I've read all of this before, but I thought that I would share it with all of you, since you may not know as much as I have learned abou the lap band. I have my orientation for the surgery o n June 13th in San Francisco. Once that is done they will do a number of medical tests to be sure that I have a good blood counts and such and that all my organs work like they should. Then, if all goes well, we will schedule a date for the surgery. I have never had diabetes or high cholesterol, so I don't have those against me, and I'm pretty sure all my organs work well. Withour further ado (retrieved from http://www.bariatricedge.com/dtcf/pages/3_Procedures.htm):

Defining Bariatric Surgery
Bariatric surgery is a treatment option for people living with morbid obesity—especially for those who have not experienced long-term weight loss success through other means. Often referred to as weight loss surgery, bariatric surgery has transformed the health and lives of more than 800,000 people in the past six years.26

How Does Bariatric Surgery Work?
Bariatric surgery is the clinical term for several different procedures. The procedures use one or both of two approaches to help patients lose weight and improve or resolve co-morbid conditions .

Restrictive Procedures
During these procedures, the surgeon creates a small stomach pouch, which limits the amount of food patients can eat. The smaller stomach pouch fills quickly, which helps patients feel satisfied with less food.
Examples of restrictive bariatric procedures:
- Gastric banding

- Sleeve gastrectomy


GASTRIC BANDING
Gastric banding is a restrictive surgical procedure. During this procedure, two medical devices are implanted in the patient: a silicone band and an injection port. The silicone band is placed around the upper part of the stomach and molds the stomach into two connected chambers. The injection port is attached to the abdominal wall, underneath the skin. The port is connected to the band with soft, thin tubing.
The band is adjustable. Adjustments are made by your healthcare professional using a needle to inject saline solution into your band through the port. Adding saline increases the amount of restriction provided by the band, helping patients feel fuller sooner and with less food.
Life After Gastric Banding
Excess Weight Loss
Gastric banding patients typically lost 47% of their excess weight.4

Health Benefits
Studies found that gastric banding:
- Resolved type 2 diabetes in 47.8 percent of patients4

- Resolved high blood pressure in 38.4% of patients4

- Improved high cholesterol in 78.3% of patients4

For more information about the effect of gastric banding on weight-related co-morbid conditions, visit Health Benefits.

Quality of Life
One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:1
- Overall quality of life improved greatly
- They experienced improved physical functioning and appearance
- They experienced improved social and economic opportunities

Recovery
Your healthcare team will advise you when to return to work and when you are able to resume normal activities.
Potential Concerns of Gastric Banding
- Gastric banding can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by your surgeon to achieve success.
- Gastric banding requires more intensive follow-up care than most other bariatric surgeries.This is mostly because the band is adjustable. Keep in mind that even after reaching and maintaining your success weight, you may still need to see your healthcare professional for further adjustments.

Malabsorptive Procedures
During these procedures, the surgeon reroutes the small intestine so that food skips a portion of it. The small intestine absorbs calories and nutrients from food, and avoiding part of it means that some calories and nutrients are not absorbed.
Surgeons rarely perform strictly malabsorptive procedures. Most procedures that use malabsorption also use restriction.
Combination Procedures
Certain procedures such as Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption. During this procedure, the surgeon creates a small pouch. The surgeon then attaches a Y-shaped section of the small intestine directly to the stomach pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. The smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.
Examples of combination bariatric procedures:
- Gastric bypass

- Biliopancreatic diversion with duodenal switch

These different methods work to help patients lose excess weight, lower their BMI , and transform their health by resolving or improving co-morbid conditions . Bariatric surgery has many benefits that can lead to a healthier, higher quality of life. It also has certain risks.

It’s obvious to many people who have lived with morbid obesity for years that the disease has a severe negative impact on quality of life. Because of morbid obesity, you may choose not to participate in certain activities. You may feel that you have limited career choices.
What you may not know is that morbid obesity has been found to affect the quality of your health and the length of your life. 4
Morbid obesity has been linked to several serious and life-threatening diseases. These co-morbid conditions include type 2 diabetes , heart disease and high blood pressure, acid reflux/GERD, and cancer. Most of these conditions do not develop for years. So many people living with morbid obesity may have one or more of these health issues without even realizing it.
Bariatric surgery may offer you a whole new outlook on health…
- One study found that gastric bypass surgery reduced the total number of co-morbid conditions of participating patients by 96%. 5

- Many surgeons recommended bariatric surgery as a treatment option for type 2 diabetes.12 In some cases, resolution of type 2 diabetes occurred within days of the surgery. 4

- A meta-analysis stated that several studies found that bariatric surgery patients felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery. 4

BARIATRIC SURGERY RISKS
Bariatric Surgery Indications
Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index (BMI) of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, and medications.In some cases, a person with a BMI of 35 or greater and one or more co-morbid condition may be considered for bariatric surgery.

