Casco Bay Surgery

Laparoscopic Adjustable Gastric Band (Lap-Band) Placement
Post-Operative Instructions

Pre-Admission Appointment

Hospital: Maine Medical Center – Brighton Campus (not the main hospital)

Report to: Pre-Admission Testing    

Date:                                              Time:

Surgery Appointment

** Don't eat or drink after midnight before surgery (except to take your usual medication). **

Hospital: Maine Medical Center – Bramhall Campus (the main hospital)

Report to: ASU                                Date:

Arrival Time:                                    Surgery Time:

 ** Surgery date is tentative until insurance approves. We will submit to the insurance company. **

The Pre-Admission Unit (PAU) is located at the Brighton Campus of Medical Center. At this appointment you will meet a member of the anesthesia team who will talk to you about general anesthesia and assess your risks of undergoing anesthesia. You may have an EKG and blood work at this appointment.

The anesthesiologist will also review with you which medications you should take the night before surgery and which ones you should take with a sip of water the morning of surgery. This is very important. If you have any questions about this, ask them to write down your instructions for you.

If you take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Advil, Aleve, Motrin, Naprosyn or Celebrex, you should discontinue those 10-14 days before surgery. They can cause bleeding. If this creates a problem for you or you have any questions about it, please call the Bariatric Surgery Center.

If you are a former smoker who quit in order to enter the Bariatric program, a nicotine level will be checked.

You will also be weighed. If you have gained weight since your last visit to the MMC Bariatric Surgery Center, your surgery may be delayed.

Description of the Operation

We will be doing a laparoscopic adjustable gastric band (Lap-Band) placement for you. The operation involves creating a small tunnel behind the upper part of your stomach and wrapping the band around through it. The band is then locked securely in a ring around the upper stomach, almost like a wrist-watch. Prepare to stay overnight, but you might be able to go home the same day as your operation.

The Lap-Band is usually left empty or only partially filled for the first 4-6 weeks after surgery but often affects appetite and ability to eat anyway. The Lap-Band is a tool to help you achieve sustained weight loss by limiting how much you can eat, reducing your appetite, and slowing digestion.

Your Recovery

Because of the way your operation will be performed (laparoscopy), we'll put little or no restrictions on your physical activity after the operation. Your level of discomfort should prevent you from over-exerting yourself. As long as you don't lift or strain beyond the point where it hurts, you should be fine. Your pain will most likely fade rapidly, so you should be able to return to work or normal activities within a few weeks, depending on the activities. You may resume showering and are encouraged to walk the day after surgery. Simply let the pieces of tape (or glue) I use to close your skin fall off on their own.

Pain Relief (after discharge from the hospital)

1. Take Extra Strength Tylenol (or generic acetaminophen) 1000mg as needed to control discomfort.

2. Take 1-2 oxycodone 5mg tablets every 3 hours as needed for discomfort that remains after taking Tylenol. This is a narcotic painkiller. If you use it you must beware of becoming drowsy or inattentive, and you will not be able to drive or operate dangerous equipment. It can also cause nausea and constipation. If you can't take oxycodone (the ingredient for Percocet and Tylox) we'll substitute a different painkiller.

3. Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). These medications can be too harsh for your esophagus and gastric (stomach) pouch during the first month.

Other Medications

1. Take one chewable Centrum multivitamin daily.

2. Take Prevacid 30mg once a day for the first month to decrease stomach acid production. If you were taking an acid-suppression medication (for example Zantac, Prilosec) before surgery you may use that instead.

3. Resume all other usual medications unless we instruct you otherwise. Be aware that diabetes medications can sometimes be cut back or discontinued soon after surgery. If you have diabetes, monitor your blood sugar closely and contact your primary doctor or us if you have questions about dosing.

Diet & Fluids

This is the most important part of your first month recovery. It is essential that you adhere strictly to the written first month blended diet. You should already have a separate copy of the dietary handbook. If not, contact the Bariatric Surgery Center (207-396-5688) to get another copy. During the first month the stitches around your Lap-Band must be protected from over-stretching and violent vomiting (occasional vomiting is almost unavoidable). You must also take in enough liquids to prevent dehydration and enough protein to prevent dangerous malnutrition. Dehydration can cause nausea, fatigue, lightheadedness and dark urine. Before you go home you should be given a Bariatric Surgery Center water bottle. By filling this 5 times a day with any type of liquid and drinking it, you will get your required daily fluid amount of 8 cups (64 oz.). Our dietitians are available to assist you during weekdays through the Bariatric Surgery Center.

Most Frequent Problems

Discomfort - Abdominal soreness above your belly button is the most common immediate problem after waking up and can last for a couple of weeks. Despite this, the most important thing you can do for yourself in the hospital and at home is to get out of bed and take short walks. This helps keep your lungs expanded to avoid fevers and pneumonia and keeps the blood moving in your legs to prevent dangerous blood clots.

Dehydration – If you don’t drink enough you will be become dehydrated. You might then feel nauseated, fatigued, and lightheaded (especially when standing up) and urinate less often & smaller amounts and have darker urine than normal. To correct this problem, drink more often. Don’t hesitate to call us at the Bariatric Surgery Center for advice.

Wound drainage & infection – It is not unusual for an incision to drain bloody fluid after you go home. This is usually not dangerous because it is almost always fluid that collected under your skin right after surgery and is not new bleeding. It will stop draining after all the fluid comes out, usually within a few days. Infections are uncommon and rarely serious after a laparoscopic operation. The incision most likely to cause trouble is the bigger one above your belly button (where the port is). An infection will be red, warm, firm, and tender. The infected fluid will look more like pus than like blood. An infection around the port can be serious and must be seen by us immediately at the Bariatric Surgery Center.

Reasons to Call the Bariatric Surgery Center or Your Surgeon (Casco Bay Surgery)

1. Pain not controlled by your medication.
2. Persistent vomiting or dry heaves.
3. Fever and wound redness or persistent leakage from an incision.
4. Unusual or one-sided leg swelling, particularly if painful or tender (might be a blood clot).
5. Sudden shortness of breath that doesn't improve with 5-10 minutes of rest (might be a leak or blood clot).
6. Any questions or concerns what so ever.

If you call us during the first few weeks after surgery be ready to tell us your heart rate. If you don’t remember how to measure it then be ready to feel and count your own pulse for us on the phone.

Follow-Up Appointment

We need to see you in the Bariatric Surgery Center 4-6 weeks after your hospital discharge. Please call to confirm your appointment or to arrange one if you don't have a date and time yet.

The Bariatric Surgery Center
12 Andover Road
Portland, Maine 04102
(207)-761-5612
Toll-Free: (866)-268-9274
Fax: (207)-253-6073

Last updated 5/7/07