Treatment Options

Adjustable Gastric Band

About the procedure:
In this procedure, an inflatable silicone band is placed around the top of the stomach to help control the flow of food through the stomach and decrease hunger.  Based upon the needs of the patient, the balloon can be adjusted to decrease the small pouch outlet which slows the emptying of food into the larger portion of the stomach and then the intestines. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. Reduced hunger, and decreased food cravings assist in maintenance of a diet resulting in weight loss.   Vitamin, nutrient and medicine absorption are unchanged yet some medicines are not well tolerated after the procedure.

How It Works:
A small gastric pouch is created restricting meal volume, but more importantly, the band allows early and prolonged satiety.   Patients feel satisfied with a small amount of food, and they are not hungry or looking for food between meals.

Indications:
The AGB is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 30 – 39 with one or more severe co-morbid conditions, or those who are 30 lbs. or more over their estimated ideal weight.  A patient with a BMI of 40 usually weights about 100 lb above their ideal body weight.

Malabsorption:
No change in vitamin or nutrient absorption is caused by the Adjustable Gastric Band

Vitamin Requirement:
Two daily multivitamins should be taken while a person is losing weight due to the decreased nutrient intake of dieting. Vitamin D as needed.

Dietary Restrictions:
Patients may experience difficulty with thick breads and fibrous foods.  Patients must take care to thoroughly chew food after surgery to prevent regurgitation.  A low carbohydrate diet enhances the effectiveness of this procedure.

Laparoscopic:
Yes

Number of incisions:
1 to 5 small incisions. Single incision surgery available to appropriate patients.

Intestinal Rerouting:
No

Cutting or stapling:
No

Hospital Stay:
Outpatient – patients typically go home the same day

Recovery:
Most patients return to normal activity in five days.
Full surgical recovery occurs in two to three weeks.

Post Op Diet:
As with all surgical weight-loss programs, it is imperative that band patients adhere to a strict postoperative diet. Patients must stick to a liquid protein diet for 2 weeks after surgery; they then graduate to 2 weeks of a soft protein based diet. And at 4 weeks, patients transition to a low carb solid diet. Once goal weight is achieved, usually 2-3 years after surgery, most patients consume a normal healthy diet with the appropriate number of calories for their height and build to maintain their weight.

Mortality:
The reported risk of mortality during the first 30 days following surgery for the adjustable gastric band is one in 2000 for a Center of Excellence Surgeon.  Those who die rarely do so from the procedure, but usually from an underlying obesity related illness, such as coronary artery disease with subsequent heart attack. We have never had a peri-operative death following gastric band placement.

Hair Loss:
Patients may experience hairloss during the  period of rapid weight loss, but hair growth usually normalizes with weight maintenance.

Bone Disease or Osteoporosis:
No increase in risk

Iron Defiency Anemia:
No increase in risk

Reversible?:
Yes. While it is intended to be a long-term treatment, the Adjustable gastric band can be removed at any time.  The stomach is generally restored to its original form and function.

Easily Adjustable:
Yes. Adjustments performed without additional surgery.  Allows individualized degree of restriction for ideal, long-term weight loss

Pregnancy:
Supports pregnancy by allowing stomach outlet size to be opened for increased nutritional needs

Contraindications:
The AGB is not recommended for non-adult patients (will be evaluated on a case-by-case basis), patients with conditions that may make them poor surgical candidates or increase the risk of poor results, who are unwilling or unable to comply with the required dietary restrictions, or who currently are or may be pregnant.  Patients with Lupus are excluded from possible band candidates.

Weight Loss:
Typical patients lose weight at a rate of 1-2 pounds per week.  While weight loss is usually slower with an adjustable gastric band than with RNY gastric bypass or Sleeve Gastrectomy, the weight loss period normally extends two to three years from the date of surgery.

Patients can expect to maintain a total excess weight loss of 55%.

 

Sleeve Gastrectomy

About the procedure:
In this procedure, the part of the stomach that easily streches to hold large meals is removed leaving an aproximately 1/2 inch wide by 8 – 10 inch long sleeve shaped stomach.  The natural outlet of the stomach, the pylorus, is maintained to help pace the emptying of stomach contents.  The section of stomach removed creates the hunger driving hormone ghrelin.  Removing this section of stomach results in a marked decrease in ghrelin production  and a lack of hunger.  The lack of hunger usually lasts for 6 months to two years following surgery but the sensation of fullness after small meals lasts for a very long time. Vitamin, nutrient and medicine absorbtion are minimally changed and all medicines are well tolerated after Sleeve Gastrectomy.

