Retaking control of your life. A guide for patients

Transcription

1 Retaking control of your life A guide for patients

2 A growing problem As our portions become larger and our way of life more sedentary, we are eating more and exercising less. The natural consequence of this trend is now seen in what many healthcare professionals call the obesity epidemic. It s a fact that European obesity rates have tripled in the last 20 years which, if nothing is done, will mean that nearly 1 in 5 people will be affected by Many countries now face a major healthcare crisis. The link between obesity and serious health conditions, including death, is clear. Diabetes, heart disease, stroke, cancer and hypertension are all closely correlated with obesity and are also increasing, straining healthcare budgets. The more overweight we are, the worse the problems become. Dietary advice of every kind is also on the rise, but diets alone rarely change long-term eating habits and many schemes have not delivered the anticipated successful weight-loss and long-term results they continually promise. Thousands of obese people clearly need more help than can be provided with drug therapy or dietary advice alone. Such alternative solutions must combine the best of today s medical technology with proven principles for healthy lifestyle change. Causes of Obesity Obesity is not a sign that a person is out of control. Many factors can lead to this chronic disease: Energy balance - Taking more energy from food than your body needs can lead to weight-gain, depending on your metabolism (how efficiently your body gets energy from food) and activity level Heredity - If others in your family are obese, you have a higher risk for obesity Metabolic disorders Changes in metabolism may affect your energy balance and your weight Eating and social habits - Eating an unbalanced diet, snacking between meals and not getting enough exercise may all contribute to obesity Psychological factors - Social or emotional eating is also one of the main causes of gaining excess weight. Any one or a combination of these factors can lead to obesity 2

3 Measuring Obesity The most common measurement for obesity is the Body Mass Index (BMI). The obesity categories adopted in 1998 by the National Institutes of Health (NIH) for adults are: BMI Classifications BMI Classification Normal Overweight Moderately Obese Severely Obese 40 or above Morbidly Obese You can work out your own BMI by using the following calculation: Your weight in kilograms divided by the square of your height in metres kg = BMI m 2 But please remember, this is only a guide. BMI does not distinguish between fat and muscle. It is possible for a heavily muscled individual to have a BMI in excess of 25 without increased health risks. Your doctor will be able to give you a much more accurate health assessment based on your BMI together with other relevant health factors. The threat of Morbid Obesity The Morbid Obesity category represents individuals who carry the largest and most dangerous amount of excess body weight. In simple terms, it is defined as: BMI of 40 or above, or Weighing at least twice the ideal weight Morbid obesity greatly increases the chance of developing health conditions that can result in significant physical, mental and social disabilities. It can also cause death. Morbidly obese as well as severely obese individuals with a BMI of 35 or more with obesity-related health problems, may be considered candidates for obesity surgery. 3

4 Treatment Options Non-surgical treatments Diets Millions of individuals turn to a whole variety of diets to treat their obesity. However, many who lose weight this way quickly regain it when the diet ends, which leads to more dieting, replacing meals with special drinks or taking diet pills. This cycle of losing weight and gaining it back is called the yo-yo effect. While temporary weight-loss can help, the yo-yo effect can make it harder to lose weight in the future, as each weight-loss cycle reduces your metabolic rate meaning you burn fewer calories. As a result, the majority of people will not achieve long-term weight-loss through dietary regimens alone. Medication There are many types of prescribed and non-prescribed slimming pills available. They generally work one of two ways, by either acting as an appetite suppressant or by reducing the amount of fat that is absorbed into the body during the digestive process. Whilst a number of well-known prescription drugs have been shown to deliver some weightloss, it may be accompanied by unpleasant side effects that make it difficult to sustain treatment. The claims made by many of the non-prescription and natural slimming remedies available over the counter are largely unproven. Surgical treatments If non-surgical methods have not helped you lose weight and keep it off, you still have another option. Studies demonstrate that weight-loss surgery (bariatric surgery), as compared to non-surgical treatments, yields the longest period of sustained weight-loss in patients who have failed other therapies. 2 As with all surgical procedures, weight-loss surgery does carry risks and therefore the decision to have surgical treatment cannot be taken lightly. Furthermore, surgery is not a panacea in itself. It s success relies on your commitment and discipline to want to change your eating habits and lifestyle, treating the surgery as an enabling tool to help you achieve your weight-loss goals. Is surgery right for you? If you are ready to take an active part in reducing your weight, your surgeon will consider the right treatment for you. You will be well-informed about the advantages, disadvantages and risks involved. Your surgeon will not perform the operation unless he or she knows you understand the problems your excess weight is causing. Also, your surgeon will make sure you know that you have responsibilities, such as adopting new eating patterns and a new lifestyle. There may of course be medical reasons why surgery is not right for you. Your doctor or surgeon will go through your medical history and test results with you prior to agreement. When the relative risks of living with obesity-related health problems are weighed against the risks associated with surgical intervention, surgery may remain the best hope for these individuals to lose weight and keep it off. 2 4

