(703) 583-3130, (703) 583-3129, (540) 659-1800, Ext. 3130 or Ext. 3129
Fax: (703) 583-3063
Email: weightlosssurgery@potomachospital.com
Free Informational Seminar - Weight Loss Surgery: Gastric Banding & Other Options : Click here for dates and times.
To request our free weight loss surgery brochure click here.
Potomac Hospital’s Weight Loss Surgery Center has been named
a Center of Excellence
Potomac Hospital’s Weight Loss Surgery Center has been named
a Center of Excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS). The ASMBS Center of Excellence designation recognizes surgical programs with a demonstrated track record of excellent outcomes in bariatric surgery.
“We are very proud to receive the Center of Excellence designation from the ASMBS because it was created to recognize bariatric surgery centers that perform well and to help surgeons and hospitals continue to improve the quality and safety of care provided,” says Gail Russell, MSN, R.N., vice president of Nursing.
Denis Halmi, M.D., FACS, and Daniel Tran, M.D., FACS, perform more than 300 weight loss surgery operations each year at Potomac Hospital.
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Feelings of failure or helplessness are common among those who have repeatedly tried and failed to lose weight. Many have turned to weight loss surgery as the only effective long term solution.
If you are 100 pounds or more over your ideal body weight, you may be a candidate for weight loss surgery. Potomac Hospital offers minimally invasive techniques for weight loss surgery, including laparoscopic gastric banding and gastric bypass.
More than 300 operations are performed here each year. Our patients experience excellent outcomes. Expert help is available for insurance pre-approval. Potomac Hospital participates with many managed care insurance companies and most major commercial insurance plans.
At Potomac Hospital's Weight Loss Surgery Center, patients receive care from specialized, experienced surgeons, nurses, operating room personnel and anesthesiologists, plus the full support team of medical specialists, dietitians, and physical therapists.
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Janice LaVoie, left, Potomac Hospital's Weight Loss Surgery Center director, and Aniysha Nelpurackal, assistant director, are here to help our weight loss surgery patients through the surgical process. |
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Dr. Denis Halmi (left) and Dr. Daniel Tran of Potomac
Hospital's Weight Loss Surgery Center . |
The weight loss surgical team at Potomac is lead by Denis Halmi, M.D., FACS, and Daniel Tran, M.D., FACS. They are board certified general surgeons who specialize in weight loss surgery and are members of the American Society for Metabolic and Bariatric Surgery. The surgical team has performed more than 2,000 operations since the program began in 2000.
For more information about their practice, go to www.VirginiaWeightLossSurgeryCenter.com and www.ObesityHelp.com
The decision to have weight loss surgery is life changing. In order to help patients understand the consequences of surgery, we offer teaching before and after surgery. We also hold monthly support group meetings with patients who have had surgery and others who are considering whether or not the procedure is right for them.
For more information about the Weight Loss Surgery Center at Potomac Hospital, click on the links below:
Why obesity happens
Who is a candidate for weight loss surgery?
Calculate your body mass Index
Ideal body weight
Weight Loss Surgery Support Group
What type of weight loss surgery is performed at Potomac Hospital?
What happens during surgery?
What happens after surgery?
The patient experience
Achieving your goals
Diet will continue to be important
Results to expect
Insurance coverage
To be considered for surgery
Pre-surgical evaluation, testing and preparing for surgery
The day of surgery
Pain management
What are the complications of surgery?
Post-surgery diet, medications and follow-up care plan
Information for international patients from the United Kingdom
Why obesity happens
People gain weight when the amount of energy they take in (calories from food and drink) is greater than the amount of energy they burn (daily activity and exercise). The balance between calories eaten and calories burned is influenced by genetic, psychological, social, emotional, and environmental factors. In other words, almost everything in life!
Therefore, weight loss can be achieved if one eats less and exercises more. Unfortunately, the result is usually short-lived and most people tend to regain the lost weight. Ultimately, little can be done to change the rate at which people burn calories. At present, gastric restrictive surgery offers the most effective long-term solution for the treatment of morbid obesity.
Who is a candidate for weight loss surgery?
