Adjustable
Band - Frequently Asked Questions
 |
How
much weight will I lose? |
 |
| |
| Weight loss is more
variable with Adjustable Gastric Band than with
other operations. Some patients lose all their excess
weight, and some lose very little. Since the Band
is only a tool, your weight loss will depend on
how well you use it. You can easily cheat by drinking
high-calorie liquids. That said, average weight
loss is 50% of excess weight at 5 years. But this
includes all patients, including those who have
lost little or no weight. |
| |
|
|
How
is the band ajusted? |
|
| |
| The Band is tightened
by accessing the port with a needle. This is most
commonly done in the office. Some surgeons do it
at the hospital under x-ray guidance, but this is
generally not necessary, and makes the procedure
much more expensive. For patients with very thick
abdominal walls, it may be more difficult to find
the port. In our office we have an ultrasound machine
which makes it possible to access most ports without
need for x-ray. |
| |
|
|
Can
I adjust my own Band? |
|
| |
| No You Can’t. Attempting to
adjust your own band may result in infection and
you may require another operation to remove the
band. |
| |
|
|
Why do I have to take vitamins? |
|
| |
| The Adjustable Gastric Band operation is purely restrictive,
so technically you don't need to take vitamins if you are eating a healthy
diet. On the other hand, by definition you are eating a hypo-caloric diet,
one which will cause you to lose weight. Because of this, we worry that
you won't get all the vitamins and minerals you need. This is the main reason
we ask you to take vitamins after the surgery. |
| |
|
|
What about the gallbladder? |
|
| |
| We don't remove the gallbladder unless you already have gallstones
that are causing symptoms. Weight loss is slow and natural, so the risk
of gallstones is not sufficiently elevated as to make gallbladder removal
worth doing. |
| |
|
|
Can the Band be rejected by my body? |
|
| |
| The Band is made of silicone rubber, and cannot be rejected.
Of course it can become infected and require removal, but this is not the
same as being rejected like a transplanted organ. |
| |
|
|
What happens after I lose my weight? |
|
| |
| The Band causes you to lose weight by restricting your caloric
intake to less than your caloric expenditure. As you lose weight, your calorie
requirements diminish. Once intake matches expenditure, you stop losing
weight. |
| |
|
|
How long does the Band stay in? |
|
| |
| The Band stays in forever. If it is removed you will regain
all the weight you lost. |
| |
|
|
What is a slipped Band, and what causes it? |
|
| |
There are two types of slippage; anterior and posterior. This
refers to whether the front or back side of the stomach slips. There is
something else called concentric pouch dilation, but this is not the same
as slippage. Slippage or prolapse is when the stomach slides up through
the Band, making the pouch bigger. If this happens the Band usually becomes
too tight, and patients experience symptoms of reflux (heartburn) as well
as nausea and vomiting. This is because the amount of stomach being “squeezed”
by the Band is increased, thereby obstructing the Band.
There are several causes. Posterior slippage was more common when the Band
was placed by the “perigastric” technique. With this technique
the back side of the stomach was free to slide up through the Band. These
days most surgeons use the “pars flaccida” technique, which
was developed to prevent posterior slippage, and has more or less eliminated
the incidence of this problem.
