1. Will I have much pain?
2. What kind of scars will I have?
3. Where is the port placed?
4. Will I feel the port?
5. Does the port restrict my activities?
6. Is the band permanent or can it be removed if necessary?
7. Can I have other weight loss surgery in the case of failure or complication of the band?
8. What will my weight loss be?
9. Is Gastric Banding risky?
10. How do I deal with Health Insurance companies?
11. Do I have to follow a diet prior to surgery?
12. How long do I have to stay in hospital?
13. What pre-operative tests do I need?
14. How long does the operation take?
15. What type of anaesthesia is used?
16. Will I go to recovery post operatively and for how long?
17. When do I have my first adjustment?
18. Will the band be filled at the time of the surgery?
19. How many adjustments do I need?
20. What sort of fluid is used to adjust the band?
21. Is an adjustment painful?
22. How much fluid will be placed in the band?
23. Do I have the band filled under X-Ray?
24. Can I go to my GP for an adjustment?
25. Do I need to go to a hospital for an adjustment?
26. Can I have my adjustment done closer to home if it is difficult to get to London?
27. What if the band is too tight?
28. What is the cost of a Lapband adjustment?
29. What can I do to ensure an optimal weight loss?
30. How do I cope with eating out?
31. Will I need to take a vitamin supplement?
32. Can I take medication after having the band?
33. Why do I have to avoid aspirin and non-steroidal anti-inflammatory pain relievers?
34. Can I take alcoholic drinks?
35. What if I become ill?
36. Is gastric banding effective?
37. Is hiatus hernia a contra indication for gastric banding?
38. What type of band is used?
39. Are there sutures that need to be removed?
40. Why the gastric band?
41. Is gastric banding suitable for all eating disorders?
42. What if slippage, erosion and dilatation of the oesophagus occur?
43. What is 'the window of opportunity'?
44. Will I need a Tummy Tuck after my weight loss?
45. What will be done to prevent blood clots (thrombosis) from occurring?
46. Can I fly home the next day after having my surgery?
47. Can I do scuba diving?
48. When can I return to work?
49. What about pregnancy?
50. Do I have to join a support group?
51. Is every pain in the upper abdomen band-related?
52. Can I have an adjustment if the operation was done elsewhere?

Will I have much pain?

You can have some pain on the left side or in the left shoulder. This will be due mainly to the carbon dioxide, which filled your abdomen during the laparoscopy. A plain painkiller (paracetamol) ( Tylex° effervescent, Tramake° insts. ) will provide relief. Sometimes the pain lasts longer ( weeks ) , probably due to irritation of the left diaphragm but will disappear spontaneously.

What kind of scars will I have?

You will have 4 small scars as well as a slightly larger one for the placement of the port.

Where is the port placed?

The port will be placed on the left side of the abdomen or at the bottom of the breastbone. Placement at the bottom of the breastbone is my favoured position as it makes the adjustment as easy as possible. If either of these sites would be a problem for you, please discuss this with your surgeon before the operation.

Will I feel the port?

You will probably be able to feel the port when you press on the area. It should however not be painful or noticable.

Does the port restrict my activities?

There are no restrictions. You can exercise and do all the normal sporting activities. If the access port causes discomfort then please talk to your doctor.

Is the band permanent or can it be removed if necessary?

If no complications occur there will be no reason for removal of the band. It is intended to remain in place permanently. It can be removed laparoscopically, but one must remember that you would probably regain weight, as the stomach will return to its normal shape.

Can I have other weight loss surgery in the case of failure or complication of the band?

Yes you can switch to a gastric bypass or a bilio-pancreatic diversion (BPD) although some adhesions could make the operation a lot more difficult.

What will my weight loss be?

Weight loss varies from patient to patient and depends on several factors. A total commitment to a new lifestyle and eating habits are crucial. A weight loss of 4kgs or ¾ stone in 2 months is likely. You must remember that the weight loss is slow, gradual but permanent. Most publications show that you can lose about 50% - 70% of your excess weight within 1 - 3 years.

Is Gastric Banding risky?

Most published reports indicate that laparoscopic adjustable gastric banding has less risk than other surgical treatments for obesity. However, all surgical procedures carry risks with a possibility of complications.

How do I deal with Health Insurance companies?

Some companies will cover your expenses, however, many do not. It will be necessary for you to research the situation with your own Health Insurance company.

"Never depend on someone else to do your job.The Insurance battle has no place for passivity. If something needs to be faxed, copied, mailed, checked, cross-referenced, called in, confirmed, verified, communicated, delivered or couriered, YOU DO IT"

Do I have to follow a diet prior to surgery?

