Q: How soon can I resume a normal diet after surgery?
A: "After laparoscopic gastric banding or sleeve gastrectomy, the next day you are having clear fluids and generally for the first two weeks we get you to have fluids of a thickened texture, something that will go up a fat McDonalds straw will be fine for the first couple of weeks just to allow the surgery to settle down just so there aren't any issues and after that you go mush, baby food, thickened stuff for the next week or two. A dietitian takes you through all of this, then after four weeks you're back onto normal foods, you chew things thoroughly and you will find that you having less than you've ever had before and you will be feeling full."
Q: Do I still need to continue with my diet?
A: "Once the band or the sleeve is in place, by 4 to 6 weeks you are back to normal food. You were just eating everything as healthy and as well as you can, you're just having smaller quantities and you're chewing things up very thoroughly. This is obviously integrated with our dietician who has a chat to you, and basically we work out where you're up to in your life and how things have been modified since you've had the operation, but generally once you get back onto the normal foods that you enjoy, you eat absolutely everything the same but in a lesser percentage wise of all the different ingredients so long as it's nutritious for you."
Q: Do I need to stay in overnight for a lap band?
A: "No. If you've had a laparoscopic gastric banding, and you're well that evening, and your surgery was done through the day, and happy to go home, that's absolutely fine."
Q: What do I need to do after surgery, do I need to exercise?
A: "No. For the first two weeks after obesity surgery, you would walk around and upgrade yourself into brisk walks, but after two weeks you should be able to get back onto a healthy lifestyle program. And that really means doing whatever exercise you enjoy, try integrate it with your friends, family and your lifestyle. Clearly exercise facilitates ongoing weight loss, and most patients when they lose a lot of weight with the surgery, feel terrific and want to start doing more movements and doing more exercises, so I really encourage that to be implemented into the post operative stage, so you can make this a lifelong change."
Q: What about pain relief after surgery?
A: "No. After surgery when you're in hospital you will have some stronger medication, but when you go home and walking around, you should, and most patients would be able to remain on simple analgesics such as Panadol two 4 hourly, and Nurofen, an anti-inflammatory as well. They work well as a great combination, they don't constipated you and providing you don't get side-effects from either those, then you can take two of each, which I would say four tablets four times a day. Most patients are pretty brave and they decide not to have tablets, but if your discomfort is getting more than three or four out of ten, I encourage you to take it, it means that you are more mobile and you'll be able to move around which is good for you in a post-operative setting."
"If you're on stronger medication such as Panadeine Forte, a dygesic, Endone, of which many of you are, they can be constipating and they can have affects causing things such as headaches, irritable bowel or other side effects. If you have those issues you should go back to simple Panadol and Nurofen, but if they are working for you well, such as dygesic and Panadeine Forte, by all means take them. Beware that they are constipating, and you might need to take opium medicine, or whatever you choose, whatever works for you pretty soon on so make sure you don't could get profoundly constipated."
Q: What happens to the wounds after keyhole surgery?
A: "No. After laparoscopic surgery when you go home, most patients will have no stitches to take out, which means they'll be a little suture below the skin, dissolvable, falls away you'll see nothing on the skin surface, you'll have a small strip of paper on the outside, a long thin strip called a Steristrip*, and on top of that, a broad BandAid type material, take that BandAid material off Day one or Day two after your operation because if you have a shower, that will get wet and moist underneath and it gets a bit yucky after a while. So take the outer dressing off but leave those little strips of paper, they're fabulous, have a shower, pad it dry, keep them on, and they'll peel off in about five or seven days. If they're still there in a week just take them off, be brave get in the shower just peel them off and they will be fine, that's all you need to do. If you find that the wounds are looking red it often is a little bit red around the wound for the first day or two afterwards it often turns into a bruise, looks a bit yellowy, but if it's spreading redness, worsening discomfort, that's the time to contact us and we'd have a look at it, rarely you can get a infection and will give you some antibiotics and we'll have a look at the wound and we'll reassure you. "
Q: Will the adjustment hurt?
A: "The adjustments aren't considered too uncomfortable by the patients, quite interestingly. They walk in, they want it tightened, they jump up on my couch, we squirt a ml in straight under the skin without local anaesthetic because it's so close to the skin that we use the same local anaesthetic type needle, patients go straight home with a small little Band-Aid."
Q: How is the band adjusted?
A: "Adjustments are routinely carried out in the rooms. Local anaesthesia may or may not be needed. A fine needle is passed through the skin into the access port to add or subtract saline. This process most often takes only a few minutes. Most patients say it is nearly painless. Occasionally they might need to be done in the X-ray department. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should be shielded."
Q: Will I be sick a lot after the operation?
A: "The LAP-BAND System limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following
the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation."
Q: How long will it take to recover after surgery?
A: "If LAP-BAND surgery is performed laparoscopically, patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer."
Q: How much weight will I lose?
A: "Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits. Obesity surgery is not a miracle cure,
and the pounds won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity."
Q: How do the weight-loss results with the LAP-BAND compare to those with the gastric bypass?
A: "You should focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health."
Q: Does the LAP-BAND require frequent office visits after surgery?
A: "Check-ups are a normal and a very important part of the LAP-BAND System follow-up. "
Q: Does the LAP-BAND limit any physical activity?
A: "The LAP-BAND does not affect or hamper physical activity including aerobics, stretching and strenuous exercise."
Q: How is the band adjusted?
A: "Adjustments are often carried out in the X-ray department. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should
be shielded. Sometimes adjustments can be done in an outpatient clinic or office. Local anaesthesia may or may not be needed. A fine needle is passed through the skin into the access port to add or subtract saline. This process most often takes only a few minutes. Most patients say it is nearly painless."
Q: Do I have to be careful with the access port just underneath my skin?
A: "There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port
is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible."
Q: Can the band be removed?
A: "Although the LAP-BAND System is not meant to be removed, it can be. In some cases this can be done laparoscopically. The stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight or even gain more."
Q: Will I need plastic surgery for the surplus skin when I have lost a lot of weight?
A: "That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mold itself around the new body tissue. You should give the skin the time it needs to adjust before you decide to have more surgery."
Q: Is it true that the LAP-BAND seems "tighter" in the morning?
A: "This is a fairly common feeling, especially for people with bands that are tight or just after
an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the LAP-BAND feels tighter during menstruation."
Q: Will I feel hungry or deprived with the LAP-BAND?
A: "The LAP-BAND makes you eat less and feel full in two ways - by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the LAP-BAND is a tool to help you change your eating habits."
Q: What will happen if I become ill?
A: "One of the major advantages of the LAP-BAND System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed."
Q: What about pregnancy?
A: "Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band may be made tighter again, and you can resume losing weight."
Q: Will I need to take vitamin supplements?
A: "You may, It's possible you may not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron."
Q: What about other medication?
A: "You should be able to take prescribed medication. You may need to use capsules, break
big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this. "
Q: What if I go out to eat?
A: "Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much."
Q: What about alcohol?
A: "Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss."
Q: Can I eat anything in moderation?
A: "After your stomach has healed, you may eat most foods that don't cause you discomfort.
However, because you can only eat a little it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition section of this booklet and as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the LAP-BAND may be greatly reduced or cancelled."
Q: Will I suffer from constipation?
A: "There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fibre. This should not cause you severe problems. If difficulties do arise, let us know as soon as possible."
