North Jersey Bariatrics

Support

After Surgery, it is very common for patients to experience a slight to significant sense of depression. “Why did I do this?”, “How did I let myself get to this point?” as well as second thoughts or feelings of regret. “I should have never done this!” “I want the band out!” These feelings are usually temporary and after the first post op visit once you realize the success you have had with weight loss will go away!

For those of you that are lucky enough to have a spouse or significant other to lean on, now is the time. If you are alone, Support Groups are a great way to share common experiences, meet new friends, and problem solve together.

Remember there are so many of you out there, experiencing and feeling the exact same way. You are not alone! Some patients feel more comfortable with chatting on line. There are a number of web sites that offer chats. Be extremely wary of people giving you hints on how to “beat the band” or how to cheat. These are destructive tips that will NOT help you.

In addition, we like to try to get our patients together in a type of buddy system. This can encourage participation in events like exercise or attendance at support groups. Successful patients love to tell their story and love to help others to achieve their goals. If you are interested, call the office and we will be happy to find you a buddy!

The most important thing to remember is to reach out if you feel you are struggling or not doing well. Call the office immediately and set up an appointment to discuss your concerns with the surgeon. Often times there is a simple solution to get you back on track. The surgeon, nutritionist, psychologist and exercise specialist are all here to help you. Take advantage of all and see how much you can benefit from their knowledge.

Managing Stress

Remember that surgery is only a tool to help you. The most challenging aspect is often the social and emotional changes that occur as you start your physical transformation. Please be aware that we offer several support groups throughout the month in addition to private psychological counseling to help you through this difficult time.

Plan Ahead for Challenging Situations

Overeating at parties is easy to do. Snacking is considered a bad habit after this surgery, so make “party eating” one of your meals for the day. Never munch directly from the bowl; instead, place food directly on your napkin or small plate and take only the food you are planning to eat.

Remember: You can’t eat more than a small child’s portion now. Look for the protein items first and supplement with other choices after you’ve eaten some protein. A party is not a good place to try a new food for the first time. You don’t want to end up sick or sleepy and have to go home ahead of schedule. Take time at get-togethers to socialize more and enjoy the people present.

The greater number of events, places, and situations that you associate with food, the more often you will feel like eating or perhaps feel deprived that you can no longer eat like you once did. Learn to focus on other things rather than food. You should eventually feel a sense of freedom from the drive to eat – use this opportunity to find new focus and enjoyment in life.

Learn to eat more slowly and deliberately to allow your body to feel the fullness and to digest your food better. When you eat too fast, you are at risk for overeating which can lead to pain. In addition, not chewing your food well enough could cause you to vomit. Old habits will have to be worked on until your new slow eating is your normal style of eating. Again, Support Groups can help you to deal with these issues.

Talk, Talk, Talk About It

Using assertive communication can minimize conflicts and provide healthier, happier relationships. Whenever you have a drastic life change (your new eating style, exercise habits, and much smaller body), your relationships will definitely change too. Helping them change for the better may require some vigilance on your part.

Be open when something bothers you by communicating with those around you. It will also help if you share your experiences with your significant other and develop your goals and plan of attack regarding your compliance issues (exercise, follow-up appointments, vitamin purchases, etc.) with them. Support groups help tremendously with these situations. Spouses are welcome and may learn that others might be having a hard time as well.

The commitment to have surgery is frequently a very private and personal decision. Having surgery is not something to be embarrassed about. Honesty is the best policy. Being frank about what you are doing and why could improve personal relationships.

Nevertheless, some people choose not to share this decision with others. Soon most people will notice your weight loss. Preparing an answer in advance often will help you out of an uncomfortable situation. Suggested remarks are:

“I’m exercising regularly, eating less, and drinking lots of water.”

“I’ve decided to take better care of myself and change some old habits.”

