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• Laparoscopic Adjustable Gastric Banding

  A Laparoscopic Adjustable Gastric Band procedure is a purely restrictive surgical procedure in which a flexible silicone band, much like a belt buckle, is placed around the top part of the stomach. The inner surface of the band is lined with an inflatable balloon that is connected to a reservoir by tubing. Your surgeon can fill the balloon with fluid by injecting the reservoir to make the band tighter around the stomach.

  The band works by decreasing the amount of food the patients can eat at one time. Because food is regulated, most patients feel full faster. Food digestion occurs through the normal digestive process.

  Advantages

  1. restricts the amount of food that can be consumed at a meal
  2. food consumed passes through the digestive tract in the usual order allowing it to be fully absorbed into the body
  3. in multiple studies involving over 3000 patients, excess weight loss ranged from 28-87 percent, with a minimum of 2 year postoperative follow-up
  4. band can be adjusted to increase or decrease restriction
  5. surgery can be reversed

  
  

  Risks

  1. gastric perforation or tearing in the stomach wall may require additional operation
  2. access port leakage or twisting may require additional operation
  3. may not provide the necessary feeling of satisfaction that one has had enough to eat
  4. nausea and vomiting
  5. outlet obstruction
  6. pouch dilatation
  7. band migration/slippage

  For more information on the Lap-Band system, visit lapband.com or realize.com

• Gastric Bypass Roux-en-Y

  In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

  According to the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss surgeries in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

  Advantages

  1. The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
  2. One year after surgery, weight loss can average 77 percent of excess body weight.
  3. Studies show that after 10 to 14 years, some patients have maintained 50-60 percent of excess body weight loss.
  4. A 2000 study of 500 patients showed that 96 percent of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

  Risks

  1. Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss. Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  2. A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
  3. A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
  4. In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
  5. The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

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• Is the treatment of obesity with the LapBand experimental or investigational?

  Treatment of morbid obesity with the LapBand is not experimental or investigational. It is a proven and accepted form of surgical treatment for morbid obesity.

• How do I choose which surgical option is right for me?

  Learn as much as you can about the different weight loss surgery options, including advantages and disadvantages, before your appointment with the surgeon. When you have your appointment for evaluation you can discuss your concerns and your surgeon can assist you in making the best choice for you.

• How long will I be in the hospital?

  LapBand operations are done as an outpatient surgery. You will go home the afternoon following your surgery, or the next morning. Gastric Bypass is an inpatient procedure and you will be in the hospital for approximately 2 - 3 days.

• How long before I can go back to work?

  Most people find that they are comfortable to go back to their desk jobs within a week. You may require a longer time away from your work depending on the nature of your job.

• How will my diet change after I have this operation?

  There is no particular "diet" after surgery. You will need to eat 3 balanced meals per day including fruits, vegetables, protein, and dairy. The main priority during meals will be adequate intake of protein such as lean meats, fish, yogurt, low fat cheese, beans, and nuts. The way you eat after surgery is just as important as choosing healthy foods. It is important to use the eating methods learned in your nutrition consult such as avoiding liquids with meals, chewing foods adequately, stop eating at the first sign of fullness, avoid snacking, and eliminating liquids with calories or carbonation.

• Will I ever be able to eat normally again?

  It depends on what you consider to be "normal" eating. You will always have limited portion sizes and will want to avoid snacking between meals. The eating methods after surgery will always be the same. However, you will be able to purchase all foods at a regular grocery store and there will always be an option for you on a restaurant menu.

• The new pouch seems so small. Will I be able to get all my nutrients with a stomach that size?

  Yes. The combination of a balanced diet and a daily multivitamin will help ensure you are getting adequate nutrients.

• I've heard a lot about dumping syndrome. Can you tell me more about that?

  Dumping syndrome may occur if you have had gastric bypass surgery. It happens when you consume foods high in fat or sugar such as sweets, fruits, or starches causing cramping, sweating, fatigue, weakness, hypoglycemia, and hunger. When one of these foods flows into the intestine a rush of water enters to dilute the sugar or fat molecules. This rush of fluid causes the intestine to stretch leading to cramping and often diarrhea. In addition, the pancreas reacts to the high concentration of sugar by producing excess insulin. The increase in insulin often leads to hypoglycemia (low blood sugar). Hypoglycemia causes feelings of fatigue, weakness, sweating, and hunger. Dumping syndrome does not happen to everyone and may only occur for the first few months post-op. Avoiding high sugar foods or combining these foods with other low sugar foods will help to prevent dumping syndrome.

• Is the decrease in portion sizes enough to promote weight loss?

  No. Although the decrease in portion sizes will promote weight loss initially it is important to fill those portions with low fat, healthy foods as well as incorporate an exercise plan in order to promote continued weight loss. Small portion sizes alone cannot guarantee long-term success with poor food choices and lack of physical activity.

• What do I do if I want to get pregnant?

  It is strongly suggested that you wait for at least 18 months after your weight loss surgery. During that time, you must practice an effective form of birth control to avoid serious health risks to you and your unborn child.

• Does insurance companies cover weight loss surgery?

  Some insurance policies do cover weight loss surgery, but it depends on the policy you hold. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria.

  Some of the key steps you can take to help obtain insurance coverage for weight loss surgery:

  • Read and understand the "certificate of coverage." If you do not have one, consult your company's benefits administrator or as your insurance company directly.
  • Your primary care physician may be the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, the support of your primary care physician is essential.
  • Organize your medical records, including your history of dieting efforts, visits to a health care professional for obesity-related issues or visits to supervised weight loss programs.
  • Document all weight loss attempts made through diet centers and fitness club memberships.
  • If your surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company.

  If your initial request for pre-authorization is not approved, insurers provide an appeal process that allows you to address specific reasons for denying your request. Your customer representative at your insurance company, or Texas Department of Insurance, can help guide you through the process.

• Okay! I'm ready to see if I would qualify for bariatric surgery. How do I get started?

  For information on how to begin the process of being evaluated for bariatric surgery, contact us at (512) 341-6850.