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. A typical weight loss is around 3-4st (40-60lbs) but some can lose as much as 100lbs or even more.
Will I have pain after the operation?
You may. There are two possible sources. 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 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 after a few days. As a general rule, most people do not have severe pain from this procedure and what discomfort they do have responds to a few days of simple painkillers such as paracetamol.
How soon can I drive after the operation?
You should not drive for 72 hours 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 expect to be back at work after about one week. If your job involves some lifting, you will probably need a two week period to allow the wounds to heal.
Should I expect frequent vomiting?
There should be no vomiting at all. The LAGB is a satiety device, designed to provide a gentle ‘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 have a device 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 multivitamins each day just to make sure you are covering all your requirements, especially B vitamins, folate and iron. Suitable preparations include:
What about physical activity?
- Forceval (once daily)
- Centrum Fruity Chewables for Adults
- Bassett’s Active Health Multivitamins
- Sanatogen A-Z Complete
- Superdrug A-Z
- Lloyds Pharmacy A-Z
Regular physical activity is a very important factor in achieving your weight loss goals following a gastric band. 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 the band itself, the connecting tubing or the access port through physical activity. Is it true 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 sharp scratch through 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 - 2lbs (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 satiety, 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 not true. A band which is over-adjusted can be dangerous, increasing the chance of slippage and other complications. 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. Is it safe to have other surgical procedures with the band in place?
Yes. It is usually perfectly safe to have other surgical procedures. However, it is important to let your surgeon know that you have a gastric band in place. You must also let us know immediately. We recommend that if your surgery involves general anaesthesia, we empty the band beforehand. This is just a precaution in case you have a reaction to the anaesthetic which causes vomiting, putting pressure on your band. As soon as you have recovered, the band can be re-adjusted. 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 advised about this. What happens if I become pregnant?
The LAGB does not interfere in any way with normal pregnancy, of course the chance 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. Please contact Healthier Weight as soon as you are aware of your pregnancy. Can I drink alcohol?
Yes – in moderation. Alcohol has a high calorific value (7kcal/gram) and can provide a lot of unwanted calories which will pass easily through your band. So you need to exercise caution. 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 a 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?
Some patients can burp quite easily, although others find it more difficult. 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 may find it 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 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 your surgery. What about flying?
Some people report that the band feels tighter when they fly. The most likely explanation for this is to do with atmospheric pressure. Contrary to popular belief, modern aircraft are not pressurized to sea level pressure. Indeed, on most flights the cabin altitude will be between 6,000 and 8,000 ft. (1,828m and 2,438m) even though the aircraft is flying at much higher altitudes. In other words, on most flights, it is as if you are on top of a hill or small mountain. This can result in an expansion of gases in the body cavities, including the stomach, by as much as 25%. This expanding gas in the stomach makes the gastric band feel tighter (as well as making your ears pop), though this quickly returns to normal shortly after landing. You can use this slightly more restricted band to your advantage by sticking to fluids and avoiding the (usually dreadful) aircraft food!
Incidentally, the gastric band does not usually set off airport security or x-ray scanning systems, though with the latest “body scanning” technology the band could be visible. This is why it is important to carry your special gastric band Emergency Card with you at all times. If I'm going on a plane, do I need to be aware of when to have my band adjustment?
If you require an adjustment before you fly, there must be a minimum of 2 weeks
after your appointment and before your travel. 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 years 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 - 15% 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. We do all we can to reduce the risk of band failure, but it becomes very difficult in circumstances where an 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 skin?
Possibly. The amount of lax skin depends upon your age and the amount of weight you are carrying before your operation. Generally, the older and heavier you are, the more likely you are 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 at least one year, preferably two years after your LAGB implant before making any decisions about cosmetic surgery. Furthermore, it is imperative that any corrective surgery should be done by a surgeon with specific expertise in this field. If you are interested in cosmetic surgery, please contact us and we will arrange for you to have a consultation with our own bariatric cosmetic specialist.