How It Works:
1.)  The small gastric pouch restricts meal volume, but more importantly, it allows early and prolonged satiety. Patients feel satisfied with a small amount of food, and they are not hungry or looking for food between meals.

2.)  Removal of the remnant portion of the stomach minimalizes production of the hunger hormone ghrelin which markedly reduces hunger for a long time.

Indications:
The sleeve gastrectomy is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 – 39 with one or more severe co-morbid conditions, or those who are 100 lbs. or more over their estimated ideal weight.  A patient with a BMI of 40 usually weights about 100 lb above their ideal body weight.

Malabsorption:
A minimal decrease in the absorption of some nutrients has been suggested.

Vitamin Requirement:
Two daily multivitamins should be taken while a person is losing weight due to the decreased nutrient intake of dieting.  Vitamin D as needed.

Dietary Restrictions:
Patients may experience dumping syndrome with intake of carbohydrate foods.
A condition known as “dumping syndrome” occurs as the result of rapid emptying of stomach contents into the small intestine.  This is often triggered when too much sugar or large amounts of food are consumed.  While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, fainting, and on occasion, diarrhea after eating.  Some patients are unable to eat  sweets after surgery without experiencing dumping syndrome.  A low carbohydrate diet enhances the effectiveness of this procedure.

Laparoscopic:
Yes

Number of incisions:
1 to 4 incisions. Single incision surgery available to appropriate patients.

Intestinal Rerouting:
No

Cutting or stapling:
Yes – Stomach Wall

Hospital Stay:
Inpatient – Patients usually stay 1-2 night in the hospital

Recovery:
Most patients return to normal activity in two weeks.
Full surgical recovery occurs in two to three weeks.

Post Op Diet:
As with all surgical weight-loss programs, it is imperative that sleeve patients adhere to a strict postoperative diet. Patients must stick to a liquid protein diet for 3 weeks after surgery. Patients then graduate to a soft protein based diet for 2 weeks and then at 8 weeks, patients transition to a low carb solid diet. Once goal weight is achieved, usually 2-3 years after surgery, most patients consume a normal healthy diet with the appropriate number of calories for their height and build to maintain their weight.

Mortality:
The reported risk of mortality during the first 30 days following surgery for the sleeve gastrectomy is less than one out of 500 patients.  We have never had a peri-operative death following primary sleeve gastrectomy.

Hair Loss:
Patients may experience hair loss during the period of rapid weight loss, but hair growth usually normalizes with weight maintenance.

Bone Disease or Osteoporosis:
No increase in risk.

Iron Defiency Anemia:
No increase in risk.

Reversible?:
No. The sleeve gastrectomy is irrevirsible.  Once the stomach is cut and the stomach remnant is removed it can never be restored.

Easily Adjustable:
No. The sleeve gastrectomy can only be adjusted through an additional surgical procedure.

Pregnancy:
It is not recommended that you become pregnant during the weight loss period following a sleeve gastrectomy due to inability to intake adequate nutrition.  Weight loss after sleeve gastrectomy occurs because the patient cannot intake enough nutrition to support themselves, rendering them incapable of providing adequate nutrition to support a developing baby.

Contraindications:
The sleeve gastrectomy is not recommended for non-adult patients (will be evaluated on a case-by-case basis), patients with conditions that may make them poor surgical candidates or increase the risk of poor results, who are unwilling or unable to comply with the required dietary restrictions, or who currently are or may be pregnant.

Weight Loss:
Typical patients lose weight at a rate or 2-3 pounds per week.  Weight loss is rapid but usually slows by twelve to eighteen months post op.

Patients can expect to maintain a total excess weight loss of 60%.

RNY Gastric Bypass

About the procedure:

In this procedure, the top portion of the stomach is stapled off from the natural stomach  creating a small (1 ounce) stomach pouch. The remainder (remnant) of the stomach is not removed, but is stapled and cut away from the stomach pouch.  Portions of the small intestine are re-rerouted in a “Y” shape.  The outlet from the newly formed 1 ounce pouch is sewn  directly to the new small intestine resulting in early satiety and reduced absorption of food, nutrients and vitamins.   Bypassing the remnant  stomach causes a marked decrease in ghrelin production and a lack of hunger.  The lack of hunger usually lasts for 6 months to two years.  Vitamin and nutrient absorption are significantly reduced and some medicines are not well tolerated after the procedure.

