FAQ

Q: How much weight will I lose?
A: Individual weight loss varies, and the amount lost will depend upon a number of factors. In the first instance, the band must be positioned correctly, and the patient must be committed to a change in lifestyle and eating habits. Surgery to reverse obesity is not a miracle cure; the kilos won’t come of by themselves. It is important that realistic weight loss goals be set from the outset. Loss of up to one kilo per week in the first year after surgery is possible, but 0.5 kilos per week is more achievable. Twelve to eighteen months after surgery, weekly weight loss will be less. It is important to lose weight gradually to avoid creating health problems. Remember, the main goal is to solve or prevent health problems associated with severe obesity, which include increased risk of heart attack or stroke, fatigue, depression, and lowered self-esteem. Individuals who are significantly obese should consult a doctor about a program of gradual weight loss to avoid placing undue strain on the heart and other organs associated with too rapid loss, which can create other health problems.

Q: How do weight loss results with the LAP-BAND™ System compare to weight loss with gastric bypass surgery?
A: Reports from surgeons indicate that gastric bypass patients lose weight faster in the first year. After five years, however, many LAP-BAND™ System patients have achieved weight loss comparable to gastric bypass patients

Q: What is the post-operation recovery period?
A: If LAP-BAND™ System surgery is performed laparoscopically, the typical hospital stay is less than 24 hours. Most patients can return to work within a week and resume exercising within a month to six weeks. If the LAP-BAND™ System is installed through open surgery, or if there are complications, the recovery period can be significantly longer.

Q: Will the LAP-BAND™ System require frequent doctor visits after surgery?
A: Check-ups by your doctor are an important part of the recovery programme after LAP-BAND™ System surgery. Many surgeons perform follow-up checks with patients once or twice during the first month, and every four to twelve weeks thereafter during the first year. Adjustments are performed as required during these visits. Depending upon the individual patient, follow-up visits are scheduled every three to six months during the second and third year.

Q: Will the LAP-BAND™ System limit physical activity?
A: Once the patient is fully recovered, the LAP-BAND™ System does not interfere with physical activity, including aerobic, stretching or other strenuous exercise. Regular exercise will help in maintaining a desirable weight.

Q: How is the band adjusted?
A: Adjustments are done in the hospital X-Ray department, outpatient clinic, or doctor’s office. A fine needle is inserted to access the port to add or subtract saline. The process takes only a few minutes and for most patients is relatively painless. If X-rays are used, the reproductive organs should be shielded.

Q: Do I have to be careful with the access port which is just underneath the skin?
A: The access port is under the skin in the abdominal wall, and once the incisions are completely healed it should cause no discomfort nor limit any physical activity. Other than some minor discomfort when adjustments are made, there are no other restrictions. If the patient experiences persistent discomfort in the area of the port, a doctor should be consulted.

Q: Can the band be removed?
A: Obesity is a chronic condition requiring lifelong treatment. The LAP-BAND™ System is designed to remain in place for life. If the patient experiences problems with the band, can’t lose enough weight, or is unable to adjust to the new eating habits, the doctor might suggest removal. Generally, after removal of the LAP-BAND™ System, the patient’s stomach will return to its normal form and the digestive tract will function normally. It should be borne in mind, however, that after removal of the band, weight is likely to increase.

Q: After loss of a lot of weight, will plastic surgery be required to remove the excess skin?
A: If weight loss is gradual, the skin will often mold itself around the new body tissue. In any event, plastic surgery is ordinarily not considered for at least a year or two after the operation. It is important to give the skin the time it requires to adjust before deciding to have additional surgery.

Q: Will I feel hungry or deprived with the LAP-BAND™ System?
A: The LAP-BAND™ System causes a person to eat less and feel full in two ways – firstly by reducing the stomach’s capacity, and secondly by increasing the time it takes food to pass through the digestive tract. Depending upon the individual, after a small amount of food, the patient should feel full. The LAP-BAND™ System is a tool to help change eating habits. If nutrition guidelines are followed carefully, and food is chewed well, the patient should not feel hungry or deprived.

Q: What happens if I become ill?
A: A major advantage of the LAP-BAND™ System is that it can be adjusted by removing saline if the patient’s illness requires eating more. When the patient has recovered and still wants to lose weight, saline can be added, tightening the band. If for some reason the band cannot be loosened, it might have to be removed.

Q: How does the band affect pregnancy?
A: Weight loss can make the menstrual cycle more regular, making it easier to become pregnant, and resulting in fewer complications that affect women who are overweight. The extra weight of pregnancy, combined with an already overweight body can place significant strain on the heart and joints. If the patient has to eat more during pregnancy, the band can be loosened to permit this. After pregnancy, the band can be tightened to assist in post-partum weight loss, and help to regain the pre-pregnancy weight.