At Potomac Hospital's Weight Loss Surgery Center, criteria for surgery is:
- Body Mass Index (BMI) greater than 40, or are 100 pounds or more over ideal body weight (IBW)
- BMI of over 35 (60 pounds or more over ideal weight) and are experiencing significant negative health effects (co-morbid conditions), such as high blood pressure or diabetes, related to being severely overweight
- Severe obesity longer than five years
- Failure of previous dieting and medical weight loss attempts
- Appropriate pre-surgical evaluations and medical clearances
- Age of 18 or older
Morbid obesity is a chronic disease, meaning that its symptoms build slowly over an extended period of time. An estimated 25 million Americans are considered morbidly obese. Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that can result either in significant physical disability or even death.
As you read about morbid obesity you may also see the term "clinically severe obesity" used. Both are descriptions of the same condition and can be used interchangeably. For more information go to www.VirginiaWeightLossSurgeryCenter.com or www.weightlosssurgeryinfo.com.
What type of weight loss surgery is performed at Potomac Hospital?
Potomac Hospital offers minimally invasive techniques for weight loss surgery, including laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding (LAP-BAND® and Realize® Band). These procedures are primarily restrictive surgeries that limit the ability of the stomach to store food. Roux-en-Y gastric bypass and gastric banding have been shown to be safe and effective for weight loss.
Revisional weight loss surgery is also offered at Potomac Hospital. These operations are generally reserved for those who have had prior weight loss surgery but failed to lose adequate weight or have regained significant weight. Revisional surgery is generally more complex with higher operative risks. Gastric pouch enlargement from overeating is one of the most common causes of weight regain. In select patients, pouch reduction can be performed by a very minimally invasive technique using a device called StomaphyX™. For more information about this device, please see below and visit the website www.stomaphyx.com.
In 1991, the National Institutes of Health officially endorsed certain types of weight loss surgeries as accepted treatments for selected patients. Since 2006, Medicare has approved and endorsed these operations as well. The surgery is normally reserved for patients who are morbidly obese (BMI over 40). However, patients at lower weights (BMI of 35 or more) with serious obesity-related medical conditions may be considered for the surgery.
At Potomac Hospital, weight loss surgery is primarily performed by laparoscopic ("keyhole") techniques. In laparoscopic surgery, the operation is performed by placing thin, long instruments and a small, lighted telescope through several small incisions (each less than half (.5) an inch) in the abdomen. In select patients, the mini-incision open surgery is performed through a single four-inch incision at the upper abdomen.
Compared with the traditional long abdominal incision, these smaller incisions are less painful, faster to heal, and have lower risk of infection and hernia formation.
What happens during surgery?
LAP-BAND®
REALIZE™ BAND
Placement of the adjustable gastric band (LAP-BAND® and Realize™ Band) is available at Potomac Hospital. In the gastric banding procedure, a silicone elastic band is placed around the upper part of the stomach -- forming a small pouch above, a narrow channel, and the larger stomach below.
The band is connected to an elastic tube, which is then connected to an access port placed deep under the skin of the abdomen. No division or stapling of the stomach or intestine is necessary.
When food is consumed, the small pouch fills quickly and then empties slowly creating a sustained feeling of fullness. The food gradually passes through the narrow channel to the lower stomach and into the intestine for digestion.
The tightness of the band, or the size of the narrow channel, can be adjusted by injecting or withdrawing fluid (saline) from the access port under the skin. The adjustment is made if the band is too loose and you are not losing adequate weight or if it is too tight causing you to vomit. The adjustment can only be performed at your surgeon's office.
The band is normally left in place for the rest of the person's life. Removal requires another surgery and is only performed if there are severe side effects or complications. Weight gain is expected if the band is removed.
Weight loss in gastric banding patients is generally slower compared to gastric bypass patients. Tightening of the band is only performed when you are following the dietary guidelines and are still not losing adequate weight or when you are not feeling adequate restriction. On the average, most patients will need three to four adjustments in the first year to attain acceptable weight loss.
Surgery generally takes about one hour and patients typically stay in the hospital overnight. However, some have been able to go home the same day. Most patients are able to return to work after one week.
