Bariatrics Division

Frequently Asked Questions
What is BMI and how does it pertain to weight loss surgery?

Body Mass Index (BMI) is a standardization of weight as it relates to how tall a person is. As we all know, a 300 lb person that is 5’4″ is much different than some one that is 6’0″. BMI allows us to compare different people on a standard curve.

Morbid obesity was defined by the National Institutes of Health (NIH) in 1991 as a BMI greater than 40 (over 100 lbs over ideal body weight) or BMI greater than 35 with severe medical problems such as diabetes, high blood pressure, and sleep apnea.

Based on this definition, insurances have developed guidelines that they use to cover weight loss surgery. It does vary somewhat from insurance company to insurance company but this is generally the criteria that you will need to meet.

Please use our BMI calculator to see if you meet these levels.

 

Is weight loss surgery right for me?

Choosing weight loss surgery to control your weight is a major decision. For success, both your mental and physical effort will be needed. Obesity is a major health problem in the United States. More than one in every three people in the United States today is obese. These people are at increased risk of developing medical conditions and complications, called co-morbidities.

Obesity is measured in terms of a person’s Body Mass Index (BMI), which is a calculation from a person’s height and weight. A normal BMI is between 20 and 25. People with a BMI greater than 40 are considered morbidly or clinically severely obese. This usually correlates to an actual body weight that exceeds ideal body weight by 100 pounds. Morbid obesity is a chronic, life-threatening, progressive, and genetic disease of excess fat storage. It is progressive because it does not go away and in the absence of an effective treatment, it only gets worse. It is life-threatening because of the several co-morbidities caused by obesity. Recently, it has been classified as a medical disease. It is not something trivial. It is not a matter of willpower or mind over matter.

Your BMI can be a good indicator as to whether you are a candidate for weight loss (bariatric) surgery. You may qualify for surgery if you have a BMI of 40 or greater. If the person is motivated, has failed nonsurgical means of weight loss, has already developed two co-morbidities and has a lower BMI of 35, they may also qualify for weight loss surgery.

 

What are co-morbidities of obesity?

Overall, life expectancy is reduced by 12 times for those who are morbidly obese verses their healthy counterparts. Morbidly obese people on the average die ten to fifteen years earlier than non-obese people. Multiple body systems are stressed, altered, or damaged by this added weight.

Cardiac

  • The risk of Coronary artery disease is at least two times higher among morbidly obese people.
  • High blood pressure is 16 times more common in morbidly obese people. This can lead to blood vessel damage and heart disease. Depending on the amount of weight loss after surgery, approximately 2/3 of these people are able to come off of their blood pressure medications.
  • Heart failure is more common in the obese due to the increased workload on the heart.
  • Heart disease is currently the leading cause of death in the United States.

Pulmonary

  • Obstructive sleep apnea (when you stop breathing in your sleep) is observed in 5% of morbidly obese women and 20% of morbidly obese men. Oxygen levels can drop down to 50%-70% during sleep. This can even lead to death. After weight loss surgery, 95% of these people are cured of sleep apnea.
  • Lung volumes are markedly decreased.
  • Pulmonary hypertension is more common.

Gastrointestinal

  • Gastroesophageal reflux disease is increased due to the increased pressure on the diaphragm caused by excess weight. This can lead to damage of the esophagus. It can also occur at night while sleeping. Acid, may not only back up into the esophagus, but it may also be aspirated into the lungs.
  • Fatty infiltration of the liver is more common. This can lead to inflammation, hardening and even scarring of the liver.
    Developing gallstones is six times more likely to occur in obese females.

Genitourinary/Reproductive

  • Urinary stress incontinence is more likely to occur due to increased pressure on the bladder.
  • Increased likelihood of urinary tract infections.
  • Increased likelihood of abnormal menstrual cycles and infertility problems.

Endocrine

  • Type II or adult-onset diabetes mellitus is ten times more common in morbidly obese people. Diabetes can lead to loss of vision, tissue, nerve and organ damage and/or failure. The vast majority of these people are cured of their diabetes with bariatric surgery.
  • Increased likelihood of infertility problems.
  • Can lead to abnormal menstrual cycles.
  • Hormonal imbalances can lead to abnormal hair growth in females.
  • Increased cholesterol and lipid (fat) levels. This can contribute to blood vessel damage and heart disease.

