Frequently Asked Questions
Common Questions Regarding Lap Band Surgery
Q. What are the advantages of a Laparoscopic Gastric Banding?
A. The laparoscopic gastric band is performed through 4 tiny incisions, and 1 larger incision to accommodate the port. The Lap Band does not involve any cutting or rerouting of intestine, and therefore takes approximately 1 hour to perform. You should expect to be discharged the day after surgery. In certain cases you may be discharged on the same day. The Lap Band is adjustable and reversible.
Q. What kind of preparation is there before surgery?
A. You should avoid the “last supper” syndrome in the period prior to your surgery. This can lead to significant weight gain and greater difficulty in performing your surgery. We ask that patients stop smoking at least three weeks prior to your date of surgery. You are expected to start a clear liquid diet on the day before surgery. You may not eat or drink anything after midnight on the night prior to surgery unless otherwise instructed. If you are taking medications, please consult your surgeon or primary care physician for instructions on whether to take your medicine on the day of surgery.
Q. How long is the procedure and what is the postoperative care?
A. The procedure takes an average of one hour to perform but may vary depending on your BMI. The whole process from the time you come into the operating room to the time you arrive in recovery is longer to account for anesthesia and awakening afterwards. Therefore, your loved ones should expect to talk to the surgeon approximately 2 hours after you leave them. After the recovery room you will either go to the surgical floor or to the ICU. This will be determined by the surgeon and anesthesiologist at the time of your surgery.
Q. What happens the day after surgery?
Most patients are out of bed and taking 30 cc of water approximately every hour. You will be required to have an esophagram (xray of your esophagus and upper part of stomach) and will have to drink a small amount of liquid at the time of this test. The esophagram is performed to evaluate your pouch size, band placement, and flow of liquids through the band. Once your surgeon has determined that you are able to go home, you will be discharged from the hospital. You will be required to follow the dietary modifications as outlined.
Q. How about drains and wound care?
A. You will not have any tubes in your nose or your bladder. There are no sutures or staples to be removed. The incisions will be covered with Steristrips that should be left alone. You may shower 24 hours after the surgery and wash with warm, soapy water.
Q. Could there be complications from the surgery?
A. Yes! Although the band has less complications than a gastric bypass, there are several potential complications of the “Lap Band” that you need to understand. The band can slip out of place, allowing the pouch to become quite large and thus ineffective. You can avoid this by not overeating in the immediate post-op period. Early prolonged vomiting can lead to slippage.
The stomach can also herniate underneath the band, again allowing the pouch to enlarge. The band can erode into the stomach causing pain and discomfort. The port can become infected, and may need to be removed. Certain patients will experience delayed emptying of the stomach. This is especially true for male diabetic patients. This means that no liquid passes through the band because of swelling. If this happens, you will need to stay in the hospital for several days until the swelling resolves. If you have questions about the complications call the surgeon to discuss this further.
Q. Do some people not lose weight with the “Lap Band”?
A. Adjustable gastric banding is designed to result in a small gastric pouch, which limits the volume of food that can be consumed at any one time. Generally, it does not restrict fluid intake or the consumption of foods that “melt in your mouth”, such as sweets. People who eat small quantities of food throughout the day and those who consume large quantities of high calorie beverages will not experience adequate weight loss. In addition, the band NEEDS to be adjusted in order to work effectively. Without the adjustments the band may not allow you to feel the restriction necessary to result in feeling satisfied with small portions and thus lose weight consistently.
Q. What kinds of foods should I be eating?
A. The day after surgery you will begin a clear liquid diet (Stage 2). The day after you return home, Day 2 after surgery, you will progress to protein shakes (Stage 3). This will continue for two weeks. You will then begin soft foods (Stage 4) and continue for the next three weeks. At week five, you will start solid food (Stage 5). You should make an appointment to see the surgeon one week after you have started solid foods. You are required to meet with the dietician prior to starting each new stage of your diet.