For more information, please go to www.LapBand.com and www.RealizeBand.com.
Roux-en-Y Gastric Bypass
In gastric bypass, the stomach is completely divided into two sections - a small working section called the "pouch" measuring approximately 20 to 30 cc (the size of a hard-boiled egg) and a larger, excluded (bypassed) portion of the stomach.
Over time, the larger, excluded portion of the stomach will shrink slightly but will not cause any problem. Although not receiving food, the larger stomach is still producing acids and other digestive juices along with channeling bile and pancreatic enzymes down the intestine for digestion.
The working pouch is so small that it can hold only one to two ounces of food. When food is consumed, the pouch fills quickly creating the feeling of fullness, even though the remaining stomach is empty.
The small intestine is also divided. One end, the Roux segment, is connected to the pouch so the food can pass from the pouch into the small intestine for digestion, thus bypassing the stomach. The other end, the biliopancreatic segment (the continuation of the duodenum), is connected further down the small intestine for drainage of bile and digestive enzymes.
The outlet between the pouch and the intestine is deliberately made small in order to delay the time it takes for food to pass through it. With the small pouch and slow transit time, a small amount of food can make you feel full for a long time.
Surgery takes about one-and-a-half to two hours and patients typically stay in the hospital two to three days. Most patients are able to return to work after two to three weeks.
Gastric Pouch Reduction Using the StomaphyX™ Device
Top view of gastric pouch before and after
Widely recognized as the next step in the evolution of minimally invasive techniques, StomaphyX is a surgical method of fastening tissue and modifying the gastrointestinal tract without incision. The StomaphyX device is introduced into the body through the mouth.
The procedure is performed under visualization of an endoscope. The wall of the gastric pouch is suctioned into the lumen of the StomaphyX device, creating a tissue fold or plication similar to a pleat. Fasteners are then placed through this plication to hold the tissue fold in place. Multiple pleats will be constructed until the geometry of your pouch becomes smaller.
Over the weeks following the procedure, the tissue of the plication will fuse, making it strong and stable.
The procedure generally takes about one hour and patients typically stay in the hospital overnight. Most patients are able to return to work in a few days.
For more information, please go to www.Stomaphyx.com.
What happens after surgery?
In gastric bypass, most patients can expect to lose 60 to 70 percent of their excess weight within the first year. Sixty to 70 percent of patients can expect to maintain their weight loss long term. In gastric banding, approximately two-thirds of patients can expect to lose 50 to 60 percent of their excess weight in the first two years. Most patients experience significant improvement or completely resolved obesity-related medical conditions (such as high blood pressure, diabetes, and sleep apnea, to name a few). All of these factors help to increase self-esteem and improve quality of life.
However, surgery does not guarantee patients long-term success. In order to achieve and maintain successful weight loss, patients must follow the program guidelines and modify their lifestyles and eating habits permanently. Some of the program recommendations include:
- Main source of nutrition should be protein-containing foods, fruits, and vegetables.
- Eating and drinking very slowly (small bites and sips).
- Separating liquids from meals (do not drink for at least 30 to 45 minutes after each meal).
- Drinking at least 64 ounces of water every day.
- In addition to the water, sugar-free, caffeine-free, non-carbonated beverages may be used.
- Avoiding concentrated sweets and high fat foods.
- Taking daily supplements of multivitamins, calcium citrate, vitamin B12, protein and iron (generally for menstruating women ).
- Slowly increasing physical activity, beginning with walking immediately following surgery.
- Maintaining regular follow-up with your surgeon and dietitian.
- Attending support group meetings.
What do patients think about their experiences?
For more information about life after gastric banding or gastric bypass surgery and for additional resources, go to www.VirginiaWeightLossSurgeryCenter.com, www.LAPBAND.com, www.REALIZEBAND.com, www.ObesityHelp.com, www.WeightLossSurgeryInfo.com, www.bariatricedge.com, and www.Stomaphyx.com.
Achieving your goals
Potomac Hospital's weight loss surgeons offer the following suggestions to help patients maximize the chances for long-term success.