Q: Will it be necessary to take vitamin supplements?
A: Because it can sometimes be difficult to get sufficient vitamins and minerals from three small meals a day, it might be necessary to take supplements. During regular check-ups, your doctor will determine if you are getting enough of the essential vitamins and minerals (especially vitamin B-12, folic acid, calcium, and iron), and might prescribe supplements to ensure your body gets the necessary nutrients to maintain good health. Iron deficiency can cause anaemia and weakness; insufficient calcium can lead to osteoporosis (especially in women who suffer greater bone density loss than men as they age); and deficiency in consumption of B-12 on a daily basis can cause neurological problems.

Q: Will the band affect other medications?
A: The patient might be advised to avoid aspirin and other non-steroidal anti-inflammatory pharmaceuticals, which can cause irritation of the stomach lining. This condition, if it persists, might require that the band be removed. It is advisable to take capsules or break tablets in half or dissolve them in water to prevent them getting stuck in the stomach, which can also cause gastric distress.

Q: What about eating out?
A: When eating out, order smaller portions, and eat slowly. Try to finish the meal at the same time as other diners. It might be advisable to inform your host or hostess (or the wait staff) in advance that you cannot eat very much. When people understand that this is part of your weight loss program, they are usually very cooperative. On long airline flights, it is advisable to drink lots of water and skip every other meal served.

Q: What about alcohol?
A: Alcohol has a high caloric content and can break down vitamins. An occasional glass of wine or other alcohol, though, will not usually inhibit weight loss. Beer and ale consumption should be significantly reduced, as these beverages are much higher in caloric content than wine and other liquors.

Q: Can anything be eaten in moderation?
A: After the stomach has completely healed, most foods that don’t cause discomfort can be consumed. Because of the smaller amounts, however, it is important to include foods in the meal that are rich in essential vitamins and nutrients such as those recommended in the nutrition section of this booklet, and as advised by your surgeon or dietician. Foods that are high in sugar and far, or high calorie drinks such as milkshakes can reduce or even negate the effect of the LAP-BAND™ System.

Q: Will I be sick often after the operation?
A: The LAP-BAND™ reduces food intake. If after the operation there is persistent discomfort or illness, it could be caused by not chewing food thoroughly, or by failure to follow diet rules properly. It could also be caused by improper placement of the band. Consult your surgeon if problems persist. Vomiting should be avoided as much as possible, as it causes the stomach to stretch, which can cause part of the stomach to slip through the band and reduce its effectiveness.

Q: Will the band cause constipation?
A: After a decrease in food intake, reduction in the volume of stools is normal. This should not cause significant problems. If difficulties do arise, consult your surgeon, who might suggest a mild laxative. Drink plenty of water; at least 6-8 glasses per day; which will help avoid constipation.


Balloon

Q: How much weight will be lost?
A: Weight loss will vary depending upon how well the programme is followed and whether eating habits are properly adjusted. Average weight loss can be between 15 and 20 kilos.

Q: Can the patient feel the balloon in the stomach?
A: During the first few days there will be some discomfort, but after that, the primary sensation of the BIB™ is a feeling of satiety.

Q: Are there any side effects or complications with the BIB™?
A: The first three days are the most difficult. Cramps, nausea, and vomiting are the most common effects. It is important to follow your doctor’s instructions and drink plenty of liquids after the first day. Medication can help ease the discomfort.

Q: How long does it take to recover after the procedure?
A: Plan for at least three days of no activity in order to recover from the procedure. Quick resumption of normal physical activity will depend upon how quickly your body adjusts to the BIB™.

Q: How will weight loss results compare with other diet programmes?
A: Because the BIB™ gives a feeling of fullness, the patient is better able to control eating habits and make healthy diet changes. Patients can expect to lose more weight with the BIB™.

Q: Does the BIB™ require frequent doctor visits after the procedure?
A: The follow-up programme is critical to the success with BIB™, along with learning new lifestyle skills. While the BIB™ is in place, there will be at least monthly visits with the doctor and support team to evaluate progress and teach valuable health, nutrition and exercise principles. This will provide a foundation for long-term success.

Q: Will the BIB™ limit activity?
A: There should be no heavy activity the first week. Once the body has adjusted to the BIB™, normal activity can be resumed. A regular exercise programme is highly recommended and will improve the chances of success.

Q: What happens if the BIB™ leaks?
A: In the rare event of a leak, there will be a change in the urine color (it will be greenish due to the non-toxic blue dye added to the saline in the balloon). Although uncommon, this can be serious. If there is a change in urine color, consult a doctor immediately. If the BIB™ deflates, it might pass through the body naturally. In some cases it might need to be removed by a doctor.

Q: Can I drink alcohol?
A: While moderate alcohol consumption will not affect the gastric balloon, the extra caloric intake will not help with weight loss. Always follow the advice of a doctor or dietician.

Q: Are there any food restrictions?
A: After insertion of the BIB™, the patient will not feel like eating as much as before insertion. Consumption of fatty foods or sweet might cause a feeling of illness. With the BIB™ in place, overeating can result in a serious medical condition.