No, although some surgeons will ask you to go on a diet in order to make your liver smaller, therefore making the surgery easier. In our experience this has never been a problem and we therefore do not request any pre-op dieting.

How long do I have to stay in hospital?

You will stay in hospital for 24 hours, entering on the morning of the surgery and leaving the following morning.

What pre-operative tests do I need?

A blood test and an ECG, which can be done in Belgium, are usually all that is necessary. In selected cases, if indicated, we need other complementary tests. These will be indicated at your consultation.

How long does the operation take?

The gastric banding procedure will take about 30-45 minutes. If you have had previous upper abdominal surgery the procedure could take longer if adhesions are present.

What type of anaesthesia is used?

The operation is carried out under general anaesthetic. It is not possible to have a local or spinal anaesthesia.

Will I go to recovery post operatively and for how long?

You will go to recovery for 1 or 2 hours until you are well awake and stabilised after the operation.

When do I have my first adjustment?

The first adjustment is done between 4 and 8 weeks after surgery. If you have a good weight loss, however, and you are eating much less than before, your doctor can decide to postpone the adjustment until the weight loss slows or stops.

Will the band be filled at the time of the surgery?

In many cases the band will be filled with a few cc during the operation to ensure that the band fits well around the stomach.

How many adjustments do I need?

An average of 3 - 4 adjustments spaced about 4 to 8 weeks apart during the first year. If your weight loss stops for 3 - 4 weeks or you don't experience a feeling of satiety then you must make an appointment to see your surgeon.

What sort of fluid is used to adjust the band?

The band is filled with sterile saline, which is water containing 0.9% salt.

Is an adjustment painful?

The procedure is normally not painful; however local anaesthesia is available should it be necessary. If the port is well located and easily felt it takes about 30seconds to complete the adjustment

How much fluid will be placed in the band?

This varies from person to person, but on average your band will be filled with 2 or 3 cc per session. The total amount injected can go from 4cc to 10cc, but the effect you experience will not be dependant on this amount. It is very individual and you should therefore not make comparisons with other patients.

Do I have the band filled under X-Ray?

This is not necessary due to the easy location and access to the port. It would be useful to have an X-Ray control once a year.

Can I go to my GP for an adjustment?

No. You GP will not be familiar with the procedure. A special needle is required to do the adjustment. Leaks in the port or the tubing can occur if the injection is not performed correctly.

Do I need to go to a hospital for an adjustment?

No, it is an outpatient procedure. If an X-Ray is necessary then you will have to go to a hospital or a private radiology department.

Can I have my adjustment done closer to home if it is difficult to get to London?

Yes, we are doing all that we can to have agreements with other surgeons across the UK who are familiar with the banding procedure ( ask our admin team ). There is also the possibility of travelling back to Belgium to have the adjustment at St. Elizabeth Hospital.

What if the band is too tight?

If you are unable to drink an adequate amount of fluid, or if you vomit regularly, then your band may be too tight. Heartburn, burping, chronic coughing and hoarseness can also be signs of overfilling of the band. If this does occur you need to call your healthcare provider to check your condition and if necessary withdraw some fluid.

What is the cost of a Lapband adjustment?

The cost of an adjustment in our clinic will be 60 pounds.

What can I do to ensure an optimal weight loss?

To ensure optimal weight loss you should

1. Drink a lot of water
2. Eat less
3. Stop eating as soon as you feel full
4. Avoid the "hard stop" (eating until you have a pain in your chest)
5. Use smaller plates
6. Avoid snacking and grazing
7. Eat dense food
8. Do not drink while you eat
9. Do a lot of exercise
10. Have regular band adjustments
11. Stick to the 'Ten Commandments'

How do I cope with eating out?

Order smaller portions; eat slowly so as to finish your meal at the same time as your table companions. Sit on the aisle seat in case you need an urgent visit to the bathroom. Advise your companions of your inability to eat big portions of food.

Will I need to take a vitamin supplement?

In general this will not be necessary, as you will continue to eat healthily

Can I take medication after having the band?

Yes, but you may need to break or crush tablets. Coated pills should not be broken, so ask your pharmacist for a liquid form of the medication.

Why do I have to avoid aspirin and non-steroidal anti-inflammatory pain relievers?

These kinds of medications can cause stomach ulcers. There is evidence of the possibility of the area where the band is placed to be vulnerable to ulcer formation. This could necessitate the removal of your band.

Can I take alcoholic drinks?

Alcohol contains a lot of calories (7 kcal per gram) and also breaks down vitamins. An occasional drink will not affect your weight loss program.

