DrJoya.com - Weight Loss Surgery in Mexico - Lapband - Realize Band - surgery in Mexico: Laparoscopic Obesity Surgery

What Is The Lap-Band®?
Approved by the FDA in June 2001, the BioEnterics® Lap-Band® Adjustable Gastric Banding System is the newest and the only adjustable surgical treatment for morbid obesity in the United States. It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed.

This is a video of Dr. Joya doing an actual lapband procedure....

Minimally Invasive Approach
The Lap-Band® uses new surgical technology to help you lose weight by reducing how much your stomach can hold and lengthening the feeling of being full. There is no cutting or stapling needed to divide the upper stomach pouch from the lower stomach. The result is you take in less food - but unlike stomach stapling, the Lap-Band® can be adjusted to suit your situation, and can be removed if necessary.

During the procedure, surgeons usually use laparoscopic techniques (using small incisions and long-shafted instruments rather than a large incision), to implant an inflatable silicone band into the patient's abdomen. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the stomach and the intestines. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. In turn, this results in weight loss.

Least Traumatic Procedure

Since there is no cutting, stapling or stomach rerouting involved in the Lap-Band® System procedure, it is considered the least traumatic of all weight loss surgeries. The laparoscopic approach to the surgery also offers the advantages of reduced post-operative pain, shortened hospital stay and quicker recovery. If for any reason the Lap-Band® System needs to be removed, the stomach generally returns to its original form.

Adjustable Treatment
The Lap-Band® System is also the only adjustable weight loss surgery available in the United States. The diameter of the band is adjustable to meet your individual needs, which can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren't experiencing significant weight loss can have their bands tightened.

To modify the size of the band, its inner surface can be inflated or deflated with saline solution. The band is connected by tubing to a reservoir, which is placed well under the skin during surgery. After the operation, the surgeon can control the amount of saline in the band by entering the reservoir with a fine needle through the skin.

The BioEnterics Lap-Band® System and accessories contain no latex or natural rubber materials.

Lap-Band Indications

The Lap-Band® System is not right for everyone.

The Lap-Band® System may be right for you if:

• You are an adult (at least 18 years old or 15 with parental consent)
• Your BMI is 35 or higher or you weigh at least twice your ideal weight or you weigh at least 100 pounds (45 kilos) more than your ideal weight.
• You have been overweight for more than 5 years
• Your serious attempts to lose weight have had only short-term success.
• You do not have any other disease that may have caused you to be overweight.
• You are prepared to make major changes in your eating habits and lifestyle.
• You are willing to continue working with the specialist who is treating you.
• You do not drink alcohol in excess.

If your BMI is less than 35, the Lap-Band System may not be right for you. On the other hand, Dr. Joya may consider it if you have health problems that are related to obesity.

Contraindications

The Lap-Band® System is not right for you if:

• You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe oesophagitis or Crohn's disease.
• You have severe heart or lung disease that makes you a poor candidate for surgery.
• You have some other disease that makes you a poor candidate for surgery.
• You have a problem that could cause bleeding in the esophagus or stomach. That might include oesophageal or gastric varices (a dilated vein). It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel).
• You have portal hypertension.
• Your esophagus, stomach or intestine is not normal (congenital or acquired). For instance you might have a narrowed opening.
You have experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
• You have cirrhosis.
• You have chronic Pancreatitis.
• You are pregnant. (If you become pregnant after the Lap-Band® System has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.)
• You are addicted to alcohol or drugs.
• You are under 15 years of age.
• You have an infection anywhere in your body or one that could contaminate the surgical area.
• You are on chronic, long-term steroid treatment.
· You cannot or do not want to follow the dietary rules that come with this procedure.
· You might be allergic to materials in the device.
• You cannot tolerate pain from an implanted device.
•You or someone in your family has an autoimmune connective tissue disease. That might be a disease such as systemic lupus erythematosus or scleroderma. The same is true if you have symptoms of one of these diseases.

• Dr. Joya believes that patients with a "sweet tooth" will not do well with the Lap-Band® System. If you eat a lot of sweet foods, Dr. Joya would prefer to do the Bypass operation. The same is true if you often drink milkshakes or other high-calorie liquids.

The advantages of BAND surgery include:
• Reduced surgical trauma and pain
Less invasive for the abdominal wall (requires small incisions of 5 to10 millimeters) and for the stomach (no cutting or stapling of the organ is needed)
• Shorter hospitalization than standard surgery
Respect of the anatomical and functional. integrity of the stomach without by-passing portions of the stomach or intestines.
• Individualized to the patient's needs via inflation or deflation of the band.
• Fully reversible by simply removing the band.

LAP-BAND Risks / Complications
The LAP-BAND System is designed to be adjustable after surgery and to assist you in losing weight and maintaining your weight loss. However, following the surgery there are risks of complications associated with the placement, movement, infection, or leakage of the band or port. In addition, some patients experience more post-operative gastric symptoms, such nausea and vomiting, than others. There also remains the possibility that you may not lose weight or that you may even gain weight or that very rapid weight loss could cause health problems.

