Your motivation is the key
We will ensure that you understand the problems your excess weight is causing. You have the most important role to play. Your responsibilities will include new eating patterns and a new lifestyle.

If you are ready to take an active part in reducing your weight, the LAP-BAND may be an ideal treatment option for you. It is important that you know about the advantages, disadvantages, and risks involved.

The LAP-BAND System may be right for you if :

• You are between 18 and 60 years old.
• 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 do not drink alcohol in excess.

The LAP-BAND System is not right for you if :

• You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers or esophagitis.
• You have severe heart or lung disease that makes you a poor candidate for surgery.
• You have serious or untreated psychological problems.
• You have a problem that could cause bleeding in the oesophagus or stomach. That might include oesophageal or gastric varices (a dilated vein).
• You are pregnant. If you become pregnant after the LAP-BAND System has been placed, the band may need to be deflated or removed.
• You or someone in you family has an autoimmune connective tissue disease. That might be a disease such as systemic lupus erythematosus or scleroderma.

You should remember that the LAP-BAND System by itself will not solve the problem of severe obesity. The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits.

The LAP-BAND System has the following advantages :

1. The LAP-BAND is adjustable.
   Normally, you do not need more surgery to adjust the size of the opening between the upper and lower stomach. Adjusting the amount of fluid in the band may be a regular part of follow-up for this procedure. It is a feature that may become more important as you lose weight. With the LAP-BAND System, the amount of food you can eat at one time can often be changed with a simple inflation or deflation of the band via the access port.
   
   
2. The LAP-BAND is reversible.
   It is anticipated that the LAP-BAND would never need to be removed. Only if there is a problem with the band would removal be necessary. Removing the LAP-BAND will restore your stomach to its original form and function and it is likely you would begin to gain weight.
   
   
3. The procedure can usually be performed on an outpatient basis.
   Patients normally leave the hospital or clinic the same day as their surgery. If a large incision is required or if you have other significant medical problems, admission to hospital may be required. After the procedure, patients usually get back to their normal activities in a week or two. It may take four weeks or more if the procedure is not done laparoscopically or if there are complications.
   
   
4. There is no stapling of the stomach
   The LAP-BAND does not involve stapling or diversion of the gastrointestinal tract. Gastric banding is less invasive and easier to adjust or reverse. Operations which rely on stapling have a higher rate of complication due to problems with potential poor healing of the stapled area.
   
   
5. LAP-BAND does not rely on malabsorption
   Most other weight loss surgical procedures (such as gastric bypass) achieve results with a combination of restriction of the stomach plus malabsorption. Long-term follow-up of patients who have had malabsorption procedures show complications such as liver cirrhosis and osteoporosis that may not be reversible. The only supplement necessary for LAP-BAND patients is a chewable multivitamin.

"The advantage of LAP-BAND is that it goes around the outside of the stomach, and the procedure can be reversed. I wouldn't have other surgeries. Having my stomach stapled is so final. Obviously, the LAP-BAND is also 'final', because you have to 'wear' it for the rest of your life. But it's good to know you can have it removed if there is a problem. With the LAP-BAND method, your new small stomach won't let you eat much. This means you can lose a lot of weight in a short time. It also means the weight loss is long lasting. With a diet, you always put the weight back on or even put on more. I've won the battle with my body and my mind. I'm going to make sure it stays that way." (LAP-BAND patient)

1. The Gastric Bypass
The Gastric Bypass is both a restrictive and a malabsorptive procedure. With this surgery, most of the stomach and part of the intestines are bypassed. With the Gastric Bypass, the stomach is stapled to make a smaller pouch. Then a part of the intestines is attached (usually stapled) to the small stomach pouch. The result is that you cannot eat as much and you absorb less nutrients and calories from your food. This is the most commonly performed weight loss surgical procedure in the United States. The associated risk of death may be as high as 1%. We do not perform this procedure at the Surgical Weight Loss Centre due to the relatively high risk of complications. The lack of adjustability and reversibility are limits of the procedure. There are significant long term health consequences of malabsorption.

2. Vertical Banded Gastroplasty (VBG)
The VBG is a restrictive surgery. The surgeon uses staples to make a small stomach pouch. This reduces how much food your stomach can hold. When the amount of food the stomach can hold is reduced, you feel full sooner. But at the same time, the stomach digests nutrients and calories in a normal way. This operation requires a major operation to reverse and is not adjustable. This operation has historically failed to maintain adequate weight loss and is rarely performed.

