LAP-BAND FAQ

LAP-BAND

• What to Expect

  The Lap Band Procedure usually requires only a 24 hour hospital stay.  The procedure itself takes approximately an hour to an hour and a half and results in very little post-operative pain.  In fact, most patients who undergo the lap-band procedure do not need to take prescription pain medicine - Tylenol or Advil usually is enough.
  
  The process begins with an informational seminar and a pre-operative visit with your surgeon.  To see a list of our upcoming seminars, click here.  At the seminar, you will receive more information about the process and have a chance to ask the surgeon any questions that you may have.  The pre-operative visit is a one-on-one opportunity to meet with the doctor to review your medical history and again ask any questions that you may have.
  
  The major determinant of the time until surgery can be scheduled is your method of payment.  Most insurance companies require an extensive pre-operative evaluation before they will authorize Lap Band Surgery.  This evaluation frequently includes a medically supervised diet for 6-12 months, a cardiology evaluation and a psychological assessment.  The necessary steps vary from insurance to insurance and can only be determined by contacting your carrier directly.
  
  Any patient with a history of significant heart disease would clearly require a cardiology appointment before undergoing lap band surgery, but those without any history of heart disease or any symptoms of heart disease would not require this evaluation.
  
  After your surgery is scheduled, you will be given instructions on a pre-operative diet.  This diet is designed to shrink your liver to decrease the risks of this very safe surgery even further.  The length and extent of the diet depends on your pre-operative weight.
  
  All operations are performed at Harper University Hospital in Detroit, Michigan.  We recommend a follow up visit approximately one week after surgery.  Your first band adjustment appointment is typically anywhere from 4-8 weeks after the operation.  This provides an opportunity to review your diet and go over strategies of the successful lap-band patient.  At each subsequent adjustment (usually a total of 4-8 post-operative adjustments are necessary), we will review your diet and your medical health and make any changes necessary to ensure your weight loss success.

• How the Lap Band Works

  The most commonly performed procedure worldwide for obesity is laparoscopic placement of the adjustable gastric band (Lap-Band).  The Australians have extensive experience using this method and have provided tremendous insight as to techniques and post operative management.  This procedure takes approximately one hour, with a 23 hour inpatient hospital stay.
  
  The Lap Band procedure is a purely "restrictive" procedure.  That is, when the fit of the band is optimal, patients will be restricted to the amount that he or she can eat at any one time and allow the patient to feel satisfied after eating only a very small amount of food.  The true secret of the Lap-Band is that it takes away your hunger.  The Lap Band is made of silicone and is placed around the upper portion of the stomach partitioning the stomach into two separate but connected reservoirs.  The stomach above the band is referred to as the pouch.  The stomach below the band is often referred to as the reservoir.  Although the stomach has been compartmentalized it is not cut or divided.  In other words, there is no permanent anatomical change made to the patient's stomach.   This technique leaves the digestive tract in the normal anatomical sequence for digestion and absorption. 
  
  The intended effect is to reduce the stomachs capacity for a meal.   The shape of the stomach can be visualized as an hour glass. Once ingested, food slowly moves from the upper pouch into the lower reservoir through a narrowed passage between the two compartments.   The speed at which food flows through this channel is controlled by adjusting the diameter of the band.  The band is connected to a port that is secured to the abdominal wall deep underneath the skin.  In the doctor's office the port can be felt on examination and accessed with a special needle to make adjustments.  When sterile salt water is placed into the port it travels through the tubing and into the inner tube of the adjustable gastric band.  The inner tube inflates putting pressure around the upper portion of the stomach decreasing the size of the passage.  When optimally adjusted patients feel satisfied after small amounts of food, are less hungry in between meals and spend far less time thinking about food.   Post operative follow up and frequent adjustments are necessary throughout the first 6 months to one year after the operation to ensure success. 
  
  One advantage of gastric banding is that the stomach is not cut, stapled, or entered.  Thus, the risk of infection is less and there is no possibility of staple-line disruption.  However, there is always a risk of injuring the esophagus or stomach when placing the band.  Other important advantages are that the operation is easy to revise and is the only completely reversible technique if such a need arises. In such a case, the band is removed and the stomach recovers its normal anatomy.