Q: How is the BIB™ removed?
A: The BIB™ is removed in the same manner that it is inserted, through the mouth. This 20-minute procedure is performed under sedation.

Q: Are follow-up visits required for success?
A: The BIB™ gastric balloon is only one part of the solution to help change a person’s lifestyle, which is required for long-term success. Participating in the programme will provide the education and support to change lifestyle habits.


Gastric Bypass

Q: What are the risks of gastric bypass surgery?
A: As with any surgical procedure, gastric bypass surgery does have risks. The main risk is the surgery itself; therefore, it is important to ensure that the surgeon is qualified, experienced, and has a high success rate with this type of surgery. In addition to the risks associated with surgery, the most common risk is nutritional deficiency. A series of vitamin supplements are therefore recommended following surgery. Gastric bypass surgery might also initially cause ‘dumping’ – food passing too quickly through the stomach and intestines. This condition is made worse by eating highly refined, high-calorie foods like sweets. These risks, however, should be balanced against the long-term health risks associated with obesity.

Q: Do I need a gastric band or a gastric bypass?
A: For patients with a Body Mass Index (BMI) greater than 40 gastric bypass surgery is the recommended procedure. For those with a BMI under 40, gastric banding is usually recommended. These guidelines, however, are not fixed, and selection of the procedure should be made after consultation. On occasion, doctors will recommend a sleeve gastrectomy as the initial procedure, followed by a gastric bypass.

Q: Is exercise necessary?
A: Gastric bypass surgery offers a strong incentive to change, rather than a quick solution to obesity. There will still be a need to change the foods consumed, in addition to an exercise programme to maintain a healthy weight.

Q: Is pregnancy possible after a gastric bypass?
A: Actually, with loss of weight, the chances of becoming pregnant are improved. It is suggested that patients wait about 12 months after surgery before trying to become pregnant. Once weight has stabilized, there will be adequate nutrition for both mother and baby.

Q: What are the different types of bypass surgery?
A: There are two main types of gastric bypass procedures, both of which reduce the size of the stomach pouch and reduce the amount of food absorbed.
1. Roux-en-Y Gastric Bypass (RGB): In this procedure, a small stomach pouch is created by stapling part of the stomach together, or by vertical banding. This limits the amount of food that can be eaten. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum. This is demonstrated below:

2. Biliopancreatic Diversion Gastric Bypass (BPD): This is a more complicated procedure, in which portions of the stomach are removed and the small pouch that remains is connected directly to the final segment of the small intestine. Most of the small intestine (duodenum and jejumum) us bypassed resulting in significant reductions in calorie and nutrient absorption.

Q: How long does a gastric bypass take?
A: This depends upon the patient, the surgeon, and whether the procedure is being done as on open or closed (keyhole) procedure. Open gastric bypass operations usually take 90 – 120 minutes, but a laparoscopic bypass can take up to twice as long.

Q: How long is the hospital stay after a gastric bypass?
A: After open operations, most patients are discharged after three or four days. After the laparoscopic procedure, patients can usually be discharged after the second or third post-operative day.

Q: What are the benefits of gastric bypass?
A: For seriously obese patients, the benefits of a gastric bypass procedure significantly outweigh the risks. Generally:
• 75% of patients can expect to lose 75 to 80% of excess body weight, most of which is lost in the first two years following surgery.
• There major improvements in the risk factors for heart disease and cancer.
• 70-80% of patients with hypertension can stop taking medication and cholesterol levels will be reduced.
• Most Type II diabetics will be cured.
• There will be major improvements in a wide range of weight-associated conditions. These should include sleep apnea, asthma, joint pain, arthritis, reflux, fatigue, and shortness of breath.
• Bypass patients report less depression, improved self esteem and confidence, along with an overall increased sense of well-being.

Q: What are the risks of gastric bypass?
A: As with any surgical procedure, there are risks and long-term complications associated with gastric bypass, including:
• Bleeding
• Complications due to anaesthesia and medications.
• Infection
• Pulmonary embolism (blood clots on the lungs).
• Deep vein thrombosis
• Dehiscence (wound breakdown).
• Leaks from the staple line.
• Injury to the spleen.
• Marginal ulcers.

In experienced hands, however, the risks with this procedure are currently very small. Most published reports show that the overall mortality rate for bypass surgery is less than 1%.

Q: What about getting nutrients in the diet after bypass?
A: It is important to note that not only does bypass result in less absorption of calories, it might also reduce the absorption of important vitamins and minerals such as iron, vitamin B-12 and calcium. Deficiencies in these essential elements can cause many problems. Iron deficiency causes anaemia and weakness, and calcium deficiency can lead to osteoporosis. Lack of B-12 daily can cause neurological problems. For this reason, patients undergoing gastric bypass are recommended to take daily vitamin and mineral supplements.

Q: What is dumping syndrome?
A: “Dumping syndrome,” a condition in which consumption of sugar causes abdominal cramping and diarrhoea, can also occur. Some people will also regain some of the lost weight in subsequent years.