Some of the specific major risks associated with the LAP-BAND and laparoscopic surgery are:

Major Risks associated with the LAP-BAND
band leakage	reflux
erosion of band into stomach	difficulty swallowing
enlargement of stomach pouch or band slippage	dehydration
blockage of stomach outlet	gas bloat
nausea	constipation
ulceration	weight regain
gastritis	in extremely rare cases, death
Major Risks associated with Laparoscopic Surgery
damage to spleen, liver	blood clots
perforation of stomach / esophagus	lung problems
damage to major blood vessels

Please note that laparoscopic surgery is not always possible. In the event that one or several of these complications occur during surgery, the surgeon may need to switch to an "open" method. This happened in only about 5% of the cases in the U.S. Clinical Study, and has happened in less than 0.1% of the cases in our surgical experiences.

Diets for Gastric Banding Patients Designed By Dr. Joya

The Diet designed by Dr. Joya for all patients with a 40+ BMI (for two weeks pre-op):

DIET: Breakfast, Lunch, and Dinner should be low calorie protein shakes or Non fat yogurt. Dr. Joya highly recommends a company by the name of REVIVAL SOY http://www.revivalsoy.com or go to a health store and look for a low calorie protein shake with high energy. The rest of the day or if you are still hungry at meal time you can have clear liquids. You should drink about 8 glasses of water or more a day. And Jell-O the low calorie kind is a clear liquid. Other clear liquids are beef and chicken broth, apple and grape juice, nonfat milk, and cranberry juice.

FOR SMOKERS:

Dr. Joya also wants you to do Balloon exercises if you are a smoker :

Just blow up 40 balloons for each day during the two week preop diet period. (the small party balloons that are hard to blow up). Discard each one after you inflate it.

The diet will reduce the risk of complications during your surgery and will reduce the size of your liver. The balloons will strengthen your lungs for surgery. Both are very important to do preop.

NOTE: IF YOU ARE A SMOKER: YOU MUST ALSO DO THE FOLLOWING:

Quit Smoking Immediately and Do the above mentioned Balloon exercises.

After your weight los surgery in Puerto Vallarta Dr. Joya will place you on a 2 week liquid diet and then graduate you onto a puree/baby food type diet for one or more additional weeks. The longer you stay on liquids the more weight you will lose.

A few key things Dr. Joya wants you to remember:
• When you start your Puree diet, you may boil meat and/or chicken and vegetables and potatoes and then place them in a blender or food processor. This can be done for a variety of food and season to taste.
• Once you start solid food you should be aware of a few important things to remember: 1) Use smaller plates and dinnerware so that you do not need to fill up your plate. 2) Cook less food. 3) When you go out to dinner try to share a meal with a companion and order your own salad or soup. 4) If you pack leftovers for work, use smaller containers (1 cup of food at the most)
•“Bread” is very problematic down the road. Immediately after surgery, you may not have any problems with bread, however after your first or second fill, watch out. Bread slowly is eliminated from your diet as it causes great pain and tastes so good. Also fresh baked breads may cause indigestion, so start by eating crackers , pita bread, and Mexican tortillas.
• The most common “problem” meats include any type of Red Meat including: beef, lamb, lamb chops, many types of roasts, chunky beef, any type of over cooked tough meat including chicken. Mostly the problem exists with red meat, but dry chicken is very dangerous. Fish rarely causes any problems. If you need red meat, cut it into very tiny bites and chew it about 30 times. Once the meat gets stuck in the band, prepare yourself for a moment or two of pure pain that shoots through your abdomen area. The pain may last for a few minutes or even a few hours until the piece of food passes the band.
• Rice is very dangerous and should be avoided at all costs especially if it is sticky white rice. Some people tolerate fried rice better than others, and some don’t tolerate any rice. Whatever you do, if you need rice, please make sure it is coated in a gravy and you chew it really carefully. Take very small bites of rice, as a mouthful of rice will cause pain for hours on end if it gets stuck in the band.
• Skin on fruit may also get stuck in the band, we always recommend that you peel your fruit before eating it.
• Raw carrots and potato skins may as well cause problems.
• You may want to overcook your pasta as well as a very soft noodle may cause you great pain as it passes through the band. It also may cause indigestion.

Post Surgery Diet designed by Dr. Joya

LIQUID DIET UNTIL DAY 14 POST SURGERY…
For the first two weeks post surgery you will be on a liquid diet.

WEEK 1 DAY 1 POST OP TO DAY 7 - CLEAR LIQUIDS
• Clear liquids are any liquid you can see through, non carbonated beverages, basically water, tea, coffee, clear fruit juice and Jell-O. Note: Carbonation will cause gas and discomfort.
• Drink slowly. This is very important. If you drink to fast, you will feel like vomiting and you will feel pain in your stomach area. Take small sips and gradually increase them as the days go on. Drink A LOT of water.
• When in the hospital, do not feel that you need to drink everything sent on your tray at once. Drink everything slowly, pace yourself and take your time.
• When you get home, your body will need the nutrients from what you drink to heal itself. You need fluids which give you energy, protein, vitamins, and minerals. NOTE: The liquids must be able to pass through a straw to be considered liquid.

