of 10 rules;


1. Eat three meals per day, no skipping of meals. Each meal should last between 15-30 minutes.


2. In each meal you must eat a low fat animal protein, what we call a "High Biological Protein", for example, chicken, fish, turkey, lean meat. You may also have a fruit and a portion of vegetables. You should take a one-a-day multiple vitamin. These include vitamins and nutrient supplements. There are certain drugs that you must avoid, including all Non-Steroidal Anti-Inflammatory Drugs (e.g. Advil, Motrin, etc), and aspirin.


3. You may not drink with your meal. You must also allow a 30-minute window before and after your meal in which you do not drink any beverages.


4. Otherwise, you may drink to your preference, however, all beverages should be 'Zero' calories; therefore, no fruit juices, alcohol, or soups may be consumed. It is advisable to avoid gulping beverages.


5. You must eat slowly, and chew your food to a soft consistency.


6. All patients should participate in an exercise program, which is increased gradually, given the individual characteristics of patients. We encourage patients to begin walking in the hospital. This activity improves the recovery process by improving such factors as respiratory status, decreasing pain sensitivity after surgery, and increasing mobility. In the weeks immediately following surgery, we continue to support daily walking, gradually building up the time and speed of the walks. At this point we are beginning to introduce walking for aerobic benefits (exercise to increase Oxygen use, increase metabolic efficiency to improve weight loss results). Walking, treadmill, stationery bike, aerobics class are some of the most popular activities. Finally, several months after surgery, we advise patients to add in a moderate weight-training program, perhaps two sessions a week. This step helps patients maintain good lean muscle mass - in other words; body weight is lost from excess fat, not muscle. This fact is very important for maintaining general health status.


7. Success - losing massive body weight, improving related medical problems, feeling and being well AND maintaining your weight loss over many years requires at least 80 % cooperation with these guidelines and any special orders given to you by Dr. Jayaseelan. There is just no way around this fact. Our final guideline is to advise patients to attend every monthly team office meeting. This rule is incredibly important because it gives us all the chance to help correct little adjustment problems before they become crises, and it gives the opportunity for patients to have monitoring and help to really make the most of their surgery.

Even though the program may sound impossible, having the surgery itself makes these major behavior and dietary changes not only possible, but also very "do-able". With the help of the team, and successful prior patients, we build each step of change carefully, one after the other, to help you reduce anxiety, create a healthy outlook and adjust to new, permanent way of living with a slim and healthier self.

Will I be able to maintain my goal weight for many years or the rest of my life?
Yes! As long as you keep the commitment to the steps of the program to at least 80 % consistency, and keep a good relationship with your bariatric surgery team. Remember morbid obesity is a chronic disease process and you must maintain good healthcare practices, following doctor’s guidelines for the rest of your life.

I feel pretty discouraged and hopeless about my weight. I hardly ever go out, feel ugly have low self esteem. If I lose all this weight, how will my life change?
Of course, we can't predict exactly how your life will change after losing 100, 150 or 200+ pounds. That old motto, "everyone is an individual" is wise and true! We can ASSURE you that your life WILL change and the changes are very likely to be quite dramatic! Over the last few years that we have monitored our patients, we find that some of the major changes to be:

Improved physical status, for example: blood pressure, blood sugar and respiratory regulation, more energy, less body aches and pains, improved sleeping.

Improved psychological status, including decreased depression, improved self esteem, improved social skills, more confidence and realistic hope for the future.

Changes in relationship, including family, love relationships, friends and co--workers. In general these changes are positive and exciting. They are also demanding. In order to cooperate with our program, patients must really put their own health care choices first. This is very often a change for our patients, since many have felt depressed and hopeless they have given their own lives the lowest priority. Our patients have to learn to make assertive, healthy decisions for themselves, even when these decisions upset their loved ones. For example, they may choose to go on their exercise walk instead of sitting down and eating pretzels, OR they may have to deal with their spouse's jealousy or discomfort when they become increasingly attractive and independent.

Body image: Patients undergo incredible changes in how they see and feel their bodies. Losing 100 or more pounds creates drastic changes in body size, appearance, and related areas such as dressing choices, feelings of being attractive and sexy.