(1) You must be prepared to make major, permanent changes in your dietary, behavioral, and social habits. For example, if cravings for carbohydrate-rich foods (such as bread, rice, and pasta) or sweets (such as candy and ice cream) caused you to consume large amounts of these items, you must make a decision to get rid of these types of food from your home.
(2) Your family must be supportive of your decision. It is often difficult or impossible to "prove" your will power to overcome the temptation of eating unhealthy foods when these are within your reach. If depression played a factor in your consumption of large amounts of food, you must seek professional help to change that behavior. Anything less than total commitment leads to a high likelihood of failure.
(3) You must demonstrate a strong motivation or commitment to modify your eating habits and lifestyle. Even after successful surgery and significant weight loss, some patients ultimately regain some, most, or all of the lost weight. A medical evaluation usually reveals pouch enlargement from overeating and/or unwise dietary choices. For these reasons, patients will usually not be considered for surgery if they do not demonstrate a strong motivation or commitment to modify their eating habits and lifestyle.
Diet will continue to be important
At your initial visit well before the surgery, it is strongly recommended that you change your diet to include only the following four food groups:
1) protein-rich foods such as meat, fish, cheese, or soy-based products (tofu)
2) vegetables
3) fruits
4) small amounts of high-fiber starches (such as whole wheat wraps or bread)
You should not eat anything that does not fall into the above four categories. For example, muffins, bagels, French fries, donuts, candy, rice, pasta, or potatoes do not qualify as part of the four food groups above. Furthermore, none of your beverages can contain any sugars or calories. Fruit juice consumption is not recommended.
Having weight loss surgery does not mean you will no longer have to diet. And you should not think of life after surgery as dieting.
A diet usually means a temporary change in the way you eat or the food you ingest. Rather, you should think of it as a permanent change in the way you eat and the kind of foods you select. This operation is meant to help you limit your food intake by reducing your feelings of hunger.
Weight loss is still your responsibility. You must consume fewer calories than you burn in order to lose weight after surgery. The dietary restrictions after surgery will appear to be more rigorous than any other dietary program you've tried previously.
Results to expect
Every patient's eating habits, exercise program and metabolism influence weight loss. Therefore, it is impossible to predict exactly how much weight a person will lose after surgery.
On average, gastric bypass patients can expect to lose about 20 to 25 pounds per month for the first three to four months. The weight loss will gradually taper as you reach your target weight. The significant decrease in appetite and the small gastric pouch are primarily responsible for the greater weight loss when compared to the Band patients. Furthermore, gastric bypass patients can experience very unpleasant side effects when they deviate from the recommended dietary regiments (i.e. dumping syndrome).
Gastric banding patients can expect to lose about 7 to 10 pounds per month. Unlike the gastric bypass patients, gastric banding patients do not experience a significant decrease in appetite or unpleasant side effects if they deviate from the recommended dietary regiments. Remember that the band will only help controlling the food portion size and not the types of food. Therefore the weight loss is generally slower.
Most obese people have medium-to-large body frames (bone and muscle). Reaching a so-called "ideal" body weight is unrealistic, and may even be dangerous. Fortunately, most people look and feel terrific at a 60 percent loss of excess weight. More importantly, they are much healthier.
Most obesity-related medical conditions, such as diabetes and high blood pressure, will be improved or even cured after weight loss.
Remember, though, that obesity is a complex problem, one that is not cured solely by an operation. Keeping the weight off requires ongoing dietary, exercise and behavioral changes, as well as long-term participation in the program. Unfortunately, over time some patients will consume more food than their pouches were meant to hold. This can cause the pouch to stretch, which will result in weight gain.
It cannot be overemphasized that, in order to avoid stretching the pouch, it is better to consume frequent small meals (4-5 times per day) than to consume fewer large meals. Healthy snacks such as cheese sticks, carrots, celery, etc. can be consumed between the meals. Patients can maintain their small pouch size indefinitely by adhering to the above rule. Furthermore, in gastric bypass patients, the staple line can pop open under pressure from excess food with serious or even deadly consequences.
