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Laparoscopic Adjustable Silicone Banding with the LAP-BAND' has proven to be a safe Bariatric surgical procedure. It is minimally invasive, adjustable and easily reversible. It does not involve rerouting or rearranging of the intestines. It does not involve dividing the gastrointestinal tract, and therefore it involves no staple lines. It is a purely restrictive procedure, and thus, does not involve any malabsorption. The operative time is among the shortest of Bariatric procedures, and the length of hospital stay is usually one night. This procedure has also been proven to be one. of the safest operations, with a mortality rate of approximately I in 2,000. This is about one tenth the mortality rate of gastric bypass'. It works because patients eat less and have a sense of fullness, otherwise known as a sense of satiety. The procedure was first introduced by BelacheW2 in 1993. There have been more than 100,000 of these surgeries performed to date.

Living with the LAP-BAND presents unique lifestyle adjustments and challenges. We will provide an overview of the dietary guidelines, role of exercise, and adjustment schedule. It cannot be overemphasized that the LAP-BAND is a purely restrictive model for weight loss. This is in stark contrast to both the Roux-en-Y Gastric Bypass and the Duodenal Switch which involve a malabsorptive component to the operation.

Comparing weight loss from a LAP-BAND to either of these operations is like comparing apples to oranges. The first rule in living and thriving with the LAP-BAND is to remember that the weight loss is slow and gradual. Weight loss in the range of 1-2 lbs. per week is considered successful. A common source of disappointment and frustration comes when a LAP-BAND patient compares his or her weight loss to a sibling or coworker who has had a gastric bypass. Patience and understanding are critical components to success with the LAP-BAND.

After surgery, patients will be required to make changes in their eating habits and modifications in behavior in order to achieve weight loss goals.

Diet Progression after Surgery
Day 1-3 - Liquid Diet
Day 4-5 - Full Liquid
Day 6-8
- All of the above PLUS
- Mashed potatoes
- Chicken noodle soup or Condensed chicken and rice soup
- Applesauce
- Oatmeal or malt o meal
Week 2-3 - Soft mushy food
Week 4-6 - Soft regular food
Week 7 and on - Regular food

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It is important not to drink with meals. Drinking liquids with meals or too close to mealtime may cause bloating, nausea, or vomiting. Fluid intake is very important for prevention of dehydration and constipation. Sip on water all day. Do not drink liquids 30-45 minutes before and 45-60 minutes after meals. This will avoid flushing out the stomach for longer periods of time and therefore prevent rapid hunger. Early hunger can cause increased calorie intake and weight gain. Do not use a straw. This can cause your stomach to fill with air. Avoid regular soda and adding sugar to beverages. Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool Aid, coffee, unsweetened tea, or broth. Avoid carbonated beverages and sodas for one month after surgery. These can cause bloating. Avoid alcoholic beverages.

Exercise is absolutely critical to obtaining maximal success following Bariatric surgery. Durability of weight loss is predicated on compliance of diet but predominately on exercise habits. This is even truer with the LAP-BAND than with gastric bypass or duodenal switch because these surgeries have a malabsorptive component. Patients must exercise at least 30 minutes a day, 3-4 times a week. Any activity that increases the heart rate for an extended period of time can be chosen. This can include walking, running, swimming, aerobics, or hiking. The key is to find something that is enjoyable and make it part of the daily routine.

Adjustment Schedule
The adjustability of the LAP-BAND is one of the great advantages of the LAP-BAND over the gastric bypass or duodenal switch. The Vertical Band Gastroplasty, or VBG, is a restrictive operation but is not adjustable. After a period of 6 weeks following LAP-BAND placement, a patient may require an adjustment, also known as a "fill."

Three main factors are used to determine whether or not to add fluid to the LAP-BAND: weight loss, level of hunger and degree of restriction. If a patient is not losing adequate weight (less than 1-2 lbs. per week), is ravenous, and seems to be able to eat more with meals, then it is time to do a fill. Most adjustments can be done in the office in less than 15 minutes. Fluoroscopy or X-ray is only necessary if the adjustment port cannot be accessed in the office. The first adjustment is done no sooner than 6 weeks post-operatively. Subsequent adjustments are done at 4-6 week intervals based on the aforementioned criteria. 

It is also important to look out for negative symptoms after an adjustment. Symptoms of chest pain after eating and drinking, nausea, vomiting and reflux can mean that the LAP-BAND is overly tight. More subtle signs can be nighttime coughing or choking, and an inability to eat a range of foods. It is important that patients remember that weight loss should be gentle and gradual. Patients must resist the temptation to be too tight too fast. This can lead to dysfunctional eating habits, in which patients convert their diet to liquid calories. If obstructive symptoms are present, then fluid should be removed from the band.

Follow-Up Schedule
Patients will be seen at 4 week intervals in the first year following LAP-BAND placement. Follow-up with a nutritionist is encouraged, as is attendance in a support group. Medical co-morbidities can also be improving as weight loss is progressing, and as result, medications and dosages need to be adjusted. It is, therefore, critical that close follow-up is also occurring with a patient's primary care physician. The LAP-BAND is easily reversible, but must be viewed as permanent. It should not be removed when patients have reached their target weight.

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