Question and Answers for you About Life After Lap-Band Surgery
Questions and Answers about Lap-Band
I am a lapband patient two years post op and have been very successful in my journey. Has it been easy no way but well worth it. So many have questions about the surgery so I hope that I have answered them all for you.
This list of questions and answers have been compiled so that once you leave here most, if not all of your questions have been answered. As with anything involving your health, please consult your doctor and surgeon if you have any questions regarding your planned surgery. These questions and answers are only helpful to those contemplating surgery, what they can expect, after surgery; however everyone is different and may not have the same outcome.
Who invented the Lap-Band?
Mitiku Belachew, MD is not only the inventor of the LAP-BAND System, but also the first surgeon ever to place a LAP-BAND in Sept of 1993. He lives and practices surgery in Huy, Belgium.
How do I find a qualified surgeon?
When looking for a surgeon you want to find a Bariatric surgeon who is board certified. Go to his website if he has one and read his reviews. If they offer coupons for surgery, skip over them that is a red flag. Call and ask how many procedures he or she has done. Ask about their after care program and if they have support meetings. These are important things. Ask others about their surgeons and how they feel about them. You want a top quality surgeon who is compassionate and knows exactly what he or she is doing.
What is it made of?
The Lap-Band is made of silicone material. On the inside of the band are little pillows that expand when an adjustment or fill is made, creating a smaller opening in to the stomach from the pouch.
How much does it cost?
Most insurance companies will cover the cost of weight loss surgery if you qualify however if you do not have insurance or your insurance will not cover these expenses it can cost anywhere between 15 and 20 thousand dollars.
How is the Lap-Band placed?
The Lap-Band is placed through laparoscopic surgery and the patient is put under general anesthesia.
How do I qualify?
Most patients are required by insurance to have a BMI or body mass index of 35 or more and at least two co morbidities. These include high blood pressure, diabetes, sleep apnea, and being obese for at least two years.
What are the risks?
Although the risk is less with the Lap-Band surgery it is still surgery. Risks associated with the lap-band are nausea and vomiting, band slippage, acid reflux, erosion, infection, and blood clots
How does the Lap-Band work?
The lap-band is an adjustable band that is placed around the top portion of the stomach or fundus, making a small pouch where food is held until digestion begins. The band can be adjusted to make the stoma smaller (the opening) or larger. In time the band will adhere to the stomach tissue making it harder to slip. The band is sewn to the stomach and a port is placed in the muscle which is also stitched.
What is the side affects of the surgery?
Although the band is safe there is always a possibility of it slipping or the band eroding.
Is the surgery safe?
With every surgery there are risk but compared to the By-pass where the entire stomach is cut away and intestines detached, there is really no problems associated with lap-band surgery other than of the normal kind.
Why will I have gas?
During surgery your stomach will be inflated with air and most will be removed before they close up your incisions, however some will remain and dissipate over a few days.
How is it adjusted?
The lap-band is adjusted through a port that is placed under the skin and sewn into the muscle. The port is accessed with a needle and filled with saline. When the band is filled it will become tighter around the stomach making it harder for you to eat more and will help you to stay full for 4 to 5 hours.
Can I do my own adjustments?
It is not impossible for someone to do their own adjustments however the answer is NO, NEVER, DON’T EVEN TRY IT. If you were to screw it up your doctor probably would not want to fix it.
How many incisions will I have?
You can have anywhere from one to five incisions depending on how your surgeon performs the surgery. You will have to ask him about this at your appointment.
How much pain will I have?
With every surgery there is pain. That is normal. To what extent you have pain is another question. Everyone’s pain tolerance is different and to say it is going to be really awful or not would not be a proper answer. You may have some discomfort mainly at the port site and gas or bloating for the air that is placed in your abdomen during surgery. You may also have shoulder pain due to gas, however if that shoulder pain last more than a week it could be the band lying on the phrenic nerve.
How will surgery help me?
Lap-band surgery will give you the tool needed to promote a healthy weight loss. It will not be a fast weight loss and you can average 2-3lbs a week which is totally normal. Remember slow and steady wins the race.