How It Works:

1.  The small gastric pouch restricts meal volume, but more importantly, it allows early and prolonged satiety. Patients feel full with a small amount of food, and they are not hungry or looking for food between meals.

2.  Bypassing the remnant portion of stomach decreases production of the hunger hormone ghrelin  which markedly reduces hunger for a long time.

3.  Bypassing the remnant stomach and some of small intestine provides impaired absorption of nutrients that a patient consumes.

4.  The dumping syndrome (cramping abdominal pain after eating carbs and sweets) occurs in two out of three patients reminding those patients to eliminate carbohydrates from their diet.

Indications:

The gastric bypass is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 – 39 with one or more severe co-morbid conditions, or those who are 100 lbs. or more over their estimated ideal weight.  A patient with a BMI of 40 usually weights about 100 lb above their ideal body weight.

Malabsorption:

Yes.  The absorption of most vitamins minerals and nutrients are decreased after the gastric bypass.

Vitamin Requirement:

Three daily multivitamins, B12, folic acid, Calcium iron and Vitamin D should be taken should be taken for the rest of a person’s life due to the malabsorption of gastric bypass.

Dietary Restrictions:

Patients may experience dumping syndrome with intake of carbohydrate foods.

A condition known as “dumping syndrome” occurs as the result of rapid emptying of stomach contents into the small intestine.  This is often triggered when too much sugar or large amounts of food are consumed.  While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, fainting, and on occasion, diarrhea after eating.  Most patients are unable to eat any form of sweets after surgery without experiencing dumping syndrome.  A low carbohydrate diet enhances the effectiveness of this procedure.

Laparoscopic:

Yes

Number of incisions:

5

Intestinal Rerouting:

Yes

Cutting or stapling:

Yes – Stomach Wall and small bowel

Hospital Stay:

Inpatient – Patients usually stay 1 night in the hospital

Recovery:

Most patients return to normal activity in two weeks. Full surgical recovery occurs in two to three weeks.

Post Op Diet:

As with all surgical weight-loss programs, it is imperative that gastric bypass patients adhere to a strict postoperative diet. Patients must stick to a liquid protein diet for 3 weeks after surgery.  Patients then graduate to a soft protein based diet for 2 weeks and then at 8 weeks, patients transition to a low carb solid diet. Once goal weight is achieved, usually 2-3 years after surgery, most patients consume a normal healthy diet with the appropriate number of calories for their height and build to maintain their weight.

Mortality:

The risk of mortality during the first 30 days following surgery with the gastric bypass is 0.5-1% (less than one out of every 100 patients die from the procedure).   We have never had a peri-operative death following gastric bypass surgery.

Hair Loss:

Patients may experience hair loss during period of rapid weight loss.  Hair growth does not always normalize with weight maintenance as it can be a side effect of nutritional deficiencies related to malabsorption of critical nutrients.

Bone Disease or Osteoporosis:

Patients are at increased risk as a result of malabsorption of critical nutrients.

Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hip bones.  Women already at risk for osteoporosis that can occur after menopause, should be aware of the potential for severe bone calcium loss.  All of the deficiencies mentioned above must be managed through proper diet and vitamin supplementation.

Iron Deficiency Anemia:

Patients are at increased risk as a result of malabsorption of critical nutrients.

Because the duodenum is bypassed, poor absorption of iron and calcium can result in the loss of total body iron and a predisposition to iron deficiency anemia.  This is a particular concern for patients who experience chronic blood loss, excessive menstrual flow or bleeding hemorrhoids.

Reversible?:

Technically difficult to reverse, however, it is possible to rejoin the stomach sections, and reposition the small bowel.  The stomach and small bowel will never function as they did before surgery.

Easily Adjustable:

No. The gastric bypass can only be adjusted through an additional surgical procedure.

Pregnancy:

It is not recommended that you become pregnant during the weight loss period following a gastric bypass, as women are often malnourished. Weight loss after gastric bypass occurs because the patient cannot intake enough nutrition to support themselves, rendering them incapable of providing adequate nutrition to support a developing baby.

Contraindications:

The RNY Gastric Bypass is not recommended for non-adult patients (will be evaluated on a case-by-case basis), patients with conditions that may make them poor surgical candidates or increase the risk of poor results, who are unwilling or unable to comply with the required dietary restrictions and vitamin supplementation, or who currently are or may be pregnant. Patients with osteopenia or osteoporosis are excluded from possible gastric bypass candidates due to malabsortion of necessary Calcium and Vitamin D supplementation.

