Post Operative Guidelines – LAP-BAND® Surgery

Liquid Protein Diet. 2 Weeks

There are three reasons for the post-op liquid protein diet:

• It is easy to tolerate while everything heals.
• The patient is provided with a balanced diet which sustains weight loss while preventing out-right starvation.
• The liquid protein diet is a means to changing food preferences. It separates the patient in time from previous eating behaviors. Because it is monotonous, it can make a future transition to a low fat diet seem tasty in contrast. The theory is that the low fat diet will then become a preference.

Soft Transitional Diet. 7 Days:

The 2-week liquid protein diet is followed by a 7-day soft transitional diet. In going from liquids to solids, a puree diet is helpful in preventing unnecessary vomiting

The soft diet consists of: Hot cereals, non-fat cottage cheese, non-fat yogurt, baby food and nearly anything that the patient is willing to put through a blender and can swallow without chewing. .

High Protein, Low Fat, Low Sugar Diet. Life:

Following 7 days, the patient can resume eating small quantities of low fat, low sugar, high protein food. Patients should avoiding obvious high calorie type foods including:

Cheese, nuts, butter, mayonnaise, most crackers and foods cooked in oil like fries and chips.

Most patients are well aware of which foods are high in fats and therefore to be avoided but the above list is worth mentioning. If in doubt, they should look at the labels on the packages. This information is also available on our website.

Vitamin, Mineral Supplementation:

Multivitamin/mineral supplementation is desirable. Our recommendation is to take a multivitamin with iron every day.

Expectations:

We expect patients to commit themselves to a lifetime of regular scheduled exercise (minimum of 3 times a week) and dietary discipline, which includes three-five high protein, low fat meals a day and no snacking. It is especially important to avoid high calorie foods that will easily pass by the LAP-BAND® without resistance such as ice cream, candy, and high calorie liquids like soda and milk shakes. Foods such as these can lead to inadequate weight loss.

Follow-up and LAP-BAND® adjustments:

Frequent follow-up by us is necessary to inflate the band and to help reinforce good dietary and exercise behavior. We aim for weight loss of 1-2 pounds per week. When weight loss falls below this, and the patient is maintaining good dietary and exercise habits, we tighten the band. The average patients receives 4-6 adjustments the first year and fewer thereafter.

Cautionary considerations:

Medications:

We advise patients to crush tablets after surgery. Uncrushed tablets can get stuck at the LAP-BAND® stoma. Capsules can be taken whole. Because sustained release medications cannot be crushed, they are not desirable after surgery.

Vomiting:

Vomiting can occur for many reasons after surgery. Early after surgery (first 6 weeks), vomiting is often the result of eating too quickly or not chewing well enough. Changing eating habits results in relief.

Later after surgery, vomiting can be due to excessive band tightness. Over time, we inflate the band to further limit intake. If we inflate the band excessively, patients will have increasing problems tolerating solid foods. If patients are eating slowly and chewing well, and they continue to have problems like pain and vomiting after eating solid food, the remedy is to slightly loosen the band.

Vomiting can also be caused by a complication known as slippage. This occurs when the band slips out of its normal position close to the gastroesophageal junction. This uncommon complication is best diagnosed by an upper GI contrast study. Repairing the slippage requires an operation.

We counsel patients to contact us if they develop vomiting because it can signify a surgical problem.

Comorbidities:

Diabetes usually improves very rapidly after surgery. Medication dosage should be reevaluated frequently in the early postoperative period to prevent hypoglycemia.

Hypertension is also responsive to weight loss. Medication dosage should be evaluated frequently in the early postoperative period.

Sleep apnea usually improves very rapidly with the onset of weight loss.

The LAP-BAND® in most patients relieves GERD. Patients generally do not need reflux medications postoperatively. If the medications were for the purpose of treating gastritis or ulcer disease, they should be continued.

Gallstones can develop in patients who have lost large amounts of weight and should be suspected if right upper quadrant pain develops.