If you are considering weight-loss surgery as a means of achieving permanent weight loss, we believe we can provide you with the information you need. If you’re like most overweight people, you’ve tried both natural and medically-assisted diets with only limited success. You have probably also regained most, if not all, of the weight you lost by dieting (called the “yo-yo syndrome”).
Over the last few decades, the medical community has generally come to agree that obesity (the medical term for being seriously overweight) is likely a combination of genetics and lifestyle choices. This can be a sometimes-deadly combination, which makes it virtually impossible to achieve permanent weight loss through dieting alone. And is often only controllable through surgical intervention.
Although weight-loss surgery may be your only practical alternative, it is, nevertheless, a life-changing procedure. The decision to proceed should only be made once you are thoroughly familiar with its advantages and disadvantages. You should also discuss your decision with your family and personal physician.
Laparoscopic Adjustable Gastric Banding (LAP-BAND®)
The procedure is performed laparoscopically, which means that a tiny camera allows the surgeon to see inside your body as he or she performs the procedure. Only a few very small incisions are made in the abdomen (about 1.5-2.5 cm each). The band is placed around your stomach using long, thin instruments.
This procedure is a restrictive operation that reduces your stomach’s capacity, thus restricting the amount of food you are able to eat at one time. Adjustments to optimize the system are made through a discrete, comfortable access port that is placed just beneath the skin.
A sleeve gastrectomy is another restrictive form of weight loss surgery in which approximately 85 percent of the stomach is removed, leaving a small stomach “sleeve” resembling the shape of a shirt sleeve. This reduces the amount of food one can consume.
Endoscopic Outlet Pouch Reduction Procedure
Have you started to regain weight after initial success from Gastric Bypass surgery? Over time, the stomach pouch or the outlet that connects it to the small intestine can stretch. As a result, patients can eat more food before feeling full. We now offer a safe and effective endoscopic procedure to reduce your enlarged pouch and outlet to their original post-operative proportions.
This procedure is performed using a small flexible endoscope and specialized devices that allows sutures to be placed through the endoscope. The scope and suturing devices are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Sutures are then placed around the outlet to reduce the diameter, typically from the size of a silver dollar to the size of a dime. The same technique may then be used to place additional sutures in the stomach pouch to reduce its volume capacity.
By now, you should have determined that you meet the basic criteria for bariatric surgery and that you are ready to commit to a change in your life-style.
If you have medical insurance, you will need to determine if your policy covers any or all of the included costs, such as the surgery itself, the surgery center, the anesthesia, the provider and the consultation and follow up appointments. Insurance coverage varies between providers and even between employers using the same provider. Therefore, you will need to check your individual policy to see if it specifically excludes weight loss (or bariatric) surgery. If you are unable to find the answer by reading the policy, you should call your provider or health plan administrator and ask them specifically: “Does my insurance policy cover LAP-BAND® surgery?” We can also contact your insurance company for you after your initial consultation.
If you are covered:
Make a list of their criteria and conditions. Many providers will also require that you have one or more of the following prior to approving coverage:
- • psychiatric evaluation
- • sleep apnea study
- • cardiac evaluation
- • family physician recommendation
If you are not covered:
Ask if this is based on a “written exclusion” in the policy. If there is a written exclusion, there is little you can do other than change insurance carriers. If there is not a written exclusion, you should ask why LAP-BAND® surgery is not covered. Unfortunately, there are some insurance companies that will initially deny coverage (even without a written exclusion) with the hope that you’ll give up, so be persistent. You may also want to check the ObesityHelp.com database of Insurance Providers & Government Programs to see if others have been approved or denied by your provider.
If you do not have insurance or your insurance will not cover the procedure, we work with Prosper Healthcare Lending, the premier financing company in the healthcare industry. With over $3 Billion borrowed and over 250,000 people empowered, this is a name and a program you can trust.
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Schedule a pre-surgery consultation meeting with Dr. Luttrell. A friend or significant other may participate if you like. During this consultation, Dr. Luttrell will:
- • review your medical history with you
- • explain the surgical procedure, risks and possible side effects
- • discuss the minor pitfalls you may have
- • answer any questions you may have
- • obtain written permission to contact your insurance provider should you decide to have surgery
If you are paying cash, we can schedule your surgery date during your consultation unless you would like more time to make a final decision. If you will be relying on insurance for payment, Dr. Luttrell will dictate a letter of “Medical Necessity” and we will request “pre-certification” from your insurance provider.
Depending on your medical case and your insurance provider, this process can take anywhere from a few days to several months. The process may also include providing them with any other documentation they request from our office, other physicians or clinics involved in your medical care, and/or directly from you.
Once our letter is sent, you can help keep the process moving by contacting your insurance company at regular intervals to determine the status of your request. We will also periodically check status.
Our staff will work hard to obtain insurance approval for your procedure by responding to any requests the insurance company makes and we are always happy to answer any questions you may have during this period.
Once we receive approval from your insurance provider, we will contact you to schedule a date for your surgery and any pre-surgical tests that will be required.
After surgery, you will need a new nutrition plan. Dr. Luttrell will discuss this in detail and can help you learn about and get used to the changes in lifestyle and eating habits you need to make.
It is very important to follow the eating and drinking instructions starting right after the operation to allow the new stomach structure to heal completely and in the right position. This may take a month or more. It is also important, especially in the early weeks, not to stretch the small stomach pouch above the band. Vomiting can stretch the stomach and can increase the chance of stomach tissue slipping through the band.