Q. Will insurance cover surgery for morbid obesity?
A. Every insurance company has its own policy regarding this. If you decide to go ahead with surgery, our staff will work with you and your insurance company to obtain the appropriate precertification approval. You need to familiarize yourself with your individual insurance policy in order to provide our office with essential referral forms and other information necessary to expedite the preoperative process, however we will take care of the process for you. You will not be required to call your insurance company or send in any information regarding your precertification.
Q. What can I expect at my first visit?
A. Your first visit will be a consultation with the surgeon. You will be questioned regarding your medical history. Detailed information will be necessary regarding previous attempts and failures at weight loss programs. We would like you to bring a list of the medications you are currently taking. Patients who wish to proceed with surgery will be given a list of required tests that need to be completed prior to surgery. These tests can all be done here or if necessary, they can be done at an institution close to your residence.
Q. What can I expect if I decide to go ahead with surgery?
A. The preoperative process usually takes four to eight weeks to complete. You are required to arrange a subsequent appointment at the office to review the results of your tests as well as to discuss the surgery and sign the informed consent forms. At this visit you should be accompanied by a family member, spouse, or significant other who will be your support system before and after surgery.
Q. Are there special instructions for the one to two weeks before my surgery?
A. We recommend that patients who smoke refrain from smoking for three weeks prior to surgery because of the increased risks of pulmonary complications. Patients who take Aspirin, Motrin, or Motrin-like products, Aleve, or special non-steroidal drugs for arthritis or joint pain must stop these 3 days before surgery. These medications interfere with blood coagulation. Failure to recognize this will result in increased blood loss during the surgery. Tylenol is safe to take.
We encourage patients to maintain a healthy, well balanced, low fat diet prior to surgery. It is absolutely necessary to avoid binge eating in the days prior to surgery. Failure to do this can result in increased size of the liver, complicating the surgical procedure. We also encourage patients to avoid alcohol for two weeks prior to surgery.
Q. What is Pre-Admission Testing?
A. Patients are required to visit the Hospital at which they are having surgery several days prior to the scheduled surgery date. During this visit, patients will meet with anesthesia and nursing personnel. Additional testing, including blood work may be done during this visit to complete the preoperative preparation.
Q. What can I expect the day of surgery?
A. Patients must take nothing by mouth after midnight the night before surgery. You may brush your teeth and rinse with a small amount of water. Anesthesiologists may give specific directions for medications either the night before or the morning of the surgery. Patients are expected to be in the Admitting Office of the Hospital two hours prior to their scheduled surgery.
Q. What will my recovery be like?
A. Immediately after surgery, patients are taken to the Recovery Room where they are closely monitored. The surgeon will meet with families immediately after surgery at the family waiting area near the Operating Room. If families are not present at the conclusion of surgery, a call to a family member can be made at your request.
Respiratory support is continued until patients demonstrate that they can breathe spontaneously and sufficiently to maintain adequate oxygen levels in the blood. The breathing tube may result in a minor temporary sore throat after its removal. Patients usually stay in the recovery room approximately 2 hours and are then sent to their hospital room or in the case of same day surgery, sent home. Family members are usually allowed to visit the patient for a few minutes while in the recovery room. Pain is usually minimal and controlled with IV medication or pain pills. Patients are sent home with a prescription for narcotic pain meds for the first few days.
Q. How many days will I be in the hospital?
A. You should expect to leave the hospital the day after surgery unless you have arranged to be sent home on the same day. If you would like to be sent home on the same day, you must discuss this with the surgeon ahead of time so that appropriate arrangements can be made.
Q. When will I be able to drive?
A. You may drive 3 days after your surgery date. After that, it is okay as long as you feel up to it and you are not taking narcotic pain medications.
Q. Will there be any discomfort after my surgery?
A. You can expect some incisional discomfort beginning immediately after surgery. The pain will diminish each day. You will be discharged on oral narcotic pain medication, if necessary. Otherwise you may take Extra-Strength Tylenol.
