Converting from Lap-Band to Gastric Sleeve

Have you considered converting from the Lap-Band to a Gastric Sleeve? For some the Lap-Band isn’t the right tool for weight loss. They have tried to make it work, but it just didn’t work. No need to feel guilty about it.

It Isn’t You
First, no guilt. For some the band simply didn’t work well or it worked for a while, and now it isn’t working as well as it did before.

For others, this is a second chance. The band may not have been the right tool.

Some may be tired of food getting stuck, not being able to eat some foods that are healthy, but get stuck (vegetables, chicken, eggs).

For some the band worked well, then it slipped a bit and ever since then you have not been able to get back to that great “sweet spot.”

Commit to This
US Food Consumption

When you look at what the US consumes as a nation, it is a lot of processed foods. Most of my patients when we look we find that this is a key to too much weight. No matter what weight loss surgery you have, or revision you have. You do need to commit to changing what and how you eat. So what should that be? There are nine foods that have been identified as important, some you need less of (less dairy, less meat) and some you need more of (more vegetables, more legumes).  We will give you the score sheet and recipes for this – but this is the lifestyle you should commit to.

What Is A Gastric Sleeve (Laparoscopic Vertical Sleeve Gastrectomy)?
gastric sleeve

It is called a “sleeve” because when we remove the outer portion of the stomach it looks like a sleeve. That outer portion of the stomach is called the “fundus” and is responsible for producing a lot of acid as well as a fair bit of appetite hormone.

Removing a part of the stomach does a couple of things: it decreases the amount of room in the stomach for a meal and it removes a portion of the stomach that is responsible for appetite.

The stomach is completely removed and sent to a pathologist to examine.

How Do You Convert From a Lap-Band to a Sleeve?
The surgery is done laparoscopically through five small incisions – all above the belly button.  One incision is made to remove the port from the Lap-Band.

The operation then goes to remove the Lap-Band and any scar tissue that is underneath the band. Once the band is removed then the stapling begins over a guide to make sure the remaining stomach isn’t too big or too small.

How Much Stomach Do You Remove?
Some say we remove 90% of the stomach, some say 85% – and that is a bit misleading. It isn’t what we remove, it is what is left. For some people there is a lot of stomach and for others there is less.  We leave enough so that the stomach holds about 1/2 a cup.

How Long Does The Surgery Take?
Typically the operation lasts an hour. It can take longer, if there is more scar tissue (adhesions) or shorter. We never know until we get there and there is no way of telling how long a surgery will take.

Do You Stay In The Hospital?
There are a fair number of people who go home the day of surgery.  That depends on a lot of factors, but if after this laparoscopic operation you are up, walking, able to drink liquids, and pain is controlled many want to recover at home instead of the hospital. However, some insurance companies require some to stay overnight in the hospital, and some are more comfortable if they spend a night in the hospital. Some will spend longer in the hospital.

When Can I Go To Work?
Most people go back to work the week following surgery. There are some people who go back to work the next day, and some people who have six weeks of paid sick leave and take all of it. We think taking a week off is reasonable for most sedentary jobs.

The more you walk after surgery, the faster you recover and the faster you heal.

What Are Possible Complications? 
Complications can happen to the healthiest person, with the best of surgeons. But patients and surgeons do their best to avoid complications and often we see it as there are things the patient can do to prevent complications and things the surgeon can do to prevent complications.

Infection is always a risk anytime a surgeon makes an incision. Infection can be anything from needing some ointment to treat to major abscess inside the body that have to be treated with intravenous antibiotics and drains.  Surgeons do a lot of things to prevent infection: we use powerful antibiotics through the IV before surgery starts to make sure your level of antibiotics in the skin are high. We have the nurses clean your skin to lower the risk. We sterilize all our instruments we use on you, and make certain that they are.

What you can do to prevent infection starts before surgery. First, wash yourself daily with an antibacterial soap.  Second, do not shave the skin where we are planning to do surgery. If you suspect you have an infection before surgery, let your surgeon know- it is easier to reschedule a surgery than have it complicated by an infection. Finally, get mobile before surgery. The more you can walk, or move the better you will be.

After surgery the best thing you can do to prevent infection is to walk. Get up as soon as you are recovered and start walking. When you walk you pump more blood and inspire more oxygen that facilitates healing.

Bleeding can happen with any surgery. Bleeding can be as minor as having a bruise by one of the incisions to have internal bleeding needing surgery to correct. What we do to prevent bleeding is careful surgery, but even with very careful surgery and seeing no bleeding when we finish surgery there can always be some vessel that starts to bleed later. What we do to prevent this is the use of sophisticated instruments that not only cut tissue, but use ultrasonic technology to seal blood vessels before cutting them. We always check to make certain there is nothing bleeding before we leave the operating room. What you can do to prevent this is to stop taking aspirin, Motrin, Alleve, and other non-steroidal anti-inflammatory drugs one week before surgery (and for two weeks after). If you take any “blood thinners” (Coumadin, Warfarin, Plavix) we will have special instructions for you to minimize the effect of these on surgery.

Overall, the risk of any infection and any bleeding that would require you to stay longer in the hospital or having some intervention is less than 1%. The risk is real, but it is very small.

Leaking of the staple line means that the staple line breaks down and stomach content leaks, which can cause most patients to stay in the hospital for at least a month. There are three reasons a staple line will leak. One is a faulty staple cartridge. Since these are machine made and have a high degree of engineering this is rare. However, we will test the staple line at the time of surgery to make certain it is holding. We do that with a “leak” test. The second reason is some people don’t heal tissues well – certain diseases, or people on certain drugs. The most common reason is people who eat something or drink fast too soon after surgery. We will give you step by step instructions of what to eat and when

A Good Choice
While the surgical risks of converting are higher than the first time you had surgery (more adhesions) it is still a small risk (in large series this conversion is less risky than joint replacement surgery).

So if the Lap-Band isn’t working for you, consider converting to a Gastric Sleeve. If you want us to help you please email us at or call the office during regular hours 480-500-5080. Office hours are Monday-Friday from 8-12, and 1-4. We close Friday at noon and on most holidays.

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