Body Image

Keep in mind that as your body undergoes changes in weight and size, it is likely you may not see your body as others view it. It takes time for your mind to catch up with what your body is doing. It is similar to the phantom limb phenomenon, where a person who has lost a limb continues to experience pain or feeling from the missing part, and in fact, feels they still have that limb. As you lose weight, you may actually be surprised when you see your reflection in a store window or mirror. You may not feel like that person is you! It is normal to feel like you are still the same size as you were before, but there are some definite ways to help you work through this:

• Take a picture of yourself every few weeks during your weight loss and compare the changes
• Try on clothes in a smaller size; you’ll be surprised how quickly you’ll be changing sizes
• Have someone point out a person in a public place who is about your current size so you have a new frame of reference
• Take measurements of yourself every few weeks and record the results
• Save an outfit from your pre-op size and try it on every few weeks or whenever you need a lift

Accept compliments graciously. Don’t minimize or qualify your weight loss; you have worked hard for the outcome you are being complimented for. Simply say, “Thank you.”

Points to Remember

Remember to focus on your internal assets, accomplishments, abilities and honorable qualities. We are not just our bodies.

Don’t judge anyone based on personal appearance and don’t allow others to judge you based on your body size.

Take time out for yourself and your body. Listen to your favorite music, read, start a garden, choose a hobby – all will enhance your quality of life.

Keep a journal of your thoughts, feelings, and dreams, which can assist you in targeting your great accomplishments. It feels good when dreams and goals are met. Journalizing your weight loss experience may help you appreciate it down the road.

Relaxation techniques provide relief from stress. Take time out for yourself each day. Soft music, a walk alongside the shore, watching your favorite comedy are just a few ways to relieve stress.

Exercise is a great stress reducer. It not only helps with toning and cardiovascular fitness, it also improves how you feel about yourself. Your skin will love it too!

Communication is the key for maintaining close, healthy relationships. Share yourself with those around you. Allow others to share their feelings also.

Exercise

Exercise is an extremely important part of any successful weight loss program. A lot of patients feel they are “too heavy” to exercise but most don’t realize that there are many different options for exercise. Not all activities put pressure on the joints and there are many programs that can be tailored to your weight and your individual goals.

Some patients feel embarrassed to go to a gym and work out next to “thinner” people. Again there are a large variety of gyms, some of which do not cater to the ultra thin.

Keep in mind, that as you start to lose weight and feel better you will notice your energy levels increasing.

Take advantage of this feeling and channel it into exercise. Any amount is better than none. There is no question that incorporating exercise will dramatically increase your results, and help you to feel better!

Exercise releases natural “endorphins” which make you feel good and may even prevent you from the desire to overeat. If you make exercise a regular part of your day, you will see how you can begin to manage stress better, sleep better and feel better about yourself while improving your overall health.

Consult with your physician and surgeon before starting any exercise program. You can discuss the different options with your doctors or our exercise specialists can help tailor a program to your needs at “The Gym” with or without the cost of a regular membership. If you have questions regarding this feel free to contact them directly or our office for more details.

If you prefer, Englewood Hospital offers private as well as group consultations with a physical therapist/personal trainer.  Custom made work outs can be outlined for you and done at your home or in the rehab facility at the hospital. You can contact Englewood Hospital directly or the office for more information on pricing.

Smart Eating

Eating after Bariatric Surgery is often something that scares people away from surgery. There is a misconception that you will never be able to eat “normally” again. That is simply not true. The goal is to have you eating small healthy meals that will provide you with the right balance of foods.

Obviously we do not encourage fast foods or foods high in sugars or complex carbohydrates. That is not to say that on special occasions you may never have a bite of cake. The idea is to limit it to special occasions and to eat in moderation. Keep in mind that some gastric bypass patients with dumping syndrome may truly never be able to tolerate sugars.