Important Considerations
Bariatric surgery should not be considered until you and your doctor have explored all other options. The best approach to bariatric surgery calls for a discussion of the following:
- Bariatric surgery is not cosmetic surgery.
- Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.

- Together, you and your doctor should discuss the benefits and risks.
- You must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
- Complications after surgery may require further operations.
- Patients who underwent bariatric surgery have significantly reduced rates of developing cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, psychiatric disorders, and pulmonary disorders. 6


Risks Associated with Abdominal Surgery
- Bleeding
- Pain
- Shoulder pain
- Pneumonia
- Complications due to anesthesia and medications
- Deep vein thrombosis
- Injury to stomach, esophagus, or surrounding organs
- Infection
- Pulmonary embolism
- Stroke or Heart Attack
- Death
Note: Risks are associated with any type of surgery, including abdominal surgery. These risks are greater for individuals who suffer from obesity.
Risks Associated with Bariatric Surgery
- Abdominal hernia
- Chest pain
- Collapsed lung
- Constipation or diarrhea
- Dehydration
- Enlarged heart
- Gallstones, pain from passing a gallstone, inflammation of the gallbladder, or surgery to remove the gallbladder
- Gastrointestinal inflammation or swelling
- Stoma obstruction
- Stretching of the stomach
- Surgical procedure repeated
- Vomiting and nausea
Note: Your weight, age and medical history play a significant role in determining your specific risks. Your surgeon can inform you about your specific risks for bariatric surgery.
Risks Associated with Gastric Banding- Migration of implant (band erosion, band slippage, port displacement)
- Tubing-related complications (port disconnection, tubing kinking)
- Band leak
- Esophageal spasm
- Gastroesophageal reflux disease (GERD)
- Inflammation of the esophagus or stomach
- Port-site infection
Note: Complications may result in reoperations. Refer to the Realize™ Band Patient Guide for a full description of risks and side effects. To order a patient guide click here.

Risks Associated with Gastric Bypass- Dehiscence (separation of tissue that was stitched or stapled together)
- Leaks from staple lines
- Ulcers
- Dumping syndrome, an unpleasant side effect that may include vomiting, nausea, weakness, sweating, faintness, and diarrhea
- Required supplementation of diet with a daily multivitamin, calcium, and sometimes vitamin B12 and/or iron
- Inability to detect the stomach, duodenum, and parts of the small intestine using X-ray or endoscopy, should problems arise after surgery such as ulcers, bleeding, or malignancy
- Increased gas

Compare Mortality Rates
Procedure Mortality Rate Occurs In…
Gastric banding 0.1% 1 out of every 1,000 people
Gastric bypass 0.5% 1 out of every 200 people
Hip fracture repair 3.3 to 8.2%10, 11
6 out of every 200 people10, 11

According to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement, the operative morbidity (complications) associated with Roux-en-Y gastric bypass in the hands of a skilled surgeon is roughly 5%, and the operative mortality (death) is roughly 0.5%. 9
For gastric banding, the same consensus statement reported that, in the hands of a skilled surgeon, the operative morbidity is approximately 5% and operative mortality is approximately 0.1%. 9

Why Would I Have an Open Procedure?
In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used.
Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:
- Prior abdominal surgery that has caused dense scar tissue
- Inability to see organs
- Bleeding problems during the operation

Based on patient safety, the decision to perform the open procedure is a judgment made by your surgeon either before or during the actual operation.
DAY OF BARIATRIC SURGERY
For many bariatric surgery patients, the day of surgery is a major milestone. Postsurgical patients often referred to this day as their “birthday” because it signifies a life-changing transformation.
Preparing for the Day of Surgery
It’s critical that you follow your surgeon’s specific instructions the day of surgery.
These instructions generally include:
- Do not drink or eat anything prior to surgery—most often this fasting period begins the night before surgery.
- Most medicines can be taken the day of surgery, just with small sips of water. Your doctor will have instructions regarding specific medications.
- Bring all of your medications with you.
- If you have a CPAP (Continuous Positive Airway Pressure) machine, bring it with you for use in the hospital.
- Arrive early; some hospitals and surgery centers require patients to arrive two hours early.
What to Expect the Day of Surgery
- When you arrive, you will undergo several preoperative steps.
- You will speak with your nurses, and often, your surgeon and anesthesiologist.
- An IV line will be started to keep you hydrated and to administer medications such as antibiotics.
- The preoperative experience is often a short one, after which you will be taken to the operating room.
- Your anesthesiologist or anesthetician will provide you with anesthesia medications to put you under.
- Bariatric procedures, whether they are minimally invasive or open, generally take 75 to 90 minutes.

