FAQ's for LAP-BAND® | FAQ's for Roux-en-y Gastric Bypass

FAQ'S FOR LAP-BAND®

1.  Should I have the LAP-BAND® taken out once I lose the weight?

No, the LAP-BAND® is designed to stay in for a lifetime. Studies show that most patients will regain their weight if they have the band taken out.

2. Do I have to have adjustments for the rest of my life? How many adjustments will I need?

Patients may need a little adjustment to the band volume every couple of years after the initial incremental adjustments that are required at the beginning. The average patient who wants to lose weight as fast as they can will come in 6 to 8 times in the first year after surgery. Year two they may come in for an adjustment once or twice. Year three they may not need an adjustment at all.

3. Why don’t you just “crank it up” and make the band tight all at once during surgery?

The body needs to adjust to the new band. There is a little bit of swelling right after surgery and tightening the band too early or too fast after surgery has been shown in the research to result in more complications (including having to have the band taken out).

4. Is there such a thing as having the band tightened too much?

Yes, the band can be over-adjusted. When the band is too tight, patients cannot eat solid foods without regurgitating the food or feeling very uncomfortable for many hours until it goes down. When the band is too tight, patients tend to gain weight because they are resorting to the liquid and/or softer foods that travel through the band easily. These foods tend to be higher in fat and higher in sugar. When patients start this dysfunctional eating pattern, they are taking in more calories than if the band was looser. A band that is too tight will also cause heartburn and coughing in some patients.

5. What happens if 10 years from now I start to gain weight? What do I do?

We see you annually in the office for a check-up, however if you are gaining weight, it is time to come in so that we can assess the problem. It could mean that you need a little adjustment in your band volume to provide a little more restriction. There may be a problem related to the types of food you are eating or there may have been a life crisis and emotional eating or depression may be taking hold.

6. What is the LAP-BAND® made out of?

The LAP-BAND® is made out of silicone and titanium.

7.  Is it possible for a person to reject the band?

Yes it is possible to have a reaction to any foreign body. Studies on the LAP-BAND® have shown that it is extremely rare.

8. Do adjustments hurt?

There are fewer nerve endings in the skin of the abdomen and patients say that the adjustments are nearly painless. Patients have said that the needle stick hurts less than a shot and less than the needle stick for blood studies.

9. How long has the LAP-BAND® been in existence?

LAP-BAND® was first placed in patients in Belgium in 1994. The FDA approved the Lap-Band for use in the U. S. in June of 2001.

10.  Are adjustments made in the surgeon’s office?

Yes, adjustments are made in the surgeon’s office. On a rare occasion, the port is difficult to feel and a patient may have to go to the radiology department to have the port accessed under fluoroscopy. Adjustments are usually conducted by the nurse practitioner or the physician’s assistant.

11. How much weight loss can I expect with the LAP-BAND®?

For the first 1-2 years you should expect 1-2 pounds of weight loss per week. In the long term, you can expect to have 50-70% of your excess weight stay off.

12. Will I be hungry after surgery?

Each person is very different. Some patients feel restriction immediately after the surgery while others do not feel restriction until after the first Lap-Band adjustment at  6 weeks. Some are hungry sooner than others, given the same intake of foods.  Some begin to exercise after surgery and seem to lose weight faster.

13. If after surgery, and despite following all the rules, I am at a plateau of weight loss,
      what should I do?

Plateaus are a normal part of the weight loss process. In the first year or two after surgery, weight loss plateau usually means that you need to come in and have a little bit of fluid put in the band to increase restriction. Occasionally, plateaus are caused by the Band being too tight. If the Band is too tight weight loss will resume after a little fluid is taken out of the Band. If the above causes are ruled out, we will have you keep a food and exercise diary for 3 days. The diary will include the times and quantities of foods eaten, drinks taken, protein grams consumed, and an exercise log. We may have you consult with the dietician as well.

14.  What should I do if I “can’t cope” after surgery?

Weight loss surgery causes a lot of changes in a patient’s life including dietary changes and development of a new lifestyle. With any change in our lives, there is a feeling of loss of previous life patterns. Patients may have feelings of sadness, anger and frustration when going through so many changes at once. We remind patients to be patient with themselves!  We try to assure patients that mood swings are temporary and are a part of adjusting to change. Behavior change experts say that if you do something 21 consecutive days, you begin to form a new habit.  And after 90 days that habit becomes a part of your lifestyle.