Learning to eat smart is a process that takes a certain period of trial and error before it is mastered. Most of us have had years of eating too quickly, not chewing our food and mixing food with liquids. To change these habits takes time. Some helpful hints are to use a toddler spoon and fork. That way you can only take small bites. Put your fork or spoon down in between bites. Do not eat “on the go” or under stressful situations, but rather look for a quiet, peaceful place where you can focus on your meal and the time it should take to eat it. Be mindful to chew your food until it is pureed in your mouth before swallowing.

Remember that the size of your “new” stomach (pouch), as well as the opening from the pouch to the small intestine, is much smaller than before surgery. Because your stomach size is smaller, you must eat and drink differently. The following is a list of things that will happen after surgery:

• All patients will progress through the 5 stages of the diet. Lap Band patients progress more quickly through the stages than gastric bypass patients.
• It is very important that you progress through the stages exactly as prescribed. Advancing too quickly can lead to serious consequences such as pouch disruption and delayed leak.
• DO NOT eat solid foods before the appropriate time!
• Your stomach will only be able to hold a few ounces of food at any one time.
• Beverages cannot be consumed during meals.
• Large pieces of food will not pass easily through the stoma (opening from pouch to intestine). You will need to choose soft foods and chew foods very well when your diet progresses to regular texture.
• Eat slowly. It should take at least 30 minutes to eat a meal.
• Food will empty from the stomach much slower than before the surgery. Because of this, you will feel full quickly and will stay satisfied longer.
• Start slowly and introduce one new food at a time.
• STOP eating if you feel pain, fullness, discomfort, nausea or vomiting. Occasional vomiting is common and food intolerances vary on an individual basis. If a food is not tolerated, reintroduce it a week later.
• You may experience changes in taste and appetite.
• You may not feel hungry or want to eat, but it is important to eat at regular intervals in order to recover from surgery and stay healthy.


Do Not Eat fatty foods

• Avoid high fat foods and foods with added sugar. These foods can cause Dumping Syndrome in Gastric Bypass patients.
• Protein is the most important type of food for your continued safe and healthy weight loss. Protein is essential for healing and ensures muscle mass maintenance during weight loss. Insufficient protein intake can result in impaired healing, hair loss, muscle wasting, dry and scaly skin, and poor resistance to infection.
• Consumption of starches (Bread, Pasta, Rice and Potatoes) should be limited. This can result in increased calories and fat storage.


Eat fresh fruit

• You should increase your intake of fruits and vegetables. Re-introduce raw vegetables slowly. Make sure to chew very well. Apples with peels and citrus fruits may not be tolerated at first.
• Drink at least 6-8 cups (48-64oz) of fluids daily to prevent dehydration.
• Gastric Bypass patients need to supplement their diets with a multivitamin plus iron, vitamin B-12, and calcium for the rest of their lives.
• Lap Band patients need to supplement their diets with a multivitamin for the rest of their lives. Calcium is recommended.

Helpful tips:

• Do not lie down after eating or drinking.
• Stop drinking at least 30 minutes before eating a meal.
• Wait thirty minutes after eating before you begin to drink again. Combining food and liquids together can result in bloating.
• Try not to eat for 3 hours prior to bedtime. This helps with digestion and prevents regurgitation.
• Eat a balanced diet as much as possible. Because the amount of food eaten at each meal will be small, it is important that they be high in nutritional value.
• If you plan your meals ahead of time and have the ingredients on hand, you are less likely to make poor food choices.
• It is best to prepare your own foods so you know exactly what you are eating. If a recipe yields too much food, you can either divide the recipe in half, or freeze leftovers in small containers to save for other meals.
• Use a thermos or chill your glasses in the freezer to keep your protein supplement cool while you are drinking it.
• Add some variety to your protein supplement by purchasing sugar free syrups (available at Vitalady.com) or adding 2 drops of Mc Cormick Imitation Extracts.
• Sometimes trapped gas can cause chest discomfort. You may try using Gas-X to relieve the pain. If it persists you must contact your doctor.
• REMEMBER to take your vitamins and supplements!
• Ice cube trays are handy for storing pureed food (each cube section is about one fluid oz).
• Baby warmer trays may be helpful for keeping pureed food warm while it is slowly being eaten.
• Colace (Docusate Sodium) is good for CONSTIPATION. You do not need a prescription. You should first make sure you are drinking enough water and eating enough fiber. For extreme cases you may take Milk of Magnesia.
• Do not swallow any pills whole. They may be crushed and mixed with sugar free applesauce. You may also use liquid forms of medication if available.
• If you are having trouble tolerating food, you may substitute solid or pureed foods with a protein shake.
• When advancing from liquid to puree or later on to soft food, you may experience problems with vomiting. This occurs with overeating, not chewing well or mixing liquid and solid food. If you do vomit, make sure you are not eating too much at one time and that you are chewing well. You must call your doctor if it persists.
• Food intolerances will vary on an individual basis. If you have a problem with a new food, wait several days before trying it again. Record any recurrent problems with new foods in a food diary. Bring this to your next visit with the physician and/or dietician.
• Gastric Bypass patients may also experience body odor. Devrom pills and capsules are available and may help with this. Call 1-800-453-8898 for more information.
• Alcohol may be consumed on occasion, however, it is very high in calories and sugar, and may cause dumping syndrome.
• Remember that the nutritionist is here to help you. Whether it is to review healthy choices, or ingredients, to understand what foods will give you the most energy or to meal plan in advance with you, she is there to help you! There are a number of books that focus on menus for bariatric surgery patients. In addition support groups or your buddy can provide a wealth of knowledge on what works or doesn’t work at different stages of the diet.

Post Operative Recovery

Life after Surgery can be an even more stressful time for patients than before surgery. Most patients are anxious and concerned that they are doing things “the right way.” If you have questions, we are here to help! You should never be afraid to reach out to the surgeon, nutritionist, psychologist or office staff with questions. The patient manual as well as our website has a lot of information but sometimes patients just feel better speaking with someone. Our mission has always been to provide a warm and caring atmosphere where patients feel supported. We especially try to encourage patients who feel they are not “doing well” to come in or call and discuss their concerns with the surgeon.

Follow up Visits

You should keep regularly scheduled visits with the nutritionist as well as with the surgeon. All patients are seen within 7 to 10 days after surgery.

Lap Band patients are then seen at 6 weeks and a minimum of monthly thereafter for the first year. At one year Lap Band patients will undergo laboratory tests to check vitamin and supplement levels as well as an UGI to check the placement of the band. After that patients are seen at least once a year or more often if needed/requested by the patient. Remember that adjustments to the band are absolutely essential to ensure adequate weight loss.

Gastric Bypass patients are seen at 3 weeks, 3 months, 6 months and yearly. Gastric Bypass patients will have their vitamin and supplement levels checked at 6 months and then yearly thereafter.

Keep in mind, that surgery is not the “easy way out.” This is a difficult process that takes time and commitment from you in order to be successful.

Regular visits with the surgeon are essential to make sure that your progress remains on track. It is important to always call the surgeon if you have concerns with abdominal pain, vomiting, and or fever > 101.0F.

Going Back to Work

This is often a difficult question to answer as different people experience pain and discomfort in different degrees. Most patients following laparoscopic surgery describe the pain as “muscle soreness” and not true pain.

Patients are sent home with narcotic pain meds and usually will need them for the first few days if only at night.

You will be allowed to drive 3 days after you return home from the hospital and as long as you are not taking narcotic pain meds.

There is a large variety in the time patients take to return to work often based on one’s own desire to return to work! In general most patients return to work after one week following laparoscopic gastric banding and 2 weeks following laparoscopic gastric bypass.

Keep in mind, that in the first two weeks, patients are often tired and weak as they are only consuming liquids and protein shakes. These feelings subside significantly once the puree diet is started.

