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Description of your Lap-Band Surgery

The Lap-Band is considered the simplest weight loss surgery because there is no cutting or stapling of the stomach or intestine. However, it is still major surgery and will require that you make a serious lifestyle adjustment post-operatively. A minimally invasive technique, known as laparoscopic surgery, is usually performed during this procedure. Several small incisions are made on the abdomen, through which plastic tubes or ports are inserted. Through these ports, the surgeon will place a laparoscope (a video camera) and other thin instruments to obtain images of your internal organs.

An inflatable silicone band, similar to a belt, is placed around the top portion of your stomach and secured with sutures. This creates a two-ounce stomach pouch and a three cm (one inch) opening between the pouch and the rest of the stomach. The band is attached to a port, or tube, that is then placed under the skin, in the upper part of your abdomen. The surgeon uses the port to inject saline into the band, adjusting the size of the opening into the stomach and limiting the amount of food that can pass through. The size of the opening through the band is important to weight loss. It usually takes three to four adjustments to reach a pouch size suitable for successful weight loss. With this pouch size, you should feel full with three to four small one or two once meals a day. The actual size slightly varies from patient to patient.





What to Expect

The surgery takes one to two hours, with at least a one-hour stay in the recovery room and then you will be taken to your room at Brookdale's Bariatric Unit . You will be asked to walk on the day of your surgery and will not be allowed to have anything orally until cleared by your surgeon, usually the following morning. You will first be given ice chips and sips of water. If you tolerate them well, you will then be placed on a clear liquid diet. You will also have an IV, which will deliver fluids for hydration, antibiotics, pain medications, and other mediations, and if necessary, a bladder catheter. The bladder catheter will be removed when you are awake and able to use the bathroom or bedside commode. A compression device that massages the legs to increase blood circulation and decrease the possibility of blood clots will be used as well. These will be used until you can walk regularly. You will also be asked to cough frequently, take deep breaths, and breathe into a device called an incentive spirometer, all steps taken to prevent breathing problems and pneumonia. You may remain in the hospital for one or two days after surgery.

First day after surgery

You may be taken to the Radiology Department the morning after surgery for a dye swallow study. You will be asked to drink a small amount of contrast material. From this, the Radiologist will be able to determine if the band placement was successful and confirm that no complications exist. When you return to the Bariatric Unit, you will resume eating ice chips and drinking small sips of water. Once well tolerated, you will be given a clear liquid diet. As long as your body accepts the fluids and there are no complications, you will be allowed to go home. In addition to the surgeon's instructions, someone from the Advance Bariatric Care Center will visit you at the hospital and provide supplemental instructions for your home care.

Until you go home

Your surgeon will monitor your progress and make any necessary changes to your care throughout your stay. Most of the discomfort you experience will come from the gas used during your laparoscopic surgery or from the incision created if you had an open procedure done. You may not be hungry but you must sip liquids to prevent dehydration. The more you get up and walk, the faster your recovery will be. A staff member from the Advanced Bariatric Care Center will visit you during your hospital stay and provide you with instructions for when you are discharged.

What to do with the Lap-Band at home

Depending on your surgeon's recommendations, you may remain on a full liquid diet for two to three weeks before being moving on to soft foods. Gradually you will be able to eat solid foods, which will require chewing each bite 15 to 30 times. It is very important to stop eating just before you feel full to prevent stretching your new pouch. Do not drink with meals - you can drink up to 30 minutes before and half an hour to one hour after meals.

Optimal weight loss will not be achieved if food intake consists of soft foods, such as mashed potatoes, yogurt, cream soups, ice cream, puddings, most desserts, and most junk foods. High calorie liquids, such as milkshakes or malts, will run through the band quickly and only add unnecessary calories. The success of the Lap-Band procedure depends on keeping the pouch full as long as possible. The Advanced Bariatric Care Center advises that you only eat substantial foods - foods that take some time to digest and remain in the pouch for a while. At each meal, protein should be eaten first, followed by a complex carbohydrate, such as a whole wheat product. It is okay to snack, however, your choices should healthy. Consider beef jerky, a small piece of chicken breast, and a spoonful of tuna. Avoid snacking on junk food, cookies, chips, cakes, ice cream, etc. Remember, you should eat at least 65 grams of protein each day. This can be accomplished by drinking protein supplements and taking your vitamins and calcium citrate as instructed. This is very important for your recovery.

Protein and Vitamins - While your body does not demand food for three weeks after surgery, it is very, very important that you take vitamins and ingest adequate protein everyday. Again, this is very, very important for healing and successful weight loss.

During the first couple of weeks of your recovery, we want you to consume at least 75 grams of protein a day. Afterwards you will need about 65-100 grams of protein for maintenance, depending on your pre-surgery weight and goals. Protein supplements are available at the Advanced Bariatric Care Center, both in your ready to drink and powdered forms. A nutritionist is available to help you plan and meet your liquid and protein intake requirements, as well as address your concerns if you are lactose intolerant.

Changing HOW and WHAT you eat may be challenging at first but in time and with practice you will learn what your body needs and how to get your needed nutrients. Vitamins are also important. Your surgeon will recommend special vitamin capsules when your pouch has fully healed. Right after surgery, however, you can take any chewable or liquid multivitamin. Since vitamin D deficiency sometimes occur after weight loss surgery, you should try to spend some extra time outdoors, to make sure you get ample amount of sunshine. Vitamin B-12 deficiency may also occur. Your doctor will check your B-12 levels after surgery and make any necessary recommendations. Thereafter, you should have your B-12 levels checked annually.

Liquids - It is vital that you drink a sufficient amount of liquid every day. Initially, you should have three to four glasses a day and then increase to seven or eight a day. All clear liquids are okay-water, sugar-free Jell-O, tea, broth, or sugar-free powdered drink mixes such as ice tea, lemonade or others. Only specially formulated Stage 1 protein are permitted. In the beginning, drinking may be difficult for you, but developing a habit of sipping a little bit at a time, is quite helpful.

Calcium and iron - You may need to take iron and calcium supplements for the rest of your life. The vitamins we recommend you take once your pouch is healed, may contain your iron requirements. You will also need to take 1200mg of calcium citrate daily. Your calcium needs and intake will be addressed in your four-week follow-up visit. As with B-12 iron, calcium and related tests will be done annually.

Exercise - Exercise is an extremely important part of your weight loss program. We do however, advise that you do not lift anything heavier than 10 pounds the first three weeks after your surgery. You should begin walking one week after your surgery, gradually increasing the time and distance you walk.

Wound care - You will most likely have steri-strips on your abdominal wounds (if done laparoscopically). When showering, direct the shower stream directly on your incisions. When finished, pat (do not rub) the incision area dry. Once in a while, there may be some small openings in the outer layer of your incision. This normally happens when the stitches begin to irritate your skin. Some patients develop an infection or abscess in the area between the skin and the abdominal muscles. A bulging redness accompanied by pain, fever (usually 101 * or above), and sometimes drainage, may indicate infection. If you are experiencing any of these symptoms or suspect an infection, you must immediately call your surgeon at 718-240-8446.

The above information, along with other written and verbal suggestions we have made, should answer most of the questions you have about your home care. If other concerns arise, please do not hesitate to call us.

Congratulations as you progress towards a new lifestyle

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