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LAP-BAND System Weight-Loss Results

The LAP-BAND System is a tool to help you achieve sustained weight loss by limiting how much you can eat, reducing your appetite, and slowing digestion.  Remember, though, that the LAP – BAND System by itself will not solve morbid obesity, nor will it ensure that you reach your goal weight at all.  The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits.
Some people lose more than others, and though you may never reach your ideal weight, chances are good that with weight loss your health and self-image will improve.

LAP-BAND System Removal

If there is a problem with the band, if you can't lose enough weight or can't adjust to the new eating habits, your surgeon may suggest removal of the band.  This decision will come after your surgeon consults with you.  Generally, after LAP-BAND System removal, your stomach will be restored to its original form and the digestive tract should function normally.  Please keep in mind that when the band is removed, your weight will likely increase.

Minimal Trauma

• Least invasive surgical option
• No intestinal re-routing
• No Cutting or stapling of the stomach wall or bowel
• Small incisions and minimal scarring
• Reduced patient pain, length of hospital stay and recovery period

Note: Surgeons report that at 5 years, many LAP-Band and Gastric Bypass patients achieve comparable weight loss (55% for LAP-BAND and 59% for Gastric Bypass)

• Significantly lower mortality risk compared to other obesity surgeries
• Low risk of nutritional deficiencies associated with Gastric Bypass
• Reduced risk of hair loss
• No “dumping syndrome” related to dietary intake restrictions.

• Removable at any time
• Stomach and other anatomy are generally restored to their original forms and functions

• Almost 150,000 LAP-Band's placed worldwide
• Standard care for hundreds of surgeons around the world
• Academic publications with up to 8 years follow-up

You may be eligible for LAP-BAND System surgery if:

• You are at least 18 years old.
• Your BMI is > 40 or you weigh at least twice your ideal weight or at least 100 pounds more than your ideal weight.
• You have been overweight for more than 5 years.
• Your serious weight-loss attempts had only short-term success.
• You are not suffering from any other diseases that may have caused you obesity.
• You are prepared to make substantial changes in your eating habits and lifestyle.
• You are willing to continue being monitored by the specialist treating you.
• You do not drink alcohol in excess.

If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is over 35 and you are suffering from serious health problems caused by you weight.  Your surgeon may have additional criteria. 

The LAP-BAND System is not right for you if:

1. You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, or Cohn's disease.
2. You have severe heart or lung disease that makes you a poor candidate for surgery.
3. You have some other disease that makes you a poor candidate for surgery.
4. You have a problem that could cause bleeding in the esophageal or gastric varies (a dilated vein).  It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel)
5. You have a portal hypertension
6. Your esophagus, stomach, or intestine is not normal (congenital or acquired).  For instance you might have a narrowed opening.
7. You have or have experienced an operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
8. You have cirrhosis.
9. You have chronic pancreatitis
10. You are pregnant. (If you become pregnant after the LAP-BAND System has been placed, the band may need to be deflated.  The same is true if you need more nutrition for any other reason, such as becoming seriously ill.  In rare cases, removal may be needed.)
11. You are addicted to alcohol or drugs.
12. You are under 18 years of age. (There are exceptions may be considered depending on health issues.)
13. You have an infection anywhere in your body or one that could contaminate the surgical area.
14. You are on chronic, long-term steroid treatment.
15. You cannot or do not want to follow the dietary rules that come with this procedure.
16. You might be allergic to materials in the device.
17. You cannot tolerate pain from an implanted device.
18. You or someone in your family has an autoimmune connective tissue disease.

Your surgeon will not perform the operation unless he or she knows you understand the problems your excess weight is causing.  Also, your surgeon will make sure you know that you have responsibilities, such as adopting new eating patterns and a new lifestyle.  If you are ready to take an active part in reducing your weight, your surgeon will consider the treatment.  You should be well-informed about the advantages, disadvantages and risks involved.  Be sure to investigate whether this treatment is right for you.

Before your surgery, please speak with your surgeon about the procedure in detail.  Your doctor may also want you to meet with other experts who can help you understand what will happen during and after the operation.  These experts might include:

• A dietitian
• A physiotherapist
• A psychologist
• Other specialists

You will also have a number of tests before your surgery to evaluate your health.  When it is time for surgery, you will be admitted to the hospital either the day before or on the morning of your surgery.

At the start of the operation, you will be given general anesthesia.  If your case is typical, the operation will be performed laparoscopically.  During the operation, the band part of the LAP-BAND System will be fastened around the upper part of your stomach to create a small stomach pouch.  Part of the lower stomach will then be sutured over the band. The rest of the lower stomach will stay in its normal position.  The access port for adjusting the band will be placed under your skin.  To do this, the surgeon will slightly enlarge one of the operative incisions.