What if I become ill?

If your illness requires an increase in your food intake then withdrawing some fluid from the port can loosen the band. After your recovery the band can be re-adjusted.

Is gastric banding effective?

All the studies have shown that surgery is far more effective than conservative treatment - not only in weight loss, but also in improving the quality of life, curing diabetes and high blood pressure, reducing cholesterol levels, improving sleep apnoea, arthritis and many more ailments common to overweight. Although the weight loss after gastric bypass is faster in the first year, the results of gastric banding after 5 years are comparable to those of the gastric bypass.

Is hiatus hernia a contra indication for gastric banding?

No, it is not a contra indication. The symptoms of a hernia will often improve or even disappear after the banding. There are rare occasions where the hernia can become worse and symptoms of this would be severe heartburn, regurgitation etc. In cases of a large hernia, a repair of the defect can be performed.

What type of band is used?

We use mainly the French band (Heliogast) or the American band (Lap-band).

Are there sutures that need to be removed?

You will have the choice between different wound closure systems: non-dissolving stitches or staples that have to be removed, or dissolving stitches, medical glue or steri-strips.
The options should be discussed with your surgeon before the procedure.

Why the gastric band?

Although the gastric bypass is considered to be the "gold standard", one has to take into account that obesity is a 'behavioural disease'. Therefore if a surgical option is preferred, it has to be as simple as possible, with an acceptable complication rate, is perfectly reversible and at the same time offers excellent results. In our opinion, therefore, this is the procedure we propose as a solution to patients that are suitable for weight loss surgery.

"without studying and doing your homework, you may fall into the trap that weight loss surgery is magic and as soon as you get up from the operating table you're just a few short days away from 'Thin Land'."

Is gastric banding suitable for all eating disorders?

More than one publication shows that binge eating and sweet eating, formerly considered to be contra-indications to banding, are well treated by gastric banding. The publications also indicate that this procedure is also a good indication for the super obese patient (BMI>50).

What if slippage, erosion and dilatation of the oesophagus occur?

Slippage is still the most common complication although its frequency has dramatically dropped to between 3% - 4%. This most often occurs within the first 3 years.
Symptoms

• Persistent vomiting
• Pain and discomfort

Treatment

• Loosening of the band
• Possible revision laparoscopy

Erosion is even less frequent and can occur in the first years post operatively Symptoms

• Discomfort
• Ability to eat larger amounts
• Weight gain
• Occasional infection of the port site

Treatment

• Removal of the band either by laparoscopy or gastroscopy

Dilatation of the oesophagus

Symptoms

• Vomiting
• Discomfort

Treatment

• Loosen the band

What is 'the window of opportunity'?

This is the period in which you will be able to have a good weight loss. This is normally in the first 2 - 3 years after the procedure.

Will I need a Tummy Tuck after my weight loss?

This will depend on how much weight you lose and how your body reacts to the weight loss. Pronounced weight loss can cause excessive abdominal skin and relaxed abdominal muscles that will need to be corrected by a Tummy Tuck or an Abdominoplasty.

What will be done to prevent blood clots (thrombosis) from occurring?

During surgery you will wear anti-thrombosis stockings. You will also be administered with a low molecular weight Heparin (Fraxiparine) to prevent thrombosis. You will receive a subcutaneous injection after surgery and another the following day, prior to discharge from the hospital.

Can I fly home the next day after having my surgery?

Yes you can fly home. The fluid inside your band will not be affected much by the pressure changes. You will not notice any effect at all. Thrombosis will also not be a problem due to the heparin injections you received in hospital.

Can I do scuba diving?

Yes you can because the band will not be affected by pressure changes.

When can I return to work?

You can return to work after 1 or 2 weeks depending of the type of work you're doing.

What about pregnancy?

You can become pregnant after gastric banding. We recommend however that you wait at least 1 year. The band need not be removed, but if necessary it can be emptied.

Do I have to join a support group?

This can be very helpful. People who are "in the same boat" can exchange ideas, discuss their situation, their success, their failures and do something about it. The attendance of health professionals, nutritionists,dieticians….. would even be more helpful.

Internet support groups and chat groups could also be useful although there is a lot of misinformation : " seeing on the internet must not be confused with believing".

Is every pain in the upper abdomen band-related?

Certainly not. This may be the first thing you think of, but there are numerous other reasons for upper abdominal pain : peptic ulcers, gastritis, pancreatitis, gallbladder diseases, disorders of the liver….

Can I have an adjustment if the operation was done elsewhere?

Yes you can. Telephone our admin dept. to arrange an appointment in London.