We advise patients that if they experience persistent sadness for more than 14 consecutive days, along with loss of interest in things they were previously interested in, they should contact the Bariatric Clinic or their primary care physician. These are signs of depression.

Patients who continue to struggle after routine intervention by the Bariatric Clinic, may be referred to the behavioral nurse or a mental health practitioner in the community.

15. What should I do if I cannot exercise very much due to back pain?

We know from experience and scientific research that you will decrease post-op complications and increase your chances of weight loss through following the pouch rules and nutrition handbook AND being more active.  We encourage you to find resources in your community to help you develop a program of movement and activity.  For example, many of our patients with joint problems enroll in water exercise programs at a therapy pool.  Others find that recreation programs have recumbent exercise bicycles that allow you to sit while pedaling a bicycle. 

16. I’m worried that after surgery, my emotional eating will return.  Want can I do?

Here are several suggestions we give our patients: Talk about your feelings with your support persons. Perhaps the stress in your life is high and you are returning to old habits of coping. Schedule an appointment with the behavioral nurse to explore alternatives to dealing with emotions in ways other than eating. Call the clinic and ask for them to send you resources on dealing with problem eating behaviors and the “100 Healthy Alternatives“ handout. Attend support group meetings to hear how other patients are solving that problem. Log onto Remedy MD and use the chat line.

17. What is the purpose of support groups?

There are many benefits to attending support groups; here a just a few of them: 1) To hear from others who have similar problems to you own, 2) To celebrate positive changes in each patient’s life since the surgery, 3) To learn new information about bariatric lifestyles, 4) To brainstorm solutions to problems, 5) To provide motivation to follow the rules that will work for individuals for a lifetime 6) To meet people who have had successful results of the surgery and are willing to help others, 7) To talk with a group of people who understand your journey like no one else does!

For patients who have not achieved the weight loss they had hoped, we encourage them to return to the group. In support group, our most important rules are confidentiality and to listen for understand. There is no “scolding” or berating. A bariatric lifestyle is not about perfection, but about doing the best we can to achieve weight loss goals and to maintain the losses. It is all about people working very hard to make changes. We learn from each other.

18. How much pain will I be in after the LAP-BAND® procedure?

Most patients experience mild to moderate pain. The most common analogy used by patients post-op is that it “feels as if they did 200 hundred sit-ups in a row and their abdominal muscles are sore”.  More pain is commonly felt over the port site incision. Your pain will be well controlled so you will be able get up out of bed to walk and move around after surgery.

19. When will I be allowed to drink after surgery?

You will most likely be able to drink clear liquids on the day of surgery after you have had your Upper G.I. x-ray and it has been reviewed by the radiologist and Dr. Johnell. Whether you are going home the day of surgery or the morning after surgery, you will usually be able to drink liquids on the evening of surgery.

20. How long are visiting hours?  Can my family stay with me at the hospital?  What about
      children visiting?

The general visiting hours for the hospital are from 8:00am-8:00pm. These are just guidelines to allow patients time to rest which will aide their recovery.  If you will need to come to see your loved one before or after "normal" visiting hours, then that is okay.  Just be aware that the main entrances to the hospital will be locked at 8:00 PM and you would have to gain entrance to the hospital through the Emergency Room. 

Family members can stay with the patient in the room overnight. If you decide to stay the night with you family member, be aware that some of the rooms on the surgical floor are not private rooms and they are small in size. 

Children of any age are allowed to visit their families while in the hospital. The only exception to this rule would be visitation within the Intensive Care Unit.

21. If I qualify for same day discharge surgery, how long will I be in the hospital?

Starting from the time you reach the surgical floor to recover, it has been on average 6-8 hours.  Times differ from patient to patient.

22. What are the expectations of patients in the hospital after surgery? 

• Get up out of bed
• Walk in hallways as much as tolerated
• Sit in chair as much as tolerated
• Use your incentive spirometer (plastic breathing device) 10 times per hour while you are awake
• Concentrate on fluid intake
• Work on achieving good pain control with your nurse prior to discharge

23. Which insurance companies typically cover the LAP-BAND®?

As of November 2005, the following companies have covered LAP-BAND® surgery:
Aetna, Anthem Blue Cross Blue Shield, Beech Street, Cigna, Banner Choice Plus, Great West, Humana, Mountain States, Sloan's Lake, United and Wausau.