Why would I choose Lap-Band over the other procedures?
With Lap-Band surgery there is no cutting or stapling of any organs. It is reversible as the other surgeries are not. Vitamin deficiency is very profound in by-pass patients.
Where can I find more information?
When you find a surgeon, most of them have their own website and you may find information there, at their seminars, and online in general. However do not take Bariatric forums as your soul means of information.
What does it mean to have a slipped band?
When the band slips it moves from the place it was surgically placed. Chronic vomiting is a true sign of a slipped band.
How is a slipped band fixed?
Sometimes doctors will unfill the band completely and give the stomach a rest for a few weeks to see if this solves the problem. If time does not fix it then another surgery is required.
Will my body reject the band?
Because the band is made of silicone, your body will not reject it.
What is erosion of the Lap-Band?
Intragastric band erosions have been reported at rates that vary from 3 to 10% depending on the operatory technique or surgeon’s experience, the device used and the patient’s eating behavior. There are several different and controversial theories for the cause of erosion:
- The Lap-Band around the stomach gradually erodes into the stomach wall over time, and goes into the gastric lumen, as we have seen with other intrabdominal devices.
- The stomach damage done during the Lap-Band procedure debilitates the layers of the stomach wall, resulting in erosion at a later time.
- The sutures were placed too deep and trespassed all the wall layers of the stomach, causing micro perforations that generate leaking, infection and later erosion.
- Events that happen inside the stomach, such as frequent vomiting, medications, ingestion of irritants as spicy or hot food, alcohol, etc. as well as a large adjustment to the band system, will produce an ulcer that penetrates toward the balloon of the band.
Will I need my gallbladder removed?
The lap-band does not require the gallbladder to be removed.
How does the pouch become dilated?
The pouch will become dilated if you consume too much food on a daily basis, drink carbonated beverages, and throw up.
What if I need the band removed?
If by chance you ever need your band removed, you can have a new one replaced usually in the same surgery, unless medical problems do not permit it.
What age can I have surgery?
You must be at least 18 years of age and up to 55 years old. There have been surgeons who have operated on older individuals but the older you are the more at risk you become.
Does everyone need vitamins and what kind?
Because you are not eating a complete diet in the beginning months after surgery a vitamin is recommended. Most people can not take whole vitamins due to the size but chewable ones are acceptable.
What will the band not do for me?
It will not make your food choices for you that is totally up to you. It will not tell you when to stop eating; you must have some constraint on the amount of food that you allow yourself to eat. It will not stop you from eating ice cream, chocolate, milkshakes, or any other junk food. That is up to you to make it happen.
What about cosmetic surgery after weight loss?
Some people whose skin is not elastic and will not go back in to place may need plastic surgery, but not everyone. Everybody is different and will lose weight differently. Also realize that most insurance companies will not pay for cosmetic surgery. So this is something you need to think about saving for if you think you will need it.
What tests are required before surgery?
Most of the time you will need lab work, a stress test, an upper GI, psych evaluation, a sleep study, and a chest x-ray.
Can my port flip and the doctor have trouble accessing it for a fill?
Yes your port can flip but is again one of the complications it happens to very few people and if it flips it will need to be surgically fixed.
How many cc’s can go in a band?
The old lap-band’s use to be just 4 cc bands but today’s bands can hold anywhere from 9 to 14 cc’s depending on your doctors preference.
Can I have a leak in my band?
Yes this is also another possible complication; however your doctor should have tested the band before placing it in you and once inside of you.
Is a fluoroscopic fill better than a blind fill?
If your surgeon has performed many surgeries then he should be a pro at filling a band, along with numbing before a fill it can be done and over by the time it is done under fluero or numbed.
What is the preoperative diet consist of?
Many doctors will place you on a diet two to three weeks before surgery to shrink some of the fat around the liver, not the liver its self, and to prepare you for the weeks after surgery. Most preop diets consist of three protein shakes a day and 4 oz of protein once a day with a vegetable.
Will my doctor know if I cheated on my preop diet?