Accepting normal body image is sometimes a major challenge for obesity surgery patients! Even though wearing a size 8 dress may be a lifetime goal, some patients require some adjustment time to accept this reality, sometimes still "feeling fat", or worrying that they will gain weight back. We find that as more time passes and patients learn to become experts in managing the program guidelines with their individual lives, they experience more real success, and the new healthy body image becomes more comfortable and reliable.

What is Adjustable Gastric Banding (AGB)?
In the adjustable gastric banding method a band is applied around the stomach about 20 mm below the gastro-esophageal junction. On the inner lining of the band there is a longitudinal balloon (like a bicycle tire).

This balloon is through a small tube attached to a subcutaneous port. The band is left empty at time of surgery but is thereafter gradually filled with fluid by injection through the subcutaneous port. It is thus possible to vary the opening in the stomach after surgery.

The balloon band system can be regarded as putting a straight-jacket on the stomach. The band induces an early feeling of satiety and thereby decreases food intake. Our method as well as other methods for obesity surgery does not however change the basic patient behavior pattern. If the band is removed the weight will quickly increase to what it was before surgery. This means that the operation is not a definite solution to the patient eating pattern or the problem of morbid obesity. It however induces sustainable weight loss and therefore it leads to a healthier life with fewer risks for obesity related secondary diseases. How is AGB Performed?

In most cases the band is applied through laparoscopic surgery. The total experience in Sweden is now about 1000 cases. About 100 of these have been put in place using laparoscopy. The first patient was operated in 1985 and the method has since then developed gradually. Today we can expect that approximately 75% of the patients will loose 80% or more of their overweight within 18 months after surgery. Recent results indicate that weight loss is sustainable since most patients have the same weight at four years as at two years after surgery.

Are there any short-term side effects of the operation?
Vomiting
Most patients will once or twice feel pain or vomit after intake of food. This is in most cases caused by eating too much and too quick. If eating is slow and calm, patients will learn to listen to the signals from the stomach. Eating should be abandoned if the patient feels nauseated, have pain or vomits. Regular vomiting is a sign of warning. This can either be caused by wrong eating behavior or be caused by the outflow of the gastric pouch becoming too narrow. This means that the band may need to be adjusted. Regular vomiting should be discussed with the physician in charge and corrected.

Constipation
Many patients feel constipated after surgery. This is mainly caused by the fact that the reduced food intake leads to less feces and it is thus normal with fewer bowel movements. If laxatives become necessary, it is advisable to abstain from so called bulking agents and instead use liquid laxatives.

Hair loss
Many patients are suffering from increased hair loss during the first six months after surgery. This is also caused by the relative starvation. This, however, never leads to baldness and normal hair growth will eventually return. What complications may occur?
Adjustable gastric banding is well tolerated by most patients. Complication rates are low but this does not mean that complications are non-existent. The following is list of the complications that have been seen following this operation;

Infection
There have been a few cases of deep infection in the abdomen leading to removal of the band. There have also been some infections of the port system leading to removal of the port. Sterility during injection is obviously of great importance in order to minimize or avoid this complication.

Port Problems
There have been port problems in about 4% of the cases. There have been two types of problems. The first is dislocation of the port. It may move around, turn up-side-down and can in this position not be injected. It is thus necessary to adjust it. This is a simple operation in local anesthesia but nevertheless a nuisance to the patient. The second problem is perforation of the connecting tube close to the port. Some patients have extra fat over the chest and it is therefore sometimes difficult to hit the ”bulls eye”with the needle and the tube may be accidentally perforated. This leads to loss of fluid, widening of the opening and subsequent weight gain. This is also corrected in local anesthesia. The port is brought to the surface, a bit of the tube including the hole is cut off, and the remaining tube is reattached to the port and finally the port returned into position. The design of the system has because of this problem been changed. The distal 2 cm of the tube is now covered with a protective sleeve in order to avoid this problem.

What is the long-term success rate?
There are various reported success rates for different types of procedures and there is never a guaranteed 100% success rate.When is a person considered obese?
Recommended BMIs are in the range of 20 to 26. The "overweight" range is 26 to 27.3 for women, 26 to 27.8 for men, though some authorities peg the upper limit of overweight at a BMI of 30.

Most authorities say that "obesity" begins at BMIs above 30 for women and 30 for men. All authorities agree that anyone with a BMI over 30 is obese. According to these conventions, the woman who is 5' 0" and weighs 155 has a BMI of 30.14, and is obese.