WEEK 2 DAY 7-14 – FULL LIQUIDS

NOTE: The liquids must be able to pass through a straw to be considered liquid.
PLEASE try to stay away from Protein Drinks. If you feel that you do need Protein drinks, we recommend Revival Soy, you may order this online at http://www.revivalsoy.com

• When you are drinking liquids in the 7-14 days post surgery, try to drink slowly. Also drink plenty of water. You may also add into the mix, liquid yogurt, fruit juice, thin and smooth vegetable juice like V-8, chicken and beef broth, more water, and more water. We can not stress how important it is to stay fully hydrated.
• Also every day try to drink a small amount of apple, prune or pear juice to help prevent constipation.
• By the end of Week 2 before the 14 day mark, you should no longer be vomiting, regurgitating or feeling discomfort when you drink liquids. If you are still experiencing these symptoms contact us immediately or contact your post care doctor.

COMMON QUESTIONS RELATED TO THE LIQUID PHASE:
Why do I have Diarrhea?
• You may be experiencing Diarrhea because you are only drinking liquids and no solid foods. Your diarrhea should stop as you move to the solid food phase.
Why am I thirsty?
• You are not drinking enough water, you should carry a bottle of water with you at all times, and sip from it at will. When it is empty fill it up and do it again. Drink slowly, but drink often so long as you are not in any discomfort.
Why am I hungry?
• If you are hungry, it is because you are not drinking enough liquids that fill you up. Try liquid Yogurt, and milk. If you are still hungry ask yourself if your mind is playing games with you or are you really hungry. There is always a difference.
• Hunger also means that the liquids are passing through the band quite easily, and you may be ready to advance to the puree diet that starts at day 15
Why am I tired and how do I get more energy?
• Water is the key to life, and you may be lacking water. Try drinking more water! Also the anesthesia at times makes people feel tired as well.
Why is my shoulder hurting after my surgery?
• The gas used during the surgery to inflate your stomach at times causes this pain in your shoulder. It should go away in a few days post surgery, but if it lingers we recommend contacting us or your after care doctor.
PLEASE NOTE: We recommend that you contact a dietician near you to help establish a diet you can use after you have the band placed. We recommend showing the dietician these diet recommendations so that they may prepare a diet to help you lose the maximum amount of weight using the band as your tool.

DAY 15 UNTIL DAY 21 – PUREED FOODS

• The Key to making Puree food great is all in the seasoning. If you prefer, you may always open a jar of baby food, but sometimes it is just better to make it yourself. Please see your food processor instruction and menu ideas for puree food ideas. Also remember that mashed potatoes are a viable food source in this week. And do not forget to drink a lot of water!

Tips:
• Use a small bowl for your puree food. (preferably one that holds about ½ cup of food.
• Use this bowl to serve yourself all your food for this week.
• Eat slowly, try to eat your food over 20 minutes.
• Eat up to six times a day, preferably 3-6 times a day, eating half cup portions each time.
• Drink a small glass of lowfat or nonfat milk, plus 1 cup of low fat yogurt each day. This will give you protein.
Here are some food ideas:
*Blended Fruit and water
*Blended fruit and milk
*Lowfat or non fat yogurt
*Breakfast cereal (soggy)
*Blended Healthy Choice or Stouffer Dinners
*Baby Food
*Low fat Jell-O Pudding
*Blended Meat and vegetables
*Mashed Potatoes
Menu Ideas for the Puree stage:
Breakfast: Mix ½ cup of yogurt, 1 glass of milk and 1 egg in a blender with your favorite fruit. This makes a great beverage that is filling and enjoyable.
Snack: Drink 1 glass of water, and blend juice and/or fruit with water and ice into a frothy beverage.
Lunch: ½ cup of boiled and blended chicken and vegetables with a small serving of apple sauce.
Snack: ½ cup of yogurt and blended fruit.
Dinner: ½ cup of boiled beef, and potatoes, blended, and served with a small serving of mashed potatoes.
Late Night Snack (if necessary): ½ cup of apple sauce.
ALWAYS: Keep drinking water, and vegetable juices with pulp, this gives you fiber. Also take a vitamin supplement if possible.
You may add additional Fiber to your diet.
• NO LONGER drink protein shakes, you will get enough protein from eggs and other sources of protein in your diet.
• NOTE: If you vomit or regurgitate your food, you are simply eating too much, cut back, and slow down in your consumption.
• ALSO, if you are really still hungry between meals and snacks you may add more yogurt (up to 1 cup, no more) to your shakes.
• PLEASE DRINK a lot of water, before your meal, and try not to drink any liquids for 30 minutes after your meal to prevent flushing the food through the band.

DAY 22 FOR LIFE – also known as the REAL food stage.

This is the start of your new life

Protein

8 ounces of skim milk
1 medium egg
1 ounce sliced cheese
1/4 cup creamed cottage cheese
1 ounce lean meat or fish
1/2 cup low-fat plain yogurt
1/4 cup strained baby food meat
1/4 cup low-calorie custard
1/4 cup vegetables
1/4 cup cereal
1/4 slice toast
1/4 cup potato
1/4 cup fruit