- After surgery, your healthcare team will continue monitoring you and arrange for you to be taken to recovery.

RECOVERING FROM BARIATRIC SURGERYRecovery takes time and patience. The diet is strict; you may experience discomfort and pain as your body heals, and the length of time to return to normal activities can vary from patient to patient. Some patients are able to return to work within a few weeks and see weight loss fairly soon after surgery. For others, a couple of months go by before they experience noticeable weight loss.
One study found that ,on average, gastric bypass patients:
- Started an oral diet in 1.58 days2

- Left the hospital on the second day2

- Returned to work at 21 days2

Many bariatric patients who experienced transformations of their health were able to do so because they began exercising and eating healthfully prior to surgery. Losing a few pounds before surgery can help to reduce the possibility of surgical complications.
Call Your Bariatric Surgeon
If you experience any of the following:
- Pain and/or swelling in your feet, calves, or legs
- Abdominal pain
- Bleeding
- Blood in stool
- Pain, burning, urgency, frequency of urination, or blood in urine
- Signs of infection such as fever or chills
- Vomiting or severe nausea
- Redness, swelling, pain, bleeding, or discharge at the incision sites
- Coughing, shortness of breath, or chest pain

POST-OP BARIATRIC SURGERY RECOVERY DIET
Your bariatric program will provide you with specific information about what to eat after surgery, but here are some generally accepted guidelines to give you an idea of what to expect.
One to Two Days Post-op
At this time, your bariatric surgeon will be monitoring your progress by seeing how well you tolerate low-sugar, non-carbonated liquids such as water, tea, broth, or Gatorade®.3 Sugar-free gelatin is another option.
Use a cup to drink. Avoid sipping from a bottle or straw—you could swallow too much air and get gas.
A Note on Sugar-Free Foods
Artificial sweeteners such as Splenda®, Equal®, and Sweet’N Low® are calorie-free alternatives to sugar.3 Most bariatric surgery patients are able to tolerate artificial sweeteners in moderation. It’s important to keep in mind that these artificial sweeteners are used in many no- and low-calorie foods. An excessive amount of artificial sweeteners can lead to dumping syndrome in gastric bypass patients.
Three Days to One Month Post-op
If you tolerate liquids well, your surgeon will likely recommend that you move on to a pureed diet and begin eating three meals per day. However, if you are not hungry, you do not have to eat.
Remember, your stomach will be very small, and so will your portions. You should only eat a few tablespoons at a time.
Many patients are able to consume about 16 to 24 ounces, roughly two to three glasses, of protein shake each day.
Hydrating Is Critical
You must remain hydrated. Hydration is critical, but can be difficult because your stomach will be roughly the size of an egg. Here are a few tips:
- Drink 48 to 64 ounces of water each day.
- Sip calorie-free liquids frequently—when not eating.
Keep the following in mind:
- Do not drink while eating.
- Wait at least one hour after eating to begin drinking again.

Protein and Nutrients
Bariatric programs generally recommend including quite a bit of protein in your diet, because your body will need it while you are healing. The recommended daily requirement for adults is 60 to 65 grams of protein.
Healthy protein sources include:
- Lean meats
- Beans
- Eggs, especially the whites
- Dairy products
Getting enough nutrients is often a challenge for bariatric surgery patients. You have the same nutritional requirements as people who have not had bariatric surgery, but a far smaller stomach and, for gastric bypass patients, a limited ability to absorb nutrients and calories.
Bariatric programs generally recommend taking chewable multivitamins and chewable calcium supplements every day.
Tips- Eat slowly. Plan on spending about 30 minutes eating a meal.
- Chew thoroughly so that your food is the consistency of peanut butter.
- Cut up meat to the size of a pencil eraser when eating.
- Stop eating before you feel full.

