Laparoscopic Adjustable Gastric Band (LapBand®)
Overview – The laparoscopic adjustable gastric band takes about 1–1½ hours. In the operating room, the patient has had Sequential Compression Devices (SCDs, also known as leg squeezers) and a preoperative dose of subcutaneous enoxaparin, as well as a dose of IV antibiotics. The surgery involves insertion of 4 to 5 working 'ports' on the abdomen. The band is then placed around the upper portion of the stomach creating a small pouch capable of holding about 20-40cc.
Post-op care – The patient is brought from the recovery room to their room or intensive care unit (ICU) when alert. Patients with severe sleep apnea, pulmonary hypertension, or intraoperative difficulty will stay overnight in the ICU. A Patient Controlled Anesthesia (PCA) pump will be ordered for overnight pain control, and strict nothing by mouth is observed: no ice chips, no sips of water, nothing. A swab sponge may be used to keep the mouth moistened. Patients should begin walking as soon as they are awake and alert enough to stand and walk with assistance. Early ambulation is an important part of Deep Venous Thrombosis/Pulmonary Embolism (DVT/PE) prevention in surgery for morbid obesity.
The following day (postop day #1), a swallow study will be performed in radiology, to check for a leak, alignment of the band and to be sure that there is no obstruction to liquids. First, water-soluble contrast is swallowed and observed passing through the band. If there is no leak seen, barium is then swallowed and observed passing. Barium is not used until a leak is ruled out, because free leakage of barium into the peritoneal cavity can be intensely inflammatory and dangerous. If the swallow study is normal, the patient is allowed to begin a Stage 2 diet and may resume medications as written by the surgeon. All medications should be crushed or in liquid form.
Diet stages –
Hot or cold liquids should be avoided right after surgery, as this can lead to pouch irritation and PO intolerance.
Diabetic patients should have orders to check their blood glucose every 6 hours. Many patients with Type II diabetes can be discharged on no medication whatsoever; their caloric intake is so low that some will normalize their blood sugar immediately. The surgeon will decide this based on their in-house blood glucose values.
Patients are typically discharged on postoperative day #1 on a Stage 2 diet. They will stay on Stage 2 until their 2-week followup visit with the surgeon. They are instructed to attempt to get 72-96 oz of fluid daily, in order to prevent dehydration. This may involve constant 'sipping' of water, Crystal Light, protein drinks, etc. Typically patients who are doing well with their Stage 2 diet after the first 2 weeks will be advanced to the Stage 3 diet for the 3rd week. As the patient begins their 4th week they will advance to a Stage 4 diet. Just prior to returning to the clinic for their 1 month follow up, patients will have labs drawn and if all is going well at the 1 month visit, they may undergo their first adjustment/fill of the band.
It is imperative that patients follow the guidelines set forth by the program for advancing their diet. Taking in solid foods too early on can compromise the stomach pouch and lead to a slippage or obstruction of the band.
Shower – Patients may shower beginning the day after surgery, with their back towards the water. They are instructed to wring out a soapy washcloth over the incision(s) and rinse using the same technique. No baths until the surgeon gives the OK, typically after two weeks.
CPAP / Oxygen – Patients on CPAP or oxygen prior to surgery will need to continue it after surgery. They are instructed to bring their CPAP machine with them on the day of surgery. They must use it at all times while sleeping, whether for naps or at night. Preoperative pressure settings are continued in the hospital.
Exercise – Patients can resume light aerobic exercise (walking, elliptical, stationary bike) when they feel able. No lifting is allowed over 10 pounds for 6 weeks. Driving is not permitted until the patient is pain-free and off all narcotic pain medications. Patients may begin weight training 6 weeks after surgery.
Nausea / vomiting – Patients may experience nausea and/or vomiting. In the hospital we will have medications ordered to help with this. Typically this is early on in the postoperative period, usually from the anesthetic. It is important that patients avoid things that may cause vomiting. Overeating or trying foods earlier than recommended may lead to obstruction of the esophagus and result in vomiting. This may lead to slippage of the band and more serious complications.
Pain medication – Patients are typically provided with either Lortab elixir or crushed Vicodin or Percocet. Patients with pre-existing chronic pain syndromes requiring narcotics will need to continue seeing their chronic pain specialist. Narcotic prescriptions for pre-existing conditions will not be continued or refilled by the UT Center for Bariatric and Metabolic Surgery. All postoperative medications should be crushed.
Smoking – Smoking should be permanently discontinued after gastric bypass. We require all our patients to be smoke-free for six (6) months at the time of surgery. Smoking increases the risk of perioperative pulmonary morbidity and coronary events.
Vitamins – A chewable multivitamin with iron, and a chewable calcium citrate supplement should be taken daily.
Constipation – Some patients may experience occasional diarrhea related to certain foods or related to the new anatomic configuration of their gastrointestinal tract. Some patients may become constipated after discharge, and we recommend taking one to two tablespoons every six hours of milk of magnesia (as needed). If constipation persists more than 1-2 days or is accompanied by bloating, nausea, vomiting, or abdominal pain, please call us at 210-450-9900. If it is outside of our regular clinic hours (8-5, Monday-Friday), please call the emergency number provided in your patient information packet.
Follow-up appointments – your 2-week and 4-week follow-up appointments are scheduled at the at your pre-op appointment office visit. Please be sure to call us at 210-450-9900 (8 am-5 pm) if you have any questions or if we need to reschedule your appointment.