3. LAP-BAND Adjustable Gastric Banding
This procedure restricts how much the stomach can hold by placing an adjustable band around the upper part of the stomach. 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 gastric bypass, the LAP-BAND can be adjusted to suit your situation, and can be removed if necessary. Adjusting the volume of liquid in the band is a simple office procedure and is done with a needle puncture through the skin to the reservoir in the abdominal wall.

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. It is both successful and comfortable because it does not leave the patient feeling constantly. Laparoscopic adjustable gastric banding can be performed as an outpatient, thus reducing the need and potential complications of a hospital stay. The minimally invasive nature of the procedure means that the recovery from surgery is much more rapid that with other weight reduction surgical procedures.

The weight loss associated with the LAP-BAND is generally not as rapid as with the other procedures, but tends to be more steady and sustained. Rapid weight loss is associated with its own set of risks and potential complications. Removal of the LAP-BAND and reversal of the procedure is possible if necessary or desired. When the device is removed the stomach returns to normal shape and function.

All surgical procedures have risks. When you decide on a procedure, you should know what the risks are. Your surgeon will speak with you in detail and provide information about the risks and complications that might arise.

What are the general risks?
Using the LAP-BAND System includes the same risks that come with all major surgery. There are also added risks in any operation for patients who are seriously overweight. There is a risk of gastric perforation (a tear in the stomach wall) during or after the procedure that might lead to the need for another surgery. In the U.S. clinical study this happened in 1% of the patients. Certain diseases such as heart, liver or kidney disease, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You should know that death is one of the risks. Death can occur despite all the precautions that are taken. In the United States there have been six deaths in over 50,000 LAP-BAND procedures. Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), pancreatitis (inflammation of the pancreas), abdominal pain, incisional hernia, infection, dehydration, diarrhea (frequent semi-solid bowel movements), constipation, dysphagia (obstruction of passage of food through the bottom of the esophagus), fever, chest pain, incision pain, contact dermatitis (rash), band system leak, gall stones, port displacement, port site pain, spleen injury, and wound infection.

What are the specific risks and complications?
Published results show that LAP-BAND surgery has fewer risks than any other surgical treatment for obesity. Most complications are not serious but some may require hospitalization and/or re-operation. The specific complications listed below will be reviewed with all patients prior to surgery. The specific complications are :

• Rare
  • band slippage - 1 to 2% of patients
  • band erosion - early or late - 0.5% of patients
• Very Rare
  • leakage of the balloon on the band
  • leakage of the reservoir
  • spleen or liver damage (sometimes requiring spleen removal)
  • damage to major blood vessels
  • perforation of the stomach or oesophagus during surgery

Laparoscopic surgery is not always possible. We may need to switch to an "open" method due to some of the reasons mentioned above. This happened in about 5% of the cases in the U.S. Clinical Study. Obstruction of the band can be caused by food, swelling, band slippage or the band being over inflated. Some complications may require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. The weight loss with LAP-BAND surgery is usually gradual and controlled. Rapid weight loss may lead to symptoms of malnutrition and you can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder. It is possible you may not lose much weight or any weight at all.

If any complications occur, you may need to be admitted to the hospital or return to the hospital later.

Laparoscopic Adjustable Gastric Banding is not an insured service of The Taj Medical Group. We offer a comprehensive program that includes pre-operative consultation, surgery, the Lap-Band implant, and all post-operative care. Post-operative follow-up is critical to the success of the procedure and the fee includes all visits and telephone follow-up for one year after surgery.

The all-inclusive cost for Lap Band surgery at The Taj Medical Group Hospital in India is 5,800 GBP. Any office visits that are necessary after the first year are 100 GBP per visit. All fees are not subject to GST or other taxes. It is classified as a medical expense and can be claimed on the federal income tax return as such. These costs will be explained prior to the surgery.

The cost of Lap Band surgery should be compared with the cost of many commercial weight loss programs that charge 100 GBP per week or more (5,000 GBP per year). The failure to obtain and maintain meaningful weight loss with these non-surgical methods translates into a disappointing expense without long term results.

Patients may choose to finance their weight loss surgery. At The Taj Medical Group we offer several different financing plans for our patients benefit. These are arranged through major lending institutions that specialize in financing for medical and cosmetic procedures. The process is completely confidential. The applications forms are available at our office. We can then forward the completed application to the company for approval or the patient may do so themselves. The cost of fully financing the 5,800 cost over three years is approximately 170 GPB per month.

Most patients are approved for financing. Approvals are usually received by the same day or within 24 hours. The interest rates are competitive with most major credit cards and are clearly outlined during the application process. Repayment is extremely flexible and is always totally open so that total repayment can be made at any time without penalty.