He or she probably will not, however if you start cheating this soon in the game you can be setting yourself up for failure. Stick to the diet your doctor put in place for you.
What can I expect in the preop holding area?
Once you are taken back to the preop area, you will have an IV started, a bag of fluids hung, any lab work needed the day of surgery, you blood sugar tested if you are diabetic, and a heart monitor placed on your chest. You will be given something to help you relax before you are taken to surgery. They will also weigh you; take your temperature, pulse, and blood pressure.
Can my family come with me?
When you are first taken back to holding your family will not be able to go with you. Once they are done getting you prepped they will call your family to come back with you.
When should I call my doctor if something is abnormal?
Once surgery is over and you go home, you should call your doctor if you are having any pain in your chest, legs, have a severe headache, or run a fever. These can be major issues. CALL HIM OR HER THEY ARE ON CALL 24 HRS A DAY PEOPLE.
Should I ever have heartburn or reflux after surgery?
NO!!!! If you ever have heartburn or acid reflux after surgery or a fill you are too tight and need fluid removed. Under no circumstances should you have heartburn or reflux.
Why no nsaids?
NSAIDS or aspirin products can sit in the pouch causing the pouch to erode. It is better to ask your doctor his opinion of this.
Is my stomach big just because I am?
No your stomach is not big just because you are big. All of our stomachs are about the same size no matter how obese you are. If your organs grew while you were gaining weight none of us would be able to walk.
Will I be able to drink alcohol?
Although no one can tell you what to do because you are an adult, empty calories being consumed will not help with your weight loss. Of course everything in moderation but I would wait for the first six months at least to help my own weight loss.
How much food will I be able to eat in one sitting?
In the beginning once you are off your liquids and full liquids then mushy phase you will then upgrade to solid foods. You should be able to eat 2 to 4 oz and no more than that.
Why does my doctor tell me to use a small plate?
You need to learn portion control and using a large dinner plate may make you put more food on it then you should eat. If you stick to a small desert plate you can almost guarantee you will not overeat.
What if I can eat just as much as pre surgery?
Before any fills take place you may be hungry just like you were pre surgery however just because you can eat as much as you want you shouldn’t. Measure your food and only eat that. If you are still hungry an hour later eat a little more. You have to learn self control and over eating is not going to help you learn new eating habits at all.
How will I know when I am full?
You really don’t want to get to the point where you are full or over full but there are a few signs that some people have that is the signal to quit eating. Your nose may run, you may get hiccups, and you can possible have left shoulder pain. Enough food to tame your hunger is all you need. There is no reason to stuff your self anymore. It is now time to learn what true portion sizes look like and that it will make you full.
Can I snack between meals?
Most doctors do not want patients to snack between meals. It is really up to you to follow your doctors post op diet. Usually most doctors will say three meals and day and no snacking. If you are at proper fill level you will not need to snack. Unhealthy snacking can lead to no weight loss. If you do need to snack, you need to eat fruit or something low calorie. No chips, dips, filled crackers, or sweets.
What questions should never be asked in a public forum?
A lot of people will join a Bariatric support forum to get opinions from other patients who have already had surgery, however it is not for them to give you medical advice or if you are having issues after surgery. You should not be asking for help if you are having chest pain or any other pain. These things should be left for your doctor to discuss with you. Call them; that is what they are there for. Also if you choose not to follow your doctors instructions that should also not be posted because other members who are following their doctors instructions will be very willing to shoot you down to the ground.
How do I know the difference between being to tight or just right?
If you are having heartburn, or reflux, pain while eating, getting food stuck regularly, or experiencing anything other than normal eating you are probably too tight. Also if you are not losing weight steadily after a fill you could also be eating slider foods and not getting the proper nutrition to lose the weight. If you have trouble keeping down fluids then you are definitely too tight.
What are slider foods?
A lot of people who have issues eating will try to eat things with lots of gravies, chicken and tuna salads, use barbeque sauces and eat puddings that will go down easily. These things can cause weight gain because they are full of fat. You have to learn to eat with your band and not use easy foods just because they go down better.