Oncological (Cancer)

  • The risk of breast cancer and ovarian cancer is three times higher in morbidly obese women.
  • The risk of colon cancer and prostate cancer is three times higher among morbidly obese men.
  • The risk of uterine cancer is five times higher among morbidly obese women.

Musculoskeletal

  • Osteoarthritis of weight bearing joints including knees, hips and low back due to
  • increased stress on joints.
  • Chronic lower back pain
  • Disc herniation

Psychosocial
There is no doubt that obese individuals have lifestyle restrictions. Mobility and physical incapacity due to back/joint problems and shortness of breath are very common among the morbidly obese individuals. This can have a substantial impact on both social and work life. Impairment of body image is a major form of psychological distress for a person who is obese, thus leading to poor self-esteem. They face the social stigma and judgment of being overweight on a daily basis. Repeated failure of diet and exercise often lead to feelings of despair, helplessness and depression.

 

How does surgery help with weight loss?

Anatomy and Physiology
In order to understand how bariatric surgery results in weight loss, it is necessary to understand how food is digested.

  1. After swallowing, food enters the stomach, which acts to hold the food, allowing only small amounts to pass further into the digestive tract. The volume of a normal stomach is usually 600-1000 cc. (20-30 oz.)
  2. In the first part of the small intestine (duodenum), food encounters bile that is secreted by the liver and gallbladder, as well as enzymes from the pancreas. These chemicals help with digestion, as well as, absorption as the food is broken down. The small intestine is where most of the absorption of food occurs and may reach a length of over 20 feet.

Most bariatric procedures work one or both of the following methods:

  1. Restrictive component – portion of the stomach may be restricted, removed or bypassed so as to reduce the volume of the stomach. Thus, only a limited amount of food can be eaten prior to getting the sensation of being full.
  2. Malabsorptive component – Bile and pancreatic secretions needed for digestion of food are directed away from the food. These secretions reach the food several yards down the length of the small intestine, thus delaying digestion and resulting in incomplete absorption of the food.

Most patients lose anywhere from 40% to 70% of their excess weight after weight loss surgery. Most weight loss happens over a period of one to two years. Optimum weight loss requires dieting and exercise after surgery. Motivated patients lose more weight because they follow dieting and exercise advice strictly. Bariatric surgery will NOT make you lose weight. It can only help your diet and exercise efforts be more successful so you do lose weight. The surgery limits the amount of food you can eat at any one time, but it is not an easy way out. If you overeat, you can stretch out your small “pouch” or stomach and you will fail to lose weight. You can become sick and may even regain weight if you do not follow your diet and exercise regimen. Remember this is only a tool to help you lose weight, you still need to do the work that is required – diet and exercise!!

 

What are the different types of weight loss surgeries?

Several weight loss surgeries have been developed over the last few years. We offer two different procedures, Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding. These procedures are carried out under general anesthesia and can be done through a midline abdominal incision or laparoscopically. Removal of the gallbladder may be included as part of the procedure due to the high incidence of gallstone disease seen with morbid obesity and also seen after significant weight loss.

Gastric Bypass
Gastric Bypass is the most commonly performed weight loss surgery done in the United States to date. Other names for this procedure include Roux-en-Y gastric bypass or Roux-en-Y gastrojejunal bypass. This is one of the two operations approved by the National Institute of Health (NIH) consensus conference in 1991 for the treatment of morbid obesity. According to the American Society for Bariatric Surgery, Roux-en-Y gastric bypass is the current “gold standard” procedure for weight loss surgery. This surgery can be done laparoscopically or open. This procedure combines both the restrictive and malabsorptive components as previously described.

The stomach is divided into a small upper part and a large lower part. The small upper part of the stomach now acts as the new stomach. This part of the stomach is called the stomach pouch or gastric pouch. The usual size of the gastric pouch after surgery is one to two ounces or the size of a small fist after surgery. The size of an average stomach is equal to the size of a person’s head or six cups.

About 1/3 of the small intestine is bypassed and a 2 1/2 foot length of intestine is connected from the small stomach pouch to the rest of the intestines. The lower part of the stomach and first part of the small intestine will no longer be used. Roughly 2/3 of the small intestine is still used for digestion and absorption of food after food passes from the small stomach pouch into the small intestine.

