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Common LAGB questions

The following are some of the most commonly asked questions in relation to laparoscopic adjustable gastric banding (LAGB).

 

Is the band always implanted using “keyhole” surgery?

Yes.  Nowadays, the band is almost never implanted using open surgery.  The only exception to this would be if there were highly unusual technical reasons why the band could not be implanted laparoscopically (i.e. using keyhole techniques).  

 

How much weight can I expect to lose?

On average we expect LAGB patients to lose 50-60% of their excess weight.   Obviously some people will do better and some not as well as this. 

 

Will I have pain after the operation?

Yes, you will have some discomfort and there are two main sources for this.  Firstly the port entry sites, through which the operating instruments and camera were passed can be sore, especially the one where the band access port was placed in the deep tissues.  Secondly, it is quite common to have left shoulder pain after the procedure.  This is actually pain coming from the diaphragm which is the large, thin sheet of muscle separating the chest from the abdominal cavity.  It usually settles down after a few days.  As a general rule, most people do not have severe pain from this procedure and what discomfort they do have, usually responds to a few days of simple painkillers such as paracetamol.   

 

How soon can I drive after the operation?

You should not drive for 2-3 days after surgery to allow the effects of the anaesthetic and any post-operative analgesia (painkillers) to wear off.  Thereafter you may find driving a little uncomfortable until the port sites have fully healed – usually around 10 days.

 

How long will I be off work?

 

This depends upon what you do for a living, but if you have a sedentary occupation you can generally expect to be back at work after about 1 week.  If your job involves some lifting, you will probably need a two-week period to allow the wounds to heal.

 

 

What about scars following surgery?

Generally there is minimal scarring following LAGB.  The ports are placed in the abdomen through 4 or 5 narrow (1cm) incisions and the access port is fixed through an incision about 3-4 cms.  These are sutured and/or glued and will normally heal in about 10-14 days.  Thereafter the scars should fade gradually.  Some individuals have a greater tendency to form keloid, which may result in thicker and more prominent scars.

 

Should I expect frequent vomiting?

There should be no vomiting at all.  The LAGB is designed to provide a gentle restriction or “brake” on your eating.  It is NOT meant to stop you eating.  If you are vomiting frequently, there is something wrong with your band adjustment or you are not following the eating rules.  Persistent vomiting may be a sign of band slippage.

 

What about medication?

Usually, you will be able to continue with your regular medication.  However, if your tablets are very large, it may be necessary to break them up (most good chemists will have a little contraption that will allow you to do this quite easily).  Try them first.  If you feel they are sticking, you can crush them up and take them with a spoonful of yoghurt to disguise the taste.  Before doing this, however, you should check with the pharmacist that this is OK.  Some tablets are specially formulated to be released slowly or coated to protect the stomach and these properties may be destroyed if you crush them.  Capsules should not be a problem because they are soft and designed to soften and melt inside the stomach. 

 

Will I need to take vitamin supplements?

 

Yes.  Because you are eating much less and losing weight, we recommend that you take a soluble multivitamin each day just to make sure you are covering all your requirements, especially B vitamins, folate and iron. 

 

What about physical activity?

 

Regular physical activity is a very important factor in achieving your weight loss goals following LAGB.  You will be given specific information and advice about physical activity after surgery, but to begin with we strongly recommend walking.  As you become fitter you may wish to become involved in more strenuous forms of activity and there is no exercise that must be excluded because of the band.  You cannot damage either the band  itself, the connecting tubing or the access port through physical activity. 

 

Is it true that sweet eaters do less well with a band?

No.  Although it is a very common belief – even among health professionals – that sweet eaters will do poorly after LAGB, this is emphatically NOT true.  There are good scientific data to show that sweet eaters do just as well as anyone else following LAGB.

 

Are the band adjustments painful?

No they are not.  Experience suggests that some people worry more about the procedure for adjusting the band than they do about the surgery to implant the band.  In practice, each adjustment consists of a brief scratch of the skin with a small needle and then some very mild discomfort as we push on the access port .  It usually takes a few minutes and does not require any form of anaesthetic (it would hurt as much to put in some local anaesthetic as it does to do the adjustment itself).  After your first adjustment has been done you will be less anxious when it comes to further adjustments. 

 

How often will I need to have the band adjusted?

This really depends upon how well you are doing.  In general, if you are losing 1-2 lbs (0.5-1kg) each week, have no symptoms and feel well, your band is fine.  If your weight loss is very slow, or if you feel you have very little restriction, you may need a further adjustment.  There is considerable individual variation in how many adjustments are required in the first 12-months.  Some need just one, a few may need five or six.  But do remember that more is not necessarily better.  Some people think that if the band is producing good weight loss, then tightening it further will result in even more dramatic losses.  This is nonsense.  A band which is over-adjusted can be dangerous, increasing the chance of slippage and other complications.  

 

Does the band leak?

The answer is YES, a tiny amount of fluid can leak from the band system over time, so you will probably need a top-up to restore your usual level of restriction.  If you don’t realize this, you may find yourself feeling hungry and putting on weight for no obvious reason and blaming yourself.  So even when you have achieved your weight loss, we ask you to stay in touch and attend for an annual “MOT” just to make sure everything is OK.   