How will I know when I need a fill?
If you are hungry in less then four hours, are not losing weight, or are looking for food between meals then it is probably because you need a fill.
How many fills will I need to get to the green zone?
Everyone is different and it may take 3 or 4 or up to 7 ccs in your band or more. No one can tell you exactly when you will be in the green zone.
How does a fill feel and what should I expect when getting an adjustment?
Other than pressure you should have only mild discomfort when getting a fill. The doctor will place a needle in your port and if you have fluid already in it some will start to come into the syringe that is how they know they are in the right place. Some people feel nothing and some can feel the band tightening around the stomach. Once the fill is in they will sit you up and make you drink water to make sure it is going down correctly. Do not leave that office until you know you can drink the water without any issues.
What does sliming mean?
Sliming is the body producing excessive mucous when food gets stuck in the stoma, it will not go down and you will have to spit it out. Yes it is gross but it happens.
What is P-bing mean?
P-Bing is just another word for productive burping which also happens a lot with the band.
How will I know which foods will bother me?
You really won’t have a way of knowing which foods your band will not tolerate until you ingest them. Your doctor will give you a list of foods you should not eat which will include bread, pasta, rice, and crackers. I say if you put it in water and it expands don’t eat it because once it is in your stomach and it has nowhere to go but to get stuck and the pain will make sure you never eat it again. Be smart and do not test your band.
Is it okay to throw up?
It is never okay for people with the band to throw up. Throwing up can cause band slippage. Does it happen of course but if you come down with stomach flu you may need fluid removed so that it can come up without issues.
Is sugar free okay?
All of your drinks should be sugar free but when is sugar free not okay. When you look on the package of a sugar free food and it says this is not a low calorie food. Many candies, cakes and other sugar free foods will have this on the package. Of course sugar free pudding and jello are fine.
Why no carbonated beverages?
This has been a controversy among band patients and there is a reason why no carbonated beverages. It can stretch your pouch and cause erosion. I am sure that giving up soda and beer will not kill you but if you don’t lose the weight that will. If you decide that you want to drink soda after being told not to, then you have to reap what you sow.
How long will my port area hurt?
Your port is sewn in to the muscle and can hurt for several months this is normal. It is the largest incision and will take the longest to heal.
Why is protein important?
Because your diet has been drastically cut in calories if you do not eat enough protein and it should always be the first thing you eat, once your fat stores are used up you will start losing lean muscle mass which can cause atrophy of the muscles.
What if I do not like meat?
There are plenty of other options for people who do not like meat. Eggs, low fat cottage cheese, beans, legumes, low fat dairy, tofu and protein drinks. You have to watch protein bars because some are loaded with sugar.
Can a person fail at losing weight?
Yes there have been people who have not lost weight with the band but most of those people thought they could live life like they did before surgery. You have to make a conscience effort to diet and exercise for life.
Will my doctor provide me with a Lap-Band card?
Your doctor should give you a card with the type of band you have so that if you ever run into trouble and need medical care somewhere else you will be able to provide it to them.
Am I entitled to eat kid’s meals at restaurants?
Most restaurants will let you order kids meals but you have to remember most kids meals are not healthy choices and are loaded with fat.
Do I need to count calories?
You need to consume a certain amount of calories per day and that is totally up to your doctor as to how many they would like you to eat. Always write down what you eat and plan your meals carefully so you won’t set yourself up to eat on the run.
What about slim fast?
Slim fast is not a good source of protein and is full of sugar. When you are choosing your protein drinks you should make sure the sugar content is low and the protein content is high. Since in the beginning you will be drinking them a lot, you want something high in protein such as the EAS carb control that has 17 grams of protein, 3 grams of fat and less than 1 gram of sugar.
Can you give me a sample diet for a day post banding?
Once you are able to resume to normal foods some people can not eat breakfast and may only drink protein shakes due to their band being too tight.
I have one egg over easy and 3 0z of low fat meat for breakfast
A small salad with meat or low fat cheese at lunch
Dinner is usually fish, or chicken grilled or baked and a side vegetable
If I do get hungry between meals I only eat fruit or sugar free pudding and nothing else.