Insurance coverage
Many insurance programs will cover the cost of surgery. However, it is your responsibility to confirm this with your insurance company prior to making the appointment. Please keep in mind that some insurance carriers may have specific exclusion criteria or requirements to be met before weight loss surgery is covered.
Request for insurance authorization for coverage of your surgery will be submitted after the initial evaluation to determine whether you are a surgical candidate. The date of surgery will be determined when you have completed all pre-surgical evaluations.
You may pay for the surgery yourself if insurance coverage is not provided. There are also several financing options available through participating banks.
Insurance companies that participate with Potomac Hospital.
To be considered for surgery
After you've made your decision and want to be considered for surgery, you should:
- Make an appointment to meet with a weight loss surgeon who will conduct an initial surgical evaluation. Please contact the Virginia Weight Loss Surgery Center at the Century Medical Building, 2280 Opitz Boulevard, Suite 320, Woodbridge, Virginia, at (703) 878-7610. (Required)
- Attend one of the bi-monthly seminars. (Strongly recommended)
- Attend a bi-monthly Weight Loss Surgery Support Group meeting. (Strongly recommended)
These steps are designed to determine whether you are a potential surgical candidate and to educate and prepare you for the significant changes that will occur after the surgery. Our experience has shown that the better prepared you are before surgery, the better your long-term results will be.
Those patients who do not meet criteria as surgical candidates may be referred for medical weight loss or further dietary management before becoming surgical candidates.
Pre-surgical evaluation, testing & preparing for surgery
All patients are required to have the following completed before the date of surgery:
- Medical evaluation and clearance by your primary physician.
- Cardiology evaluation in selected patients to uncover potential heart disease and to determine treatment as necessary.
- Pulmonary evaluation including a pulmonary function test and when indicated, a sleep apnea test.
- Psychological or psychiatric evaluation in selected patients to be sure that you are able to cope with the major lifestyle changes that will occur and to uncover and treat any mental health problem.
- Gastroenterology evaluation if necessary.
- Endocrinology evaluation if necessary.
- A short course of preoperative liquid diet (i.e. Optifast) may be required in some patients to help decrease the size of the liver in order to decrease the surgical risks.
- If you do not have your own specialists, we will provide the names of expert physicians who can perform the above evaluations, or you can call Potomac Hospital's Health Connection referral service at (703) 221-2500 for information about specialists on Potomac Hospital's medical staff.
If you do not have your own specialists, we will provide the names of expert physicians who can perform the above evaluations, or you can call Potomac Hospital's Health Connection referral service at (703) 221-2500 for information about specialists on Potomac Hospital's medical staff.
Pre-operative testing
Once you have been approved for surgery by your insurance, you will need additional appointments for pre-operative testing. This will include a blood test , UGI series (X-rays), and possibly an abdominal sonogram. If necessary, more extensive evaluations of your heart, lungs or gastrointestinal tract will be performed.
Potential risks and complications of the surgery will be clearly explained to you. Any questions you may have with regard to the surgery or the hospitalization will also be addressed. You will need to sign a consent-to-surgery form.
You will also be counseled about the use of certain medications, such as aspirin, birth control pills, blood thinners and heart medications. It is strongly recommended that women of childbearing age not plan to become pregnant for at least two years after the surgery. Pregnancy can be extremely dangerous for you and your baby during the period of rapid weight loss.
Preparing for surgery
You must stop taking any medication containing aspirin or ibuprofen (Motrin®, Advil®, Excedrin®, Bayer®, Aleve®, etc.) at least seven days prior to the surgery. This will reduce the chances of excessive bleeding during the procedure. You should also stop taking birth control pills about two weeks before surgery to reduce the incidence of blood clot formation.
On the day before surgery, you should be on a clear liquid diet (broth, Crystalite, etc.). You must not take anything by mouth after midnight the night before the operation, except certain medications as determined by your surgeon.
The day of surgery
On the day of your procedure, you will need to check in at Potomac Hospital at least one and a half hours before the time of surgery. Your surgeon and the anesthesiologist will meet you in the preoperative area to answer any additional questions you may have. Just before you are taken into the operating room, you'll be given antibiotics to minimize the risk of infection and heparin (a blood thinner) to prevent blood clots from forming.