Medications Post op

You should review your medications with your primary care physician and surgeon before surgery so you know which medications to take and which to stop before surgery. Following surgery you should review this list with your surgeon. Make an appointment within a few days after discharge to see your primary care physician as the need for certain hypertension and diabetes medications often changes pretty rapidly and you may feel symptoms. Certain NSAID medications including aspirin as well as contraceptive medications may not be restarted right away. Be sure to review this with the surgeon.

Sexual Activity/Pregnancy

You must use your judgement with resuming sexual activity following surgery. It is often best to wait for the first post op visit to ensure that you are feeling well and you have been checked by the surgeon prior to resuming sexual relations. Keep in mind, you should plan NOT to get pregnant for at least 18 months following gastric bypass surgery. If you have a Lap Band, you should let your surgeon know immediately so that the band may be deflated. For gastric bypass patients, you must let your OB/GYN know that you have had the surgery as you will be required to take additional vitamins and supplements to support the baby and your nutritional needs.

Plastic Surgery

All patients that lose a significant amount of weight, whether it is rapidly or slowly will experience some degree of loose skin. Exercise can definitely help especially to maintain tone but usually will not completely prevent loose skin. This is a very individual process and depends on the degree of damage to your skin. You should not plan to consider plastic surgery until you are close to your goal weight. If you are interested you may consult with any plastic surgeon you choose. Dr. David Abramson works with Dr. Vaimakis and all different types of surgeries are performed by Dr. Abramson with Dr. Vaimakis present. If you are interested you may contact Dr. Abramson directly to set up a consultation.

Finances and Insurance

Due to the increasing popularity and demand for Bariatric Surgery, most insurance companies look for any reason to deny coverage. In fact, some policies will specifically exclude Bariatric Surgery from their plan. In order to navigate through the system it is extremely important to understand what you are asking for and where to find it. It has been our experience that patients that call their insurance companies themselves are often given wrong information and sometimes even multiple different answers to the same question. For this reason, Sandra Bryant, our insurance specialist will take care of this for you.

Almost all insurance companies will want documentation of previous weight loss attempts whether it is from your doctor’s office or through a supervised program like Weight Watchers or Jenny Craig. Call your doctor’s office and obtain your medical records that have your weight documented. Obtain records from any specialist you may have seen such as your gynecologist, or orthopedic surgeon. Some insurance companies require 6 months of a medically supervised weight loss program prior to your surgery, so documentation is essential. Interestingly enough, there is no evidence in the literature that preoperative medically supervised diets have any beneficial impact on the success of your surgery. The insurance company, however; is counting on you getting frustrated and giving up. Don’t let them be right. The more information you have, the better.

The approval process can be long, tedious and complicated. Keep in mind, that every carrier has multiple different plans with different benefits and exclusions. In order to verify what specific plan you have, you must contact the office.

There are certain things you can do to help the process. If you are at all contemplating surgery begin to visit your doctor once a month and get started on a medically supervised diet plan. Once you have decided on surgery, schedule your appointment with the surgeon and let our insurance specialist verify your benefits. Keep in mind there is no charge for the initial consultation, so you have nothing to lose. If you don’t have insurance or have an exclusion, there are many different options for payment including financing plans.

Remember that this surgery can be lifesaving! Whatever work you may have to do now will more than be worth it in the long run.

The Process

Preparing for surgery

If you have carefully considered the risks and benefits and you would like to pursue bariatric surgery the next steps would be:

1. Attend a Free Informational Seminar

Informational Seminars are given a minimum of twice a month by the surgeon. They are limited to a small group in order for patients to be able to ask questions. You will have a chance to meet with the members of our team and learn, in detail, about the different types of surgeries available, as well as their risks and benefits.

2. Schedule an appointment to meet with the Surgeon

During your appointment, you will meet privately with the surgeon. She will discuss and review your medical history and any previous attempts at dieting. You will have the opportunity to discuss which operation is best for you and then review the risks and benefits of that procedure. Dr. Vaimakis encourages family members or supportive friends to attend these meetings as, this is an important aspect of your success.