There are clear advantages to having laparoscopic surgery.  In an “open” surgery, a larger incision is made. After a laparoscopic surgery, most people feel much less pain, there are fewer wound complications, and patients recover faster and are able to resume normal activities sooner.

Once the anesthesia has worn off, you may feel some pain, which can usually be relieved with ordinary painkillers.  The hospital staff will help you get out of bed and start moving as soon as possible to help prevent blood clots, respiratory problems, and bedsores.

On the day after the surgery you will likely have an ex-ray.  This allows your health team to see that the LAP-BAND System is in the right place and that the new stomach outlet is opened.  You may be asked to swallow a liquid that can be seen on X-ray.

For LAP-BAND surgery, hospitalization is usually less than 24 hours.  The hospital stay may be longer if there are complications or if the surgeon has to convert to an “open” surgical procedure.  If there are no complications, you should be able to resume normal activities within a week or two after surgery.

Post-Surgery Diet Nutrition & Exercise

After surgery, you will need a new nutrition plan.  Discuss this in detail with your surgeon and/or dietitian as they can help you learn about and get used to the changes in lifestyle and eating habits you need to make.

It is very important to follow the eating and drinking instruction starting right after the operation to allow the new stomach structure to heal completely and in the right position.  This may take a month or more.  It is also important, especially in the early weeks, not to stretch the small stomach pouch above the band.  Vomiting can stretch it, so it is important not to vomit.  Vomiting can increase the chance of stomach tissue slipping through the band.

The goal during this early post-operative period is to protect the small stomach pouch.  Only thin liquids can be tolerated at this time.  It is also important to keep hydrated with lots of water.  Other liquids recommended during this phase include:

• clear broth or soup (with no vegetables or meat and not creamy)
• skim milk
• fruit juice
• no-sugar-added popsicles

During this phase you may start having slightly textured foods.  Aim for the consistency of baby foods.  This will help you transition to more sold foods later.  Because protein is so important to help you maintain muscle while you are losing weight, eat protein-rich foods first, and then move on to fruity and vegetables.  Foods in this stage may include:

• pureed skinless chicken or fish
• mashed potatoes
• peas
• low-fat yogurt or pudding

In the first few weeks you may be able to eat foods that might not be allowed in your diet later as these foods may contain too many calories.  It is more important in the first few weeks to let you stomach adjust to the LAP-BAND System than it is too lose weight.  Also, your timing and progression into each dietary phase may vary.  In general, you should follow the advice of your surgeon and/or dietitian about nutrition.
Soft Foods (5 weeks post-op)
Your meals can now include tender cooked foods like fish and ground turkey.  Now that you can chew, make it a habit to chew foods well.  If you have dentures, be sure to cut your food into small pieces and chew it thoroughly.  If you don't follow these precautions, you may experience vomiting, stomach irritation and swelling.  You could also have stoma obstruction.

If solid foods cause nausea and vomiting go back to the liquid diet you had earlier.  Then you can slowly add soft foods and eventually transition to solid foods.  Always ask for advice from your doctor or dietitian that is specific to you situation.  Vomiting may increase the incidence of slippage, stomach slippage, or stretching of the small stomach pouch above the band.

Your New Nutrition Plan

When you can eat solid foods without problems you will need to pay close attention to your diet.  Liquids will pass through the reduced stomach pouch quickly and will not make you feel full.  The LAP-BAND was designed to restrict solids, not liquids.  Drinking liquids during or immediately after meals tends to flush food through the pouch and will not get the prolonged feeling of satiety needed to help you eat less.

Staying hydrated throughout the day is important.  Drink at least 6-8 cups of water per day and make sure you consume them between meals.

Many patients have a difficult time with solid foods during the morning hours.  If this is the case for you, you can open up your LAP-BAND by starting with a couple of glasses of liquids before your first meal.
Too much food or big chunks of food can block the stomach pouch outlet.  You can avoid this problem by chewing food well and eating small bits at a time, it is important to remember that your new stoma opening is approximately the size of a dime.  Chew your food adequately so that it can easily fit through the opening.

Eat only three small meals a day and make sure that these meals contain adequate nutrients.  Your stomach can only hold about ¼ cup of food or 2oz. at a time.  Stop eating when your hunger is gone or when you feel comfortable.

You may find that the small stomach pouch makes digestion of high-fiber, high-fat and dry foods more difficult.  Tolerance will vary from person to person.  Ask your surgeon and/or dietitian about your food choices.