 

What happens if I lose too much weight?

It is very unusual for this to be a problem, but if your weight continues to decline even when you have achieved your goal, we would remove some fluid from the band to reduce the amount of restriction.  This is a great strength of the band – it can be adjusted to suit the requirements of the individual.

 

Can the band be removed?

Yes.  It can be removed relatively easily, though it is not our intention to remove it.  Furthermore, because the LAGB does not involve any cutting of the bowel or stomach, removal of the band will leave behind a fully restored and normal stomach and alimentary system. 

 

Will I be constipated?

Possibly.  As you eat less the amount of residue (especially fibre) in your diet falls and your bowel activity will decrease.  If you do become constipated, there are plenty of effective remedies which can deal with the problem.  You will be given advice about this later. 

 

What happens if I become pregnant?

The LAGB does not interfere in any way with normal pregnancy.  Of course the likelihood of becoming pregnant is much higher as a result of the band, since weight loss is known to increase fertility.  There is a protocol for managing the band if you become pregnant, so you need have no concerns about this.    

 

Can I drink alcohol?

Yes – in moderation.  Alcohol has a high calorific value (7 kcal/gram) and can provide a lot of unwanted calories which will pass easily through your band.  So you need to pay attention.  However, there are some health benefits to be derived from moderate alcohol intake and there is some evidence to suggest that it may even enhance weight loss.  So we are quite happy for you to have the equivalent of one unit of alcohol per day.  [NB.  There is one unit of alcohol in half pint of normal strength beer, half a standard (175ml) glass of wine or a small single measure of spirits].

 

Can I burp with the band?

Not very easily.  As we eat it is normal to swallow a certain amount of air, but we can usually bring this up again without difficulty.  The band interferes with this natural process so that whilst people may want to burp they find it much more difficult.  The good news is that for some reason this is a relatively short-lived problem which does not seem to persist beyond the first few months. 

 

Is it true that the band is tighter in the morning?

This is a fairly common feeling, especially for patients with bands that are tight to begin with to facilitate maximum weight loss or for patients who have just had an adjustment.  Some women have also noticed that the band feels tighter during menstruation.  It is probably a function of changes in fluid balance in the tissues and is of no real significance other than the fact that you may need to be more careful eating or drinking in the morning. 

 

Can I eat anything in moderation?

Yes.  You may eat most foods that don't cause you discomfort.  However, because you can only eat small amounts, it is quite important to include foods which are rich in protein but low in fat and sugar.  We encourage you to eat vegetables, fruit, wholegrains, lean meat and fish.  You will receive detailed nutritional information following you surgery.    

 

What about air travel?

Some people feel that the band is tighter when they are flying.  This can occur if there are any small air bubbles in the band.  At normal pressure on the ground, tiny bubbles don’t matter, but at 30,000 feet the pressure in the cabin may be inadequate and the bubbles can expand making the band feel tighter.  As a result, you may find it a little more difficult than normal to swallow solid foods.  This will return to normal once to get back to ground level.  We do all we can to remove air from the band, but it’s not always possible to eliminate them entirely.  Incidentally, the gastric band does not set off airport security or x-ray systems.

 

Is silicone dangerous (toxic) to me?

There is no evidence at all to suggest that silicone is dangerous.  Silicone implants have been used in various areas of medicine for more than 50 years, but have never been shown to be dangerous.  Even the widely publicised concerns about breast implants turned out to have no scientific foundation. The gastric band is made of solid silicone and, unlike breast implants which had a liquid silicone core, cannot leak into the tissues. 

 

How long will the band last?

The short answer is that we really don’t know.  The first band was implanted in 1993 and so our experience is limited to the 15 years or so which have elapsed since then.  However, silicone has been used in the manufacture of medical devices for many years and there is no evidence to suggest that it carries any long-term risks.  Whether the band structure will remain intact in the very long-term (30+ years) remains to be seen. 

 

Do some people fail with the band?

Every medical treatment has a failure rate and the LAGB is no exception.  About 10% of LAGB patients will fail due to a variety of reasons, including an inability to comply with the nutritional requirements of the band, physical inactivity or a failure to attend the follow-up clinic to have the band adjusted properly.  It may occasionally be due to leakage from the band or a slippage.  We do all we can to reduce the risk of band failure, but it becomes very difficult in circumstances where the individual is simply not committed to working with the device.   However, if you are really determined to get a good outcome, most of the reasons for failure can be overcome. 

 

Will I need cosmetic surgery to get rid of excess fat?

Possibly.  The amount of lax skin depends upon how much weight you are carrying before your operation and your age.  Generally, the heavier and the older you are, the more likely you are going to have lax skin.  Younger patients have a greater degree of natural elasticity in the skin, so there is quite a lot of re-modelling as weight loss progresses.  The most common need is to have the abdominal apron removed, though some patients have more extensive “body-contouring”.  Whatever your inclination, you should wait until about two years after your LAGB implant before making any decisions about cosmetic surgery. 


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Note:

The information within this guide to obesity / weight loss surgery is provided by Healthier Weight. Intuition Communication Ltd bears no responsibility for information published in this guide. Read Disclaimer in full.