Also, unlike gastric bypass surgery, which is both restrictive and malabsorptive, the Lap-Band procedure only limits caloric intake without affecting the body’s ability to absorb nutrients. This is particularly important during pregnancy, because patients need to ensure that they take in extra vitamins and minerals to support the growth of the baby in the womb. Later, the Lap-Band can be adjusted back to kick-start weight loss again.

The Lap-Band is also a good option for women who may be in a high-risk category for pregnancy, because the surgery is reversible. Removing the band entirely before trying to have a child can minimizing the chance of health risks related to the gastric band during pregnancy.

Perhaps more importantly, a bariatric procedure, like Lap-Band surgery, can increase the odds of getting pregnant in the first place.

“In many cases, gastric banding surgery can help women who are clinically obese and have experienced fertility problems,” notes Denton Lap-Band surgeon Dr. David Provost. Obesity has been linked to ovulation problems and also to infertility in women who ovulate normally, research shows. In many cases, after a woman loses a significant amount of her excess weight, she is able to conceive more easily.

In a study from late 2006, women who had a body mass index (BMI) of 30 or higher had more trouble conceiving than normal weight or overweight women. The higher the woman’s BMI, the lower her chance of conceiving, researchers found. For example, a woman with a BMI of 35 was 26% less likely to become pregnant, whereas a woman with a BMI over 40 was 43% less likely to get pregnant.

The sudden ability to conceive after dramatic weight loss can sometimes have comical results.

“What some patients think is nausea caused by their Lap-Band turns out to be good old fashioned morning sickness,” says Dr. Provost.

Although there are many advantages to the Lap-Band for pregnancy—from improving the chance of conceiving to allowing for weight gain during pregnancy and increasing the nutrients consumed while breastfeeding—gastric banding surgery is not the right option for everyone. Gastric bypass surgery and the sleeve gastrectomy also offer benefits for women who struggle with obesity and are planning to have a family. To learn more about the risks and benefits of each bariatric procedure and discuss your specific needs, please contact our office or attend one of our upcoming information sessions.

Dr. Provost addresses the pros and cons of gastric bypass surgery in comparison to the Lap-Band procedure to help prospective weight loss surgery patients make an informed decision.

Click here to learn more about gastric bypass surgery.

Click here to learn more about the Lap-Band procedure.

Dr. Provost explains how the Lap-Band works, and the benefits and risks to consider for this procedure.

The Lap-Band is an adjustable laparoscopic gastric band used for the surgical treatment of obesity. The band was approved by the FDA in June 2001, although gastric banding operations have been performed in other parts of the world since 1993. The Lap-Band limits how much food a person can comfortably consume and also decreases hunger. Because the Lap-Band is adjustable, patients can lose weight gradually. Although initial weight loss is 10%-15% less than weight loss following a Roux-en-Y gastric bypass, long-term outcomes are similar between the two procedures. Read the full story

The vertical sleeve gastrectomy (VSG), also known as the sleeve gastrectomy or gastric sleeve, is gaining popularity as a surgical weight loss option for those seeking rapid results. Originally developed as a two-part procedure for patients considered too high-risk for gastric bypass surgery, the gastric sleeve has been modified to a single surgical procedure that can be performed through a laparoscope.

With the gastric sleeve, the stomach is restricted to a very small size through stapling. It is divided vertically and approximately 70%-80% of the stomach is then removed permanently. The remaining portion of the stomach is connected from the esophagus through to the pylorus. This means that, unlike a gastric bypass operation, no part of the intestine is bypassed by the surgery. Instead, the stomach is reduced in size, allowing for weight loss while still keeping the functions of the intestines intact.

The gastric sleeve offers several advantages to patients who are seeking a less drastic option than Roux-en-Y gastric bypass, including:

• fewer drastic changes to your digestion than gastric bypass
• shorter recovery time than most weight loss surgery options
• more rapid weight loss than the Lap-Band procedure
• less expensive procedure than gastric bypass

As with any type of weight loss surgery, the vertical sleeve gastrectomy does have its disadvantages, which patients should consider before choosing it as an option. Possible complications include staple line leaks and strictures. In addition, gastric sleeve surgery is irreversible. The portion of the stomach that is removed is discarded and cannot be reintroduced at a later date.