Why is the band tighter sometimes and other times it is not?
Weather, barometric pressure, and stress all play a role in the tightness of the band. Some days you may not be able to eat the same thing as you did yesterday, however as you become more seasoned with the band you will know when this is going to happen.
When will I be able to eat real food?
Most people will be able to eat real food by four weeks post op. Yes it seems like a long time but your stomach needs time to heal. You do not want to upgrade your diet until your doctor says it is okay. It is not okay for you to take it upon yourself to upgrade your diet because you are hungry. Call your doctor before making that decision.
What should I have to eat at home post surgery?
Chicken broth, beef broth, sugar free jello, sugar free popsicles, hot tea, creamed soups when you move up to mushy food. Eggs also for when you progress in your diet. Also you want to try several protein shakes but just because you like them before surgery does not mean you will like them after surgery. Your taste will change so do not go buy a whole lot of one protein shake you may not like it after surgery. You do not need to buy baby food either. It is full of fat and not needed.
Will I be hungry?
This is my favorite question and the answer is yes you will still get hungry. The body’s automatic response to lack of food is hunger. That is a misconception when people say they will never get hungry again. You will but maybe not as frequently as before.
Do I really need to eat slowly?
Yes you need to learn to take 30 minutes to eat your meals or risk food getting stuck. You also need to give your brain the signal it is full. You may not have any trouble before you get a fill but you will after you are a bit tighter. Slow down and taste your food. You will realize how good it really is.
What does getting food stuck mean?
When food can not pass in to the larger portion of the stomach it will become lodge in the opening of the pouch and it will be very painful to say the least. It happens to the best of us and it is sometimes not pretty. Once food is stuck you have to wait it out and it can be a long process. Drinking water will not force the food down but it will only come back up in your throat because it has no where to go.
How can I prevent it?
Take small bites and chew well and put your fork down in between bites until you understand how well your foods are going down.
Is this going to be a diet?
Pretty much so yes. Life style change or diet it’s all the same. You have to be accountable for everything you put in your mouth and if you think that you will follow weight watchers or south beach well you can never eat that much food again in order to get all the points. Just follow the diet your doctor gave you and you will do fine.
How much food will my pouch hold?
2 to 4 0z depending on how much fluid is in your band.
How long does the food stay in the pouch?
Digestion starts as soon as food hits the stomach. It will go down slower but it will not stay there for too long maybe less than five minutes.
Should I have pain when I am eating?
You should never ever have pain when you are eating and if you do you have an issue and should call your doctor.
Why can I not eat and drink at the same time?
The purpose of not drinking during meals is to give the food a chance to stay in the pouch longer creating the sense of fullness. You should only drink 30 minutes after your meal has been consumed.
How much fluid should I drink daily?
64 ounces of fluid is recommended so you do not become dehydrated.
Are there any drinks that are unacceptable?
Carbonated and full sugar drinks should be avoided. Caffeine should also be avoided as it is a stomach irritant. If you are big coffee drinker, start weaning your self off of it before surgery or you will end up with a big fat headache.
How long will the lap-band last?
As long as you have no issues it should last forever.
What happens if I get pregnant?
All the fluid will be emptied from your band until you deliver and or stop breast feeding.
How will I be able to take my medications?
Some people have to crush their medications if the pills are too large or take liquids. You should always check to make sure the pills are able to be crushed. For the most part you shouldn’t have any issues taking medications.
What medications will I need post surgery?
Liquid pain medication and anti nausea medication which your doctor should give you your prescriptions before surgery.
What if I don’t lose weight post op?
The first six weeks is about healing not losing weight. Stay off the scale and you will be a much happier person. Although we are all eager to see the scale move sometimes post op you will not lose weight.
The most important thing you want to remember is that this is all about changing your eating habits and sometimes it will be hard especially during the holidays or family events. However these things are about the family and not about food and food should start being the last thing on your mind. We eat to live not live to eat.
© 2011 Cheryl