Laparoscopic Gastric Banding - Stomach Surgery for Severe Obesity

FAQS – BARIATRIC SURGERY

1) What is Bariatric Surgery? What does it involve?

Bariatric Surgery is surgery of the stomach or intestines to help severely obese patients lose weight by reducing their food intake.Laparoscopic Gastric Banding is the latest and safest Bariatric operation.

Laparoscopic Gastric Banding

Also know as Lapband Surgery/Gastric Bypass Surgery, it is a technique in which a silicon band is placed around the upper part of the stomach to create a small pouch. It is performed laparoscopically by a few small keyholes rather than one long, painful incision.

When the patient eats, the pouch fills up rapidly to create a sensation of fullness. The pouch then empties slowly through the constriction so that the patient does not feel hungry for several hours.

2) Why Bariatric Surgery?

Severe obesity is associated with co-morbidities such as diabetes and high blood pressure which can lead to heart disease, stroke, kidney failure and premature death. Because of poor self-image and stigmas, many obese people are also socially challenged and lonely.

Only a drastic weight loss can cure or improve these problems. When repeated attempts at dieting and exercise have failed, Bariatric Surgery may be the only viable option.

3) What is the criteria for Bariatric Surgery?

Patients with Body Mass Index of more than 32 with co-morbidities or a BMI more than 37, with or without co-morbidities.

4) What can patients expect after Bariatric Surgery?

Patients can expect a drastic reduction in appetite, accompanied by a large, steady and permanent weight loss ranging from 20kg to over 100kg. They can also expect improvement in weight-related complications and in the quality of life.

5) How long does it take?

The procedure itself takes 25 minutes. The anesthesiologist takes about 30 minutes, meaning the surgery takes about an hour in total. The patient will rest in the recovery room for about 2 hours before taken to the ward and can be up and walking about 5 hours after surgery. The patient can start drinking fluids immediately following the surgery.

 6) How long will it take to recover after surgery?
Patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.

7) What is the youngest age for which weight loss surgery is recommended?
General guidelines from the American Society for Bariatric Surgery and the National Institutes of Health indicate surgery only for those 18 years of age and older.
It is important that young weight loss surgery patients possess the physical and emotional maturity and have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success.

8) What is the oldest patient for whom weight loss surgery is recommended?
Patients over 65 require very strong indications for surgery and must also meet stringent health criteria. The risk of surgery in this age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced.

9) What foods can I take or should I avoid after the operation?
According to the American Society for Bariatric Surgery, you should avoid eating spicy food or drinking alcohol at any time, while you are in a Lapband program to lose weight. This type of food produces gastritis and edema of the gastric mucosae (swollen stomach) which causes a decrease or even blockage, of the passage through the neck of the band. This could cause harm to the stomach, and cause dehydration, making it impossible to drink fluid, (vomiting is also present) when this occurs.  Regaining weight or even minimal weight loss does and can occur. This is usually directly related to consuming high fat and high sugar foods. Weight loss surgery will only help you lose weight. It is important to follow the nutritional guidelines as a part of your new lifestyle. It is best to avoid the following foods:

• Milk shakes and malt drinks
• Cakes and other pastries
• Fried foods
• Pudding
• Chips and other high fat snack foods
• Soft drinks
• Ice cream
• Candy

10) What are the advantages and disadvantages?

Advantages:

• It is the most commonly performed weight reduction operation in Europe and the Pacific rim.
• There is very little chance of dying from operation.
• The operation is reversible.
• The band can be adjusted to increase or decrease the weight loss.
• Weight loss averages 40 to 60 percent of excess body weight.
• Malnutrition complications are rare.
• Hospital stays are short, usually less than 24 hours.
• Substantial improvement in many health problems related to morbid obesity.
• Covered by most insurance companies.

Disadvantages:

• The amount of weight loss is dependent upon the joint effort of both patient and surgeon.
• Weight loss is also dependent on frequent and long-term follow-up visits, with monthly follow-up visits for the first year.
• There is a 1 - 2 percent long-term risk of erosion of the band into the stomach and a 5 - 10 percent long-term risk of stomach slippage, which requires corrective surgery.
• Device may also need repair over time, requiring additional minor operations.

11) Can I have the Lapband removed after I get to my ideal weight?
We can remove the gastric band at any time, laproscopically. This procedure is completely reversible. What we have seen in patients who have the Lapband removed for any reason, tend to gain back all the weight that was lost. In many cases the patients return to have the Lapband replaced, within 6 to 36 months after the removal. Therefore, before removing a Lapband from the patient, we analyze the pros and cons of such a procedure.

12) What are the risks?
As with any surgery, there exists the risk of complications.
Nuisance wound problems can occur in two to ten percent of patients, but can be treated easily and without permanent side effects. Blood clots can be prevented or managed by wearing special stockings or administering a blood thinner for a short time during and after surgery. Life-threatening complications or death are rare, occurring in less than one percent of patients

 13) Will I have a scar?
Yes. The size of your scar will depend on the whether you have laparoscopic or open surgery. Minimally invasive laparoscopic surgery requires the insertion of five to seven tools through small punctures in the abdomen. These openings will heal, leaving small scars. In general, the incision from an open procedure is closed with subcutaneous sutures, which dissolve as healing progresses

14) Can it be covered by Medisave and insurance?
Bariatric surgery is classified as a medical and not a cosmetic procedure, and can be covered by Medisave Insurance

15) How much is the cost of Bariatric surgery?
In private hospitals, it ranges from S$14,500 - S$20,000 depending on weight, co-morbidities and the type of room.