3. Meet with the Insurance Specialist

It has been our experience that dealing with insurance companies is a complicated process. Sandra Bryant has over 20 years experience in this field and is knowledgeable in all aspects. She will handle this process for you in its entirety. She will be able to inform you of whether you have coverage for Bariatric Surgery, what if any copay you may have, as well as what if any copay you may have for the testing and consultations that are necessary before your surgery. If you don’t have insurance there are several payment plans and financing options that Sandra can make available to you.

4. Meet with the Surgical Coordinator

You will meet with Stella to discuss the necessary preoperative testing and consultations you may need. Dr. Vaimakis believes in making sure her patients are fully worked up and in the best possible condition to undergo surgery. There are a number of tests that all patients are required to undergo in addition to psychological and nutritional evaluations by our psychologist and nutritionist. Stella has made the process as simple as possible for you, and will provide you with a worksheet with phone numbers, locations, a space to keep track of your appointments as well as a timeline for when your tests are due. With many years of experience working with Bariatric surgery patients, Stella can answer any questions you have and will make sure that your surgery date becomes a reality.

In order for your surgery to be successful you must also commit to the following:

• Learn all you can about each procedure before making a decision.
• Discuss your decision with your family and/or supportive friend(s).
• Follow all instructions on preparing for surgery.
• Attend a support group pre-operatively, and commit to attending them post-operatively.
• Commit to improving your health by adhering to the diet and exercise programs prescribed both before and after surgery.

What to Expect

Risks and Benefits

All surgical procedures carry a certain degree of risk. Keep in mind that the risks must always be compared to the benefits obtained from weight loss and the improvement in health problems related to obesity. The overall risks of Bariatric surgery are low and most patients experience few, if any, complications. However, depending on your BMI, age, medical history and which operation you choose, complications may arise which can be serious and even fatal. It is important to discuss all these factors with your surgeon before you come to a decision if weight loss surgery is right for you. To minimize your risk, always look for a surgeon with a considerable amount of experience and remember that routine follow up with your surgeon is essential to diagnosing and treating complications in a timely fashion. In addition, Dr. Vaimakis believes that patients should notify her immediately if a problem such as fever, abdominal pain or nausea and vomiting occur.

In general the risks associated with Bariatric Surgery depend on the operation you choose.

Possible risks associated with Gastric Bypass can include, but are not limited to:

Complications

• Death
• Leak
• Stricture
• Intestinal Blockage
• Ulcer
• Bleeding
• Blood Clot
• Dumping Syndrome
• Vitamin and Supplement Deficiencies

Please speak with your surgeon to further discuss these risks and how they may affect you.

Side Effects unique to Gastric Bypass only include:

Dumping Syndrome

This occurs when food high in sugar or carbohydrates moves too quickly into the small intestine. It can cause nausea, sweating, palpitations, diarrhea and weakness. The good news is most patients avoid these foods at all cost!

Vitamin and Supplement Deficiencies

Since a portion of the small intestine is bypassed this is also the area where certain vitamins and supplements are absorbed such as calcium, vitamin B12 and iron. These supplements need to be taken for the rest of the patient’s life in order to assure adequate amounts. Levels will be routinely checked in the office to ensure compliance. Failure to maintain adequate levels can have serious consequences including but not limited to neurologic impairment.

Possible risks associated with Adjustable Gastric Banding (LAP-BAND) can include, but are not limited to:

Complications

• Slippage
• Erosion
• Stoma Obstruction
• Gastric Pouch Dilatation
• Access Port Problems
• Band Removal Due to:
• Complications, Intolerance
• or Inadequate Weight Loss
• Infection

Please speak with your surgeon to further discuss these risks and how they may affect you.

Some side effects that are common to both operations are:

Hair Thinning

Hair loss can be very alarming but keep in mind it is only temporary and will not lead to baldness. The mechanism is not well understood but relates to hormonal changes as well as protein intake and adequate vitamin and supplement levels. Along with ensuring enough protein in your diet, there are several additional over the counter vitamins and supplements that can be helpful in reversing the process.

