When Should I Have My Gallbladder Removed with Weight Loss Surgery
If you have a lap band you only need to remove your gallbladder if you are having symptoms, i.e. pain, infection.
If you develop gallstones after bypass surgery, you should have the gallbladder removed. The main reason to remove the gallbladder is if a stone should get into the common bile duct it will be difficult to remove with out major surgery. Normally you can get a procedure called an ERCP( a gastroscope goes down you throat passes into the duodenum to allow for access to your common bile duct). Since you stomach is stapled there is no way for the scope to pass into the duodenum without a surgeons assistance.
How to choose between a Lap Band and a Sleeve Gastrectomy
I will give you a short review of each procedure and then compare the pros and cons of each. The lap band is a restrictive weight loss procedure. The band divides your stomach into two sections, a small top stomach and a larger lower section. If you compare a hour glass to what the band does to your stomach, than you will have a better understanding of how it works. Just like putting water in an hour glass allows the fluid to quickly empty from the smaller section into the lower larger section, if you drink sweets they will quickly empty into the larger portion of your stomach and you will not feel full very long. And if you eat a large piece of meat, and don't chew it well it will get stuck like rocks in an hour glass. The band is adjustable so it can set for each patient at a different fill level.
The sleeve gastrectomy is also a restrictive procedure that makes your stomach into a tubular structure. It also has the same problems as a band in that sweets go down easily and if you eat too large a piece of meat it may get stuck.
I believe that the sleeve does not offer much of an advantage over a band but has a significant increased risk of complications. The main advantage of the sleeve is that there is not an implant. But the procedure is permanent and if the sleeve stretches there is no way to adjust it.
In my practice I prefer banding over sleeve gastrectomy because I believe it offers an excellent chance for long term weight loss with the least risk. As stated in other articles whether to have a bypass or a band depends on many patient factors.
What can cause pancreatitis in patients who have had a gastric bypass?
Other causes could be medications, alcohol, viral illnesses, elevated triglycerides and idiopathic pancreatitis( not a clear cause).
It is always important to contact your bariatric surgeon is you have pancreatitis.
How to manage your lap band diet.
The day of surgery you stay on clear liquids. The day following surgery starts a soft diet consisting of foods like oatmeal, soups, soft fish, cottage cheese. After one week the diet changes to regular food for lunch and dinner but the amount should be 3-4 oz of your protein, i.e. meat or fish, and 1/2cup of salad or vegetables. Breakfast should be a protein drink with at least 30gms of protein and no more than 200 calories.
At the one month visit the band is usually adjusted unless you feel full with the present amount of food and you have lost at least 4 lbs in a month. The key to success is filling the band to allow the small meals to fill you up. If you always over eat with every adjustment, you will have excessive nausea and vomiting. This leads to constantly adding and subtracting fluid from the band which reduces weight loss over time.
Remember the band acts as a restriction device only. It makes your stomach into an hour glass. Just like an hour glass liquids always pass easily, and rocks do not. Chew your food well and eat slowly. Avoid high calorie liquids or foods that become liquid once eaten.
A new method to treat Heartburn.
Heartburn affects a lot of people, especially those with weight problems. The first thing to do is get off some pounds. But even then there are those who continue to have heartburn and require medications to treat the symptoms. There is a new endoscopic procedure called esophyx that allows the physician to tighten the valve at the bottom of your esophagus. This is done using an instrument placed down your mouth while you are asleep. If you want to see what the procedure is like the company has a web site, www.endogastricsolutions.com ,that shows the procedure. If you have any questions about the procedure just email me at davidswardmd1@gmail.com.
How to get back on track if you gained weight after Bariatric Surgery. Use the 2+2 Diet!
What is new with the Lap Band?
Just recently the FDA approved the lap band for people who have a BMI of 30 or above. That means that a 5 foot six inch person weighing 180 lbs can be a candidate for the band. This is the most successful population of patients with the band because loosing 50-60 lbs and maintaining that weight loss is the area where the band is very effective.
The weight loss should be able to be accomplished in about 6-9 months. The hardest thing will be having the insurance companies agree to pay for the new guidelines. For patients that can not get their insurance companies to pay, there are cash pay options with physicians across the country. At our office in NJ, Allied Surgical Group, we offer lap banding and a year of followup for $12,000. That includes the band which cost $3200, anesthesia, the OR fees and all the surgeons fees. It is on pare with a year of nutrisystem.
It is important for you to have your banding with a physician that you can visit at least once a month for the best results. Most of my patients visit me monthly for the first 6-7 months and some once a month for the first year. Than the visits can be individually set based on your success and comfort.
If you want more information about paying out of pocket for the band email me at davidswardmd1@gmail.com
Update progress of phentermine and topamax for weight loss.
Update on patients who have had a lap band after having Gastric Bypass Surgery in the past.
Also around the same time I began to place lap bands in patients who have had laparoscopic gastric bypass and have gained weight back. These patients have done very well and have lost a significant amount of weight and have been able to keep it off. I have not had any complications in these patients but the number is limited (10) and the longest patient is now two years post banding. I must say that the patients are happy and they feel the sense of fullness that had gone away with bypass.
Out of all the procedures being offered, I feel that the band offers the best results. The hardest part of the procedure is getting the patients insurance to pay for the procedure. My suggestion to people who are looking to go down this pathway is to start documenting any medically supervised weight loss programs that you are trying. This will help with the process.
How are my patients doing with medical treatment for weight loss?
I try to encourage exercise after the first month of weight loss. Exercise will always enhance weight loss but mainly helps with weight maintainance while off medications.