5 Surgical Options There are several categories of obesity (bariatric) surgery that are designed to induce weight-loss: Restrictive - reduces the amount of food the stomach can hold but doesn t interfere with normal absorption of food and nutrients Malabsorptive - shortens the digestive tract to limit the number of calories and nutrients that can be absorbed Combination - restricts the amount of food the stomach can hold and reduces the number of calories absorbed by altering the digestive tract Adjustable Gastric Banding For many years this has been one of the most common types of weight-loss surgery performed in Europe. The operation is rather simple and fully reversible, which is major part of its appeal for patients and surgeons alike. An adjustable silicone band is fitted around the upper part of the stomach by means of laparoscopic (key-hole) surgery, meaning there are no large incisions. A new, small stomach pouch is created that limits the amount of food that can be consumed at one time and a narrowed stomach outlet increases the time it takes for the stomach to empty. The subsequent reduction in food intake results in weight-loss. The LAP-BAND TM System is the world s most widely used adjustable gastric band, with over 300,000 patients to date. There is a wealth of clinical evidence ence to support its efficacy and safety. Advantages Simple laparoscopic procedure, leaving virtually no scars Least invasive surgical approach No stomach stapling or cutting or intestinal re-routing The band can be adjusted to patients needs for optimal results Fully reversible Short hospital stay and recovery time Lowest operative complication rate 3 Nutrients and vitamins fully absorbed Lowest mortality rate 3 Disadvantages Involves an implanted medical device Slower initial weight-loss than some other, more invasive, surgical procedures For optimum results it is extremely important that patients choosing the adjustable gastric band commit to a programme of follow-up care and are willing and able to change their dietary habits. 5

6 Gastric Bypass Gastric Bypass Gastric Bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements. With this surgery, first the stomach is stapled to make a smaller pouch. Then most of the stomach and part of the intestines are bypassed by attaching (usually stapling) a part of the intestine to the small stomach pouch. The result is that you cannot eat as much and you absorb fewer calories (and nutrients). Advantages Rapid initial weight-loss Minimally invasive approach is possible Slightly higher total average weight-loss reported than with adjustable gastric band or Vertical Banded Gastroplasty (VBG) Disadvantages Complex procedure requiring cutting and stapling of stomach and bowel More operative complications than with adjustable gastric band Portion of the digestive tract is bypassed, reducing absorption of essential nutrients Medical complications due to nutritional deficiencies are expected, meaning dietary supplements are required for the remainder of the patient s life Dumping syndrome can occur (resulting in nausea, sickness and diarrhoea) Non-adjustable Extremely difficult to reverse Part of the stomach becomes inaccessible to gastroscopy (for examinations to clinically detect cancer, ulcers etc). Higher mortality rate than adjustable gastric band or VBG procedures 6

7 Vertical Banded Gastroplasty Vertical Banded Gastroplasty (VBG) is a restrictive procedure. The surgeon uses staples to make a small stomach pouch, thereby reducing the amount of food the stomach can hold. When your stomach is able to hold less food, you feel full sooner. At the same time, the stomach digests nutrients and calories in a normal way. Advantages Nutrients and vitamins are fully absorbed Simpler procedure than the Gastric Bypass Lower mortality rate than Gastric Bypass Disadvantages Requires cutting and stapling of stomach Slower initial weight loss than Gastric Bypass Non-adjustable Staple line disruption shortly after surgery can result in leakage, infection and even death Staple line disruption at a later time results in weight-regain Extremely difficult to reverse Vertical Banded Gastroplasty 7

