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Below you will find many questions about what you can expect with the Lap-Band®. Use the following links to access questions about:
Post-Operative Results, Adjustments & Follow-Up Care
Potential Side Effects, Risks & Complications
Expectations and Insurance
Surgery & Recovery
Diet, Nutrition & Exercise
Paying for the Procedure
Questions about the Lap-Band® System
Q: How is the Lap-Band® different from gastric bypass surgery?
A: The Lap-Band® is a silicone band that is placed around the stomach, creating a small upper stomach pouch that prevents a patient from eating excessively. It is only a restrictive device (not a malabsorptive one), and can be adjusted and/or removed, if necessary. The procedure to place the band is done laparoscopically on an outpatient basis, so our patients go home the same day as surgery in most cases. Recovery is relatively quick - with patients returning to work and/or most normal activities within 4-5 days. It is currently the least invasive form of bariatric surgery, with a relatively low complication rate compared to alternate obesity surgeries. (Read more about the Lap-Band® procedure) Gastric bypass surgery involves permanently changing the shape of the stomach by surgically reducing (cutting or stapling) its size to an egg-sized pouch, and then bypassing a portion of the digestive tract with the new smaller stomach. This type of surgery has both a restrictive and a malabsorptive effect, and unlike the Lap-Band®, it is essentially irreversible. Generally, gastric bypass patients stay in the hospital 3-4 days following surgery, and recovery takes approximately 2-4 weeks. Due to the nature of the procedure, gastric bypass surgery has a higher rate of severe complications following surgery and a significant mortality rate.
Q: How overweight do I need to be to consider the Lap-Band®?
A: You should be at least 75-100 pounds overweight to consider the Lap-Band® System. A better measure for determining your eligibility, however, is your BMI (Body Mass Index), a calculation based on your height and weight (Click here to calculate your BMI) The Lap-Band® is generally recommended for patients with a BMI of 35-60.
Q: Is the Lap-Band® surgery safe?
A: Yes. The Lap-Band® procedure is considered the least invasive bariatric surgery available — offering fewer complications, less pain, less scarring, and a quicker recovery than any other form of obesity surgery. However, you should discuss this directly with your surgeon.
Q: Is this surgery performed using minimally invasive surgical techniques?
A: The Lap-Band® procedure is performed laparoscopically. The cameras and instruments our surgeon uses offer superior visibility and access for precise dissection of tissues and associated blood vessels. The operation is completed in a relatively short period of time (approximately 1 hour) and with minimal blood loss. The benefits of using these minimally invasive methods are that patients experience less pain, easier breathing, minimal scarring and a quicker recovery. However, any operation has associated risks, and complications can occur whether the procedure is done "open" or laparoscopically.
Q: How many times have your surgeons performed the Lap-Band® procedure?
A: Our surgeons at Metroplex Lap Band are part of the American Institute of Gastric Banding, and are very experienced laparoscopic surgeons. As a network, they have performed thousands of laparoscopic procedures, hundreds of Lap-Band® procedures and are all FDA-approved for Lap-Band® surgery.
Q: What is the average excess weight loss and improvement of related health conditions for patients?
A: On average, Lap-Band® patients have lost about 50% of their excess weight within the first year after surgery. Most of patients' associated medical problems, such as diabetes, sleep apnea, arthropathy, or high blood pressure, have improved or disappeared completely after their Lap-Band® procedure. Potential results and weight loss expectations can be discussed in further detail with you during your initial consultation.
Q: Do you have patients who are willing to share their Lap-Band® surgery experiences, both positive and negative?
A: Yes, we encourage you to come to one of our FREE Informational Seminars where you will be able to ask other Lap-Band® patients questions about their experience with the surgery and our program, or we can provide you with some names and phone numbers of patients who would be willing to talk to you about their surgery.
Q: Will I be sick a lot after the operation?
A: The Lap-Band® System limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well enough or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band, so contact your doctor if this problem persists. Vomiting should be avoided as much as possible as it can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band and reduce the success of the operation. In some cases, it can require another operation.
Q: How long will it take to recover after surgery?
A: If Lap-Band® surgery is performed laparoscopically, patients typically spend less than 12 hours in the hospital. It takes most patients 2-3 days to return to work and approximately 2-3 weeks to resume all normal activities.
Q: Will I be able to drink alcohol after surgery?
A: Alcohol has a high number of calories and it breaks down vitamins. But an occasional glass of wine or other alcoholic beverage is not considered harmful to weight loss.
Q: What type of exercise do you recommend post-operatively?
A: Walking is great exercise to start out with following your surgery. After 6 weeks you may do any exercise you would like — aerobics, bicycling, running, strength conditioning, etc. Exercise is an important part of your post-surgery regimen, as it will facilitate weight loss and contribute to your overall health and well-being.