Examples of Pureed Foods
- Protein shakes or supplements
- Plain chicken broth: no noodles or bits of chicken
- Lean meats or poultry pureed in a blender
- Scrambled or soft-boiled eggs
- Low-fat or skim milk
- Low-fat yogurt
- Low-fat frozen yogurt
- Beans: split pea soup or fat-free refried beans
- Unsweetened applesauce
- Mashed ripe bananas
- Diet frozen juice bars

One Month to Lifetime Post-op Diet
If you tolerate the pureed diet well, your surgeon will likely recommend that you begin to incorporate solid foods.
You should slowly incorporate small amounts of new foods—a few tablespoons rather than a half-cup. Everyone encounters problems with some foods; it’s perfectly normal. If you do have a poor reaction to a certain food, you always can try it again in a week or so.
Hydration Is Still Important
Hydration will continue to be important. Hydrate with more than 64 ounces of water, calorie-free or very-low-calorie drinks, and diet frozen juice bars. Beverages such as fruit juices contain calories, which will slow down your weight loss or cause you to lose less weight than you could.
Proteins and Nutrients
You still need 60 to 65 grams of protein each day. This translates to about 4 ounces of lean meat, three times each day.
At this point, you can switch from chewable multivitamins to those in pill form.
When it comes to calcium, calcium citrate is the best-absorbed calcium. Some calcium supplements contain vitamin D and magnesium to aid in absorption.
Your surgeon may prescribe iron supplements as well.
Tips
- Incorporate new foods in small amounts.
- Avoid foods and beverages high in fat and/or sugar.
- Chew your food thoroughly.
- Eat slowly.
- If your stomach feels irritated, let it recover by consuming liquids in place of the next meal or two.

Examples of Healthy Lifetime Foods
- Lean ground beef, chicken, turkey, or pork
- Fish
- Tofu
- Cottage cheese
- Cheese
- Soft pasta
- Cooked or canned fruits and vegetables (avoid starchy vegetables such as corn)
- Whole-grain cereals and breads
- Protein shakes or supplements

POST-OP PHYSICAL ACTIVITY
Several bariatric surgery patients featured on BariatricEdge.com, such as Carlos and CJ, point to exercise as an important key to their success. Years after surgery, they continue to rely on exercise to help them stay within their selected healthy weight range and stay energized.
Regular exercise, next to following your bariatric program’s dietary guidelines, is an important factor when it comes to optimizing your health outcomes and quality of life after bariatric surgery. Check out the following for what to expect and helpful tips.
One to Two Days Post-op
Your surgical team will likely have you up and walking or doing other leg exercises as soon after surgery as possible. Walking and leg exercises after surgery help patients avoid deep vein thrombosis, a blood clot that can form in veins.
First Few Weeks Post-op
Bariatric programs generally recommend that patients phase in exercise as soon after surgery as possible. You will need to discuss specific details with your surgeon, but most patients are able to walk for at least a few minutes each day. It’s a low-impact activity and a great introduction to exercising.
Patients with a very high Body Mass Index (BMI) (70 or higher) frequently cannot walk for more than a minute or two at a time. However, the average bariatric surgery patient has a much lower BMI and is able to tolerate walking for a bit longer. Regardless of your BMI, be patient and work as hard as you can.
Tips for the First Few Weeks
- Consult your bariatric program about your exercise plans.
- If you’re unsure how to start exercising, begin by walking for five minutes, five times each week.
- Gradually increase the amount of time you spend exercising by adding a few minutes each week.
- Do not accept fatigue as an excuse to not be physically active.*
* If you experience significant fatigue, you may want to discuss it with your surgeon.
FAMILY, FRIENDS, AND FOOD
Celebrations, spending time with the family watching a favorite show, cookouts on warm evenings… eating and events are social activities that have long been tied together, and you shouldn’t have to give them up. But, after bariatric surgery and with new healthy habits, you won’t want to eat as much as you used to and, most likely, you won’t be able to.
These situations can present challenges. Sometimes even the most well-meaning family and friends may try to push food on you.
Here are some coping strategies for dealing with family and friends who don’t “get it,” and for eating in restaurants and at special occasions.
Pressure from Family and Friends
Some of your family or friends may have difficulty supporting you. They may be unaware that certain comments they make or things they do are unsupportive.
Maybe you are frustrated because a family member continues to bring home high-calorie foods, even though you are trying to avoid them. Or, maybe you are upset because a friend who only knows the myths of bariatric surgery thinks it is the easy way out.
Tips
- It may be as simple as talking with your family members or friends. Be honest and calmly let them know what your goals are, what you need in the way of support, and, specifically, what comments or behaviors are not helpful.
- You may want to offer to bring them to a support group or information session at your bariatric program.
- Provide them with the information you used while making your decision.
- Politely change the subject if eating or bariatric surgery comes up.
- If they’re unable to change their behavior, you may consider limiting the amount of time you spend with them.
Eating in Restaurants
Eating in restaurants after bariatric surgery can be challenging, especially with the size of restaurant portions. Often restaurant portions are two to four times larger than the recommended portion and are high in fat. This can lead to a slower rate of weight loss for bariatric surgery patients. For gastric bypass patients, this presents an opportunity for an unpleasant episode of dumping syndrome.
Tips
- Avoid baskets of bread or chips.
- Order salads with dressing on the side and dip your fork in the dressing instead of pouring it on.
- In many restaurants, appetizers are closer to an appropriate portion size than the entrées.
- Split an entrée with someone, or divide it and take home half.
Eating at Special Occasions
Special occasions can be challenging: There might be pressure to “try some of this,” and the food can be tempting. The festive nature might make you feel like letting go of healthy habits.
It’s important to plan ahead. Having a plan can help you avoid overeating or eating unhealthy foods.
A common mistake is to plan on eating nothing. Even with the best intentions, it’s hard to resist the atmosphere and the food.
Tips
- Eat something small before you go or drink a glass of milk, so you don’t arrive hungry.
- Enjoy conversation while you eat—you’ll eat more slowly.
- Try small amounts of new foods instead of your old favorites.

