Frequently Asked Questions

Frequently Asked Questions

If I have had a previous stomach stapling operation can I have a Lap-band®?

Yes, we have treated many people who have had stomach stapling with the Lap-Band® and found, in most cases, that it is successful.

In 2000, we reported on a prospective study of a consecutive group of 50 such patients and compared these outcomes with the 713 primary Lap-Band® patients we had treated to that date.

Significant perioperative complications occurred more frequently after revision than after primary placement (17% versus 1.1%). However, late complications were less frequent (2% versus 18%). In particular, there were no occurrences of gastric prolapse or erosion of the band into the stomach in this group. The patients had lost 47% of their excess weight at the 3-year follow-up; this was not significantly different from the 53% of excess weight lost in the primary Lap-Band® group. All symptoms of obstruction due to the stapling were relieved by the revision and a number of comorbidities were markedly improved.

Is there value in psychological evaluation before Lap-Band® placement?

We do not use psychological evaluation in our current assessment. In a previous study, we had tried to identify which type of patient would do well and which type of patient would do poorly after bariatric procedures. Each patient was formally assessed by a psychiatrist and completed a panel of questionnaires and standard psychological assessment instruments with the specific task of seeking to identify predictors of good or bad outcomes. At the completion of the 5-year study of 310 patients, no measures that predicted outcome, either positive or negative, could be discerned from the data. A recent Italian study confirms the importance of physiological and technical factors in the success of Lap-Band® placement, rather than psychological and behavioural factors. The study found that patients with eating disorders prior to surgery-eg, binge-eaters, sweet-eaters, pickers, or grazers-had no adverse weight outcome.

Personality profiling and assessing psychosocial factors have also been found to be of very limited value for predicting weight loss outcomes; there have been no consistent findings emerging from the literature. Yet psychological assessment is commonly used for patient evaluation especially in the United States and approval of the procedure by health insurance providers in the USA sometimes requires the assessment. We are not aware of any data to date demonstrating that this process enables better decision-making. To reject a patient from a bariatric operation is a serious decision, as it denies that person the considerable benefits of weight loss. Grounds for exclusion should therefore be defined clearly and their validity established by properly conducted clinical trials.

Should I expect a lot of vomiting?

There really should be no vomiting at all. The procedure is designed to place a gentle restriction on your eating. If you find that you are vomiting, then either there is something wrong with the settings of the band or there is something wrong with your following of the rules regarding eating. It is important not to have frequent vomiting as this could lead to shifting of the stomach within the band and compromise the outcome. Ideally there would be no vomiting at all.

Will I be constipated?

Inevitably as you eat less food, then you eat less fibre and bowel activity will decrease. This usually is not a problem but if it is, it is acceptable to take one of the bulk forming laxatives such as Metamucil with plenty of water and this should correct the problem.

Should I take a vitamin supplement?

Yes. You may well be taking sufficient vitamins within the food that you are able to take, but as you lose weight you have a particular need for additional vitamins and therefore we strongly recommend that you do take a multivitamin supplement. It is particularly important that the supplement has sufficient folate and iron. We will monitor specific vitamins and minerals such as vitamin B12 and folate and iron each year after operation to see if any deficiency in these is occurring. If there is, specific addition of these will be recommended.

What about other tablets and medicines?

In general you will continue to take the medications prescribed . However, if they are in the form of a bulky tablet, you may need to break the tablets up to avoid any chance of them acting as a block which could lead to vomiting. Capsules should be OK as they are designed to soften and melt inside the body.

What happens if I become pregnant?

The band itself should not interfere in any way with the pregnancy. The likelihood of becoming pregnant is probably higher because, having lost weight, your periods are often more regular. We will manage your band throughout the pregnancy to ensure that there is optimal nutritional intake for both yourself and the baby.

Is the silicone dangerous to me?

We have no information to suggest that it is. There has been concern regarding liquid silicone in breast implants. We have been unable to show in a large number of high quality medical studies that this indeed is true. The band is made of solid silicone. It cannot leak into the tissues in the way that liquid silicone can and therefore we expect the likelihood of problems is even less. However, it could be that information of problems will become available in the culture which is relevant to this question.

How long will the band last?

We really don't know. We have had similar products in use for in excess of ten years and they have not shown signs of failure. However we can't realistically expect a device such as this to last 40 - 50 years. We do expect that somewhere down the track there will be failure of the adjusting balloon in particular and should this occur, the band would need to be replaced. It is going to remain to be determined if and when this should be necessary.

Can the band be removed?