Someone who is 5' 4" and weighs 155 has a BMI of 26.6, and is overweight, but not obese. Someone who is 5' 11" and weighs 155 is in the healthy BMI range.

Morbid obesity means being overweight to the point of being prone to disease. You are considered morbidly obese if you are more than double your ideal body weight or more than 100 pounds overweight.

I would like to know if after I have AGB surgery, how long would I have to wait to have children and then how can I increase the intake of my foods to nourish my child?
There is no problem with pregnancy and birth after obesity surgery. It is good to wait about 6 months so that you get over the first phase of rapid weight loss after surgery. There are no special dietary requirements after surgery. The rule is that the baby always takes what he/she needs. So, you can feel confident that there are no problems with pregnancy should you decide to have surgery. I am very concerned about possible complications with AGB.

The risk for initial postoperative complications is very, very low. Of course it exists - but so does being hit by a car while crossing the street.

The most important thing is not really the surgery itself. This is very straightforward and simple. The factor determining final outcome is the post-op. follow-up and patient compliance. The patient has to work with the band, listen to it and behave accordingly. Patients who fight the band are not doing as well as those who are compliant.

What is the true success rate without any complications?
About 85-90%. There are three reasons for failure. First, patient-related reasons: Some patients go over to liquid high-calorie diet (cream, ice-cream, chocolate etc.). Second, band failure (leakage, breaking etc.). Third, placement failure or dislocation of the band (slippage, pouch dilatation, wrong initial placement = surgeon error).

What is the total number of deaths you have had in your practice?
No deaths after either laparoscopic or open surgery.

Is there any scaring after surgery?
There is minimal scaring after laparoscopic surgery. However - if you loose 100 pound you may need a tummy-tuck. That produces a long scar along the entire abdominal midline.

Can the port used in AGB produce allergies or infections?
There are several different types of ports; basically they are either plastic or metal. Allergy to either of these two materials probably does not exist. I have never heard of it. If you have problems with the port it is therefore always due to infection. This may be anything from a very virulent to a very slow infection. If you once get bacteria in there it is very difficult to get rid of them.

I am confused regarding my eligibility for obesity surgery. I am a compulsive over-eater and have gained 80 lbs in the past 5 years. Dieting and exercise have not been successful.

I am on my way to becoming morbidly obese. Does it make sense that I have to develop serious health problems and/or gain 50 more lbs. to become a candidate? My BMI is 33.
The overall indication is that the weight should be so high that it statistically can be proven that the patient has a significantly increased risk of dying compared to a normal weight individual. There is a lot of statistics on this and it seems as if the body can compensate for an increase until you reach BMI 38. Thereafter the risk increases very rapidly. So - most health authorities in the world (including the FDA in the USA) are not recommending obesity surgery if you are less than BMI 38. There are some exceptions. If you have additional risk factors (that may be related to obesity) such as hypertension, diabetes etc. the authorities recommend surgery down to BMI 35. I have operated a patient myself who had a BMI of 33 but she had all of the above as well as some other serious complications. On the other hand, over BMI 38 the risk increases very rapidly.

Two months after surgery, I experienced some pain. I spoke with a doctor and it turns out it was my gall bladder! So I guess nothing to worry about. Sure was painful though. Now for sure I won't eat things I'm not supposed to! Is this common?
At a recent conference, a recent French study showed that about 20% of patients having undergone obesity surgery develop gallstones within the next 24 months. The French had looked at this problem in detail and their conclusion was that quick weight loss changes the balance between the various salts in the bile. The result is that the bile becomes supersaturated with cholesterol (obese patient have a lot of that!) and the cholesterol crystallizes and forms stones in the gallbladder. Many of us have seen this in patients but we have not had the numbers clear and there has never been such a good and detailed study about it before. An obvious discussion was of course if we should automatically take out the gall bladder in all patients undergoing obesity surgery. There was no distinct answer to this question. It is obviously of benefit in 20% of the patients - but in 80% you take something out without a real reason. So - this is a difficult ethical issue. The last word has obviously not been said yet.