Data on the long-term durability of the procedure is unclear, as it has only been in practice for about five years. However, for patients seeking a less drastic solution to morbid obesity than gastric bypass and more rapid weight loss than an adjustable gastric band procedure, the vertical sleeve gastrectomy may be a reasonable option. The procedure works well because the placement of the sleeve and the restriction of the patient’s stomach create a feeling of fullness. In addition, because there is no intestinal bypass, the patient’s hormones can still communicate feelings of satiety to the brain. In other words, the gastric sleeve still allows the intestine to do its job, while restricting the volume of the stomach so that weight loss is assured.

If you are uncertain whether the vertical sleeve gastrectomy is the best option for your weight loss needs, consider consulting with Dr. David Provost at Provost Bariatrics. Dr. Provost can make the best recommendation about bariatric surgical procedures after meeting with you and assessing your medical history. Call our office at 888-715-4330 to schedule a free consultation.

Click here to learn more about what you should expect after gastric sleeve surgery.

After weight loss surgery, some patients may experience complications that require revisional surgery. This type of surgery involves going back in and revising a previous weight loss surgical procedure, so as to achieve the anticipated results of the original surgery. The most common reasons for having revision surgery involve complications, although weight gain may be another reason to revise a previous bariatric procedure.

Complications vary depending on the original type of weight loss surgery. For example, a patient who had Lap-Band surgery could experience a slipped or prolapsed band, band erosion, pouch dilation, or the band may simply not be working properly. Gastric bypass patients may experience strictures or ulcers, fistulas, pain or infection. Vertical sleeve gastrectomy patients may have to deal with fistulas, stenosis, vomiting, or a blockage. In all of these cases, revisional surgery can be used to correct the problem or revise the original weight loss surgery to ease these complications.

Another issue that may arise after weight loss surgery is weight gain. If this occurs after a vertical sleeve gastrectomy, the patient may have revisional surgery to either reverse the original procedure, or the surgeon may opt to perform a gastric bypass operation. If a patient is gaining weight after the lap band procedure, the surgeon may elect to revise the original procedure by doing a gastric bypass surgery or a vertical sleeve gastrectomy. If an adjustable gastric band experiences a mechanical complication, such as a prolapsed band or pouch dilation, the surgeon can go in and revise the band or replace it. If a patient with gastric bypass surgery is gaining weight, the surgeon can place a Lap-Band on the bypassed stomach to promote rapid weight loss.

There are other, nonsurgical options that can help a patient with post-surgical complications or weight gain. Taking medications as prescribed can help prevent complications and promote weight loss. It’s also crucial to adhere to a proper diet after surgery, as following the right eating plan can help patients lose weight rapidly and avoid post-surgical complications. Participating in a support group regularly can also significantly increase your chances of long-term success after weight loss surgery.

If you are taking your medications as prescribed by your original surgeon and strictly observing your post-surgery diet, yet you still have complications, we invite you to consult with Dr. Provost about what types of revisional surgery are best for your needs. He can work with you to formulate a plan, choosing what kind of surgery may work best to promote rapid weight loss and ease any complications you may be experiencing. To see the types of revision surgery that Dr. Provost offers, click here. To schedule a consultation, call our office at 888.715.4330.

Restrictive procedures include the vertical banded gastroplasty (VBG) and gastric banding (i.e., Lap-Band®). Both procedures involve creating a small pouch in the stomach, 15 to 30 ml, to limit the amount of food a patient can eat. The Roux-en-Y gastric bypass (RYGB) also involves the creation of a small gastric pouch which is drained by the small intestine. This operation combines gastric restriction with a minimal degree of malabsorption. An added benefit is the limitation on the intake of simple sugars, which cause you to feel ill. Although the Lap-Band procedure has gained popularity since it was approved by the FDA in 2001, the RYGB is still the most commonly performed obesity procedure in the United States.

Dr. David Provost has experience with a variety of bariatric procedures, but prefers the RYGB and the Lap-Band. Both procedures are generally performed laparoscopically in most patients. This means that instead of performing the surgery through a standard incision, typically going from below the breastbone to above the umbilicus, the operation is done through six smaller incisions, less than one inch in length, using cameras and long instruments. More information about the Lap-Band and gastric bypass procedures is available on this site.

Advantages of the Lap-Band include ease of insertion, shorter hospital stay, and rapid recovery from surgery. The risk of major complications from surgery is low with the Lap-Band, as is the operative mortality.  A disadvantage of the Lap-Band is the potential need for re-operation in the future for band replacement or removal, which may be required in up to 5% of patients. Indications for band removal include erosion into the stomach, band slippage with resultant vomiting, and port or tubing leakage. These complications are rarely life-threatening nor emergent, and can be managed laparoscopically.

