Gastric Banding–Post Surgery Information

by Christine on April 13th, 2010

filed under Gastric Banding Surgery, General Information

This blog post is a continuation of the last three gastric-banding surgery posts that I have written. Please read from the original posting first and then move on to this one in order to view them in chronological order! This posting describes the post-surgery information, like “how does the band work” and what to expect with your fills.

Post-Surgery Information

What does the gastric band do?
It’s best to visualize the band in order to understand it:

Gastric Band

In this photo, you can see that the band is placed at the top part of the stomach. There is a hose attached to the band, and at the end of the hose is the port site.

The band is a flexible plastic material. The inside of the band is, for lack of a better description, kind of like a balloon. When they first put the band on, it’s very loose. (The “balloon” is deflated.) As they put liquid in your band, the “balloon” slowly inflates, making the opening between upper-stomach and lower-stomach much smaller. This happens gradually, over the course of several appointments with your doctor.

The hose just joins the band to the port site, and there’s really not much more interesting to add about it.

Apparently the placement of the port varies from person-to-person. My ex-boss had his port side right below his sternum. My port site is adjacent to my belly button, just to the right of it. Mine is attached to my abdomen.

When you’re overweight, you will have to press pretty hard to feel the port site. As you lose weight, it is easier to feel through your skin. I’ve heard stories of people being able to see it bulge through the skin (in fact, I can kind of see mine, too, these days!), but you’d have to lose a lot of weight for that to happen.

The port site has an opening on one end of it. (That opening is just BELOW the skin.) To access the opening, the doctor takes a big, scary needle and pokes it through your skin to access the port. Sometimes the doctor will miss, and the needle will stab into your abdomen, and that hurts. BUT — when they don’t miss and are accurate, it’s surprising how much the needle doesn’t hurt. I flinch from anticipation, but it does NOT hurt. I shut my eyes because it’s scarier to watch than to feel!

They inject a harmless solution of saline into the band. If they miss the injection or if the band leaks, the saline doesn’t hurt your insides at all. It’s harmless.

So How Does it Work?
Again, a photo will explain this well:

When you eat, the food passes down your throat and into your UPPER stomach. There it sits until it passes through the small band opening. The digestion process doesn’t happen until the food reaches the LOWER stomach.

Now, you must chew your food up nice and small! If you don’t, the food will get stuck and will not be able to pass through the small opening. When that happens, you will need to vomit all the food up and start over. Yes, this sounds bulimic, but it’s completely common with gastric band patients. The food it physically stuck.

If you eat too fast, the food will get stuck in the upper stomach, which will fill up too fast. You will literally overflow, and probably need to puke some up so it’s not so uncomfortable.

That’s all the band does. Your body will still digest food the same way it always did. You will digest the same amount of calories per food item. You can still eat the same foods that you did before, probably, except that you will just need to chew a lot more. However, because food often gets stuck when you eat chunky things like steak and chicken, you will probably just opt to eat soft items (applesauce, soup, etc) just because it goes down easier.

The small opening in the band means that you eat less. You eat slower, too, which makes you feel satiated for longer.

It is very important that you follow the strict dietary guidelines following your surgery. Although it’s hard to be on a liquid-only diet for so long (ESPECIALLY after being on the vile medifast shakes!) they do this because your stomach and your band is healing. Your band needs to settle in and you need to get it tightened. You risk having it slide around on you if you eat too much! Then you have to go in for more surgery, and it gets very complicated.

The first 3-4 days you will be required to follow a clear liquid diet. That means water, water, and oh yeah, more water!

You cannot have any caffeine for at least three months after surgery. You shouldn’t have been drinking caffeine during the Medifast period, so you shouldn’t be tweaking on caffeine withdrawal….you should have gone through that already. Carbonated beverages can cause gas and bloating and increase stomach size. They are not recommended for any banded patients pretty much ever again. Assume (and try hard) to avoid this forever.

The next food phase is 5-6 weeks of a modified full liquid diet. This involves adding some diluted juice, drinking protein shakes, having pureed soup, applesauce, baby food, jello. I had tuna fish as well, and that worked out well. (I just made sure I mashed it up really well and smoothed it out with some mayo.) You can have other foods so long as you blend it up and puree it really well.

Part of the reason why they want you to do this long pureed food phase is because when you start eating real food, you ARE going to get food stuck and you ARE going to puke. The effort it takes to puke the food back up may cause the band to slip until you have received a few fills and the band fits tighter around your stomach.