Anterior slippage is when the front of the stomach slips up through the
Band. We try to prevent this by suturing the stomach below the Band to the
stomach above the Band, “locking” the Band in place in the right
spot. In spite of this, slippage still occurs. It can happen because we
haven't placed enough stitches, or they haven't been placed in the right
place. Slippage can also occur if patients eat too much and vomit frequently. |
| |
|
|
How is a slipped Band diagnosed? |
|
| |
| Fortunately, this is very easy. Often the diagnosis is made
based on the history alone. A patient who has been going along fine, with
no problems, and then suddenly develops reflux symptoms or symptoms of a
too-tight Band will most likely have a slipped Band. The diagnosis is easily
confirmed with an x-ray and barium swallow examination. Endoscopy is rarely
necessary. |
| |
|
|
How is a slipped Band fixed? |
|
| |
| A slipped Band needs to be fixed with an operation. The Band
has to be dissected out, all the sutures removed, and the position of the
stomach made right. Some surgeons remove the Band and place it back through
a new tunnel. Others just straighten things out and re-suture the stomach
over the Band. |
| |
|
|
What happens if the Band slips again? |
|
| |
| That's a tough one. One could certainly try to fix the slip
again, but my personal view is that, for whatever reason, the Band is just
not working for that particular patient, and ought to be removed. |
| |
|
|
What is a Band erosion? |
|
| |
| This is when the Band actually erodes into the stomach. It
is a more serious problem, and generally requires removal of the Band. Band
erosion is thought to be related to placing too many sutures (or too tight
sutures) at the time of Band implantation. Surprisingly, Band erosion is
often unnoticed. Occasionally the port will become infected if bacteria
track along the catheter out to the port. Other times patients will stop
losing weight. Diagnosis often requires an endoscopy. |
| |
|
|
What is concentric pouch dilation? |
|
| |
| This is technically not the same as slippage. In this case
the pouch just seems to be enlarged. Sometimes partial emptying of the Band
may help with this. |
| |
|
|
What is esophageal dilation? |
|
| |
| This is when the esophagus enlarges over time, and is probably
related to either too tight a Band, or possibly improper placement of the
Band around the junction of the esophagus and stomach. This requires loosening
or removal of the Band. |
| |
|
|
What happens if my Band has to be removed because
of complications or failure to lose weight? |
|
| |
| One option, of course, is to give up on weight loss surgery.
Another option is to convert to another procedure such as Roux-en-Y gastric
bypass. This can be done at the same time the Band is removed, and is generally
done laparoscopically. |
| |
|
Sleeve Gastrectomy
- Frequently Asked Questions
|
How much weight will I lose? |
|
| |
| This is obviously a key question. Unfortunately,
there is no long term data to give us a good answer. Preliminary
data suggests that weight loss may be similar to that
attained with Roux-en-Y gastric bypass. |
| |
|
|
Can the staples tear out? |
|
| |
| No. Once you have recovered from the surgery,
your body's own scar tissue heals the stomach tissue together,
just as your skin stays healed long after sutures or staples
are removed. |
| |
|
|
What are the staples made of? |
|
| |
| Staples are made of titanium. You can have
an MRI scan, and you can go through the detectors at the
airport without any problems. |
| |
|
|
What is a Bougie, and what size
do you use? |
|
| |
| A bougie is a soft flexible rubber tube
that comes in multiple sizes. They are designed to stretch
esophageal strictures. We use them to calibrate the size
of the gastric sleeve. The size indicates the circumference
in millimeters. I use a Size 32 bougie, which translates
to a diameter of about 10 millimeters or 0.4 inches. This
is very thin, and explains why you can't eat very much!
It is placed temporarily while performing the operation,
then removed. |
| |
|
|
What is a leak test, and should
I have one? |
|
| |
| One of the most feared causes of complications
after sleeve gastrectomy is a leak at the staple line.
These leaks can be caused either by stapler malfunction,
wrong choice of stapler size, or trying to staple tissue
too thick to accomodate the stapler. There are several
ways to test a staple line for defects. One is to submerge
the finished sleeve under saline solution and inflate
it with air from either a tube or an endoscope in the
stomach. Another is to pump a dye called methylene blue
into the stomach and see if it leaks out. These tests
are done during the surgery. After surgery, we can test
for leaks by giving contrast material (dye) by mouth and
taking x-ray pictures to look for a leak. Each test has
advantages and disadvantages, as well as significant false
negative rates (the test is normal but there is still
a leak). Another problem comes from the fact that many
leaks don't even turn up until several days to a week
after the surgery. Each surgeon has his own technique
and philosophy on leak testing, as there is no clear consensus
on the best way to check for leaks. |
| |
|
|
Why do I have to take vitamins? |
|
| |
| The sleeve gastrectomy operation is purely
restrictive, so you wouldn't think you would need to take
vitamins if you are eating a healthy diet. On the other
hand, by definition you are eating a hypo-caloric diet,
one which will cause you to lose weight. Because of this,
we worry that you won't get all the vitamins and minerals
you need. This is the main reason we ask you to take vitamins
after the surgery. In addition, the stomach secretes a
substance called intrinsic factor, which is important
in absorption of vitamin B-12. Since we are removing a
large part of the stomach there is a chance that you won't
be able to properly absorb this vitamin. For this reason
it is a good idea to take supplemental vitamin B-12. |
| |
|
|
What are the advantages of the operation
over gastric bypass? |
|
| |
| There is no rerouting of the intestines,
and no new connections need to be made. This makes it
safer, easier, and faster to perform. The lack of rerouting
eliminates the late risk of bowel obstruction from internal
hernia that comes with the gastric bypass operation. Finally,
the lack of rerouting also reduces the risk of vitamin
and mineral deficiencies. Another advantage is that the
operation is ideally suited for conversion to another
procedure such as gastric bypass, duodenal switch, or
even Adjustable Gastric Band. |
| |
|
|
What are the disadvantages as compared
to gastric bypass? |
|
| |
| The main disadvantage is that we don't have
long-term data to document that weight loss will be maintained.