Your employer usually has the authority to make a “line-item” exclusion for weight loss surgery for morbid obesity. Therefore, although the main insurance company usually covers weight loss surgery, there may be an exclusion on your employers specific policy. You need to contact the Human Resources department where you are employed to make sure they haven’t established an exclusion for surgical treatment for morbid obesity.

24. What is the age range for being eligible for LAP-BAND® surgery?

Age range is 18 to 70 years of age.

25. How many days off work will I need to take for the surgery? 

Most patients take 3-5 days off from work not including weekend days. For example: If a patient has surgery on Tuesday, they could go back to work on the following Monday; If a patient has surgery on Thursday, they could go back to work the following Tuesday or Wednesday. It varies from patient to patient.

26. What are the advantages of having LAP-BAND® surgery instead of gastric bypass   
      surgery?

The Lap-Band operation is:

• Adjustable – customized per patient
• The least invasive option
• Requires no stomach stapling, cutting or intestinal rerouting
• Reversible
• The procedure with the lowest operative complication rate
• The only procedure with a low malnutrition risk
• The most cost-effective procedure for weight loss

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FAQ'S FOR ROUX-EN-Y GASTRIC BYPASS

1. What is a realistic amount of time needed off of work post op?
A minimum of 3 weeks, but with a possibility of returning part-time for desk-type jobs, after 2 weeks.


2. Average length of time from consultation until surgery date?
Average length of time from consultation to surgery is two months.


3. I’ve had my gallbladder out; can I still get gallstones from rapid weight loss after WLS?
No, you cannot get gallstones after your gallbladder has been removed.


4. What about kidney stones? I’ve had 3 kidney stones in the past few years, and have a family history of them as well. Can WLS cause kidney stones as well as gallstones? If so, what can I do to prevent this?
WLS may very slightly increase the chances of developing oxalate kidney stones. Dehydration can lead to stones, however, and dehydration is present in varying degrees after GBP (gastric bypass).


5. Hair loss. Would Rogaine, Biotin, or something similar help with decreasing possible hair loss post-op?
Anesthesia is known to cause hair loss in some people. If you tend to lose hair with very low calorie diets, you will likely experience some hair loss after GBP. You can "tank up" on a few vitamins and minerals to attempt to minimize the hair loss. Some of these are biotin, vitamin A, zinc, vitamin C, and a few herbs. Nutrilite® makes a product called "Complex for Hair, Skin, and Nails". Patients tell me that it works! Go to:
http://www.quixtar.com/lang-ind/sh/product.asp?lnid=32212|32234|32234_|A7553
Yes, Rogaine extra-strength for men applied as directed will stimulate new hair growth (there is a generic Rogaine (Minoxidil) now, and it is a lot cheaper!


6. A book on Weight Loss Surgery that I’ve read (Weight Loss Surgery: Understanding & Overcoming Morbid Obesity by Michelle Boasten) talks about hair loss and that you should not use chemicals on your hair for several months post-op. Should I plan to stop tinting my hair for 6 months or so to help minimize hair loss?
Tinting your hair would probably affect the texture of your hair more than inducing hair loss. Hair products have tamed over the years. I personally would continue tinting my hair if grey hair would start to show. Ask your hairdresser for a natural, organic, and mild product.


7. Medications – I’m on lots now. How do you take pills immediately post-op when you aren’t eating? I’m concerned especially with the hypertension issue.
One takes pills after GBP with a lot of patience and finesse! One day at a time, add one more pill or supplement. Meds that are not optional to skip may have to be ground up and put in pudding or juice (NOT time-released meds). I tell my patients that skipping antidepressants is not optional. Anti-hypertensives (blood pressure meds) and hypoglycemics (diabetes meds), are generally not optional to exclude. You and your private physician will need to monitor these types of medications on a regular and frequent basis. It is not a good idea to take diuretics after GBP.


8. I already have a hernia and I had a tummy tuck operation. What are the odds I could get approval again once I’ve lost the weight to have a revision to the tummy tuck?
I don't know what the odds are for you to be reoperated for tummy tuck! That would depend on a few factors such as being able to "prove" a medical need, how lenient your policy is, etc.


9. How long after surgery until I could go swimming? In a pool? In the ocean? Snorkeling?
You can swim and take a bath when all wounds are completely healed closed. Salt or fresh water activities are fine.