Regular diet
After 6 weeks you can slowly start adding “real” food to your diet. You take this at your own pace, according to what works for you. As stated above, you ARE going to end up not chewing well enough or eat something that does not agree with you and you ARE going to puke. This is normal, so don’t freak out. Just remember to chew thoroughly and eat mushy foods at least at first.

You should be okay with eating lots of protein, vegetables, salads, etc. You are most likely going to have problems with bread, potatoes, and rice getting “stucK” and causing you to puke. Even a year later I really can’t eat bread at all because it nearly always gets stuck.

You will notice a huge difference in how much (quantity) food you can eat. It’s not unusual to become full after 4 or 5 bites of food. (Yes, 4 or 5 bites!) That happened to me, and I’d discover that I would be hungry again an hour later. That’s fine — grazing on small meals throughout the day is healthy!

Because you are eating so much less food than before, be sure to watch how much protein you are eating. If you are lacking in protein, go ahead an have a protein shake for breakfast. This will keep you full longer, spur on your metabolism for weight loss, build healthy muscles and bones, and other healthy stuff. You should also take a multi-vitamin every day. However be careful! Multi-vitamins are usually in big horse pills, and they WILL get stuck in your new band. Find smaller capsules or even flinstone chewables.

Foods that are typically not processed well by band patients:
(This completely varies from patient to patient. For instance, I’m fine with eating steak but many people cannot eat it at all. It also depends on how you prepare it and how well you chew. But this is a general guideline.)

* Bread, potatoes, rice
* Meats that are especially tough such as steak and pork chops. Some band patients have difficulty digesting other meats that contain gristle such as hamburger.
* Oranges and grapefruits may not be tolerated unless the membrane is removed before eating.
* The seeds and/or skins of all fruits and vegetables.
* High fiber vegetables such as celery and sweet potatoes.
* Spicy foods.
* Fried foods.
* Certain spices including cinnamon, pepper, or onion or garlic salt.
* If you are unable to tolerate milk, it’s important to add other calcium and protein rich foods such as cottage cheese. Dry milk can be added to foods for added protein.
* Asparagus
* Pineapple
* Rhubarb
* Corn (especially popcorn)
* Grapes (I think it’s the skin and seeds that cause the problem.)
* Carbonated beverages
* High calorie foods/drinks

When will I start to see weight loss happen?
For the first couple of weeks after surgery you are probably not going to see any weight loss. Firstly, your body is filled with after-surgery liquids and gasses, so it’s going to retain some water. Secondly, you’re going to be on a starvation-level diet for a few weeks, so your body isn’t going to let go of its fat without a fight. Thirdly, it’s going to be several weeks before you feel comfortable doing any kind of exercise, so your metabolism is going to slow down a bit.

Again, each individual is totally different. Their weight loss depends on how fast they recooperate after surgery, how receptive the body is to weight loss, speed of metabolism, etc. For me, I didn’t see any weight start to come off for approximately 2-3 months. This was VERY frustrating for me. I thought to myself, I went through all this surgery for nothing! My advice is to stick with it and see your doctor regularly. The weight WILL start to come off. After all, it’s in your doctor’s best interest to see you succeed because your statistics become part of his or her success rate as a surgeon. They will help you!

OMG the gas!
Okay, seriously. My doctor told me, “You’re probably going to experience some gas” but jimminy christmas, they didn’t tell me that I’d be producing enough gas to blow up a small planet!

You are going to fart. A lot. Small farts, usually not smelly. But seriously, maybe 500 times a day. Nonstop, all day long. It’s embarrassing and awkward. If it’s horrible, plan on spending a few weeks at home and away from social situations. Ask your boss to stay at your desk and away from client contact. And know this:

1.) It’s totally normal!
2.) It DOES go away and get better. I don’t think it really started to get better for me for 3-6 months.

I think you’re gassy because your body is processing your food slower than usual. You may be gulping in air between bites. Also, your food choices are probably changing as well. For instance, I have beans in my food nearly every day now. As we all know, beans = gas!

OMG the heart burn!
Immediately after surgery, your doctor probably handed you a prescription for nexxium or another antacid. You’ll probably think to yourself, “Gee, what’s this for? I don’t even have heart burn!”