Pneumatic leg pumps will be placed around your calves or feet before surgery. These will inflate and deflate to keep the blood circulating in your legs in order to prevent clots. It is important that you keep the leg or foot pumps on while you are in bed during your entire hospital stay.
In the operating room, after you're under general anesthesia, a nasogastric tube may be passed down through the nose to deflate the stomach. This tube will be removed at the end of the operation. A urinary catheter will be inserted to drain your bladder. The catheter will remain in place until the next morning. Band patients will not be required to have the urinary catheter.
Immediately after surgery, you will be taken to the recovery room, also called the Post-Anesthesia Care Unit (PACU). Once you have recovered from the anesthetics, you will be transferred to the Surgical Unit. On rare occasions, a patient may require Intensive Care (ICU) monitoring for significant respiratory problems.
If you have been diagnosed with sleep apnea, you may need to remain on the ventilator (breathing machine) in the PACU or the ICU until you are breathing well on your own. If you use a continuous positive air pressure (CPAP) machine at home, you will need to bring your CPAP machine with you on the day of the surgery for use during your hospital stay. You will be required to get out of bed as soon as possible to improve your lung function and to prevent blood clots from forming in your legs.
This should happen as early as six to eight hours after surgery, but definitely no later than the morning after surgery. In addition, you'll be shown breathing exercises that will lessen your risk of pneumonia. It's very important to follow instructions regarding these exercises.
On the morning following surgery most patients will receive an upper gastrointestinal X-ray study (UGI) to detect possible leaks. This is performed to detect possible leaks in gastric bypass patients and to check the position of the band in gastric banding patients. A diet will not be started until this testing is completed and the result is determined to be normal.
Most gastric bypass patients are ready to go home on the second day after surgery. Gastric banding patients generally go home the following morning.
Pain management
Various techniques are used for pain management while you are in the hospital.
First, the incision site is treated with long-acting pain medicine during surgery.
After surgery, most patients will use patient-controlled analgesia (PCA) to self-administer intravenous pain medication. The recovery room nurses will set up the PCA pump and show you how to use it.
PCA is a very effective way to control post-operative pain, but it will not take away all of your discomfort. You will be very sore for the first day or two after surgery, but the soreness will rapidly decrease during the next few days.
Because you cannot go home with the PCA pump, oral pain medication will be started in the hospital and will be continued while at home.
Early complications
The early complications are mostly those that can happen during, or soon after, any major surgery, and can include heart attack, infection, major bleeding (with the possibility of requiring blood transfusion), blood clots that can travel to your lungs, damage or injury to other organs, complications from anesthesia, and even death.
One rare but serious complication that can occur in gastric bypass surgery is an anastomotic leak. This happens when the staple line (the connections between the pouch and the intestine, or the intestine to the intestine) breaks down. This will usually result in a very serious type of internal infection called peritonitis. Emergency surgery may be required to correct the leak. Even if corrective surgery is performed, the patient may need to be in the Intensive Care Unit for an extended period of time, and death from this complication is a possibility.
In gastric banding surgery, injury to the esophagus or the stomach can occur with serious consequence. One may experience early infection of the port or the band that may require removal.
Gastric prolapse (slippage) is a condition when the lower stomach slides up through the band and may cause partial or complete obstruction of the pouch. In rare cases, this condition can progress to necrosis or break down of the stomach and can therefore constitute a surgical emergency.
Late complications
There are a number of late complications associated with gastric bypass and gastric banding surgery. These may occur soon after discharge from the hospital or even years later.
Bowel obstruction from adhesions (excess tissue growth that causes internal organs to stick together) or from internal hernia (when the bowel pokes through an opening in an internal membrane) can occur, with symptoms ranging from occasional abdominal pain to severe painful abdominal bloating and vomiting. A corrective operation may be required.
Rupture of the pouch can occur because of overeating. This would lead to severe consequences that can include death.
Incisional hernia (when the bowel pokes out between muscles in the abdominal wall) may develop; if so, an operation is required for repair.
