Your surgeon will determine and explain what you need to do before having obesity surgery as every individual is different, but these are answers to some of the more common questions regarding tests and procedures you may be asked to do in preparation for your surgery.
What are the routine tests before weight loss surgery?
You will be referred to a Cardiologist/Physician for relevant evaluation and this may include an echocardiogram, stress test and ultrasound. It will be necessary for you to be assessed by a psychologist, dietitian and exercise physiologist prior to your surgery.
Certain basic tests, such as a full blood examination (FBE) and chest x-ray are performed as part of your initial assessment.
What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery to minimise the chance of complications and this will be determined by your surgeon.
What should I bring with me to the hospital?
Personal toiletries and clothing for your stay that are easy to put on and take off.
What is done to minimize the risk of deep vein thrombosis (DVT)/pulmonary embolism (PE)?
Because DVT originates on the operating table, generally, patients are treated with sequential leg compression stockings and this therapy will continue throughout your hospitalization. The other major preventive measure involves getting the patient moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs.
Does Laparoscopic Surgery decrease the risk?
No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopic surgeries are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring.
Will the doctor leave a drain in after laparoscopic surgery?
Patients may have a small tube to allow drainage of any accumulated fluids from the abdomen post-operatively. This is a safety measure, and it is usually removed a few days after the surgery. Generally, it produces no more than minor discomfort.
If I have laparoscopic bariatric surgery, what can I expect when I wake up in the recovery room?
Some doctors will provide a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. Others prefer to use an infusion pump that provides a local anaesthetic in the surgical site to control pain without the side effects of narcotics.
Will I have a lot of pain?
Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain.
How long will it take to recover after surgery?
If gastric band surgery is performed laparoscopically, patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.
How soon will I be able to walk?
Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.
How soon can I drive?
For your own safety, you should not drive until you have stopped taking narcotic medications. Consult your doctor as to when you are able to drive.
Does the band require frequent follow up visits after surgery?
Check-ups are a normal and a very important part of the gastric band follow-up.
How is the band adjusted?
The surgeon can make adjustments in an outpatient clinic or office. This involves a fine needle being 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.
On occasion it will be necessary to carry out adjustments in the X-ray Department of a recommended Radiology Practice. They are carried out there so the access port can be clearly seen. When x-rays are used, your reproductive organs should be shielded. Sometimes local anaesthesia may be needed.
Do I have to be careful with the access port just underneath my skin?
There are no restrictions based on the access port. It is placed under the skin in the abdominal or chest wall, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.
Is it true that the band seems "tighter" in the morning?
This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the band feels tighter during menstruation.
Will I be sick a lot with the band in place?
The band limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation.
Can I eat anything in moderation?
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 booklet or as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the band may be greatly reduced or cancelled.
How much weight will I lose?
Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits. The type of food that patients are able to eat will vary in each individual and we would recommend that the patient reads the following literature ("The food and nutrition guide" and "The pocket gastric band guide" by Trudy Williams). Obesity surgery is not a miracle cure, and the kilos will not come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 4 kg a month in the first year after the operation is possible, but 2 kg per month is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.
Does the band limit any physical activity?
The band does not affect or hamper physical activity including aerobics, stretching and strenuous exercise.
Can the band be removed?
Although the band is not meant to be removed, it can be. In some cases this can be done laparoscopically. The stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight or even gain more.
Will I need plastic surgery for the surplus skin when I have lost a lot of weight?
That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mould itself around the new body tissue. You should give the skin the time it needs to adjust before you decide to have more surgery.
Will I feel hungry or deprived with the band?
The band makes you eat less and feel full in two ways – by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the band is a tool to help you change your eating habits.
What will happen if I become ill?
One of the major advantages of the band 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.
Will I need to take vitamin supplements?
You may. It is possible you may not get enough vitamins from three small meals a day. Discuss this with your dietitian at your regular check-ups.
What about other medication?
You should be able to take prescribed medication. You may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this.
What if I go out to eat?
Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
What about alcohol?
Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.
Will I suffer from constipation?
There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fibre. This should not cause you severe problems. If difficulties do arise, let us know as soon as possible.
What about pregnancy?
Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you do become pregnant it is very important to inform your surgeon immediately as your band may need adjusting. After the pregnancy, the band may be made tighter again, and you can resume losing weight.