Nausea and Vomiting

Most patients at one point or another will experience nausea or vomiting as they relearn the eating process. There are several helpful tips you must remember in order to avoid this. You must ensure that you are chewing your food enough. It should take you ½ hour to eat your food. You must not be drinking liquids at the same time as you are eating. Some foods may not agree with you and you may feel as though they are “stuck.” With time and practice, this can be avoided.

Benefits

The benefits of Bariatric Surgery are impressive. The difference between this and simple diet and exercise is that Bariatric Surgery has long term success. Patients are able to lose the weight but more importantly keep it off. Because of this, we see dramatic improvement in related health conditions.

In addition, many other conditions such as arthritis, skin infections, asthma, infertility and lymphedema can be improved.
There is an improvement in the ability to participate in physical and recreational activities.
The majority of patients notice improved social and economic opportunities.
Patients who may have suffered from depression or anxiety notice an improved sense of well being.

Treatment Options

The term “bariatric” is derived from the Greek word “baros” meaning “weight.” Bariatric surgery is surgically induced weight loss. There are three categories of bariatric procedures: restrictive (adjustable gastric banding, sleeve gastrectomy) which limit the amount of food one can eat and thereby decrease the calories consumed, malabsorptive (biliopancreatic diversion) which limits the amount of fat and calories absorbed and combined restrictive and malabsorptive (Roux-en-Y gastric bypass) which not only limits the amount of food consumed but also does not allow absorption of all the fat and calories from that food. All of these procedures can be effective in controlling morbid obesity. However, depending on which procedure you choose these are complex operations which can be associated with potentially serious complications.

Laparoscopic Gastric Bypass

Roux-en-Y Gastric Bypass

The Gastric Bypass procedure remains the gold standard for weight loss surgery in the United States. It has been practiced since the 1960’s, however with the introduction of laparoscopic or minimally invasive techniques, this operation has become extremely popular. The operation is performed under general anesthesia and combines both restriction and malabsorption.

The stomach is divided into 2 parts, a small (15 to 20 cc) stomach pouch which is roughly the size of an egg and a larger remnant stomach which are completely separated from each other. The small pouch becomes the “new stomach” and holds a very small amount of food. The small pouch is then directly connected to the lower small intestine with stitches. This creates “malabsorption” by not allowing food to pass through the remnant stomach and intestine thus not allowing for fat and calories to be absorbed.

The remnant stomach and intestine are not removed but rather will transport enzymes and digestive juices lower down to help with the digestion of food. The result is a sense of fullness after a small amount of food, followed by the inability to absorb all the fat and calories from the food.

“Lap Band” Adjustable Gastric Banding

"Lap Band" Adjustable Gastric Banding

The “Lap Band” was approved by the FDA in June 2001. It has been actively practiced in Europe and Australia for many years and is the gold standard for weight loss surgery abroad. This operation has become increasingly more popular in the United States and is in high demand due to its simple yet effective results.

Adjustable gastric banding is a “restrictive” operation, meaning that it works by limiting food intake but does not interfere with normal digestion. In this procedure, the band is wrapped around the upper part of the stomach, squeezing the stomach like an hour glass. This divides the stomach into two parts, the smaller part or “stomach pouch” sits above the band, while the lower larger part of the stomach remains below the band.

The two parts of the stomach remain connected through a narrowing created by the band. The band is attached to tubing which is attached to a small port that lies underneath the skin and fat. The port is not visible but can be felt with deep palpation.

On the inside of the band is a balloon. An important aspect of the Lap Band is that it can be adjusted in the office without requiring further surgery. By accessing the port with a fine needle, saline or (salt water) can be inserted into the balloon narrowing the opening between the stomach pouch and larger part of the stomach. The band thus restricts the amount of food you can consume at a single meal and keeps the food in the small pouch allowing digestion to occur slowly as food passes through the opening into the larger part of the stomach. This delay which is customized to each patient, allows one to feel fuller faster and remain full for several hours until it is time for the next meal.