Weight Loss:

Typical patients lose weight at a rate or 2-3 pounds per week.  Weight loss is rapid but usually slows by twelve to eighteen months post op.

One year after surgery, weight loss averages to 77% of excess body weight.

Studies show that after 10 to 14 years, 50-60% of excess body weight loss is expected.

What is the Obalon Balloon System?

Obalon is the FIRST and ONLY swallowable, FDA-approved balloon system for weight loss. The Obalon Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less. Three balloons are placed for a six-month non-surgical treatment, combined with a professionally supervised nutrition and exercise program for optimal weight loss. Patients in one clinical study lost twice as much weight as with diet and exercise alone.

How it works:

The Obalon Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less. During treatment you will receive our professional nutrition and exercise support to help you make the lifestyle changes that promote weight loss. The Obalon Balloon System supports you to help change your eating habits and keep the weight off for the long term.

Obalon Helps Support Long-Lasting Results:

An average of 89% of weight lost in the Obalon Clinical Study was kept off at 1 year (6 months post-removal), when combined with a moderate intensity diet and exercise program.

The procedure:

The placement of each Obalon balloon typically takes less than 10 minutes and doesn’t require sedation. In the comfort of our office, you swallow a capsule containing a small balloon, and then I inflate the balloon. The procedure is painless and you can go back to work.
After six months, all three balloons must be removed. The procedure is performed with light sedation. The removal procedure is typically no longer than 15 minutes.

Lifestyle Modification:

The Obalon Balloon System can assist with your weight loss efforts, but your weight loss success is also dependent on your readiness to develop new lifestyle skills. The degree of long-term weight loss will depend on your ability to modify your lifestyle and maintain this behavior after the balloons are removed.

Who Can Get the Obalon Balloon System?

You are a candidate for the Obalon Balloon System if you have a body mass index (BMI) from 30 to 40 kg/m2 (30 to 100 pounds overweight) and are 22 years or older. The program begins with the placement of the Obalon Balloons in your stomach for up to six months. The program should be accompanied with a healthy diet and exercise program to obtain and maintain good weight loss.

Will the Obalon Balloon System limit my activity?

Patients usually resume normal activities immediately after the balloon placement procedure. You cannot take any stomach irritating medicines like non-steroidal anti-inflammatory drugs (NSAIDs) or Aspirin while the balloons are in your stomach. Some examples of NSAIDs are Motrin or Advil. You cannot have the balloons placed if you plan to live in a place at an altitude more than 4000 feet higher or 2500 feet lower than Rockville Maryland. Please see the Safety Information section and Patient Labeling for contraindicated activities with the Obalon Balloon System.

Complications reported with the balloon:

If a person does not follow a healthy diet and exercise program they will not lose weight. The role of the balloon is only to help a person feel full after eating a small amount of food. Uncommonly, patients have nausea for the first few days after placing the balloon until the stomach adjusts to the balloon. We will prescribe anti-nausea medications to all patients. Vomiting and abdominal discomfort also rarely occur early during the balloon experience. Rare complications of stomach perforation and balloon deflation with bowel obstruction have been reported. Very rare complications with placement and removal related to the endoscopy and sedation have been reported.

Malabsorption:

The balloon results in no malabsorption. All nutrients and vitamins are absorbed normally.

Vitamin requirements:

One daily multivitamin should be taken while losing weight due to the decreased intake of nutrients while dieting. Taking vitamin D by mouth may be needed if your vitamin D is low before the balloon is placed.

Dietary restrictions:

A liquid diet is recommended for 3 weeks to help jump start weight loss. Patients may advance their diet to a low carbohydrate diet sooner if they desire. Our program diet is a low carbohydrate, balanced, healthy diet. This diet is maintained to achieve the goal weight. Once the goal weight is reached, a maintenance diet of expanded calories is begun for long-term health and happiness. A proton pump inhibitor (antacid) medication is recommended while the balloon is in place.

Number of incisions:

none

Hospital stay:

None
The balloons are placed during a brief office visit without any sedation. Six months later, the balloons are removed during an outpatient endoscopy while sedated with the patient going home from the recovery room.

Recovery:

Recovery time is minimal. Most patients return to unrestricted activity immediately following balloon placement.

Reversible:

The balloon is reversible. The balloon is not adjustable. The balloon must be taken out after six months.

Balloon Cost:

$7400 This covers the cost of the balloon and the costs of placing it and removing it 6 months later. 12 months of a physician-directed comprehensive weight loss program are also included.