Questions about Post-Operative Results, Adjustments & Follow-Up Care
Q: How much weight should I expect to lose and how fast?
A: The amount of weight you lose and the rate at which you lose it is dependent on a number of factors in addition to the Lap-Band® itself such as: your starting weight, your post-operative diet, the amount of exercise you do, etc. On average, however, patients have lost about 50% of their excess weight within the first year of surgery. Most patients find they are losing between 5-10 pounds a month, depending on their individual diet and exercise regimens. In general, it is not safe to lose weight too quickly; a weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but 11⁄2 pounds a week is more likely. Remember that your primary goal is to have a weight loss that prevents, improves, and/or resolves health problems associated with severe obesity.
Q: Will I still get hungry following surgery?
A: The Lap-Band® works best with solid foods to decrease hunger. Solid foods tend to stay in the stomach pouch longer, giving you a greater sense of fullness and satisfaction. Following surgery, you will begin by eating/drinking only liquid foods. Therefore during this time you may feel hungry. However, most patients find that they feel less hungry and more satisfied if they eat/drink the foods the recommended number of times throughout the day. Once you begin to eat solid foods you should feel very satisfied with significantly less food than you were consuming before surgery. After 6-8 weeks post-operatively, if your weight loss slows down to less than 1 pound a week, you may need to have a Lap-Band® Adjustment to tighten the band.
Q: What kind of post-operative medical care will I require and for how long?
A: You will be seen as often as necessary, of course, but we generally schedule you for a post-operative follow-up appointment two weeks after surgery. Then you will be seen at 1 month, 3 months, 6 months and 1 year post-operatively. In addition, based on your rate of weight loss and your personal weight loss goals, your band may require that you come in for band adjustments. Finally, we will have an optional support group for Lap-Band® patients dealing with emotional and psychological issues relating to body image, stress coping strategies, addictive behaviors, etc.
Q: Will there be any medications that I can no longer take post-operatively or that I will be unable to absorb properly?
A: No, you will be able to take any medication necessary. Unlike other bariatric surgeries, the Lap-Band® will not affect your absorption so the effectiveness of medication will not be diminished and/or affected.
Q: How many Lap-Band® adjustments will I need?
A: The number of adjustments (fills) you may need cannot be determined in advance of your surgery. Some patients need one adjustment, while others need two or three in the first year depending upon their individual response to the band and the degree of weight loss desired. Generally, adjustments are not performed until at least 6 weeks after your surgery.
Q: Are adjustments covered by my insurance company?
A: No, currently most insurance policies do not pay for band adjustments. If your insurance policy does not provide coverage for band adjustments, you will need to pay for this procedure yourself. For our cash-pay patients, the first year of adjustments are free, however, for all other patients, adjustments are $250 each. Individuals who have had their surgery elsewhere will be charged $500.00 for each adjustment.
Q: How long will it take to have an adjustment?
A: The adjustment usually takes only a few minutes and you will be able to leave the Center immediately following the procedure. You will be placed back on a liquid diet for a few days following the adjustment in order to give your stomach some time to adapt to the change.
Q: Will I be able to get pregnant after Lap-Band® surgery?
A: During the first year after surgery: A fast rate of weight loss during pregnancy is thought to be harmful to the developing baby. Therefore, we would like for you to use some form of contraception to avoid pregnancy during the first year following surgery. If you become pregnant, however, during this first year, we will leave your Lap-Band® in place without saline in order to ensure adequate nutrition for the baby's growth. After the first year: Many women find it easier to conceive following substantial weight loss. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band can be made tighter again and you can go back to losing weight.
Questions about Potential Side Effects, Risks & Complications
Q: What are the risks and complications involved with the Lap-Band® procedure?
A: Any gastric operation for obesity is major surgery and carries with it the risks associated with any complex operation. And although the Lap-Band® procedure is minimally invasive surgery, it is not without its own risks (laparoscopic surgery risks include: spleen or liver damage, damage to major blood vessels, lung problems, blood clots, rupture of the wound, esophagus/stomach perforation).
In rare cases, the Lap-Band® surgery cannot be performed using the less invasive laparoscopic approach. For example, if unforeseen problems arise while attempting to position the band, surgeons may have to switch to an open method. In addition, there can be serious complications that may warrant the removal of the Lap-Band® including:
• Slippage of additional stomach tissue under the band
• Erosion of the band into the stomach
• Infection and/or breakage of the injection port (rare)
• Gastric symptoms
While removal of the band can often be done laparoscopically, in some cases it may require open surgery. Serious problems such as peritonitis, infection, leaks, and long-term nutrition problems such as iron and vitamin deficiencies that are seen with gastric bypass surgery do not occur with the Lap-Band®. Re-operation rates for gastric bypass are significantly higher due to leaks, bowel blockages, outlet scarring, ulcers, and bleeding.