And remember…
If you do overeat, keep it in perspective. Overeating at a single event does not lead directly to regaining weight. It is unhealthy daily habits that do. So don’t let one slip-up lead to overeating or eating unhealthy foods at several meals. Stick with your healthy eating habits, and you will notice the difference it makes.
EMOTIONAL EATING AND CRAVINGS
Having bariatric surgery does not necessarily mean that you’ll be free from cravings or bouts of emotional eating. Succumbing to food cravings and emotional eating can lead to weight regain and, for gastric bypass patients, dumping syndrome.
Successfully overcoming cravings and emotional eating takes patience and knowledge of a few coping techniques.
Coping with Cravings
Cravings can be difficult to deal with. A lot of people fight the craving for a period of time and then try eating the desired food to get rid of the craving. This often results in eating too much of the food and then feeling guilty. Giving in to the urge often makes the craving stronger and more frequent with time.
It is actually more effective to avoid the desired food. With time, the craving will pass and will be less likely to return.
If you experience difficulty in coping with cravings, you don’t have to go it alone. Contact your bariatric program or attend a support group meeting.
Tips
- Distract yourself when you have a food craving: Take a quick walk, read a book, or call a friend.
- If a food craving is associated with a specific room or activity, break it by changing your habits. Go to a room that you don’t eat in or avoid the activity for a period of time.
- Keep high-fat, high-sugar, high-calorie food out of the house. Encourage your family to eat healthfully and to reserve these empty calories for rare occasions.
Coping with Emotional Eating
For some people, eating is a way to cope with emotions. After bariatric surgery, this can be a painful and unhealthy coping mechanism. You should know that breaking the pattern of eating in response to stress, frustration, or sadness is possible.
Identifying the Emotion
When you experience a strong emotion that leads you to food, stop and identify the emotion you are experiencing. You may open the refrigerator and realize that you feel sad or angry rather than hungry.
Ask for Help When You Need It
Breaking the connection between emotions and food can be difficult. If you feel overwhelmed or out of control, attend a support group meeting or contact your bariatric program’s mental health professional. These two resources can help you identify what’s causing the emotion and provide you with strategies and alternatives to eating.
HEALTH TRANSFORMATION
One of the most rewarding aspects of bariatric surgery is the transformation of health and increase in quality of life that many patients experience.
Studies have shown that gastric bypass patients:
- Lost an average of 61.6% of excess weight4

- Experienced significant health improvement with resolution or improvement of 96% of co-morbidities, specifically type 2 diabetes, high blood pressure, sleep apnea, depression, and back pain5

- Had significantly reduced rates of developing cancer, cardiovascular diseases, infectious diseases, and psychiatric disorders6

- Experienced 89% lower mortality rates when compared to a control group of people who did not have gastric bypass surgery and were still living with morbid obesity6

Studies also have shown that gastric bypass patients:
- Had dramatically lower hospitalization rates for cancer, heart conditions, and high blood pressure than a control group of people who did not have gastric bypass surgery and were still living with morbid obesity6

- Experienced a 77.3% drop in total cost of diabetic and blood pressure medications compared to a control group of people who did not have gastric bypass surgery and were still living with morbid obesity and these co-morbid conditions6