10. Realistically, how much weight should I (me personally) be able to lose successfully with WLS and keep off long-term?
If you are like most people, you should be able to lose up to 80% of your excess weight. Excess weight is your present weight minus your ideal body weight as outlined in the handbook. Long-term, patients tend to gain back some of their earlier loss to between 70 and 80% of excess weight.


11. I’m concerned about the possibility of infection from this surgery. What is the incidence of Dr. Johnell’s WLS patients having post-op infections?
Actually, the non-orthopedic surgery floors enjoy a low incidence of infection at NCMC. Incidence of major infections is less than 1%.


12. Which surgery would Dr. Johnell recommend for me (lap vs. open) and why?
Dr. Johnell always recommends the laparoscopic approach unless previous stomach or intestinal surgery disallows this approach. Less invasive surgery (laparoscopic surgery) has lower complication rates and is associated with lower mortality rates.


13. What is the difference in recovery time between lap vs. open?
With no complications, lap GBP patients go home the third post-op day. Open patients go home the 4th or 5th post-op day. Back to normal activities for lap. Is about 21 days. Open patients may have to wait another week or two.


14. Explain distal and proximal. I know it has to do with how much of the small intestine is bypassed. How is this determined? Per patient? By their starting weight? What would be done in my case?
Dr. Johnell will do a distal anastemosis (150cm of intestine bypassed) on larger people. Usually this correlates to a BMI of >50.


15. I have read on listservs on the Internet about people being so miserable post-op and not being able to eat virtually ANY food without getting ill. Is this common? Does this go away with time?
Getting ill immediately after surgery seems to be related to narcotic pain relievers. After about 3 or 4 months post-op, most of our patients can eat anything they want as long as it does not have a lot of sugar or fat in it. What you describe is not common.


16. What exactly happens in your body to make the weight loss slow down and stop and you get to a stage of maintaining your new lower weight? You can’t just keep on losing and never stop can you? I read on a listserv on a woman who was 5’8” and had lost down to 113 lb. and said she couldn’t stop losing, even though she was eating as much as she could tolerate without getting ill.
You generally stop losing weight when caloric intake matches expenditure. A number of factors determine this, including exercise and building lean muscle mass. Losing too much weight would be an unusual problem, and would signal possible psychological origins, “dieting”, frequent vomiting, or a disease process.


17. What is the average total lb. lost and loss maintained of Dr. Johnell’s patients? Example: average person loses 100 lb. and maintains 80 lb. loss long-term. Is it realistic that I could lose enough to get to 160 and actually maintain at 180 long-term??
Yes, it is realistic for you to do this. Averaging pounds of weight loss is not a reliable way to express weight loss. A 575 pound man might lose 250 lbs. overall, whereas someone who is only 100 lbs. overweight will lose only 80 lbs. Weight regain phenomenon occurs usually after 3-5 years post-op.


18. Once the insurance approves the surgery, is there a time limit for the surgery to be performed?
Yes, insurance companies have a time limit on how long they will approve the procedure before you must resubmit the request. I have heard 2 months, and 3 months.


19. I read that you shouldn’t drink carbonated beverages after WLS. Is this a lifetime restriction? Is it okay if you let them go flat first?
Some patients are able to drink carbonated beverage after the initial pouch growth period (4-6 months), but most patients cannot tolerate the carbonation. On occasion, I have been able to trace eating problems and epigastric discomfort back to soda when patients did not make the connection! Yes, you can make the soda go flat.


20. Are sugarless beverages, foods, etc. okay after WLS? Such as things sweetened with Splenda or Nutrasweet, etc.?
After gastric bypass surgery, patients will substitute sugary drinks with those sweetened with artificial sweeteners due to the propensity for simple sugars to trigger the dumping syndrome. All of the artificial sweeteners are okay to use. We recommend that patients undergoing gastric banding (Lap-Band) use artificial sweeteners despite the fact that they can eat sugar, to decrease calorie intake. Splenda, Sweet N Low, Equal, and fructose-based sweeteners are tolerated well.


21. I love to eat ‘snow cones’...crushed ice (made with an electric ‘snow cone maker’) with Splenda-sweetened, flavored syrup on it (made by DaVinci). How much crushed ice could I eat at one time after WLS?
After the initial recovery period in post-op gastric bypass, patients are usually able to eat ice. I have however, had some patients describe a feeling much like the dumping syndrome after drinking ice cold liquids.