8 Sleeve Gastrectomy Sleeve Gastrectomy The sleeve gastrectomy is a relatively new procedure that has gained favour with some surgeons who recommend that, in order to reduce the risks associated with weight-loss surgery, the procedure be performed in two-stages, particularly for very large patients (super obese). In this restrictive procedure the stomach is stapled vertically from top to bottom leaving a banana or sleeve shaped stomach that is around a quarter of its original size. The valve at the base of the stomach, which regulates the emptying of the stomach into the small intestine, remains intact thereby normal stomach function is maintained. The small stomach means the patient eats less before feeling full and therefore loses weight. Patients having a two-stage procedure will typically have their sleeve gastrectomy converted into a Biliopancreatic Diversion (BPD) some months later, depending on their weight-loss. Advantages Relatively straightforward laparoscopic procedure Low malnutrition risk. Nutrients and vitamins fully absorbed* Two-stage approach deemed to have lower surgical risk for very large patients Disadvantages Cutting of the stomach is required which can lead to complications such as leakage along the staple line Usually considered as a temporary procedure - for best results a second operation may need to be performed, which carries additional risks and potential for complications Irreversible Considered investigational by some surgeons (i.e. still experimental and not fully proven) * If converted to full BPD then absorption of essential nutrients will be significantly reduced 8

9 Biliopancreatic Diversion Biliopancreatic Diversion (BPD) is a malabsorptive procedure and the most extreme alteration of the digestive process. Roughly three-quarters of the stomach is removed and the stomach pouch is connected to the final segment of the small intestine. By diverting food through this new limb, the nutrients are separated from the bile and pancreatic enzymes that would break them down. As a result, BPD greatly reduces nutrient absorption and calorific intake. Advantages Greatest amount of initial weight-loss due to the high levels of malabsorption Allows larger meals because of larger stomach pouch Higher total average weight-loss reported than with VBG, Gastric Bypass or LAP-BAND TM Disadvantages Requires cutting and stapling of stomach and bowel TM More operative complications than with LAP-BAND or VBG Portion of digestive tract is bypassed, reducing absorption of essential nutrients Requires lifelong monitoring for protein malnutrition, anaemia and bone disease Patient will depend on vitamin, mineral and protein supplements for remainder of life Increased risk of intestinal irritation and ulcers Non-adjustable Extremely difficult to reverse Highest mortality rate as compared to other procedures Biliopancreatic Diversion Please consult your surgeon to help identify the best surgical option for you. 9

10 THE LAP-BAND System The world s most widely used adjustable gastric band The LAP-BAND System was one of the first adjustable gastric bands to be developed and now has almost 15 years proven experience in helping patients lose weight. The LAP-BAND System is minimally invasive, adjustable and fully reversible. It is a tool that can help improve your health, reduce your risk of developing associated medical conditions and enhance the overall quality of your life. LAP-BAND System Overview The LAP-BAND System is a silicone elastomer ring designed to be placed around the upper part of the stomach and filled with saline on the inner surface. This creates a new, small stomach pouch and leaves the larger part of the stomach below the band so the food storage area in the stomach is reduced, and the pouch above the band can hold only a small amount of food. The band also controls the stoma (stomach outlet) between the two parts of the stomach. The size of the stoma regulates the flow of the food from the upper to the lower part of the stomach. When the stoma is smaller, you feel full sooner and have a feeling of satiety so you are not hungry between meals. The band is connected by tubing to an access port that is placed beneath the skin during surgery. Later, the surgeon can change the stoma size by adding or subtracting saline inside the band through the access port. This adjustment process helps drive the rate of weight-loss. If the band is too loose and weight-loss inadequate, adding more saline can reduce the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, the surgeon will remove some saline to loosen the band and reduce the amount of restriction. The Next Generation - LAP-BAND AP System Allergan, the makers of the LAP-BAND System have worked in partnership with leading gastric surgeons around the world, to develop a device that meets many of the criteria for the ideal gastric band. It has been designed to help eliminate many of the known associated operative risks and provides unique benefits compared to other adjustable gastric bands. This effort has resulted in the development of the fourth generation LAP-BAND System the LAP-BAND AP System. LAP-BAND AP Access port 10