The sleeve may stretch out, resulting in weight regain.
Another disadvantage is that the operation is not reversible,
in that part of the stomach is removed and thrown away.
It can never be replaced. (On the other hand, there should
be no reason to want to put it back). |
| |
|
|
What are the advantages of the VSG
over the Adjustable Gastric Band? |
|
| |
With the VSG there is no foreign body to
break, slip, or erode. There is nothing to be adjusted.
Reoperation rate for these complications is therefore
eliminated. You don't need to worry about getting follow-up
care if you move to another city.
Weight loss is faster and more reliable with the VSG.
The feeling of fullness that you get from the VSG is much
more satisfying than the feeling of obstruction or discomfort
that you get with the Adjustable Gastric Band. Few patients
vomit after the VSG, while many patients continue to have
vomiting episodes long after they have their Adjustable
Gastric Bands placed. |
| |
|
|
What are the disadvantages as compared
to the Adjustable Gastric Band? |
|
| |
| The Adjustable Gastric Band is reversible;
the VSG is not. Unfortunately this turns out not to be
much of an advantage of the Adjustable Gastric Band, as
the only reason to remove a Adjustable Gastric Band is
for complications. |
| |
|
Gastric Bypass - Frequently Asked Questions
|
How much weight will I lose? |
|
| |
| Gastric bypass can yield a weight loss between
65 and 90% for the first year and it very important patients
understand that following the recommendations from the
dietitian is crucial to maximize and maintain weight loss
during the post operative period. |
| |
|
|
Can the staples tear out? |
|
| |
| No. Once you have recovered from the surgery,
your body's own scar tissue heals the stomach tissue together,
just as your skin stays healed long after sutures or staples
are removed. |
| |
|
|
What
are the staples made of? |
|
| |
| Staples are made of titanium. You can have
an MRI scan, and you can go through the detectors at the
airport without any problems. |
| |
|
|
Is the doctor going to remove my
gallbladder? |
|
| |
| We usually do not remove the gallbladder
unless there are stones cuasing problems such pain, nausea
or vomiting before surgery. |
| |
|
|
Why do I have to take vitamins? |
|
| |
| Gastric bypass involves a mala-absorption
component (re-routing of the intestine) That means, that
certain nutrients such as iron, calcium, proteins and
vitamins will not be able to be fully absorbed by the
body. This is why it is very important for you to return
to our office so we can assess your nutritional status
at least once a year for the rest of your life.
As soon as you are discharged from the hospital you
will start taking vitamin supplements, as explained
by our dietitian or surgeon. |
| |
|
|
How long does it take to do a gstric
bypass? |
|
| |
| The procedure
it takes approximately 2 hours. Sometimes, extra
time is needed if the patient has adhesions (scar-tissue)
as a result of previous surgeries (C-sections or
hysterectomies). |
| |
|
|
How Long do I have to stay in the
hospital? |
|
| |
| Most patients are discharged the following
day after surgery in uncomplicated cases. An extra day
may be needed to if post operative pain or nausea required
better control. |
| |
|
|
When can I return to work? |
|
| |
| Because the procedure is generally done
laparoscopically (key-hole incisions), most patients are
ready to return to work between 1 and two weeks. If your
work involves physical labor, you might need to wait between
3 to 6 weeks for fully recovery. No heavy lifting (more
than 10lbs) is allowed for four to six weeks after surgery. |
| |
|
| If you have questions that
have not been answered by this FAQ, please send them to
me and I will try to answer them for you. |
|