22. How common is vomiting and/or diarrhea after WLS of this type? Years ago, I remember reading and hearing about people having ‘stomach stapling’ procedures and then having terrible diarrhea and vomiting the rest of their lives.
The "stomach stapling" procedure you speak of can describe several different (older) procedures. Not a stomach stapling procedure, the Jejuno-ileal Bypass (one of the original bariatric procedures, that has been abandoned as a WLS) was associated with diarrhea, electrolyte imbalances, liver failure, and osteoporosis. Biliopancreatic Diversion is associated with occasional diarrhea and multiple BMs throughout the day. Vertical Banded Gastroplasty is sometimes associates with vomiting and gastric reflux. We rarely see persistent vomiting or diarrhea with the gastric bypass or the Lap-Band.


23. What if you get the stomach flu? Are you actually able to vomit as you did before the surgery? Do you require special medical treatment if you get this type of illness after the WLS?
Patients who get the stomach flu after bariatric surgery are unlucky and pitiful! On the discharge instruction sheet we give you in class (and you get at the hospital upon discharge) it states that you should stay away from people who are sick, and children whether sick or not. Children may be carriers of viruses when they are not obviously ill. In some cases, patients have had to come in to Urgent Care of the ER to get re-hydrated after vomiting with the stomach flu. We always prescribe anti-nausea medication for any patients who are vomiting.


24. I’ve read on the listservs of some people wearing Medic-Alert bracelets after WLS. Do you recommend this? Why or why not? If I got one, what should it say in regards to the WLS?
Medic-Alert bracelets are probably not necessary after WLS. It is only in the early post-op period that the stomach (pouch) is especially vulnerable. You have to be the verbal medic-alert for yourself if for example; a radiology technician tells you that you have to drink 12 ounces or radio-opaque fluid!! If a doctor in the emergency room wants to put a naso-gastric tube down into your stomach, you will have to tell them about your surgery. Patients in the early post-op period should have NG tubes inserted under fluoroscopy in the radiology department.


25. I read in your material that you must take vitamin supplements the rest of your life after WLS. Are these special prescriptions that you purchase through your health insurance, or do you have to get over-the-counter? Some of those are very large pills…do some of them come in liquid form to make them easier to take after the surgery?
The supplements after gastric bypass are described in detail in the pre-op class. We are very specific about what we want you to take, how large the pills are, how much, and how often supplements are to be taken. Liquid vitamins are OK once "cleared" for their adequacy...but most patients cannot stand the taste of them. Most of these are over-the-counter, but you may get a break on the iron if your insurance covers this.


26. I have neuropathy in my feet that is getting continually worse. I’ve heard that Vitamin B-12 can help this. Do you know if that is true? Do you think losing the excess weight and keeping it off could reverse the neuropathy?
I have not read any literature describing improvement in diabetes induced neuropathy after gastric bypass surgery...and so far, our patients with neuropathy have not seen any improvement. I am hopeful though! All of the B vitamins help nerve tissue. I would take 100 mg Vitamin B Complex pre-op, and the usual regimen we prescribe after surgery.


27. It sounds like the ‘diet’ you are advocating for post-op is a high protein, low carb diet. Are post-WLS patients in ketosis? Do you advocate patients following a ‘diet’ plan like Atkins or do you advocate high protein but low fat?
Yes, post-op gastric bypass patients are in ketosis especially right after surgery when caloric intake is very low. The diet we advocate includes fruits and vegetables, with an emphasis on protein as the main element of each meal. We advocate a low fat diet. Atkins diet restricts carbohydrates severely (including fruits) and allows seemingly unlimited fats.


28. Will I be able to eat fresh fruits eventually after WLS? I love fruits of all kinds.
You may eat fruit to your heart's content....But it is a trial and error situation for awhile determining just how soon you can tolerate some of the more fibrous fruits...you may never be able to eat apple skins, pear skins, or other such fibrous parts of the fruit. You may also drink fruit juices, but since they are so high in calories, we recommend no more than 8 ounces of fruit juice a day.


29. Give me a sample ‘meal’ for someone 6 months post-op. Type of food and quantity they should eat? How about 1 year post-op?
Ideal meal: 1/2 animal protein, 1/4 fruit, 1/4 vegetable, carbs in place of fruit if desired (potato, pasta, tortilla, rice). Sample: 3 oz. Chicken breast, 1/4 cup of peas, 1/4 baked potato with Tablespoon of "Take Control" (butter). Or...one half of a small hamburger with cheese, tomato, lettuce, 1/2 of a pear. This type of meal can be eaten at about 6 months after surgery.