Q: Does the Lap-Band® limit any physical activity?
A: The Lap-Band® does not hamper physical activity including aerobics, stretching and strenuous exercise.
Q: How is the band adjusted?
A: Adjustments are often carried out in the X-ray department. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should be shielded. Sometimes adjustments can be done in an outpatient clinic or office, and local anesthesia may or may not be needed. A fine needle is passed through the skin into the access port to add or subtract saline. This process most often takes only a few minutes and most patients say it is nearly painless.
Q: Do I have to be careful with the access port just underneath my skin?
A: There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor.
Q: Can the band be removed?
A: Although the Lap-Band® System is not meant to be removed, it can be, in some cases laparoscopically. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight. You may also gain more.
Q: Will I need plastic surgery for the surplus skin when I have lost a lot of weight?
A: That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation as, sometimes the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery. The slower weight loss associated with the Lap-Band® makes skin removal less likely to be needed than with the gastric bypass.
Q: Is it true that the Lap-Band® seems "tighter" in the morning?
A: This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the Lap-Band® feels tighter during menstruation.
Q: What will happen if I become ill?
A: One of the major advantages of the Lap-Band® System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.
Q: What if I go out to eat?
A: Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
Q: Can I eat anything in moderation?
A: After your stomach has healed, you may eat most foods that don't cause you discomfort. However, because you can only eat a little it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition section of this booklet and as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the Lap-Band® may be greatly reduced or even cancelled.
Q: Will I suffer from constipation?
A: There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you severe problems. If difficulties do arise, check with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Your needs will vary, but you should drink at least 6-8 glasses of water a day.
Questions about Expectations and Insurance
Q: What is expected of me if I decide to choose the Lap-Band® as a surgical solution?
A: We expect that you will comply with each step of our program including the pre-operative testing requirements, pre/post-operative diet and exercise programs, band adjustments (as necessary) and follow-up medical appointments.
Q: Will my insurance pay for the Lap-Band®?
A: About 50% of insurance plans will cover the Lap-Band® procedure with a Letter of Medical Necessity from our surgeon. However, you should check with your health plan beforehand to find out if you are covered. Please read detailed information on the insurance coverage process under "Insurance Information". If your plan does not cover the Lap-Band® surgery, we will be happy to discuss with you the more convenient "Self-Pay" option and the financing programs available to help you manage the costs. Remember that even if you pursue the self-pay option initially, you can still apply for insurance coverage / reimbursement after you have had the surgery.
Questions about Surgery & Recovery
Q: On the day of my surgery, how much time beforehand do I need to arrive?
A: You will receive a phone call from a staff nurse the day before your surgery to review last minute pre-operative instructions with you and confirm your arrival time the day of surgery. Generally, we ask that our patients arrive at the Surgery Center 1 1⁄2 hours prior to surgery.
Q: Does the Surgery Center have gowns, beds and other equipment large enough to accommodate me?
A: Yes, we has made a sincere commitment to our patients and made sure that everything in our surgery center accommodates your special requirements. As a result, we have customized beds, gowns, wheelchairs, operating room equipment and x-ray equipment designed expressly for obese patients. Furthermore, our nursing staff is fully trained to address the needs of overweight patients.
Q: Are the anesthesiologists experienced with the unique needs of obese patients?
A: Absolutely! In keeping with our commitment to the highest quality care, our surgery center only uses Board Certified anesthesiologists in the operating room, all of whom are experienced in treating obese patints — never CNRAs / nurse anesthetists.
Q: How long will I be in surgery?
A: Your operation will range anywhere from 45-90 minutes.
Q: Do you remove the gallbladder during surgery?
A: No, we do not remove the gallbladder on a routine basis unless we conduct a gallbladder ultrasound and it indicates otherwise. Your surgeon will discuss this with you further during your consultation.
Q: How long will I be in recovery following my surgery?
A: Following surgery, patients are monitored in a recovery room for approximately 3 to 6 hours before being discharged from the Surgical Center. Recovery times vary depending upon the individual patient.
Q: Am I required to stay at the Surgery Center until I have a bowel movement?
A: No.
Q: How soon and how often can I walk after my operation?
A: We encourage patients to walk as soon and as much as possible after their surgery.
Q: How long will I need to stay at the Center following my surgery?
A: As the Lap-Band® surgery is performed on an outpatient basis, almost all patients are released the same day as their surgery.
Q: Will I feel much pain after the procedure?
A: Patients are given pain medication for use at home following surgery. Most individuals experience only mild discomfort, which is generally relieved by the pain medicine.
Q: What types of pain management will you provide after surgery?
A: Generally we use liquid Vicodin® or Tylenol for our patients. We offer alternatives for those who are allergic to these pain particular medications.