11 Leading by design The new generation LAP-BAND AP System, gives both patients and surgeons alike the reassurance that they are benefiting from the latest in adjustable gastric banding technology. The key benefits: Designed to be easier to place for surgeons, meaning the procedure can be performed quickly with reduced risk of complications Soft, wide band sits gently against the stomach wall. The larger surface area in contact with the stomach means more of the stomach s satiety receptors are stimulated helping to induce a feeling of fullness The LAP-BAND AP System features a unique technology called OMNIFORM. The band consists of a series of small compartments which together form a complete ring around the stomach. As the band is inflated it retains its uniform circular shape, which means there is better contact with the stomach wall. There are no hard edges that could damage the delicate stomach tissue and, unlike some other designs, there is no risk that the band could develop a leak. The LAP-BAND AP System has a wide adjustment range and allows very precise adjustments to be made. This makes it easier to find the optimal stoma size that will deliver the best weight-loss results for you as an individual. Furthermore, the LAP-BAND AP comes in two sizes, so your surgeon can select the best one for you! The LAP-BAND AP System is the latest in gastric banding technology, combining innovative features that are designed to improve overall results for patients and minimise the risk of complications. Ask your surgeon for more information. Deflated LAP-BAND AP Inflated LAP-BAND AP 11

12 Losing weight with the LAP-BAND System The LAP-BAND System is a tool to help you achieve sustained weight-loss by limiting how much you can eat, reducing your appetite and slowing digestion. Remember, though, that the LAP-BAND System by itself will not solve morbid obesity, nor will it ensure that you reach your goal weight or even that you lose weight at all. The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits. Some people lose more than others, and though you may never reach your ideal weight, chances are good that with weight-loss your health and self-image will improve. In worldwide studies, the LAP-BAND System has been very effective in helping to reduce the weight of obese patients. Average percentage excess weight loss Published Study Number of patients studied Years after Weight-loss Surgery >5 Rubin M, Spivak H, US % 51.4% 55.5% Jan JC et al. US % 45% 57% Vertruyen M. Belgium (7 years) % 61% 62% 52% Zinzindohoue F et al. France % 52% 54.8% Fielding G. Australia % Weiner S et al. Austria (8 years) %* *8.2-year follow-up of first 100 patients 12

13 Real Life Results Victoria Turner Victoria s battle with her weight began after the birth of her second child. Every diet she attempted didn t seem to make a difference to her 16 1 /2 stone (105kg) frame. Victoria felt depressed, despondent and desperately unhappy with her appearance. So she set about researching surgical interventions on the Internet and it wasn t long before she began to feel confident that the LAP-BAND System could be the right option for her. Once I found a reputable, local surgeon, we discussed the full range of surgical interventions available. Together we agreed that the LAP-BAND System would offer me the control I needed without drastic surgery. It also was reversible, which I found reassuring. Within a month, Victoria had lost a stone (6.4kg) by eating a range of healthier food in smaller portions thanks to the LAP-BAND System. To date, Victoria has lost 6 stone (38kg), and has discovered a love of horse riding and dancing. She not only looks good but feels good too! Having the LAP-BAND System fitted has meant that I am now able to live the life I want and choose, rather than just watching others enjoy themselves. 13

14 Stomach LAP-BAND AP System Tubing LAP-BAND AP System Access Port LAP-BAND System Placement The LAP-BAND System is usually placed laparoscopically under general anesthesia. The key advantage of laparoscopic surgery is that it requires only small incisions, which means the healing process is faster, with less pain, less risk of complications and minimal scarring. First, the surgeon makes a few small incisions and places a number of tubes called trocars through the abdominal wall down which long, thin surgical instruments are inserted. A narrow camera is also passed through a trocar so the surgeon can view the operative site on a nearby video monitor. A small tunnel is made behind the top of the stomach to let the band through and allow it to be wrapped around the upper part of the stomach, almost like a wristwatch. The band is then locked securely in a ring around the stomach. The band is usually left only partially filled for the first 4 to 6 weeks after surgery, thereby not causing any gastric restriction as yet. 14

15 LAP-BAND TM System Advantages Minimal Trauma Least invasive surgical option No intestinal re-routing No cutting or stapling of the stomach wall or bowel Small incisions and minimal scarring Reduced patient pain, length of hospital stay and recovery period Fewer risks and side effects Significantly lower mortality risk compared to other obesity surgeries 3 Low risk of nutritional deficiencies associated with Gastric Bypass Reduced risk of hair loss No dumping syndrome related to dietary intake restrictions Adjustable Allows individualised degree of restriction for ideal, long-term weight-loss rate Adjustments performed without additional surgery Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs Reversible Removable at any time Stomach and other anatomy are generally restored to their original forms and functions Effective long-term weight-loss Approximately 300,000 now placed worldwide The option of first choice for hundreds of surgeons around the world 1,300 published articles and abstracts over almost 15 years 15