30. I’m employed outside the home full time. I’m also a college student (online). Do you think I can still keep up my classes and have this surgery and allow for recovery time w/o skipping a semester of class?
I do not think you will have to suspend any class time. If you do not have any complications that would prolong your recovery (rare, but it happens) your studies should be achievable.


31. How many times has Dr. Johnell found leaks from the post-op leak test and had to re-operate to fix them?
Believe it or not, leaks are not often seen on the UGI. The most benefit from this exam is insuring that there is no obstruction so that water can safely be taken. On occasion, patients have enough swelling to obstruct the outlet of the pouch (after GBP) and must stay NPO (or nothing by mouth) for another day or so. Dr. Johnell has had very few patients with leaks, less than 1%.


32. What other tests are required before and after surgery?
Tests that are standard in our program for pre-op patients are EKG, CXR, pulmonary function studies, ultrasound of abdomen, clotting studies, arterial blood gases on room air, blood chemistries, and complete blood count, Hgb AIC. Patients with thyroid problems, cardiac problems, pulmonary problems, etc., may need further evaluation by a specialist to be cleared for surgery. After surgery on the GBP patients, we check blood work every 3-6 months to look for anemia, and other indications of nutrition problems. The tests include blood chemistries, complete blood count, B12, folate, magnesium, albumin, ferritin, zinc, and other iron studies. Sometimes we get specific vitamins such as thiamin, Vitamin D, etc.


33. What is the incidence of the staples used to create the pouch coming apart at a later date, say years later?
To my knowledge, there has not been an incident of staples coming out years later in a gastric bypass patient when the pouch has been completely separated from the larger stomach called the "remnant." Staple lines commonly break down in WLS where the stomach remains intact. The body finds a way for food to break through the staple line...and patients gain most of their weight back when the line is disrupted. This was the case with the older Vertical Banded Gastroplasty operation, commonly referred to as ‘stomach stapling’.


34. How often has Dr. Johnell had to do a second operation on a patient for a complication? What sorts of complications has he seen?
In our program, less than 4% of patients have had to go back to the OR. We have seen a variety of reasons for re-op. Internal hernias resulting in twisted or obstructed bowel, leaks at the upper or lower anastemosis (connection), and bleeding, are some of the problems we have seen. They all did well subsequently.


35. Does Dr. Johnell have his patients wear a ‘binder’ after surgery? Some of the books on WLS I’ve read they talk about patients wearing this to minimize discomfort of the incision.
Patients wear an abdominal binder after "open" gastric bypass. The laparoscopic patients do not need this.


36. How do you decide how much, when, and if to reduce someone’s medications for diabetes, hypertension, etc. post-op? Is this decision made by Dr. Johnell or your PCP? Is your PCP involved in your care during your hospital stay? What is their role post-op?
The PCP follows you after surgery to determine the need for any changes in your medications. After gastric bypass, the changes may be rapid and occur immediately after surgery. Dr. Johnell does not typically manage these medical problems once you leave the hospital. If your PCP is on staff at NCMC, Dr. Johnell will ask your PCP to see you in the hospital. We ask that just as soon as you get your surgery date, you should make an appointment with your PCP for follow-up the week following your discharge from the hospital. Medication changes are not as dramatic in the Lap-Band patients, so they may make an appointment for the second or third week following surgery. Diabetics should closely monitor their own blood sugars at home.


37. I take 1000 mg. twice a day of glucophage. I know you aren’t supposed to take it for several days before surgery or before certain tests. What do I do to keep my blood sugar under control for those days?
We have patients take their Glucophage and other diabetic meds up to the time of surgery. Blood sugars are managed in the hospital using a sliding scale and regular insulin. Oral meds are started on the second post-operative day.


38. Does Dr. Johnell prescribe prophylactic antibiotics post-op?
Dr. Johnell prescribes antibiotics in the pre-op area (IV) and for 24 hours post-op in the hospital only.


39. I always get nauseous from anesthesia and w/o anti-nausea medication get extremely ill and vomit post-op. Does Dr. Johnell prescribe anti-nausea medication pre-op?
Medications besides antibiotics that are given in the pre-op area are under the domain of the anesthesiologist. The anesthesiologist will visit you in the pre-op area, at which time you may ask him for extra medications to ward off nausea. Usually everyone gets an anti-emetic preop and intra-op. Several different types of anti-emetics are available on an as-needed basis post-op.