Q: How soon after surgery will I be allowed to drink water?
A: You will be able to drink water the same day as your surgery.
Q: How long will I need to take off of work after my Lap-Band® surgery?
A: Usually about 4-5 days. Most patients feel some fatigue and weakness for 3-5 days but are able to return to normal functions after about 5-7 days. If you do manual labor, you may wish to stay off of work a little longer.
Questions about Diet, Nutrition & Exercise
Q: Will I need to follow a post-operative diet after surgery? If so, for how long?
A: We will provide you with a post-operative diet and meal plan to follow for four weeks after your Lap-Band® surgery. The diet will help decrease the initial irritation and inflammation around the stomach and allow your band to "settle" into place. At first, you will have only liquids in small amounts. Gradually, you will progress from liquids to soft foods, eventually introducing solid foods back into your diet. The transition to solids is slow and varies among patients. Eating must be done slowly and should be stopped when you feel full. Only small portions at intervals throughout the day are recommended. Eating too much at one sitting can cause discomfort and/or vomiting. Our surgeon will meet with you before and after the surgery to discuss the specific post-operative dietary restrictions and recommendations in greater detail.
Q: Will my eating habits change after surgery?
A: Yes, your eating habits will change following Lap-Band® surgery. You will find that you become full or satisfied after consuming a much smaller portion of food than you did prior to surgery. It is important that you stop eating once you feel full, as overeating can trigger pain and/or nausea. In addition, we recommend that you eat slowly and chew your food carefully.
Q: Are there any specific foods or beverages that I should not eat post-operatively?
A: Before and after surgery, our nutritionist will review with you in detail the post-operative diet you should follow as well as additional dietary recommendations and restrictions, including: Food: Lap-Band® patients should NOT eat any dried fruits, as they can swell in the stomach pouch and become stuck. It is also recommended that patients avoid "fibrous" foods after surgery as they can also get lodged in the small opening of the stomach pouch. Such foods include, but are not limited to: asparagus, pineapple, rhubarb, corn (especially popcorn) and grapes. Furthermore, nuts and seeds (walnuts, whole peanuts, almonds) appear to be hard to digest for many patients. (Note: in general, Lap-Band® patients improve their digestion if they learn to chew their food well, particularly meats.) Beverages: Most liquids are fine, but patients should try to avoid carbonated beverages as they can cause distension of the stomach pouch. In addition, patients can help avoid feeling nauseated during the first 6 weeks post-operatively if they avoid acidic juices (e.g., orange, grapefruit, lemon). Otherwise, we recommend you eat a wide variety of foods and drink ten glasses of water every day.
Q: How many grams of protein should I consume post-operatively?
A: You should consume approximately 20-35 grams a day. (Gastric bypass patients need more protein to promote healing from the major surgery.)
Q: What nutritional supplements will I need to take post-operatively?
A: We recommend that our patients take a multivitamin with iron every day. In addition, we suggest that our female patients also take a daily calcium supplement. Because the Lap-Band® procedure is not a malabsorptive one, you should enjoy the full nutritional benefits of the food that you eat post-surgery. The volume of the food you eat will decrease, however, so you will need to be sure to follow a nutritionally balanced meal plan.
Q: Will I get sick from eating sugar, natural or otherwise?
A: There are no problems with "dumping syndrome" after the Lap-Band® procedure because your stomach and intestines have not been bypassed or significantly altered. Gastric bypass patients, on the other hand, are instructed to avoid refined sugar, which can cause dumping.
Q: What is the mortality rate for the Lap-Band® procedure?
A: The mortality rate is extremely low for Lap-Band® surgery, less than 0.1%.
Q: Have you ever had any patients die?
A: No, none of our patients have died.
Q: Will I need to have a blood transfusion during surgery?
A: No, most of the time blood loss is minimal.
Q: Will I have any problems with gas post-operatively?
A: Gas is common during the first post-operative week; some patients complain of "needing to burp, but nothing comes up". This problem can usually be alleviated by walking and drinking fluids as soon as you can after surgery.
Q: How will reflux / heartburn affect me after the surgery?
A: In recent studies, patient's reflux problems have improved after Lap-Band® surgery. However, some patients may experience reflux during the early stages of their recovery.
Q: Will I suffer any hair loss or other nutritional deficiencies commonly associated with bariatric surgery?
A: No, unlike most other forms of bariatric surgery, the Lap-Band® is not a malabsorptive procedure so your body's ability to metabolize vitamins and nutrients will not be affected.
Questions about Paying for Treatment?
Q: Are there options for payment of the Lap Band® System procedure?
A: We have made arrangements for our patients who don't have insurance, or whose insurance will not cover the procedure, to finance the procedure through the CareCredit Online Credit Application Center. Click here for more information.
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