16 Who may qualify for the LAP-BAND System? You may be eligible for LAP-BAND System surgery if: You are at least 18 years old. Your BMI is 40 or you weigh at least twice your ideal weight. You have been overweight for more than 5 years. Your serious weight-loss attempts have had only shortterm success. You are not suffering from any other diseases that may have caused your obesity. You are prepared to make substantial changes in your eating habits and lifestyle. You are willing to continue being monitored by the specialist treating you. You do not drink alcohol in excess. If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is over 35 and you are suffering from serious health problems caused by your weight. Your surgeon may have additional criteria. 16

17 LAP-BAND System Surgical Procedure Pre-surgery Before your surgery, you will meet with your surgeon to talk about the procedure in detail. Your doctor may also want you to meet with other experts who can help you understand what will happen during and after the operation. These experts might include: a dietician a physiotherapist a psychologist other specialists You will also have a number of tests before your surgery to evaluate your health. When it is time for surgery, you will be admitted to the hospital either the day before or on the morning of your surgery. The operation At the start of the operation, you will be given general anesthesia. If your case is typical, the operation will be performed laparoscopically, meaning only minor incisions will be made. During the operation, the band will be fastened around the upper part of your stomach to create the small stomach pouch. The access port for adjusting the band will be placed under your skin and the two will be connected via a length of silicone tubing. Typically, the procedure will last little more than an hour, without complications. Post-surgery Once the anesthesia has worn off, you may feel some pain, which can usually be relieved with ordinary painkillers. The hospital staff will help you get out of bed and start moving as soon as possible to help prevent blood clots, respiratory problems and bedsores. The day after surgery On the day after the surgery you will likely have an X-ray. This allows your health team to see that the LAP-BAND System is in the right place and that the new stomach outlet is open. You may be asked to swallow a liquid that can be seen on X-ray. For LAP-BAND System surgery, hospitalisation is usually less than 24 hours, although this can vary depending on hospital policy or if there are complications. If there are no complications, you should be able to resume normal activities within a week or two after surgery. The first adjustment The first adjustment will typically take place 4-6 weeks after surgery. Your adjustments will often be done under X-ray so that the physician can easily locate the access port. Alternatively, adjustments may be carried out in an outpatients clinic or physician s office. Adjustments will be performed either by your surgeon, a qualified nurse or a radiologist. Further adjustments Further adjustments will take place over the comings months, with a small amount of saline being added each time, until such time as your physician is confident that you have reached your optimal level of restriction (the so-called Green Zone ). Thereafter your weight-loss will be monitored on an on-going basis and further adjustments made if necessary. 17

18 Your motivation is key to your success To work, the band needs your participation. It s vital to remember that the LAP-BAND System is only a tool that is designed to help you adapt your eating behaviours. The ultimate responsibility still lies with you the patient. Therefore it is essential that you adhere to your dietary programme and continue to meet with your medical team so that they can monitor your progress and provide any additional support you need. It s also important that your friends and family provide emotional support and do their bit to help you maintain your new healthier lifestyle. If you are ready to take control of your obesity and your life with the LAP-BAND System, talk to your surgeon about the advantages, disadvantages and possible risks of this treatment. ent. 18

19 Some frequently asked questions Q: How much weight will I lose? A: Weight-loss results vary from patient to patient, and the amount of weight you 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 kilos won t come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight-loss of 0.5 to 1 kilo a week in the first year after the operation is possible, but 0.5 kilos 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 quickly creates a health risk and can lead to a number of problems. The 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 System compare to those with the gastric bypass? A: Surgeons have reported that gastric bypass patients lose weight faster in the first year. At five years, however, many LAP-BAND System patients have achieved weight-loss comparable to that of gastric bypass patients. 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: How long will it take to recover after surgery? A: If LAP-BAND System 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: Does the LAP-BAND System require frequent visits to my doctor after surgery? A: Check-ups with your doctor are a normal and very important part of the LAP-BAND System follow-up. Many surgeons see their patients weekly or biweekly during the first month and every four to twelve weeks for the first year. Adjustments are performed during some of these visits. It is typical for follow-up visits to be scheduled every three to six months during the second and third year, depending on the individual case. 19

