Weight-Loss Surgery
Frequently Asked Questions

Weight-loss surgery alters the body’s digestive process by limiting the amount of food the stomach can hold and/or by limiting the absorption of nutrients. The most common procedures are restrictive, malabsorptive or a combination of both procedures. Restrictive procedures, such as Lap-Band, reduce the amount of food the stomach can hold, but don’t interfere with the body’s normal digestion of food and nutrients. Malabsorptive procedures bypass most of the small intestine so that fewer calories and nutrients are absorbed. Combined procedures restrict food intake as well as the amount of calories and nutrients the body absorbs.

Candidates are often 100 pounds overweight. That translates to a body mass index of 40 or over. You should have previously attempted to lose weight through traditional methods, including dieting, nutritional counseling and commercial or hospital-based weight-loss programs. Candidates may have a body mass index of 35 and over if they have medical problems that are associated with obesity, such as hypertension and diabetes.

People with an inflammatory disease, severe heart or lung disease, esophageal, stomach or intestinal problems, cirrhosis or who are pregnant are not candidates.

What are my options for weight-loss surgery?

The two most common operations are adjustable gastric banding (Lap-Band) and gastric bypass. With both procedures, the size of the area in stomach where food collects is reduced.

The adjustable gastric band is less invasive than gastric bypass and is often done laparoscopically. By placing an adjustable band around the stomach the surgeon creates an upper pouch. As the name suggests, the band can be adjusted in follow-up, outpatient procedures to ensure that the pouch is the right size to control weight loss.

During Roux-en-Y gastric bypass, a surgeon creates a small pouch at the top of the stomach using staples. The small intestine is then rearranged and connected directly to the pouch, creating a bypass of the small intestine.

The band is adjustable; the bypass is not. The band is reversible; the gastric bypass is extremely difficult to reverse.

How much weight can I expect to lose with a Lap-Band?

That depends on the individual. With the adjustable gastric banding procedure, weight loss progresses steadily over a 2- to 3-year period and then stabilizes. The final result is usually between 50 percent and 60 percent of the excess weight. After four years, studies show the level of weight loss is equal to that achieved by gastric bypass surgery.

After gastric bypass surgery, weight loss usually exceeds 100 pounds or up to 70 percent of the excess body weight, but it generally levels off in one to two years. A regain of up to 10 percent of your excess body weight is common. With adjustable gastric banding, weight gain is minimal.

Ultimately, one’s goal weight should be determined by the individual with his surgeon and should be the recommended weight based on the patient’s height.

What are the risks or complications associated with surgery?

The most common complication associated with adjustable gastric banding is the enlargement of the stomach pouch, which can occur if the stomach slips up through the band. However, modifications to the technique have been made to prevent this from occurring. Other complications reported include infection and band erosion into the stomach.

Research has found that patients who undergo a gastric bypass have longer operative times, more blood loss and longer hospital stays when compared to patients who have adjustable gastric banding. Up to 5 percent of patients undergoing gastric bypass may experience leaking, bleeding, wound infection or blockage in an artery in the lungs. In addition, because a portion of the digestive tract is bypassed, the absorption of essential nutrients is reduced and medical complications can result.

The Lap-Band can easily be removed to manage any adverse reactions you may have.

A patient’s medical history and weight are used to determine which surgery is the best option. It is also important to talk with your surgeon to decide which option is right for you.

How much do the procedures cost? Will insurance cover it? Many medical insurance companies recognize the long-term health benefits of the Lap-Band system. But since coverage varies by state and provider, you should check with your insurance company prior to making an appointment. For more information call (520) 874-7546.

In February 2006, Medicare expanded its coverage to include, laparoscopic adjustable gastric banding. However, these surgeries are covered by Medicare only if performed in a hospital or by a practice that is judged by the Surgical Review Corporation to be a Center of Excellence.

Weight-loss surgery can eliminate or improve most obesity-related medical complications, including diabetes, hypertension, high cholesterol, sleep apnea, reflux and osteoarthritis, as well as stress incontinence, dermatitis, muscle and joint pain. Improvements in body image and a reduction in the symptoms of depression have also been reported. Weight loss may also be associated with improved fertility and more favorable pregnancy outcomes.

First, a medical screening process will determine if you are a candidate. This process helps to identify the aspects of your health that will improve following surgery, as well as the aspects that may increase the risks associated with surgery.

You will also want to come to a complete understanding of the significant, lifelong lifestyle changes you must commit to, including diet, exercise, limiting alcoholic intake and smoking cessation, if necessary.

If you are doing well after surgery you may be allowed to go home the same day; however, many patients will stay overnight and go home the day after surgery. Univeristy Physicians Hospital Lap-Band patients typically return to normal activity in about one week.

Immediately following adjustable gastric banding, only sips of water are allowed. The day after surgery you will probably begin consuming small amounts of food in liquid form, progress to soft foods (such as low-fat yogurt) and eventually introduce solids approximately four to six weeks after your surgery. Your solid food needs to be soft, moist and well-chewed to avoid abdominal discomfort or nausea.

Because you will be eating much smaller amounts of food per meal, the types of food you select should be high quality and packed with nutrients, offering more nutritional value for the fewer calories you now consume. Your long-term eating plan should be low in fat and sugar and high in protein.

Care must be taken to let your stomach adapt to its new environment. Vitamin and mineral supplementation may be necessary.

Lifetime follow-up is recommended, with several follow-up visits during the first year. Adjustable gastric banding requires visits for band adjustments.
You will need to adopt a healthy lifestyle, including a new nutrition plan and regular exercise, although exercise restrictions may be in place until you are healed.

Because of the decrease in food and liquid intake, constipation may occur. A laxative may be recommended.

Medications can be prescribed as needed. However, your doctor may tell you to avoid aspirin and nonsteroidal anti-inflammatory drugs, which can irritate the stomach.

Sources
Gastrointestinal surgery for severe obesity. NIDDK Weight-control Information Network. National Institutes of Health Gastrointestinal surgery for severe obesity, NIDDK Weight-control Information network. National Institutes of Health.
American Society for Bariatric Surgery, Rationale for the surgical Treatment of Morbid Obesity
Gastric bypass: is this weight-loss surgery right for you? Mayo Clinic