Gallstones may develop in up to 30 percent of patients in the rapid weight loss period after surgery. Not all patients with gallstones will develop symptoms, but some may develop significant pain, requiring removal of the gallbladder.
In gastric bypass patients, stomal stenosis (pouch outlet narrowing) can cause vomiting after eating or drinking. This condition usually occurs gradually over days and weeks. It can usually be diagnosed and treated with endoscopy (placement of a lighted camera down the throat into the pouch) and should be taken care of as soon as possible.
Ulcers can develop in the pouch, the intestine, or at the outlet and can cause obstruction or perforation particularly in gastric bypass patients. To prevent this, gastric bypass patients are placed on anti-ulcer medications for two months or longer.
Bone loss or osteoporosis is a recognized complication that can occur even with adequate calcium supplementation. All patients are placed on calcium supplements after surgery.
Gastric band erosion (cutting) into the stomach, which requires removal of the band. Infection of the gastric band or the access port, which requires antibiotic treatment and possible removal.
Rupture and leaking of the band tubing or the access port system requiring replacement.
A small percentage of band patients may develop esophageal dilatation, which may decrease the ability of the esophagus to propel food down to the stomach. Band removal may be required.
Common problems after surgery
(1) Nausea and Vomiting
Eating too fast or not chewing well (you need to chew 25 times before you swallow), eating the wrong foods (foods high in fat or sugar content or too dry), and/or eating too much or drinking liquids with meals can cause nausea and vomiting. If you vomit, take time to think about what may have caused it. If nausea or vomiting occur after you eat a new food, wait several days before trying that food again. If you're uncertain, call your surgeon's office.
(2) Failure to Produce Weight Loss
In most cases, this is related to dietary indiscretion (eating too much and/or eating the wrong foods). In rare occasions, this can happen if the pouch or the outlet stretches, or if a fistula (a connection) forms between the pouch and the bypassed stomach. Food then passes into the larger section of the stomach, permitting overeating. The great majority of pouch or outlet stretching occurs because of overeating.
Gastric banding patients may need adjustment. Prepare a food diary and have it available for reference when you call your surgeon or dietitian. This information will assist him or her in determining the cause of weight loss failure.
(3) Vitamin Deficiency
Weight loss surgery patients must take vitamin supplements for life. Serious problems can occur if you do not take your vitamins and minerals every day. Consequences of vitamin deficiency vary. For example:
- Calcium deficiency may lead to weakened and broken bones or a collapsed spine.
- Iron deficiency may lead to dizziness, chronic fatigue, and low blood count.
- Vitamin B12 deficiency may lead to tingling of hands and feet, nerve damage, difficulty walking or holding things, paralysis.
- Vitamin B1 (Thiamin) deficiency may lead to mental confusion, muscle weakness, and numbness in your toes and fingertips.
Vitamin and mineral levels in your blood must be monitored at least twice yearly. If necessary, your vitamin/mineral supplement doses may be adjusted by your surgeon or dietitian. This is why it's important for you to continue your follow-up with your surgeon.
(4) Changes in Bowel Habits
Constipation after weight loss surgery is not uncommon and is more likely to occur if you are not drinking adequate amounts of fluid or are taking iron supplements.
Because of potential problems with hemorrhoids, hernias, and intestinal blockages, it is important to prevent constipation. If you are on an iron supplement, it may be necessary to take a stool softener for the first month or so until you can drink more fluids and eat more fiber. Stool softeners (Colace®, Pericolace®, Senokot®, etc.) are available over-the-counter. Generic Colace® is acceptable and is much more affordable. Do not take laxatives on a regular basis.
Other ways to improve regularity:
(1) Add fruits and vegetables (pureed for the first six weeks) at every meal.
(2) Beginning two months after surgery, add Metamucil®, Fibercon®, Benefiber® or Citrucel® to your diet on a regular basis.
(3) Drink lots of water (at minimum eight cups or 64 ounces of fluid per day). If you are taking fibers, be sure to drink even more than the required amount of water.
(4) Exercise regularly.
If your problem is still not resolved, you may use Dulcolax suppository, Fleet Enema, or Milk of Magnesia. Remember, you must not use these on a regular basis. If you still have a problem, please call your dietitian's or surgeon's office.