Q. Can I take over-the-counter medications after my surgery?
A. Yes. Most medications are safe to take after surgery. Tablets or capsules larger than half an inch must be broken or dissolved during the immediate postoperative period. Aspirin, Motrin, and Advil are to be avoided except under rare exceptions because of ulcer risk.
Q. How soon after my surgery can I return to work?
A. The answer to this is variable. The average employer allows up to six weeks for recovery time following upper abdominal surgery through an incision. Most “Lap Band” patients who are motivated are able to return sooner. On average, “Lap Band” patients return to work in one week.
Q. Are there long term problems from the surgery?
A. The “Lap Band” does not create the same long term nutritional problems as the Gastric Bypass. However, because you will be on a restricted diet, you need to take a multivitamin. Although the “Lap Band” is theoretically reversible, it is intended to stay in place even after you have lost your desired weight. Removal of the band can result in subsequent weight gain. Other complications such as slippage and erosion may also occur and will need to be evaluated by your doctor.
Q. How much weight should I expect to lose?
A. Most patients will lose approximately 8- 20 lbs in the first two weeks. You should expect to lose 1-2 lbs a week after that. By maintaining your recommended diet and joining an exercise program you can exceed these averages. You should see the surgeon within 10 days of your surgery and then at approximately six weeks to be evaluated for an adjustment. You need to see the surgeon once a month to follow your weight loss and be evaluated for an adjustment. On average most patients will require 3-4 adjustments.
Q. What kind of diet will I follow after the surgery?
A. Initially your diet will consist of clear liquids only and in small amounts. We encourage drinking water in small sips throughout the day in order to maintain hydration. In close consultation with your dietician and surgeon, your diet will be progressively increased from protein shakes to pureed food, and eventually regular meals at five weeks. Please realize that not all foods will agree with you initially. Bread and meats may not pass through the band. In addition some patients complain that some foods are more difficult to digest in the morning. Please consult the dietary guidelines for more information.
Q. Can I expect changes in my bowel habits?
A. Yes! Constipation is quite common particularly if you are taking iron. Dietary manipulation can be most helpful, in particular, drinking more water and adding more fiber to your diet. You should avoid laxatives unless otherwise recommended. If you have diarrhea, you should discuss it with your doctor.
Q. What happens if I get pregnant?
A. If you become pregnant, please notify the office immediately. The band can be loosened or even removed to accommodate the increased need for calories. In addition, the vomiting that occurs with morning sickness can result in slippage or herniation and may also necessitate loosening or removal of the band.
Q. What kind of support is available after the surgery?
A. In addition to seeing your surgeon regularly for follow-up, we expect you to attend the monthly support group meeting.
Q. Who is a candidate for this surgery?
A. Morbid obesity is defined as being at least 100 pounds over your ideal body weight. Patients with a body mass index (BMI) greater than forty or thirty-five with significant comorbid conditions such as high blood pressure, diabetes, sleep apnea, arthritis, etc. can be considered candidates for this surgery. This surgery is a last resort solution for weight loss. You must first try other medical attempts at weight loss before considering surgery.
Q. What is Body Mass Index (BMI)?
A. The BMI is a ratio between your weight in kilograms and your height in meters squared that helps to determine the degree of obesity. Individuals with a BMI greater than 40 are considered to have clinically severe obesity.
Q. How do I know if I need an adjustment?
A. At the time of surgery, the band is completely deflated. No adjustments are made until six weeks after surgery. The reason for this is to allow for the swelling that commonly happens after surgery to subside. At six weeks, you will have already been on solid food for one week. We will check to see how hungry you feel and how much weight you have lost to decide if you need an adjustment. Most
patients will require 3-4 adjustments in the first year. You will be seen in the office once a month after that until you are feeling full after small meals and are losing about 5 lbs a month.