Have you had many patients conceive normally and deliver without incident? Have there been any complications that you are aware of?
Having a child is no problem. It is in fact often easier to conceive after obesity surgery than before. One of the complications of severe obesity is irregular ovulation and irregular periods. Some women even loose their periods all together when they become real obese. So - absolutely no problem with having a child.

How does the body know when to stop losing weight? (I don't want to look anorexic)
Food is the same thing as gas in your furnace. If you have a bigger house you need more gas to heat it. If you have a small house you need less. So - every human being sooner or later reaches a steady state in terms of weight. You will continue to loose weight until your intake is equal to what your body is consuming. The smaller you get the less you consume, and eventually you stop loosing weight.

A friend told me that the reflux and heartburn I have now will be 10x worse after the surgery even if I eat the protein as suggested and the extremely small portions as my life style changes.
The heartburn you have right now is caused by reflux of gastric juice up to the esophagus. The acid in the gastric juice is not produced in the whole area of the gastric mucosa. It is produced in something called parietal cells. The upper limit of presence of these cells is about 2 inches from the gastro-esophageal junction. The band is placed above these cells. This means that the band actually prevents acid from running up in the esophagus. The second factor of importance is the hiatus (the opening in the diaphragm through which the esophagus goes up into the thoracic cavity). In most individuals the hiatus is tight and no gastric juice is allowed to pass up into the esophagus. In many obese individuals the hiatus muscle becomes slack - so reflux is actually a complication to obesity. When we perform gastric banding we usually tighten the hiatus muscle with a couple of sutures. The result of both these factors is that obese patient who have esophageal relux in most cases experience an instant relief of those symptoms after surgery. The hiatus is tightened and the band prevents the acid from running up. Reflux disease can occur later as a result of dislocation of the band. If the band moves down it comes below the upper limit of the parietal cells and acid is produced above the band resulting in reflux. This nowadays not so common and we always try to prevent dislocation of the band by suturing it in place.

Will my hair fall out?
You may have increased hair loss but it will come back once the weight has stabilized.

How soon after the surgery will I be able to start exercising? Will I be able to return back to work in 2 weeks?
Walking should begin right after surgery. After 4 weeks everything should be normal and you can resume, or begin, a regular exercise program.

Is the solution used for the filling the same for the LAP-band® and the Swedish band? Saline solution or a contrast medium?
There is no difference between filling a band with saline or a radiology contrast medium. The result is the same. The difference is just that if you decide to do an x-ray for some reason the band can be seen. So it is just for convenience. You do not really need fluoroscopy to do the filling, but some doctors feel more comfortable using fluoroscopy when doing the fill.

Does it mean that the intake of liquid water or others is forever restricted to a little at a time or do we at some point regain the ability to drink a glass of liquid in a usual and normal way?
No, it is just during the first 3-4 weeks after surgery. Later you can take more at a time, although you will have problems if you take a full glass in one big "gulp"! It will "return to sender", in particular if it is cold. Moderation is always the key word after obesity surgery.

Q. Is there anyone who should not have obesity surgery?
A. This surgery is obviously a very serious step. Patients with psychiatric conditions such as depression, bipolar disease, and/or schizophrenia should be under the care of a psychiatrist before they consider surgery. These conditions can become exaggerated by the body changes that are associated with weight loss. There are some medical conditions which make the surgery too dangerous to perform. These occur rarely but must be taken into account. If patients meet the eligibility guidelines that are outlined above, they are obvious candidates for success with this surgery.

Q. When can I return to normal activity?
A. You can resume normal activity within 4 to 6 weeks after your operation. Any pain related to the surgery should go away after 10 days or so. General fatigue can last from 3 to 4 weeks after surgery.


Q. When is surgery for weight loss considered successful?

A. Weight loss surgery is considered successful when 50% of excess weight is lost and the loss is sustained up to five years. For example, a patient who is 100 pounds overweight should lose at least 50 pounds; a patient who is 200 pounds overweight should lose at least 100 pounds. And they should be able to maintain loss successfully for the following five years. Ninety-five percent of patients reach that goal after gastric bypass surgery. Furthermore, 85% of gastric bypass patients go on to lose 2/3 or more of their excess weight. Seventy-five percent of patients attain the goal after vertical banded gastroplasty and the same is likely true for Lap-Band®.