Since the stomach holds less food, the person feels full after a very small meal. The connection between the gastric pouch and the small intestine is very small, so food tends to stay in the gastric pouch for a longer duration. This makes the feeling of “fullness” last longer. Since a large portion of the small intestine is bypassed, all of the calories in the food are not absorbed. This method helps weight loss but still requires dieting. One year after surgery, weight loss can average up to 70% or more of your excess body weight. Studies show that after 10-14 years, 50%-60% of excess body weight loss has
been maintained by some patients.

Risks of Gastric Bypass Surgery
Listed below are potential complications that you need to consider before choosing bypass surgery:

  • Failure to lose weight
  • Psychiatric or emotional problems, such as depression
  • Wound infection
  • Hernia at incision site (risk is much lower with laparoscopic procedure)
  • Vitamin and electrolyte imbalance
  • Stomach ulcer
  • Leaks or tears causing internal infection, requiring another surgery
  • Blockage between the stomach pouch and small intestine, which may require another procedure or surgery
  • Pulmonary (lung) complications
  • Wound dehiscence
  • Death, based on national average, is 0.5-1%

Laparoscopic Adjustable Gastric Banding
The Food & Drug Administration (FDA) approved the Lap Band in the United States in 2001. This was after extensive review of the operation and it’s potential complications. This surgery also works by creating a small stomach pouch in the upper part of the stomach. However, staples are not used and there is no re-routing of the intestines. Instead, a band is placed around the upper part of the stomach creating a small pouch. Recent developments in gastric banding include the addition of a balloon within the band. The balloon diameter can be adjusted with the injection of saline into the balloon through a port that is located just under the skin in abdomen. The adjustments are to “tighten up” the band so food stays in the pouch longer or to “loosen up” the band if there are complications. The band adjustments can be done to meet the individual needs of each patient. If necessary the band is also removable.

This surgery is the least invasive surgical option. It is performed laparoscopically through several small incisions on the abdomen. Because of this and the fact that the stomach and bowel are not cut into, patients should have less pain, a shorter hospital stay and a quicker recovery.

Risks of Laparoscopic Adjustable Gastric Banding
Listed below are the potential complications that you need to consider before choosing Lap Band surgery:

  • Band slipping out of position
  • Band erosion through the stomach wall
  • Balloon deflation
  • Obstruction of the stomach
  • Dilatation of the esophagus
  • Acid reflux, nausea and vomiting
  • Pulmonary complications
  • Wound infection
  • Psychiatric or emotional problems, such as depression

 

What is involved in the evaluation process?

We have a team of specialists that will be working with you through this process. They include:

  • Bariatric surgeon and nurse
  • Dietician
  • Pulmonologist
  • Neuropsychologist

Each will do an evaluation with you to help determine if you an appropriate candidate for weight loss surgery. They will help to ensure that you are both medically and mentally prepared for weight loss surgery. They will also be available for follow-up care after surgery if you should need them. In addition to those listed above, you may need to see other specialists for pre-operative evaluations based on your medical history. You will need to meet all evaluation requirements and recommendations prior to scheduling surgery.

The dietician will work with you to learn the new diet that you must follow after surgery. They will advise you as to the changes that you will have to make, helping you get the most nutrition out of the foods you eat. They will help you identify which foods are good sources of the necessary vitamins and protein you will require after surgery. They will talk to you about vitamin and protein supplements that you will need to take. They will also help you identify the foods you will have to eliminate from your diet.

The pulmonologist is a doctor who specializes in the lungs. This doctor will evaluate your lung status and function. They will also determine if your lungs are healthy enough for surgery. They may also test to see if you have sleep apnea. If sleep apnea is identified they may prescribe a breathing machine called CPAP for you or they may prescribe inhalers for you. This is important information for both your surgeon and the anesthesiologist to know.

The neuropsychologist will meet with you to evaluate for any emotional issues, such as depression. They will help to identify sources of stress in your life, as well as, your coping mechanisms. If food is one of these they will suggest an alternative way of coping. Major weight loss will result in big changes in your life, often causing emotional and social stress. Even good changes are stressful. Changing any habit, even eating habits, can be difficult. These will be lifelong changes for you. It will be important for you to recognize your support system through these changes, as well as, any barriers you may face. It is also important to evaluate your hopes and expectations to be sure that they match the possibilities and limitations of this surgery. It is unrealistic to expect that weight loss will turn you into a totally new person. It is, however, realistic to expect better health and to be more active.