Oh, but you will!!! I don’t think mine set in until I was in the solid-food-eating-stage of the diet, but when it did, ugh! My heartburn is pretty mild and it’s annoying more than anything. I’ve read other stories from people who have really horrible heartburn. When the acid starts to annoy your stomach, it’s important to treat that right away. If you don’t, the acid will start to irritate your stomach lining, and you’ll be at risk for eroding your plastic band THROUGH your stomach. So take your heart burn meds like a good little patient and be happy about it.

What about exercise?
It took me a few weeks to feel human enough to even walk. The doctors recommend that after surgery you walk around a bit. If your stomach is still sore from the surgery, avoid heavy lifting, situps, etc. Once you start to heal, you’ll feel better. Once you lose weight, you’ll feel even BETTER! Amp up your exercise little by little as you are feeling good. I was jogging, doing situps, and doing all forms of vigorous exercise within about 3 months of surgery. My advice is to play this by ear and do as much as you can without hurting yourself.

So what are the fills like?
I was really really nervous about the fills. I was more nervous about the gigantic needle than I was nervous about the surgery! Honestly, it is NOT THAT BAD.

You will want to see your doctor once every two weeks for follow-up appointments. During this time they will fill your band with a saline solution and make your stomach opening smaller. To do this, they stick a needle through your skin at your port site, which on me is near my belly button. You may not get a fill EVERY time, and that’s okay.

My band is a 10cc band. That means that it can hold 10ccs worth of liquid. The first time I got a fill, I got 3ccs. The second time they gave me 2 ccs. The third time they gave me 1 cc. After that the amount got smaller and smaller. I think I “maxed out” around 7 ccs. By “max out” I mean that I am able to eat food without the hole/opening being so small I need to puke everything up *AND* I’m still able to lose weight. It’s the happy medium. This happy medium is different for everyone, and your doctor will work with you to find where your sweet spot it.

Now, this was the ONE complication that I had following surgery. I had approximately four appointments after surgery when I met with the doctor’s assistant. Bless her heart, she was very nice, but after each fill I wouldn’t notice any discernible change. I would come in for my next appointment not having lost any weight and finding no difference in what I could eat, etc.

Finally my lack of weight loss for 3 months had the nurse concerned, so she made me see the surgeon again. He inserted the needle into my port site and went to suck OUT all the saline just to see how much was in the band. NONE! Apparently the assistant was injecting the saline into my flab, NOT into the port site. She was missing entirely. From that point I demanded to see the surgeon for every fill afterwards.

Boy, what a different experience! The doctor filled me up with saline and instantly I could tell a difference. After a fill, I would eat only tomato soup or pureed food. (Your stomach gets irritated by the squeezing of the band. The inflamation causes the opening to be even smaller than when it heals. The inflamation also causes heart burn.) This should only last for about 2-3 days, then the inflamation goes down and you should eat proper solid foods again. My doctor always gives me a drink of water just to make sure that the opening isn’t so small that you can’t swallow ANYTHING.

The first time I got a fill, I asked for a numbing solution. This is kind of like novacaine that makes the big, huge needle hurt less. Theoretically. They use a needle to inject the numbing solution, and to be honest I found that that hurt MORE than the giant needle! (Don’t know why, that’s just me.) It honestly doesn’t hurt too much to get an injection. The worst part is when the doctor’s aim sucks and he misses and jabs you in the abs instead. That is uncomfortable, but it shouldn’t even hurt as much as a bad feminine cramp day or a migraine.

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  • Osama

    thank you so much for sharing !!!!

  • Osama

    thank you so much for sharing !!!!

  • Chalene

    Cool stuff. My mom will enjoy this read

  • Chalene

    Cool stuff. My mom will enjoy this read

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  • Vernice Ranaudo

    It is a very serious surgery, I would not recommend it unless every other way can’t go through.

  • Vernice Ranaudo

    It is a very serious surgery, I would not recommend it unless every other way can’t go through.

  • Guest

    It’s not as bad as you make it out to be. Maybe times have changed but my doctor’s post-op diet was as follows:
    – 3-4 days clear liquids, inluding apple/cranberry/grape juice, protein shake made with water, broth
    – 10 days of full liquids, cream type soups, milk, smooties, pureed soups, coffee
    – 1 week mushies
    – 1 week soft foods moving into regular food by the end of the week. 

  • lea-ann bal

    thanks for sharing info with us had my band ten days ago i was only on liquids for three days then purreed for 2 weeks   and one week of mash and put 4mil in band when he did my    surgery.