Q. Are there any restrictions after the surgery like lifting and driving?
A. Yes. In the post operative period, especially while using any pain medication, we recommend that you do not drive. Depending on how well you are recovering from your surgery, lifting may or may not be restricted. Certainly for the first two weeks most patients are not comfortable enough to do any heavy lifting. After that, if all is going well, you can lift as tolerated.

Q: 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.

Q: 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. If difficulties do arise, check with your doctor. He or she may suggest 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.

Q: 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. Your surgeon may tell you to 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.

Q: Can the band be removed?
A: Although the LAP BAND® System is not meant to be removed, it can be. In some cases this can be done 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: 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: 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.


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. This can be done by removing saline 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 saline. If the band cannot be loosened enough, it may have to be removed.


Q: How is the band adjusted?
A: Adjustments are often carried out in the X-ray department. They are done there so the reservoir can be clearly seen. Sometimes adjustments can be done in an outpatient clinic or office. Local anesthesia may or may not be needed. A fine needle is passed through the skin into the reservoir to add or subtract saline. This process most often takes only a few minutes. Most patients say it is nearly painless.


Q: How much weight will I lose?
A: 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. In the U.S. clinical trial, 2% of patients gained some weight. 5% neither gained, nor lost weight (t5%). 61% of the patients lost at least 25% of their excess weight. 52% of the patients lost at least 33% of their excess weight. 22% lost at least 50% of their excess weight, and 10% lost at least 75% of their excess weight.
You should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Nausea and vomiting are only the most minor examples. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to 18 months after the operation, weekly weight loss is usually less. Remember that your main goal is to have a weight loss that prevents, improves, or resolves health problems connected with severe obesity.

How is the LAP-BAND® different from gastric bypass surgery?
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. (Read more about gastric bypass surgery)


What is the difference between the LAP-BAND® and the Swedish Band?
Both the LAP-BAND® and the Swedish Band are "Adjustable Gastric Banding" devices and function essentially in the same manner. We use the LAP-BAND® Adjustable Gastric Banding System because it has been approved by the FDA for use in the United States (June 2001).
How overweight do I need to be to consider the LAP-BAND®?
You should be at least 75-100 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.


Is the LAP-BAND® permanent?

No —although it is not meant to be removed, one of the unique characteristics of the LAP-BAND® is that it can be removed surgically in a manner very similar to how it was inserted (laparoscopically, using a few small incisions). Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may go back to your original weight.


Is the LAP-BAND® surgery safe?
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.


Is this surgery performed using minimally invasive surgical techniques?
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 is only as safe as the surgeon performing it, and complications can occur whether the procedure is done "open" or laparoscopically.

How many times have your surgeons performed the LAP-BAND® procedure?
Dr. Jay is a very experienced laparoscopic surgeon. He has performed thousands of laparoscopic procedures, hundreds of LAP-BAND® procedures and is FDA-approved for LAP-BAND® surgery.


What is the average excess weight loss and improvement of related health conditions for patients?
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.


Do you have patients who are willing to share their LAP-BAND® surgery experiences, both positive and negative?
Yes, we encourage you to come to one of our FREE Information Sessions 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.

What type of post-surgery support do you provide for me?
Our staff is committed to providing our patients support before, during and after their LAP-BAND® surgery. Following surgery, our surgeon will work with you to create a post-operative diet and exercise program designed to help you achieve the healthiest weight loss possible. We will also have you come to our office for follow-up appointments several times during the first year after surgery and annually thereafter. In addition, we offer our patients the opportunity to participate in post-surgery support groups and counseling.


What is expected of me if I decide to choose the LAP-BAND® as a surgical solution?
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.


Will my insurance pay for the LAP-BAND®?

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". 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.


I am interested in having the LAP-BAND® surgery, how do I learn more and start the process to see if I qualify?
Please call (972)763-0033 for an appointment
Pre-Operative Testing, Preparation & Procedure:


What are the steps I need to take prior to having LAP-BAND® surgery?
The first step is submit a completed Registration Form to us ,then a member of our staff will contact you to schedule a surgical consultation. If you are approved for surgery after your initial consultation, you will need to complete various pre-operative testing requirements. Once the results of all of the testing has been evaluated and medically cleared by the physician, your surgery date will be scheduled. Please note that the timing for the completion of these steps and the scheduling of surgery varies from patient to patient based on whether or not you are paying for the operation yourself (approximately 2 weeks) or seeking insurance coverage for the procedure (generally 6-8 weeks). To read about these steps in greater detail, please see our Patient Steps form.