40. Since I’m familiar with both, can you compare the recovery from WLS to the recovery from open gallbladder surgery or a tummy tuck? Is the WLS a longer/more difficult recovery or are these other surgeries more difficult? Why?
Patients tell me that open gallbladder and tummy-tuck are more painful than laparoscopic gastric bypass. Recovery is more difficult with the GBP due to the fluid and supplement regimen one must follow post-op, but it is not necessarily more difficult than open gallbladder surgery for any other reason.


41. Do you have post-op WLS patients who are willing to speak to me about their experiences?
We do have post-op bariatric surgery patients called "Bariatric Angels” who are willing to speak with you. Some of these patients will even come visit you in the hospital. Call the office for some names and numbers, or come to the support group meeting for a list to take home.


42. Tell me about your support program for your WLS patients.
The Gastric Bypass support group meets on the first and third Monday of each month from 6:30-8:30 p.m. in the lower level conference room of the Clinic. The Lap-Band support group meets on the first Tuesday of each month from 6:30 p.m. until 8:00 p.m. same location. Some groups have guest speakers, others are pure emotional support. They vary. All group leaders are licensed professionals: 2 RNs and a medical social worker.


43. Explain how the size of the pouch is determined during the surgery? Is it guesswork or done with the aid of an instrument?
The size of the pouch is never guesswork, is approximately one half-ounce in size when created, and is created using an instrument called an "anvil."


44. About ½-1 oz. is the size of the initial pouch that is made, correct? What is the size of the pouch long-term?
Over a period of about two years, the pouch will expand and mature. Two weeks after surgery, patients are usually able to drink 2 ounces at a time without trouble. Pouches grow to an average of 6 ounces in size when completely mature, with a range of 3-10 ounces. Patients must refrain from overfilling the pouch especially in the first two years after surgery so as not to “stretch” it out. Patients can make their pouches permanently too large for life if they “push it”. Weight loss can be as low as 30-40% of excess body weight lost in these cases.




45. Are the staple lines stitched in addition to the staples?
Sometimes the staple lines are hand-stitched in addition to stapling. Dr. Johnell uses special strips called Peri Strips, to reinforce the staple line. I don’t think we have seen a leak since he started using this technique.


46. What rechecks are done post-op? Do you do 'leak tests' periodically to check for leakage after healing should have been accomplished? Or is that unnecessary?
Office rechecks are at 6 days, 1 month, 3 months, 6 months, 12 months, 18 months, 24 months, and yearly (if possible for patients), after that. Upper GI is not necessary post-op (except for the one the day after surgery) unless there is a problem.


47. Does my having diabetes affect the recovering/healing process?
We haven't seen a big problem with wound healing in our diabetic patients, probably because open cases are rare, and the small incisions left behind from laparoscopic surgery are easy to manage. I haven't seen a difference in recovery between patients based on diabetic history.


48. I don’t have receipts for my previous weight loss attempts. Will this be a problem for me getting approval from my insurance carrier?
Records of weight loss attempts are required by some carriers no matter what. If patients do not meet the National Institutes of Health criteria for WLS, records may be required. Some insurance carriers such as Cigna are requiring fairly strict documentation.


49. I’ve heard that insurance requires you to have failed at a ‘medically supervised weight loss plan.’ Does Optifast qualify for that requirement?
Insurance carriers are so individual in what they consider adequate. I do know that Optifast and Medifast qualify. Check your policy or call them to clarify this issue.


50. Do you know if my insurance requires a psychiatric evaluation before approving the surgery?
The need for a psych evaluation will be determined by both your insurance carrier and the bariatric team. We are in the process of having every patient get a psychological evaluation.


51. If so, do you recommend a psychiatrist/psychologist for me to see?
We have several psychologists to recommend, your insurance may require that you use their list of providers.


52. What area at NCMC are patients put after surgery?
Patients go to "Three North Central" from the recovery room. Open cases go to the ICU for 24 hours.


53. Are there nurses at NCMC who have special training and understanding to care for patients after this surgery?
The nurses on 3NC are well-trained on post-op care of the bariatric patient. We always get great reviews about our hospital nurses.