20 Q: Does the LAP-BAND System limit any physical activity? A: The LAP-BAND System does not hamper physical activity including aerobics, stretching and strenuous exercise. Q: How is the band adjusted? A: Adjustments are either carried out in the X-ray department or in an outpatient clinic or office. When X-rays are used, your reproductive organs should be shielded. 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 and 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 any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor. Q: Can the band be removed? A: Obesity is a chronic disease that requires lifelong treatment, so the LAP-BAND System is designed to remain in place for the duration of your life. If there is a problem with the band, if you can t lose enough weight or can t adjust to the new eating habits, your surgeon may suggest removal of the band. This decision will come after your surgeon consults with you. Generally, after LAP-BAND System removal, your stomach will be restored to its original form and the digestive tract should function normally. Please keep in mind that when the band is removed, your weight will likely increase. 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 as, sometimes the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery. 20

21 Q: Will I feel hungry or deprived with the LAP-BAND System? A: The LAP-BAND makes you eat less and feel full in two ways first, by reducing the capacity of your stomach and second, by 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 System 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 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 to 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 B 12, folic acid and iron. Your surgeon may advise you to take supplements. Q: What about other medication? A: You should be able to take prescribed medication, though 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. Always ask the doctor who prescribes the drugs about this. Your surgeon may tell you to avoid taking aspirin and other nonsteroidal anti-inflammatory pain relief because they may irritate the stomach. The problems these drugs may cause could result in band removal. 21

22 Q: What if I go out to eat? A: Order only a small amount of food, such as an appetiser. 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 and 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 dietician. If you eat foods that contain lots of sugar and fat or drink liquids full of calories, such as milkshakes, the effect of the LAP-BAND System may be greatly reduced or even negated. Q: Will I be sick a lot after the operation? A: The LAP-BAND System limits food intake. If you feel nauseous or sick on a regular basis, it may mean that you are not chewing your food well enough 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 contact your doctor if this problem persists. Vomiting should be avoided as much as possible as it can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band and reduce the success of the operation. In some cases, it can require another operation. 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, check with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Your needs will vary, but you should drink at least 6-8 glasses of water a day. 22

23 One final point: It is important to ask your surgeon all the questions you have about obesity surgery and the LAP-BAND System. It is also essential that you follow his or her advice. Important contact details Name: Date of procedure: Doctor: Telephone: Dietician: Telephone: Other medical contact: Telephone: NOTES: 23

24 References: 1. World Health Organisation- Europe 10 things you need to know about obesity. WHO European Ministerial Conference on Counteracting Obesity, Istanbul, November American Society for Bariatric Surgery. Rationale for the Surgical Treatment of Morbid Obesity. 8 April Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review. Surgery 2004; 135: Rubin M, Spivak H, Prospective Study of 250 Patients Undergoing Laparoscopic Gastric Banding Using the Two-Step Technique; Surgical Endoscopy, 2003; 17: Jan JC, Hong D, Pereira N, et al. Laparoscopic Adjustable Gastric Banding Versus Laparoscopic Gastric Bypass for Morbid Obesity: A Single-Institution Comparison Study of Early Results, J Gastrointest Surg 2005; 9(1): Vertruyen M, Experience with LAP-BAND System Up to 7 Years, Obesity Surgery 2002; 12: Zinzindohoue F, Chevallier JM, et al. Laparoscopic Gastric Banding: a Minimally Invasive Surgical Treatment for Morbid Obesity: Prospective Study of 500 Consecutive Patients, Annals of Surgery 2003; 237(1): Fielding G, LAP-BAND Experience with 620 Cases over Forty-Five Months, Obesity Surgery 2000; 10: Weiner S, Engert R, et al. Outcome after Laparoscopic Adjustable Gastric Banding 8 Years Experience, Obesity Surgery 2003; 13: European Headquarters, Marlow International, 1st Floor, The Parkway, Marlow SL7 1YL, Buckinghamshire, United Kingdom Caution: This device is restricted to sale by or on the order of a physician. The LAP-BAND System contains no latex or natural rubber materials. mark owned by Allergan, Inc Allergan, Inc. Irvine, CA All rights reserved. This device is CE marked and FDA approved. Date of preparation: March 2008 ACA/0625/2007