What pre-operative tests maybe required?
We may require that you complete the following tests prior to surgery:
Complete blood count (CBC)
Electrocardiograph (EKG)
Upper GI


Do I have to follow a special pre-operative diet?
Our surgeon requires that you follow a no fat, liquid diet for 7 days before your surgery. The purpose of this liquid diet is to decrease the size of your liver, which in turn will make the placement of your LAP-BAND® safer.


Surgery & Recovery


On the day of my surgery, how much time beforehand do I need to arrive?
You will receive a phone call from a staff nurse the day before your surgery to review last minute pre-operative instructions with you and confirm your arrival time the day of surgery. Generally, we ask that our patients arrive at the Surgery Center 1 hour prior to surgery.

Does the Surgery Center have gowns, beds and other equipment large enough to accommodate me?
Yes, we has made a sincere commitment to our patients and made sure that everything in our surgery center accommodates your special requirements. As a result, we have customized beds, gowns, wheelchairs, operating room equipment and x-ray equipment designed expressly for obese patients. Furthermore, our nursing staff is fully trained to address the needs of overweight patients.


Are the anesthesiologists experienced with the unique needs of obese patients?
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 patients.


How long will I be in surgery?
Your operation will range anywhere from 45-90 minutes.


Do you remove the gallbladder during surgery?
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.


How long will I be in recovery following my surgery?
Following surgery, patients are monitored in a recovery room for approximately 3 to 6 hours before being discharged from the Surgical Center. Recovery times vary depending upon the individual patient.


Will I have respiratory therapy?

Yes, following surgery you will be asked to breathe in a tube every hour (incentive spirometry) until you are discharged.


Am I required to stay at the Surgery Center until I have a bowel movement?
No.


How soon and how often can I walk after my operation?
We encourage patients to walk as soon and as much as possible after their surgery.


How long will I need to stay at the Center following my surgery?
As the LAP-BAND® surgery is performed on an outpatient basis, almost all patients are released the same day as their surgery.


Will I feel much pain after the procedure?

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.


What types of pain management will you provide after surgery?

Generally we use liquid Lortab or Elixir for our patients. We offer alternatives for those who are allergic to these pain particular medications.


How soon after surgery will I be allowed to drink water?

You will be able to drink water the same day as your surgery.


How long will I need to take off of work after my LAP-BAND® surgery?
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.

Will I need to follow a post-operative diet after surgery? If so, for how long?
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.

Will my eating habits change after surgery?
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.


Are there any specific foods or beverages that I should not eat post-operatively?
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.


How many grams of protein should I consume post-operatively?
You should consume approximately 20-35 grams a day. (Gastric bypass patients need more protein to promote healing from the major surgery.)


What nutritional supplements will I need to take post-operatively?

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.


Will I get sick from eating sugar, natural or otherwise?

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: an unpleasant experience which can include sudden rapid heart rate, abdominal pain, cramps, sweating and diarrhea.

What type of exercise do you recommend post-operatively?
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.


Post-Operative Results, Adjustments & Follow-Up Care


How much weight should I expect to lose and how fast?
The amount of weight you lose and the rate at which you lose it is 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 2 to 3 pounds a week in the first year after the operation is possible, but 1½ pounds a week is more likely. Remember that your primary goal is to have a weight loss that prevents, improves, and/or resolves health problems associated with severe obesity.


Will I still get hungry following surgery?
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 LAP-BAND® Adjustment to tighten the band.


What kind of post-operative medical care will I require and for how long?
You will be seen as often as necessary, of course, but we generally schedule you for a post-operative follow-up appointment at the Office two weeks after surgery. Then you will see the surgeon 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.

How is the LAP-BAND® adjusted?
It is a quick and relatively painless outpatient procedure. You will be x-rayed during the procedure so that the band reservoir or "port" can be seen clearly. Then, a fine needle is passed through the skin into the port to add or remove saline. Adding saline tightens the band, further restricting the amount of food you can eat before you feel full and satisfied. Local anesthesia is used.


How many LAP-BAND® adjustments will I need?
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.


Are adjustments covered by my insurance company?