54. Probably one of my biggest concerns about this is how I will handle certain events in my work after surgery. I am involved in quite a few business lunches with consultants, insurance companies, etc., as well as going to workshops and conferences where meals are served. I want to minimize my weight and/or surgery becoming the topic of conversation at these events. How will I be able to handle that sort of thing without drawing a lot of attention to the fact that I’m not eating very much, plus not having anything to drink during the meal?
WHAT you eat does not draw attention to yourself, because you will be eating most foods everyone else can eat. What tends to "look funny" is the quantity that you eat. If you do not order a smaller meal such as an appetizer or salad, you will be leaving a substantial amount on your plate (especially with the mega-portions served at most restaurants these days). With finesse and tact, you can pull it off. You CAN drink with your meal but that will minimize the portion you can eat from the plate even more.


55. What about caffeine? Is that an ‘okay’ thing after this surgery? If not, why not?
I don't have a big problem with caffeine in healthy relatively young patients (under 60) in moderation. Patients that have palpitations, or other heart arrhythmias best not have caffeine.


56. As much as my right foot hurts and swells, walking is not a good exercise choice for me right now. I like our recumbent bike. How soon after surgery would I be able to ride it? I KNOW lifetime exercise is very important to make the weight stay off long term.
You may start on your recumbent bike the day you get home from the hospital. You will likely add walking soon thereafter! Because,...if you are like most patients, the incessant leg, ankle and foot swelling tends to be one of the first things to subside post-op. Plan on buying a new pair of shoes very soon after surgery (and hold onto to your precious rings, they may slip off your fingers before you get a chance to resize them).


57. I’ve read that my blood sugars may normalize within just a few days after the surgery. Does the diabetes actually ‘go away’ or is it like it is ‘in remission’? Will I need to consider myself diabetic for the rest of my life?
After gastric bypass surgery, 98% of Type II Diabetics are cured. No, it is not a remission, it is a cure! And if your diabetes goes away, then you’re not diabetic anymore!


58. How does Dr. Johnell close the incision? Staples? Or the way plastic surgery is closed to minimize scarring? If staples, are these the type that must be removed later?
Incisions after laparoscopic surgery are closed with absorbable suture, and covered with steri-strips. Open incisions are closed with staples and are removed a few at a time over the course of several weeks.


59. Page 12 of the patient handbook states that Dr. Johnell doesn’t use NG tubes. Is this true?
Dr. Johnell used to utilize NG tubes in all his patients after Laparoscopic GBP, but subsequently decided that they were widely unnecessary. NG tubes are still used for open cases.


60. Which anesthesiologists does Dr. Johnell use?
Dr. Johnell uses Dr. Matt Flaherty, Dr. Milton Dick, and Dr. Pat Koontz for anesthesia on his patients.


61. How long does the bladder catheter stay in after surgery?
The Foley catheter is removed the day after surgery in gastric bypass patients. Lap-Band patients do not have urinary catheters placed at all.


62. Does Dr. Johnell have problems with constriction of the new openings into or out of the pouch with many patients? How is this corrected if a problem develops?
We have seen 3-4% of patients with narrowing of the outlet of the pouch. The entrance to the pouch is unchanged in surgery from its pre-surgery anatomy. Treatment for pouch outlet narrowing (aka: stenosis) typically requires one or more endoscopies for dilation of the outlet, and is performed by a qualified gastroenterologist.


63. Will I be in ICU after the surgery?
If Dr. Johnell has told you that you will have an open procedure, then you will go to the ICU for observation for 24 hours.


64. Will I be in a private or semi-private room in the hospital?
Most GBP patients have a private room unless there is a shortage of beds. In this case there is an attempt made to put two GBP patients or two Lap-Band patients together in the semi-private room. You can request a private room, but if you don't already have one, there probably are no private beds available.


65. Are the staples used to create the pouch the same type of staples used internally for gallbladder surgery?
No, the staples are different for each type of surgery.


66. What do you recommend patients do to prepare for the surgery and new way of life after surgery?
We have added to our program a behaviorist to work with patients in a series of four behavior change sessions that our patients are expected to attend. The behaviorist and a psychologist are also available for private consultation post-operatively. Practice chewing food 20-30 times, slow down at meals, practice drinking fluids before meals and have no fluids for 1½ to 2 hours after the meal. Practice paying attention to what and how you are eating when socializing with others during meals. Every time you go to the grocery store, read as many labels as you can to get familiar with ingredients, and nutritive values of foods. Plan your future of regular exercise for life. If you do not have a way to get aerobic exercise at home, ask loved ones for a new or second hand treadmill or stationary bike. Plan ahead for winter. Don’t let winter weather sabotage your exercise routine.

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