3. DO YOU PERFORM THESE OPERATIONS LAPAROSCOPICALLY?
Yes. Routinely, the Lap-Band is done laparoscopically, while the RnY is done laparoscopically only on selected patients. Done laparoscopically, the post-operative recovery is faster, with less pain and less wound problems. However, the overall complication rate for laparoscopic RnY surgery is higher than in the open version. Therefore, the criteria for the laparoscopic procedures are more strict.

4. HOW DOES THIS PROCEDURE HELP ONE LOSE WEIGHT?
Weight loss surgery (WLS) is designed to reduce the size of the stomach, thus reducing food intake. With this smaller stomach, the patient feels satisfied with much less food. In many cases, the surgery also reduces the patient’s hunger sensation, his/her appetite is less, therefore, he/she is able to lose weight and maintain that weight loss. The RnY also combines a little bit of malabsorption with the small intestine rearrangement, theoretically resulting in less nutritional absorption, which then results in a faster and larger weight loss.

5. HOW SAFE IS THE SURGERY?
All weight loss surgery has associated risks and has some nutritional problems. There are risks with all major surgeries including blood clots, lung problems, infections, bleeding, and even death. During your consult, Dr. Hall will discuss with you, at length, the risks involved, both generally and based on your individual case. However, in spite of the fact that all morbidly obese patients are at higher risk, with the proper evaluation and selection, and careful consideration, weight loss surgery is surprisingly, relatively safe.

6. WHAT ARE SOME COMPLICATIONS THAT GO ALONG WITH WLS ?
Some other complications that go along with WLS include pain with meals, vomiting, intolerance to certain foods (red meat, breads, etc.), gallstones, hair loss, hernias, excess skin, depression, divorce, failure to lose weight, and finally, regaining the weight.

7. HOW LONG IS THE AVERAGE HOSPITAL STAY?
The average hospital stay is usually 3-4 days for an open procedure, depending on the patient’s recovery. It averages about 2-3 days for the laparoscopic RnY procedure. The ALB can be done as an outpatient, but sometimes requires an overnight stay.

8. HOW LONG DOES THE SURGERY TAKE?
For an open procedure the RnY takes about 90 minutes. However, the prep time and time getting the patient to the recovery room make the entire time from the waiting area to the recovery room approximately 2-3 hours. If the gallbladder is removed at the same time, an additional 15 minutes is added to the total time. Of course, all this varies considerably from patient to patient. With a laparoscopic RnY, the time can vary from one and a half to four hours. The ALB takes less than an hour.

9. ARE THE STAPLES EVER REMOVED?
The external staples in the skin are removed two weeks after surgery. The internal staples are almost never removed. Most patients do not experience any irritation or ill effects from the staples, and thus do not ever need them to be removed. However, they can be removed if necessary, however, that is vanishingly rare.

10. HOW SOON CAN ONE RETURN TO WORK?
Within two to six weeks after the open procedure, depending on how strenuous your job is. After a laparoscopic operation, the patient will probably be able to return to work sooner.

11. WILL I HAVE A SCAR?
Yes. There will be a scar on your abdomen from the surgery. The open procedure results in a scar from the bottom of the breastbone to the belly button (8 to 12 inches). The laparoscopic operations leave multiple small scars on both sides and in the middle of your abdomen.

12. WHAT KIND OF DIET DOES THE PATIENT HAVE AFTER SURGERY?
The patient can eat a limited variety of foods. However, the food must be high in protein and, of course, consumed in much smaller quantities and lower in calories. For all operations the patient will be on clear liquids for one week, then advanced to full liquids for 2 weeks, then pureed foods for 2 weeks, then onto soft foods for another week and, finally, to solid foods at 7 weeks after surgery. On solid foods, The ALB patients are strictly limited to low calorie, low carbs and low fat. The RnY patients are a little more free to vary their diet.

13. HOW SMALL IS THE QUANTITY OF FOOD?
At first, with the RnY, one to two ounces per meal, three meals a day, with small in-between meal snacks. Later, the meals can be increased to ½ to 1 cup of solid food, as tolerated. With the ALB, meals and snacks must remain 1-2 ounces each.

14. HOW WOULD SMALL AMOUNTS OF FOOD AFFECT ONE’S HEALTH?
Surprisingly, patients tolerate the diet well with no ill effects. Our dietitian will visit the patient the day before surgery and in the hospital. The patient will be given a personalized diet plan designed for him or her. This plan will include which vitamins and supplements the patient should begin taking.

15. WHAT ARE THE NECESSARY QUALIFICATIONS FOR THIS PROCEDURE?

16. WHY WOULD A PERSON CHOOSE THE SURGERY OVER THE MORE TRADITIONAL WEIGHT LOSS METHODS?
Many morbidly obese people are in a life-threatening situation. Over many years, they have tried many diets with little or no success. Even when they do experience weight loss, the weight will be regained. WLS is a procedure designed to sustain permanent weight loss and improve other medical conditions associated with obesity.

17. HOW QUICKLY DOES A PERSON LOSE WEIGHT AFTER SURGERY?
Each individual’s rate of weight loss is different. It depends on the person’s metabolism, but usually from 10-15 pounds per month. Weight loss is greater at first, and slows down as time goes by.

18. ONCE THE DESIRED WEIGHT IS LOST HOW DOES ONE MAINTAIN THAT WEIGHT?
By slowly increasing the amount of calories ingested. Once you reach your desired goal weight, the dietitian will advise you on how to accomplish this.

19. HOW SUCCESSFUL IS THE SURGERY?
The surgery is simply a tool to help you lose weight. The success depends upon your commitment to yourself and to the overall program (diet and exercise). While most RnY patients will lose 50-70% of their excess body weight by 12-18 months, long-term studies show that RnY patients will regain 10-15% over the next 10 years. A few patients will reach their ideal weight, but most do not. The ALB patients usually do not do quite so well, with most patients losing 30-50% of their excess weight and a substantial number regaining it all back.

20. HOW LONG WILL ONE HAVE TO WATCH THEIR WEIGHT?
Your weight will be a battle for you your entire life, with or without WLS. You will need to continually watch your weight and frequently readjust your caloric intake forever.

21. CAN I STILL GET PREGNANT AFTER WLS?
Yes. Weight loss surgery does not prevent you from becoming pregnant and giving birth to a healthy baby. However, because of the tremendous changes in your body from the surgery and weight loss, we recommend that you wait two years from the day of surgery until one gets pregnant. In the meantime, we strongly recommend birth control pills or whatever means of contraception your OB-GYN advises.

22. IS DIARRHEA AND FREQUENT OR ‘STINKY’ GAS A PROBLEM?
It can be a problem with the RnY if you don’t watch what you eat. Eating fatty foods or foods high in sugar can cause this. This is not a problem with the ALB.

23. CAN I HAVE DIABETES AND STILL HAVE WLS?
Yes. Diabetes is not a reason to avoid WLS. In fact, a large weight loss will help diabetes. This is also true for hypertension and many other diseases the obese suffer from.

24. WHAT ABOUT FOLLOW-UP?
When you agree to have WLS, you need to commit yourself to life-long contact with your bariatric surgeon. For those who had the RnY, we want to see you 2 weeks after surgery, 6 weeks after surgery and then at 3 months after surgery. After that, we want to see you annually. We will want you to get lab every 3 months the first year, then annually after that. For patients with the ALB we will see you 2 weeks after surgery, then monthly until the adjustments are complete. Then we want to see you every month after that until your weight stabilizes. Then we want to see you every 3 months. We have a support group that meets each month. We also expect to hear from you at any time there are ANY problems.