• Risk of Surgery

  Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with these procedures.  DMC Harper University Hospital bariatric surgeons have an excellent track record for safety with complication rates that are well below the national average.  Nevertheless, it is important that you are aware of the following risks of the lap band procedure:

   
  • Deep Vein Thrombosis and Pulmonary Embolus: This is a rare but dangerous complication. A blood clot could form in your leg or in your pelvic veins and could travel to your lungs, endangering your life.
   
  • Heart Problems: Severe cardiac problems can occur, however we will make every effort to assess your cardiac condition prior to the surgical procedure.
   
  • Lung Problems: Respiratory insufficiency or problems may occur after the surgery necessitating the use of a ventilator. This potentially would lengthen your hospital stay and your recovery.
   
  • Injuries to other Intra-abdominal organs: As with all surgical procedures, injuries to other intra-abdominal organs can occur. Your surgeon will attend to them as needed. *Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.
   
  • Bleeding: Bleeding may occur during the procedure or in the early post-operative period. You may require the transfusion of blood products as needed. Your surgeon has explained the risks of such transfusions.
   
  • Complications due to anesthesia and medications.
   
  • Infections: either at incision sites or within the abdominal cavity could require further procedures or possible need for another operation.
   
  • Slipped Band: Occasionally the LAP-BAND® can slide out of its original position or a small portion of the stomach can "slide" underneath the Lap Band. Patients usually complain of difficulty swallowing or will vomit soon after eating or drinking. The diagnosis is made with X-ray studies. An operation is required to remedy the problem. Slipped bands usually occur at least one year after surgery.
   
  • Slipped Port: If the port becomes dislodged from the abdominal wall it can make LAP-BAND® adjustments extremely difficult if not impossible. There are occasions when the port must be repositioned. This requires another operation.
   
  • Band Erosion: In the past the LAP-BAND® had been documented to erode into the stomach in a very small number of patients over a long period of time. Now, this is exceedingly rare as a result of design changes made to the LAP-BAND® as well as a change in the surgical technique used to place the band.
   
  • Band infection: As with all "synthetic implants" if the LAP-BAND® becomes infected it must be removed. This would require another operation. A LAP-BAND® can become infected if contaminated by another intra-abdominal infection (ie. "burst appendix, perforated ulcer, etc.).
   
  • Port site infection: The port is secured to the abdominal wall. If a patient develops an infection over this area it is possible for the port to become infected. Most of the time this can be treated with oral antibiotics. However, there are occasions where the port must be disconnected from the band and removed until the infection is cleared. This requires an operation to remove the port followed by a second operation to replace the port.
   
  • Mechanical Failure: The LAP-BAND® is a mechanical device that is prone to breakage or balloon rupture. In the case of mechanical failure, the device can become ineffective and will need to be replaced. Band replacement requires a second operation.
   
  • Hair Loss: Some patients report some form of temporary hair loss, which is believed to be due to a reduced and insufficient post-operative intake of protein. Again, patients need to follow post-operative instructions meticulously.
• Do I Qualify

  Harper  University Hospital uses the following criteria to determine whether or not you  qualify for the lap band procedure:

  1. Age greater than 18 years 
  2. BMI greater than 35 (usually 50 or more pounds overweight)
  3. Well motivated and well informed about the significant lifestyle changes necessary
  4. No active substance abuse problems within the last year 
  5. Are medically healthy enough to tolerate the procedure

  Unfortunately,  most insurance companies use a different set of criteria to determine whether  or not they will authorize the procedure.  Each insurance company is  different, but most agree on the following criteria.

  • Body Mass Index (BMI) of over 40, or
  • BMI of over 35 and have one or more of the co-morbidities associated with increased weight.
  • Most insurance companies expect the patient to provide written evidence that they are unable to achieve a healthy body weight for a sustained period of time through medically supervised dieting, usually in the form of a medically supervised period of diet.

  Our  highly qualified staff will work with you and your insurance carrier to  determine whether or not you meet the necessary qualifications.