Yes. It is not our intention to ever remove it, but should it become appropriate for whatever reason, then it can be removed. If it has been placed laparoscopically, then it can be removed laparoscopically. After the band has been removed, we would expect the stomach to go back to its normal configuration.

What do I do when dining out?

Because of the limited capacity you must restrict yourself generally to an entrée (appetisers in the U.S.) alone. Eat slowly while those with you overeat with two or three courses. If you are visiting friends it is probably better to advise the host or hostess that you can only eat a small amount to save embarrassment.

What about alcohol?

Alcohol is a high calorific liquid and therefore should be against the rules. However, there are health advantages in a modest alcohol intake, particularly of wine. Also we have found in our patients that those who have a modest intake of alcohol lose more weight than those who do not take any. Therefore the occasional glass of wine may help your outcome and in an appropriate social setting this is fine. The equivalent of a glass of wine per day should be actually helpful.

Will I need plastic surgery for excess skin folds once I have lost weight?

Generally, no. About a quarter of our patients need to have something done. The most common need is for the removal of the abdominal apron. We don't generally consider any plastic surgery until about two years after the procedure. Usually there is enough elasticity in the skin to take up the slack sufficiently and we wait to see how effective this is before considering surgery.

What should happen if I develop another illness?

A key advantage with the Lap-Band® is its adjustability. If you have some other illness which makes it inappropriate to have restriction on food intake, then the fluid can easily be removed and there would be very little limitation on nutrition. Once you have recovered from the illness, even if you have put on weight, the fluid can be added and the original status can be restored.

Can I burp after the Lap-Band®?

Not so easily. As we eat we always swallow air and normally we would bring this back up again quite unconsciously. The Lap-Band® interferes with this process. It is common in the first few weeks after the procedure for people to notice a difficulty with bloating and the feeling that they want to burp but cannot. This rarely seems to persist as a problem months later. We presume that the stomach below the band changes its shape enough to reduce the problem but for whatever reason it does not seem to continue to be troublesome.

How are the adjustments to the band done?

We generally will start tightening the band at about 5 weeks after the initial operation. The adjustment is almost always performed in the office at the time of consultation. It does not require any anaesthetic. It consists of passing a fine needle through the skin into the access port. It only takes a few minutes to do and is not usually associated with significant discomfort. On occasions it will need to be performed in the X-ray Department where we can see more accurately where the access port is.

We will generally adjust the band every month until we feel that we have the right setting. This may take four or five adjustments. Once the correct setting is reached we would leave it at that level as long as the rate of weight loss initially, and then the weight maintenance later on, was satisfactory. Additional adjustments can occur whenever necessary. When you reach the goal weight, we leave the setting at that level so as to maintain that weight. If we reduced the setting at this time you would expect to find an increase in your weight.

Are the adjustments very painful?

No they are not. Each adjustment consists of a jab with a needle and then some mild discomfort as we push on the access port. It usually only takes two or three minutes and doesn't require any local anaesthetic. It would hurt as much to have the local anaesthetic put in as it does to have the whole adjustment. .

Is this cosmetic surgery?

No. It is definitely not. Obesity is a potentially severe and in fact life threatening disease and this procedure is a treatment of this disease. In Australia it is recognised as such by your health funds and by Medicare. Medicare has allocated Item No. 30511 as being the one to use. If your health fund needs to know what procedure you are contemplating, please use this number as part of the description of the procedure.

How much weight can I expect to lose?

If the band is in the correct position and if you are following the rules regarding eating and exercise, then "theoretically" we can get you to any weight that we choose. This is because of the adjustability which allows us to increase or decrease the amount of restriction imposed at any one time.

However, our intention in performing the procedure is to solve your problems and we find that in general the problems associated with obesity are solved when people have lost more than half of their excess weight. We therefore aim to have you lose between a half and two-thirds of your excess weight initially and we then look to see whether there is a need for any further weight reduction in order to solve the problems.

Normally we would want you to lose this weight slowly and gently over about an 18-24 month period. Rapid weight loss is potentially harmful and may be associated with vomiting, which we want to avoid. We are normally quite happy with a weight loss of 0.5-1 kg per week early on, and then even less than that as you get towards the end of the 2 year period.

What happens if I travel, particularly to remote locations?

Generally there is no problem. You really don't want to get into any difficulties while away and therefore you have to be doubly careful to follow the rules regarding the type of food you eat. Take some information about the procedure with you and this will give doctors elsewhere much of the information that they would need to understand what has been done. I would hope that they would telephone us and discuss the problem before they interfered in any way with the device. If you are going to a truly remote location where there may not be adequate health care or where you may be at risk of gastroenteritis it may be better to remove some of the fluid from the band before you go and plan to replace it soon after you return.