Stop Smoking
STOP SMOKING!! You cannot have this surgery until you have been off all nicotine and tobacco products (including the nicotine patch and gum) for one month. Smoking is probably more dangerous to your health than obesity. Smoking paralyzes the lining of your air passages. It damages and hinders the work of your lungs and heart. It would also greatly increase your chance of having complications after surgery. We reserve the right to do a blood test for nicotine at any time during the evaluation process and before proceeding with surgery.

So, if you are smoking at the point where you are reading this information and waiting to come in for your initial consultation with your surgeon it would be in your best interest to start the quitting process now. Talk to your family physician for ideas if you need to. It is better to start quitting long before your surgery is scheduled than to run the risk of your surgery being canceled.

Financial Considerations for Weight Loss Surgery
Please understand the pre-operative evaluations, testing, surgery, hospitalization and post-operative cares are all costly. There is a lot of medical data supporting the need for surgical treatment of morbid obesity. However, many insurance companies and health plans still do not pay for bariatric surgery. Please check with your insurance company to see if you have benefits for this surgery on your policy. And please find out what requirements they may have, i.e.: 12 months documented physician supervised weight loss program, BMI > 40, etc. Due to the expenses that you may incur, we want you to know if your insurance has coverage for weight loss surgery prior to beginning the evaluation process. The surgery cannot be performed without an approval from your insurance company or a self-pay agreement if you plan to pay for surgery on your own.

A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for those patients that meet the National Institutes of Health’s surgical criteria. And while insurance coverage for this surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for approval comes from working together with your surgeon and bariatric team.

Before visiting your surgeon, it is most helpful to organize your medical records, including your diet history and prior weight loss attempts. Many insurance companies demand proof that nonsurgical methods of weight loss have been tried and failed before approving your request for surgery. Studies have shown that 98% of morbidly obese people are unable to lose a significant amount of weight and keep it off through nonsurgical means. On the average, morbidly obese people lose 10% of their weight over a period of one to two years, and over five years all of that weight plus more is gained back. Most of those who are morbidly obese have tried very hard to lose weight before considering weight loss surgery, but insurance companies want documentation of your weight loss attempts. Therefore, try to collect as much documentation as possible for us to submit to your insurance company.

Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up phone call with them if you have not heard from them in that time frame.

Finally, if your insurance company will still not pay for your surgery and you have made up your mind to go ahead with surgery, you do have the option of paying out-of-pocket. Although many patients are choosing this option, and most of them have been happy with their choice, remember pre-operative estimates of costs for surgery can be offset if you suffer any complications. Our office manager will work with you if you plan to pay for surgery on your own.

Please note that most insurance policies will not cover the expense of the dietary evaluation. Medicaid does not cover this. However, counseling is very important to the success of the surgery and is a necessary part of the evaluation process.

 

What decision is best for me?

This packet is meant to provide you with general information about weight loss surgery and the evaluation process. It is not meant to stand in place of or replace any information provided to you by your doctor. Always talk to your surgeon about information that is specific to you. Because this is a big decision about major surgery, you’ll want to gather as much information as you can. Please ask us questions. Talk with your family and others who have had the surgery. Be sure to talk to your family physician who knows you and your medical history.

The decision to have weight loss surgery should not be taken lightly. It is not any easy option, not is it a “quick fix”. Be sure that you realize and are willing to accept the potential complications associated with this surgery. It requires a great amount of dedication and motivation, along with support from family and friends. However, weight loss surgery can help you to finally achieve successful weight loss. Feeling healthy, successful and good about yourself will be well worth it.

 

What are the Medicare Guidelines?

As you are aware Medicare will only reimburse for Bariatric surgery performed in a facility certified as a Center of Excellence. We are pleased to announce that we received our recognition from the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence in July 2008. There were many criteria our program had to meet in order to make it through the certification process and eventually receive our recognition.