(5) Temporary hair loss
Temporary hair loss can occur from rapid weight loss, but may also be caused by inadequate protein in the diet. This situation is usually temporary and responds to vitamins and minerals.
(6) Gas
Gas problems are also common after weight loss surgery. If you have gas pains at home, try simethicone drops, Bean-O, Phazyme, or Gas-X. If the problems continue, call your surgeon's office.
(7) Diarrhea
If you have diarrhea, limit greasy foods, milk, and milk products. Avoid very hot or very cold foods or drinks. Pay attention to the new kinds of food or drink you are taking. Make sure you drink an adequate amount of fluid. If the diarrhea does not resolve, call your surgeon's office.
(8) Dumping Syndrome
Generally observed only in gastric bypass patients (not in LAP-BAND® patients), this happens when food is taken together with liquids or when sweet foods are eaten. Eating refined sugars and dense fats, which are "dumped" into the small intestine too quickly, usually causes it. Symptoms include abdominal fullness, nausea, lightheadedness and crampy abdominal pain followed by diarrhea. Usually the dumping syndrome can be controlled by diet and behavioral modification. Eat four to five small meals each day and do not drink fluids with your meals.
(9) Dehydration
Dehydration can occur when you do not drink enough fluids. Make sure you drink at least eight cups (64oz) of fluid each day, but not at meal times. Again, remember not to drink more than ½ cup (4 ounces) at one time. Sipping fluid throughout the day will help you meet the fluid requirement.
Post-surgery diet, medications and follow-up care plan
Your post-surgery diet will be a highly regimented program. You'll meet with a dietitian before and after surgery, and will be given detailed written diet instructions to take home.
The Typical Diet Schedule
Stage I Diet: On the morning after surgery, once X-rays (UGI series) are performed, you will start a clear liquid diet. This diet consists of sugar-free Jell-O, broth, and decaffeinated tea. Band patients may advance directly to stage II diet after the X-rays are completed.
Stage II Diet: On day two, you'll advance to a full- or nutrient-enriched liquid diet. You'll be sent home on the Stage II diet and will remain on this diet until your initial postoperative visit about one week to ten days after surgery.
Stage III Diet: Consists of pureed food. You will be on Stage III foods for four to six weeks after the operation before advancing to Stage IV.
Stage IV Diet: Regular food. However, keep in mind that this food should be high in protein, low in fat, no sugar, and with increased fiber.
Because of the small pouch size, you'll probably only be able to take in about 600-800 calories per day. It is therefore critically important to pay strict attention to your food choices, concentrating on protein-rich foods. Avoid carbohydrate-rich foods (such as pasta and rice) or empty-calorie foods (such as sweets and fruit juices). Also avoid high-calorie drinks (such as sodas and alcoholic beverages).
Medications
You will be advised about resuming your current medicines before you leave the hospital. In addition to regular medications, gastric bypass patients will need to take an acid reducer for two to three months to prevent ulcers in the pouch. You'll be required to take multivitamins/minerals and calcium/vitamin D indefinitely. Your surgeon will help clarify which medications you need to take.
Follow-up care plan
After you are discharged from Potomac Hospital, you must return to your surgeon's office for follow-up visits on a regular schedule:
- One to two weeks after surgery
- Six weeks after surgery
- Three months after surgery
- Six months after surgery
- Nine months after surgery
- 12 months after surgery
- Every six months after the first year
Each follow-up visit will consist of an evaluation by the healthcare team. During your follow-up visits, lab tests will be done to check the complete blood count, protein, iron, calcium, vitamin B1 and vitamin B12 levels in your blood. Additional nutritional supplements may be required, depending on these levels. Band patients may need adjustments during these visits.
After the first year, lab tests will be performed every six months. More frequent visits may be required, based on your individual needs. In addition, you are strongly encouraged to join the Weight Loss Surgery Support Group sponsored by Potomac Hospital.
If you have further questions or would like to schedule your preliminary consultation, please call the Virginia Weight Loss Surgery Center at (703) 878-7610 or toll free at 1 (866) 282-1412.