  
  
• The Hospital Stay

  Patients are  admitted the same day of their procedure. The procedure itself takes  approximately one hour.  The hospital stay is considered a "23 hour  admission", meaning that patients will stay overnight in a hospital room  for observation.  Most patients are able to walk the halls quite  comfortably immediately after the surgery.  You will be started on a  "clear liquid" diet as soon as you are awake enough to drink.
  
  During your  hospital stay you will meet with a nutritionist for detailed information  regarding your post operative dietary restrictions.  Additionally, your  surgeon will counsel you on the next steps after the operation and answer any  questions you may have.  Most patients are discharged by 11 am the  following day.  You will also be provided a detailed handout with post  operative information to make your recovery a smooth and comfortable  experience.

  Most patients are sent home with only a prescription for pain  medicine.  Less than half of our patients need to fill this prescription  since Tylenol or Advil usually suffices for pain control.  Those patients  who travel more than two hours will also be given a prescription for a blood  thinner to prevent blood clots from forming while they travel.

  
  
• Life After Surgery

  Going Back to Work
  Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within two to three weeks.
  
  Birth Control & Pregnancy
  It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 12 to 18 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.  Should you become pregnant, fluid can be removed from the band to reduce restriction during your pregnancy.
  
  Support Groups
  The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being.  Harper Bariatric Medicine Institute's bariatric surgeons have support groups in place to assist you with short-term and long-term questions and needs. Ongoing post-surgical support helps produce the greatest level of success.

• Post-Operative Diet

  Pre-operatively, our patients are placed on a low calorie diet for 1-2 weeks before surgery.  The purpose of this pre-operative diet is to decrease the size of the liver which will make the surgery safer.  The length and restrictions of the diet are based on your BMI and gender since these are the major determinants of the size of the liver.  The details of the pre-operative diet are spelled out in our Knowledge Center.
   
  The post operative diet has been created to help reduce the chances of having a band complication in the early post operative period. By slowly advancing your diet you are allowing your body time to heal. The band has been placed around the upper portion of your stomach and is held into position by sutures placed in key positions. Any event that leads to early pouch distension, retching or vomiting can adversely affect the position of the band. It is extremely rare for a patient to develop a positioning problem early on when the postoperative diet has been abided by.
  
  The stepwise advancement of diet may initially seem to be an eternity, but do not worry. The goal is to advance you to a "normal" diet by the 4th week after surgery. Be mindful that as you progress through the different stages you may notice that you get full quicker or even have a little discomfort after you eat. This is normal and is referred to as "the learning curve" after undergoing band placement. Over time you will learn how quickly you can drink, how much you need to chew and what items you just can't tolerate no matter what you do. No two band patients have the same finger prints, and no two band patients can tolerate every food item the same
  .
  The details of the post-operative diet are spelled out in our Knowledge Center

• Insurance and other Payment Options

  Approximately  two-thirds of all insurance policies will cover the lap-band surgery.   Health insurance can be extremely complicated and just because you and your neighbor both have "Aetna" does not mean that you both are covered  for the procedure.  Since most health insurance policies are purchased by  your employer, each employer may purchase a different package - your employer  may elect Aetna with weight loss surgery coverage, while your neighbor's  employer may elect Aetna without weight loss surgery coverage.  The first  step to determining whether or not your insurance carrier will cover the  procedure is to call the phone number on the back of your insurance card and  ask whether or not your policy will cover the lap-band surgery.
  
  As a general  guideline, these patients will not be able to acquire coverage for a lap band  procedure:

  • BMI between 30-35 
  • Age >65
  • Canadian patients (The Canadian government will not pay for the lap-band procedure)
  • Those patients whose insurance policies do not cover weight loss surgery

  Those patients  who elect the insurance payment option will need to undergo the evaluations  that are required by their insurance carrier (like a psychiatric evaluation).

  
  
  Self Pay
  

  There are self pay / cash packages available to patients whose insurance  policy does not cover the surgery.  You  should speak with a coordinator in your surgeons office regarding these  options.