There is also a process that you, as patients, must go through in order meet the criteria to qualify for weight loss surgery. The Centers for Medicare and Medicaid Services (CMS) have specified a few criteria which patients must meet prior to surgical approval and reimbursement. Surgical Associates P.C. and the Bariatric program also have criteria that must be met prior to scheduling surgery. These criteria are outlined as follows:

  1. Body Mass Index (BMI) > 35 with one co-morbidity related to obesity (i.e.: sleep apnea, hypertension, diabetes, etc) (CMS)
  2. Have been previously unsuccessful with medical treatment for obesity. This must be documented in the patient’s medical record. (CMS)
    1. At least 3 months of a structured diet must be recorded within at least 12 months of your consultation date. (i.e.: Weight Watchers-going to meetings, Jenny Craig, The Diet Center, etc.) Surgical Associates P.C. must have documentation for your file.
    2. If one of these programs is not available you may see your physician for a supervised program. A form is available for you to give to your physician so he/she may provide the required documentation and return to Surgical Associates P.C. (Please print copies of the form as needed.)
      *** Note*** You must follow up with your physician for 3 consecutive months.
  3. Dietary Evaluation
  4. Psychological Evaluation
  5. Pulmonary Evaluation
  6. Other Specialty Evaluation as ordered (i.e.: Cardiology)

We realize that you may have been dieting for the majority of your life to no avail, however, in order to keep our Center of Excellence we must have documentation that a structured diet has been followed prior to scheduling surgery. This is not only to protect us but also to protect you. If this documentation is not available Medicare will not reimburse and you will end up paying for surgery out of your own pocket.

If your consultation is still several weeks, a month or even several months out please do not hesitate to sign up and begin participating in a structured weight loss program or meet with your physician. This will speed up the process for you and will get your surgery scheduled that much sooner. Unfortunately, the dietary, psych and pulmonary evaluations cannot be started until after your initial consultation.

***NOTE: If you have any other Medicare plan other than Medicare Parts A & B, such as Humana Gold or Unicare you must call the number on your card to find out what their specific requirements are regarding weight loss surgery. THEY HAVE DIFFERENT REQUIREMENTS.

 

What if I have no insurance coverage for weight loss surgery?

Please view our Self-Pay Patients page for this information.

What is the LAP-BAND® System?

The LAP-BAND® Adjustable Gastric Banding System is the first U.S. FDA-approved adjustable gastric band for use in weight reduction. To date, this simple reversible surgically implanted device has been used in more than 300,000 procedures worldwide.

The LAP-BAND® System was approved by the FDA in June 2001 for severely obese adults with a Body Mass Index (BMI) of 40 or more or for people with a BMI of at least 35 plus at least one severe obesity-related health condition such as Type 2 diabetes, hypertension and asthma.

 

Which patients are eligible to receive the LAP-BAND® System?

The LAP-BAND® System is approved for patients (18 years and above) with a BMI of 40 or more or for people with a BMI of at least 35 plus at least one severe obesity-related health condition such as Type 2 diabetes, hypertension and asthma.

 

What are the benefits of the LAP-BAND® System?

The LAP-BAND® System is considered safer and less invasive than gastric bypass, as there is no stomach cutting, stapling or intestinal re-routing. , It is adjustable and reversible and has a lower severe complication rate perioperatively and a lower mean short-term mortality rate compared with gastric bypass. In fact, the LAP-BAND® System has a mortality rate of 0.05 percent, approximately 1/10 the mortality rate of gastric bypass.

 

How is the LAP-BAND® System procedure performed?

The LAP-BAND® System’s inflatable band is usually placed around the top portion of the stomach laparoscopically, using “keyhole” surgery, which offers the advantages of reduced pain, length of hospital stay and recovery period.i,ii
The LAP-BAND® System procedure is considered safer and less invasive than gastric bypass, as there is no stomach cutting, stapling or intestinal re-routing.i,ii

 

Is the LAP-BAND® System safe?

To date, the LAP-BAND® System has been successfully used in more than 300,000 procedures worldwide. This simple, reversible medical device has been available in Europe since 1993 and was approved by the FDA in June 2001. It is considered safer and less invasive than gastric bypass, as there is no stomach cutting, stapling or intestinal re-routing.
The LAP-BAND® System’s inflatable band is usually placed around the top portion of the stomach laparoscopically, using “keyhole” surgery, which offers the advantages of reduced pain, length of hospital stay and recovery period.i,ii
Additionally, the LAP-BAND® System has a lower severe complication rate perioperatively (less than 1%), lower mean short-term mortality rate (0.05 percent, approximately 1/10 the mortality rate of gastric bypass)iii and carries fewer risks of vitamin and mineral deficiencies than gastric bypass.

 

How much weight can a person expect to lose after having the LAP-BAND® System?

Weight should be lost gradually. A weight loss of two to three pounds a week in the first year after the operation is possible, but one pound a week is more likely. Individual results may vary.