The Lap Band requires general anesthesia, and is usually performed in one hour. Certain patients can go home on the same day but most generally stay in the hospital overnight.

REALIZE Band

REALIZE Band was FDA approved in 2007.

click image to enlarge

Realize Band works in the following way

•Wraps completely around the upper part of the stomach
•Designed for your safety and comfort
•One size fits all

REALIZE Injection Port
•Attaches to the abdominal wall
•Wide septum design to make band adjustments easier
•Minimizes bulge as you start to lose weight

•Molds the stomach into two connected chambers
•Strong, flexible silicone structure
•360° coverage on stomach for maximum comfort and minimal dysphasia
•Inside of the band has a soft balloon
•Balloon can hold up to 9cc of saline
•Low-pressure balloon design to reduce tissue trauma

•Injection Port is approx. ½” high to minimize bulge as you start to lose weight
•Injection Port can be fastened to abdominal wall in less than one minute to minimize a patient’s time under
anesthesia
•Injection Port fasteners are 66% stronger than sutures
•Top of the port has a sturdy silicone layer called a septum
•During band adjustments, saline is injected with a needle into the port through the septum

•Realize Band works in the same way as the Lap Band by:
•Creating a small, circular tunnel behind the stomach
•Inserting the band through the tunnel
•Locks the band around the stomach
•Connects tubing to the port
•Fastens the port to the abdominal wall
•Does not staple or remove any part of the stomach
•Does not reroute intestines

Each Realize Band comes with a personalized internet support system entitled:

Realize mySuccess™
•Allows you and your doctor to set goals and continuously watch your progress together – especially for the first three years
•Enables your doctor to step in precisely when needed to keep you on track
•Designed to help you establish a tailored progress plan and develop new healthy habits
•Personalized and interactive online tool available day and night

Sleeve Gastrectomy

This procedure is still considered investigational by some insurance companies. It is generally reserved for patients with higher BMI’s of 60 or > and can be used as a single procedure or as the first stage of a gastric bypass.

The operation generates weight loss by restricting the amount of food one is able to eat. The stomach is divided vertically and more than 85% of it is removed. This part of the procedure is not reversible.

The stomach that remains is shaped like a banana and significantly reduces the volume of food that can be consumed. The stomach restriction that occurs allows these patients to lose more than 100 pounds and in many patients more than 200 pounds. This weight loss allows significant improvement in health and effectively “downstages” a patient to a lower risk group.

Once the patient’s BMI is lower, they can return to the operating room for the “second stage” of the procedure.

Is Weight Loss Surgery for Me?

There are several factors to consider when deciding if weight loss surgery is right for you. The first is to determine if you are considered morbidly obese. There are several medically accepted criteria for defining morbid obesity:

1. Weigh more than 100 lbs. over your ideal body weight, or have a BMI of 40 or higher.

2. Weigh more than 80 lbs over your ideal body weight, or have a BMI of at least 35 and are experiencing severe health related conditions, such as: high blood pressure, diabetes, sleep apnea, high cholesterol.

3. You must demonstrate an inability to achieve a sustained healthy weight despite significant efforts at weight loss which may include diet, exercise and medications. Some insurance companies will require documentation of a medically supervised weight loss program in order to qualify.

4. You must be ready to making the necessary lifestyle and dietary changes. Remember that surgery is only a tool. It is not a “quick fix” and is definitely not the “easy way out”. Bariatric Surgery requires a commitment to a special diet, vitamin and mineral supplementation as well as a regular exercise program in order to be successful.

5. You must not have any untreated psychiatric conditions

6. You must be fully committed to the necessary follow up required. Both Laparoscopic Gastric Bypass and Adjustable Gastric Banding require regular follow up with the surgeon in order to remain safe and maximize outcome.