No, currently most insurance policies do not pay for band adjustments. If your insurance policy does not provide coverage for band adjustments, you will need to pay for this procedure yourself. For our cash-pay patients, the first year of adjustments are free, however, for all other patients, adjustments are $50-$250 each. Individuals who have had their surgery elsewhere will be charged $500.00 for each adjustment.


How long will it take to have an adjustment?
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.

What are the risks and complications involved with the LAP-BAND® procedure?
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.

The surgeon will review the potential surgical and/or LAP-BAND® complications in greater detail with you during your consultation. In the meantime, visit the LAP-BAND® manufacturer's Website for additional discussion of the risks and complications.


What is the mortality rate for the LAP-BAND® procedure?
The mortality rate is extremely low for LAP-BAND® surgery, less than 0.1%.
Have you ever had any patients die?
No, none of our patients have died.


Will I need to have a blood transfusion during surgery?
No, most of the time blood loss is minimal.


Will I have any problems with gas post-operatively?
Gas is common during the first post-operative week; some patients complain of "needing to burp, but nothing comes up". This problem can usually be alleviated by walking and drinking fluids as soon as you can after surgery.


How will reflux / heartburn affect me after the surgery?
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.

Will I suffer any hair loss or other nutritional deficiencies commonly associated with bariatric surgery?
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.

What will happen to me if I become ill?
One of the major advantages of the LAP-BAND® system is that it is adjustable. If your illness requires you to eat more, the band can be loosened by removing saline from it (it can also be removed if it cannot be loosened enough). Once you have recovered from your illness and want to start losing weight again, the band can be tightened again.
Administrative


Where are the operations performed?

The Surgery Center of Richardson ( 610 N. Coit Road ) and Medical City Dallas

What is the first thing I need to do if I am interested in the program?
The first step is to schedule a free consultation with our office. If you are approved for surgery after your initial consultation, you will need to complete various pre-operative testing requirements. Once the results of all of the testing has been evaluated and medically cleared by the physician, your surgery date will be scheduled. Please note that the timing for the completion of these steps and the scheduling of surgery varies from patient to patient based on whether or not you are paying for the operation yourself (approximately 2 weeks) or seeking insurance coverage for the procedure (generally 6-8 weeks).


How do I pay for the LAP-BAND® surgery?

You can either pay for the operation yourself upfront (self-pay), or you can try to get the procedure covered by your health insurance plan. If you decide to self-pay for the surgery, we have several financing options to help you manage the costs (please call our office at (972)716-9991, and we will be happy to give you this information). If you want to have your insurance company pay for the LAP-BAND®, you will need call our office at (972)716-9991, and we will be more than happy to file your paperwork for you. Please feel free to contact us to discuss either payment option.


How quickly can I get the LAP-BAND® surgery?

Self-pay patients have about 8 days from the date of their initial surgical consultation to the date of their surgery. Patients seeking insurance coverage for the procedure, however, generally wait about 3 to 8 weeks between the consultation and their surgery date due to the length of the insurance company's approval process.

   
Weight Regain
 
What causes some people to regain their weight?
Most often it is forgetting that weight control is a lifelong project. But obviously the genetic pressure to gain is greater in some than others and although we cannot currently recognize it the surgery may be better for certain types of obesity than it is for others.
Pregnancy
 
When is it safe to get pregnant?
Ideally, pregnancy should be delayed until weight loss is maximal, usually around 12 to 18 months after surgery. Weight loss makes women more fertile and decreases the likelihood of complications related to pregnancy.


How much weight should I gain?
Enough to account for the baby, the placenta, and some amniotic fluid-about 35 lbs. Ask your obstetrician.
Other Issues
 
How long after surgery before it is desirable to think about cosmetic surgery?
Results are best after weight loss has maximized-12 to 18 months after surgery.

Will I lose hair after surgery? If I do will it come back?
Hair loss is common and has never been conclusively related to any particular deficiency although many suspect that protein intake is important. If you do not have an ongoing tendency to baldness, it will all come back.

I don't have a support group where I live. What is the best way to stay in contact?
It is very important to try to followup with us at least once and better twice a year. At those times support groups can also be attended. We don't cure the tendency to gain excess weight; we manage it with discipline, support groups, accountability and sometimes adjunctive medications like ephedrine.


 
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