ORBERA Baloon

The Orbera intragastric balloon is an FDA approved tool to aid in weight loss for adults who are interested in a program of diet and exercise.  The balloon has been placed in over 200,000 patients worldwide.  Multiple studies have shown the Orbera balloon to be effective in helping patients who have not been successful with structured diet programs or who regain weight after short term success with dieting. The balloon works to decrease hunger between meals and enhance satiety.

About the procedure:

The Orbera intragastric balloon is inflated during a brief endoscopic procedure without any incisions. The inflated balloon decreases hunger and increases the sense of fullness soon after eating a small amount of food.

The Orbera balloon is part of a multidisciplinary approach to weight loss with behavioral modification and a healthy lifestyle.

How it works:

The balloon is soft, smooth, and about the size of a grapefruit. It moves freely in the stomach simulating a large meal. The balloon decreases hunger and allows a person to remain on a healthy regimen of diet and exercise in order to lose weight.

Indications:

The Orbera balloon is indicated for patients with a BMI of 30 to 40 who are interested in a multidisciplinary approach to lose weight by changing the way they eat, regular exercise, and adopting a long-term healthy lifestyle.  Those who have severe damage to the liver, who are pregnant or breast feeding, or need to take anticoagulants, gastric irritants or anti-inflammatory drugs daily should not have the Orbera Balloon.

Who is a good candidate for the balloon?

Anyone who has tried to lose weight, is committed to diet and exercise, has not been successful dieting or has regained weight after success and fulfills the Indications above is a good candidate for the Orbera balloon.   Rare patients may have a medical reason not to place the balloon so a personal consultation is necessary before balloon placement.

Complications reported with the balloon:

If a person does not follow a healthy diet and exercise program they will not lose weight. The role of the balloon is only to help a person feel full after eating a small amount of food.  Almost all patients have nausea for the first few days after placing the balloon until the stomach adjusts to the balloon.  We will prescribe anti-nausea medications to all patients. Vomiting and abdominal discomfort may occur early during the balloon experience.    Rare complications of stomach perforation and balloon deflation with bowel obstruction have been reported.  Very rare complications with placement and removal related to the endoscopy and sedation have been reported.

Malabsorption:

The balloon results in no malabsorption. All nutrients and vitamins are absorbed normally.

Vitamin requirements:

One daily multivitamin should be taken while losing weight due to the decreased intake of nutrients while dieting. Taking vitamin D by mouth may be needed if your vitamin D is low before the balloon is placed.

Dietary restrictions:

A liquid diet is recommended for 3 weeks to help jump start weight loss.  Patients may advance their diet to a low carbohydrate diet sooner if they desire.  Our program diet is a low carbohydrate, balanced, healthy diet. This diet is maintained to achieve the goal weight. Once the goal weight is reached, a maintenance diet of expanded calories is begun for long-term health and happiness. A proton pump inhibitor (antacid) medication is recommended while the balloon is in place.

Number of incisions:

none

Hospital stay:

Outpatient.  The balloon is placed during a brief endoscopic procedure and the patient goes home from the recovery room.

Recovery

Recovery time is minimal. Patients go home the same day as their procedure.  In most patients, there is an adjustment period to the balloon. Most patients experience nausea for the first three days. We recommend staying home from work or school for 3 days.  Light activity is unrestricted and exercise is increased as the stomach adjusts to the balloon.

Reversible:

The balloon is reversible.  The balloon is not adjustable. The balloon must be taken out after six months.

Balloon Cost:

$7500 This covers the cost of the balloon and the costs of placing it endoscopically, 12 months of a physician-directed comprehensive weight loss program, as well as balloon removal at 6 months.

Band Over Bypass

About the procedure:
In this procedure, an inflatable silicone band is implanted  around the small stomach pouch as a revision to a gastric bypass.  Like a wristwatch, the band is fastened around the upper stomach pouch to create a new, small stomach pouch that limits and controls the amount of food consumed and decrease hunger. The balloon can be adjusted, based upon the needs of the individual patient.  This operation does not change the decreased absorption of the gastric bypass.  Extra vitamins must be taken similar to the original Gastric Bypass and caustic medicines like Aspirin, NSAIDS, and Fosamax are not tolerated.