 

Is there a risk of death when using the LAP-BAND® System?

As with other major surgeries, death is considered a potential risk. However, the LAP-BAND® System has a lower mean short-term mortality rate compared with gastric bypass (0.05 percent, approximately 1/10 the mortality rate of gastric bypass).iii

 

Could a patient fail to lose weight after having the LAP-BAND® System procedure?

Results can vary because of a number of factors. Even though the LAP-BAND® System can limit the amount of food consumed, lifestyle changes are critical to weight loss success.

Additionally, the LAP-BAND® System can be adjusted, tightened or loosened, to enable an individual to achieve a level of satiety while maintaining a healthy diet.

 

Do patients experience a heightened sensitivity to alcohol following LAP-BAND® System surgery?

No, unlike gastric bypass surgery, there is no stomach cutting, stapling or intestinal re-routing involved with the LAP-BAND® System, therefore absorption of alcohol is not affected.

Following their surgery, we counsel our patients regarding appropriate lifestyle and diet choices, including the consumption of alcohol.

 

How many patients remove the band after having it placed?

While the LAP-BAND® System is a reversible weight-loss surgery option and it can be removed at any time.

Prior to the procedure, our practice closely evaluates patients to ensure they are appropriate candidates for the LAP-BAND® System. This includes an evaluation of the causes – both physical and emotional – that contribute to the patient’s excessive weight gain. And following the procedure, patients work closely with our surgeons and weight management team to develop a healthy eating plan, learn how to incorporate physical activity into their daily routines, have routine check-ups and ongoing band adjustments if necessary, and regularly attend support group meetings.

 

Do patients require plastic surgery due to weight loss following the LAP-BAND® System procedure?

Significant weight loss may sometimes require follow-up plastic surgery to remove excess skin folds. As a rule, plastic surgery should not be considered for at least a year or two after the operation since sometimes the skin will mold itself around the new body tissue. We counsel our LAP-BAND® System patients to give the skin the time it needs to adjust and to discuss their appearance concerns with us.

 

What are the indications and contraindications for Lap-Band surgery?

Indications
The LAP-BAND® System may be right for you if:

  • You are an adult (at least 18 years old).
  • Your BMI is 40 or greater, or you weigh at least twice your ideal weight, or you weigh at least 100 pounds (45 kilos) more than your ideal weight. Check your BMI
  • You have been overweight for more than 5 years.
  • Your serious attempts to lose weight have had only short-term success.
  • You do not have any other disease that may have caused you to be overweight.
  • You are prepared to make major changes in your eating habits and lifestyle.
  • You are willing to continue working with the specialist who is treating you.
  • You do not drink alcohol in excess.
  • Your surgeon may consider whether the LAP-BAND® is right for you if your BMI is between 35 and 40 and you have a health problem that is related to obesity. Your surgeon may also have other criteria he or she uses. Ask him or her to discuss those criteria with you.

Contraindications
The LAP-BAND® System is not right for you if:

  • You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, or Crohns disease.
  • You have severe heart or lung disease that makes you a poor candidate for any surgery.
  • You have some other disease that makes you a poor candidate for any surgery.
  • You have a problem that could cause bleeding in the esophagus or stomach. That might include esophageal or gastric varices (a dilated vein). It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel).
  • You have portal hypertension.
  • Your esophagus, stomach, or intestine is not normal (congenital or acquired). For instance, you might have a narrowed opening.
  • You have/experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
  • You have cirrhosis.
  • You have chronic pancreatitis.
  • You are pregnant. (If you become pregnant after the LAP-BAND® System has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.)
  • You are addicted to alcohol or drugs.
  • You are under 18 years of age.
  • You have an infection anywhere in your body or one that could contaminate the surgical area.
  • You are on chronic, long-term steroid treatment.
  • You cannot or do not want to follow the dietary rules that come with this procedure.
  • You might be allergic to materials in the device.
  • You cannot tolerate pain from an implanted device.
  • You or someone in your family has an autoimmune connective tissue disease. That might be a disease such as systemic lupus erythematosus or scleroderma. The same is true if you have symptoms of one of these diseases.
  • Some surgeons say patients with a “sweet tooth” will not do well with the LAP-BAND® System. If you eat a lot of sweet foods, your surgeon may decide not to do the procedure. The same is true if you often drink milkshakes or other high-calorie liquids.