There are support groups designed to provide individuals with an opportunity to share information, offer support, gain insight and become aware of options in dealing with the challenges of living with morbid obesity. In addition to attending these groups, the right post-surgery diet is crucial in achieving your weight loss goals.
Right after the operation you can take an occasional sip of water or suck on an ice cube. You shouldn’t drink more than this. The day after the operation, you can take a little more fluid but only a small amount at a time. Besides water, you should also choose clear liquids that have an adequate number of calories. To prevent nausea and vomiting, do not drink too much.
The goal during this post-operative period is to protect the small stomach pouch. Only thin liquids can be tolerated at this time. It is also important to stay hydrated with lots of water. Other liquids recommended during this phase include:
- • clear broths and soups (avoid creamy soups, vegetables & meats)
- • skim milk
- • fruit juices
- • sugar-free popsicles
During this phase you may start having slightly textured foods. Aim for the consistency of baby foods. This will help you transition to more solid foods later. Because protein is so important to help you maintain muscle while you are losing weight, eat protein-rich foods first, and then move on to fruits and vegetables. Foods in this stage may include:
- • puréed skinless chicken or fish
- • mashed potatoes
- • peas
- • low-fat yogurt or pudding
In the first few weeks, you may be able to eat foods that might not be allowed in your diet later, as these foods may contain too many calories. It is more important in the first few weeks to let your stomach adjust than it is to lose weight. Also, your timing and progression into each dietary phase may vary.
Your meals can now include tender, cooked foods like fish and ground turkey. Now that you can chew, make it a habit to chew foods well. If you have dentures, be sure to cut your food into small pieces and chew it thoroughly. If you don’t follow these precautions, you may experience vomiting, stomach irritation and swelling. You could also create stoma obstruction.
If solid foods cause nausea and vomiting, go back to the liquid diet you had earlier. Then, you can slowly add soft foods and eventually transition to solid foods. Vomiting may increase the incidence of band slippage, stomach slippage, or stretching of the small stomach pouch above the band.
When you can eat solid foods without problems you will need to pay close attention to your diet. Liquids will pass through the reduced stomach pouch quickly and will not make you feel full. These procedures were designed to restrict solids, not liquids. Drinking liquids during or immediately after meals tends to flush food through the pouch and you will not get the prolonged feeling of satiety needed to help you eat less.
Staying hydrated throughout the day is important. Drink at least 6-8 cups of water per day and make sure you consume them between meals. Many patients have a difficult time with solid foods during the morning hours. If this is the case for you, start with a couple of glasses of liquids before your first meal.
Too much food or big chunks of food can block the stomach pouch outlet. You can avoid this problem by chewing food well and eating small bits at a time. It is important to remember that your new stoma opening is approximately the size of a dime. Chew your food adequately so that it can easily fit through the opening.
Eat only 3 small meals per day and make sure that these meals contain adequate nutrients. Your stomach can only hold about 1/4 cup of food or 2 oz. at a time. Stop eating when your hunger is gone or when you feel comfortable. You may find that the small stomach pouch makes digestion of high-fiber, high-fat and dry foods more difficult. Tolerance will vary from person to person. Ask us about your food choices.
The general guide below can help you create good and healthy meals that contain adequate nutrients with little sugar and fat.
Good Food Choices
• 1 to 2 servings of fresh fruit daily
• 2 to 3 servings of fresh vegetables daily
• 1 small portion of low-sugar cold or hot cereal
• 1/2 to 1 slice of toasted whole wheat or rye bread each day
Note: some patients have difficulty eating bread
1-2 oz. of meat, fish or poultry, or one egg each day (Remove all visible fat from the meat. Remove the skin from poultry. Prepare the meat in ways that need very little fat. Grilling, steaming, microwaving, or boiling are all good ways to do this.)
Note: some patients have difficulty eating meat
Milk and yogurt are calories in liquid form. However, these types of foods have calcium, which make them an important part of a healthy, daily diet, so choose a maximum of 2 cups of skimmed milk or low-fat yogurt and 1 oz. of cheese per day.
Restrict the use of fat to 3 to 4 teaspoons of margarine, butter, or oil per day. You can have low-fat salad dressings and mayonnaise in moderation.
Drink as many calorie-free liquids per day as you wish (though not with meals).
Suitable drinks are:
- • tea or coffee (black) with low-calorie sweetener
- • water
- • non-carbonated beverages containing few or no calories
Some doctors have reported that carbonated beverages may contribute to enlargement of the small pouch and recommend they be avoided.
Foods to Avoid
Some foods have concentrated supply of calories with little nutritional value and should be avoided as much as possible. These include foods such as syrups, cakes, biscuits, jams, honey, pies, chips and pastries. Alcoholic drinks should only be consumed in moderation, for example one glass of wine per day.
Common Problem Foods
Some foods have difficulty passing through the opening of the stoma and may cause blockage. Introduce these foods slowly and individually to see if they are tolerated. Always be careful, chew well, and follow Dr. Luttrell’s advice. These include foods such as:
- dry meat and shrimp
- untoasted or doughy bread
- pastas and rice
- peanut butter
- dried fruits
- seeds and skins of fruits and vegetables
- fibrous vegetables like corn, asparagus and celery
- nuts and popcorn
- greasy or fried foods
The Next Step
To decide if weight loss surgery is an option for you, watch our online seminar for more information or call our office today. Our highly trained staff can help answer any questions as well as help determine insurance coverage.