How It Works:
When the gastric bypass Roux-en-Y procedure is performed, the stomach and stoma (connection between the stomach and small intestine) are made very small, which slows the passage of food and creates a feeling of fullness after just a small amount of food is eaten. It is believed that when the stomach pouch and stoma gradually enlarge, the feeling of fullness is no longer present.  Decreased satiety and hunger are felt. Patients are able to eat larger meals and weight regain may occur.  Even the most successful gastric bypass patients can regain weight.  Research now shows approximately 20 percent of RNY gastric bypass patients will regain weight a few years after surgery.  Placement of a gastric band over a gastric bypass restricts the size of the stomach pouch and creates a narrow outlet above the stoma to slow the emptying of food from the pouch into the small intestine.  This increases satiety following a small meal assisting the patient in further weight loss and maintenance..

Indications:
The Band Over Bypass Procedure is indicated for RNY gastric bypass patients who have experienced weight regain or inadequate weight loss following their procedure.

Malabsorption:
The Bypass malabsorption continues.

Vitamin Requirement:
Extensive daily vitamin supplementation due to malabsorption of nutrients from original RNY gastric bypass.

Dietary Restrictions:
Patients may experience dumping syndrome with intake of carbohydrate foods.
A condition known as “dumping syndrome” occurs as the result of rapid emptying of stomach contents into the small intestine.  This is often triggered when too much sugar or large amounts of food are consumed.  While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, fainting, and on occasion, diarrhea after eating.  Most patients are unable to eat any form of sweets after surgery without experiencing dumping syndrome.  A low carbohydrate diet enhances the effectiveness of this procedure.

Laparoscopic:
Yes

Number of incisions:
1 to 5 incisions. Single incision surgery available to appropriate patients.

Intestinal Rerouting:
While the original intestinal rerouting from prior RNY gastric bypass surgery remains, there is no additional rerouting of the intestine during the Band over Bypass procedure.

Cutting or stapling:
No

Hospital Stay:
Outpatient – patients typically go home the same day

Recovery:
Most patients return to normal activity in five days. Full surgical recovery occurs in two to three weeks.

Post Op Diet:
As with all surgical weight-loss programs, it is imperative that band patients adhere to a strict postoperative diet just as with the original gastric bypass surgery. Patients must stick to a liquid protein diet for 2 weeks after surgery; they then graduate to 2 weeks of a soft protein based diet. And at 4 weeks, patients transition to a low carb solid diet. Once goal weight is achieved, usually 2-3 years after surgery, most patients consume a normal healthy diet with the appropriate number of calories for their height and build to maintain their weight.

Mortality:
The reported risk of mortality during the first 30 days following surgery for the adjustable gastric band is one in 2000 for a Center of Excellence Surgeon.  Those who die rarely do so from the procedure, but usually from an underlying obesity related illness, such as coronary artery disease with subsequent heart attack. We have never had a peri-operative death following gastric band placement.

Hair Loss:
Patients may experience hair loss during period of rapid weight loss.  Hair growth does not always normalize with weight maintenance as it can be a side effect of nutritional deficiencies related to malabsorption of critical nutrients.

Bone Disease or Osteoporosis:
Patients are at increased risk as a result of malabsorption of critical nutrients.
Bypassing the doudenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hip bones.  Women already at risk for osteoporosis that can occur after menopause, should be aware of the potential for severe bone calcium loss.  All of the deficiencies mentioned above, must be managed through proper diet and vitamin supplementation.

Iron Deficiency Anemia:
Patients are at increased risk as a result of malabsorption of critical nutrients.
Because the doudenum is bypassed, poor absorption of iron and calcium can result in the loss of total body iron and a predisposition to iron deficiency anemia.  This is a particular concern for patients who experience chronic blood loss surgin excessive menstrual flow or bleeding hemorrhoids.

Reversible?:
Yes. While it is intended to be a long-term treatment, the adjustable gastric band can be removed at any time. The stomach is generally restored to the same form and function as prior to the banding procedure.

Easily Adjustable:
Yes. Adjustments performed without additional surgery. Allows individualized degree of restriction for ideal, long-term weight loss

Pregnancy:
It is not recommended that you become pregnant during the weight loss period following the Band over Bypass procedure, as women are often malnourished. Weight loss occurs because the patient cannot intake enough nutrition to support themselves, rendering them incapable of providing adequate nutrition to support a developing baby.

Contraindications:
The Band over Bypass is not recommended for non-adult patients (will be evaluated on a case-by-case basis), patients with conditions that may make them poor surgical candidates or increase the risk of poor results, who are unwilling or unable to comply with the required dietary restrictions, or who currently are or may be pregnant.

Weight Loss
Weight loss is usually slower after the band placement than during the weight loss period following RNY gastric bypass.  The intention is to halt weight regain and encourage weight loss.

Patients can expect to maintain a total excess weight loss of 60% from their highest weight.