The general guide below can help you create good and healthy meals that contain adequate nutrients but little sugar and fat.

1. Fruits and vegetables

• 1 to 2 servings of fresh fruit daily
• 2 to 3 servings of fresh vegetables daily

2. Breads and cereals

• 1 small portion of low-sugar cold or hot cereal
• ½ to 1 slice of toasted whole wheat or rye bread each day.

 Note: some patients have difficulty eating bread.

3. Meat, fish, poultry, eggs products

• 1 oz. - 2 oz. of meat, fish, or poultry or one egg each day.  Remove all visible fat from the meat.  Remove the skin from the poultry.  Prepare the meat in ways that need very little fat.  Grilling, steaming, microwaving, or boiling is all good ways to do this. 

Note: some patients have difficulty eating meat.

• 4. Dairy products
  Milk and yogurt and calories in liquid form.  However, these types of food have calcium, which makes them an important part of a healthy daily diet, so choose a maximum of 2 cups of skimmed mild or low-fat yogurt and 1 oz. of cheese a day

5. Fats

• Restrict the use of fat to 3 to 4 teaspoons of margarine, butter or oil per day.  You can have low-fat salad dressings and mayonnaise in moderation.

6. Drinks

• Drink as many calorie-free liquids per day as you wish (though not with meals).

Some foods have a concentrated supply of calories with little nutritional value and should be avoided as much as possible.  They include foods such as:

• syrups
• cakes
• biscuits
• jam
• honey
• pies
• chips
• pastries
  

Alcoholic drinks should also be consumed in moderation, for example a glass of wine per day.

Some foods have difficulty passing through the opening of the stoma and may cause blockage. These include foods such as:

• dry meat
• shrimp
• un-toasted or doughy bread
• pasta
• rice
• peanut butter
• dried fruit
• fibrous vegetables like corn, asparagus, celery
• nuts
• coconut
• popcorn
• greasy of fried food
• seeds and skins of fruits and vegetables
• membrane of citrus fruits

 

Introduce these foods slowly and individually to see if they are tolerated.  Always be careful, chew well, and follow your surgeon's or dietitian's advice.

Incorporating regular physical activity into your daily routine is as important as your nutrition plan.  Often patients have been sedentary due to decreased activity tolerance, psychological constraints, and in some cases, physical disabilities.  After LAP-BAND surgery, aerobic activities—particularly walking and swimming—are generally best tolerated.  Consult your surgeon and weight management team to find out which activity is right for you.

Surgery is the first step on the road to successful and sustained weight loss.  However, you must adopt a lifelong program that will help you meet your goals.  This multi-faceted program will include routine check-ups with your surgeon, ongoing band adjustments if necessary, and regular attendance at support group meetings.  Work closely with your surgeon and weight management team, follow their advice and communicate openly with them.  Learn to use the LAP-BAND System as a tool to help you lose your excess weight.

These rules for eating, drinking, and exercise will help you get the best results with the LAP-BAND System:

1. Eat only three small meals a day.
2. Eat slowly and chew thoroughly.
3. Stop eating as soon as you feel full.
4. Do not drink while eating.
5. Do not eat between meals.
6. Eat only good quality food.
7. Avoid fibrous food.
8. Drink enough fluids during the day.
9. Drink only low-calorie liquids.
10. Exercise at least 30 minutes a day.

LAP-BAND adjustments are performed without surgery using a thin needle to inject or withdraw saline from the band via the access port.  Being able to adjust the band is a unique feature of the LAP-BAND System and is a normal part of the follow-ups.  This feature lets your surgeon find the right level of restriction to meet your individual needs.

Following the LAP-BAND System placement procedure, the band is usually left empty or only partially inflated for a while.  Adjustments are not usually performed until 4 to 6 weeks after surgery, although the exact time will vary from patient to patient.  You and your surgeon will decide when the time is right for your first band adjustment.  To determine this, you surgeon will consider:

• Your weight loss so far
• The amount of food you can comfortably eat
• Your exercise routine, and
• The amount of fluid already in your band.

The LAP-BAND System offers you a way to obtain steady and safe weight loss.  Don't be in a hurry to have an adjustment before you are ready.

Motivation is Key

To work, the band needs your participation.  Your success will depend on you and the partnership between you and your medical team.  Your surgeon will not perform the operation unless he or she is sure that you understand the problems your excess weight is causing.  Your surgeon will also make sure you understand your responsibilities, including adopting and maintaining new eating patterns and a new lifestyle.