We have been very pleased with the results of the Lap-Band, and we believe it is an excellent alternative to the more invasive gastric bypass. Of course, to ensure long-term success, you need to adhere to prescribed eating habits and schedule routine follow-up appointments for band adjustments. For more information about the benefits of the Lap-Band procedure, please contact our office.

In addition to weight loss, many associated medical problems will resolve or improve following gastric bypass.  Adult-onset diabetes mellitus improves in over 90% of patients, with 80% becoming medicine-free, including insulin. Patients can also expect improvements in hypertension and high cholesterol, obstructive sleep apnea, shortness of breath, and other respiratory difficulties, such as asthma. Gastroesophageal reflux (acid reflux) is frequently cured immediately. Although permanent damage to joints that has already occurred is not reversible, patients will often experience significant improvements in mobility and joint pain. Improvement is also frequently observed with leg swelling or venous stasis disease, urinary incontinence, and headaches.

As a surgical procedure, laparoscopic gastric bypass has much lower rates of incisional hernia and wound infection, reduced pain, and a more rapid return to work and normal activities than the traditional open-incision gastric bypass.  Some patients may not be candidates for the laparoscopic approach to gastric bypass due to larger size or large abdominal wall hernias. Prior abdominal operations, such as cholecystectomy (gall-bladder removal), hysterectomy, Caesarean section, and appendectomy do not usually preclude laparoscopic RYGB.

For more information about the benefits of gastric bypass surgery, please contact our office to schedule a free consultation.

We typically evaluate all patients requesting a revision with an Upper GI, performed on the same day as your revisional surgical consult. This exam will tell us about your pouch, esophagus, and stoma size, and rule out hiatal hernia or device malfunction. Occasionally, we may require an endoscopy (EGD) to rule out marginal ulcer, stricture, fistula, or band erosion. We prefer to order these tests and have them performed at Texas Health Presbyterian Hospital of Denton.

Patients with mechanical failures (such as surgical complication or device malfunction) may require re-operation. Patients with mechanically intact procedures may be offered mandatory monthly dietary behavior modification for 3-6 months and then re-evaluation. Of course, a mechanical solution (i.e., a revisional procedure) will fail unless the patient modifies his or her dietary and exercise behaviors appropriately.

Dr. Provost offers the following revision surgery procedures:

• Lap-Band reposition or removal and replacement with or without hiatal hernia repair
• Lap-Band-on-Gastric Bypass
• Reversal of Gastroplasty (Stomach Stapling) and revision to Gastric Bypass
• Removal of Lap-Band System and revision to Gastric Bypass, BPD-DS, or Sleeve Gastrectomy
• Removal of Molina Band and revision to Gastric Bypass, BPD-DS, or Sleeve Gastrectomy
• Reversal of Gastric Bypass or BPD-DS
• Revision of Sleeve Gastrectomy to Gastric Bypass
• Revision to distal gastric bypass
• Revision or correction of complications

If you believe you would benefit from revision surgery, please call the office at 940-323-3450 and schedule an appointment for a consult. Dr. Provost can advise you on what your surgical options are appropriate for your individual situation.

A sleeve gastrectomy will help you to lose weight by restricting the volume of food consumed (provided that you are eating solid-type foods). The sleeve gastrectomy may also alter gastric hormone secretion for approximately one year, which helps to reduce hunger. Unlike a gastric bypass, a sleeve gastrectomy will not cause dumping syndrome, as the pyloric valve of the stomach is preserved with a sleeve.

The weight loss with a sleeve is similar to that of gastric bypass — approximately 50-70% of excess weight lost during the first year post-op. Weight-loss generally levels off after approximately one to two years, and a weight re-gain of up to 20 pounds is common. Unfortunately, at this time, there are not enough long-term studies to demonstrate the weight loss durability of the gastric sleeve procedure.

Dr. Provost can perform a sleeve gastrectomy in approximately 45 minutes. Patients can expect to spend one night in the hospital and are back to work with no restrictions in two to four weeks. The dietary guidelines following the sleeve gastrectomy are similar to those of Lap Band or gastric bypass.

Life-long follow-up with Dr. Provost and his team will provide the best weight-loss results. We will require you to come in every three months for the first two years, every six months for the third year, and annually thereafter.

Short-term complications following a vertical sleeve gastrectomy are similar to those of the gastric bypass and can include pulmonary emboli, anastomotic leak, bleeding and wound infection. The nationally reported operative (<30 days post-op) mortality rate is about 0.5 percent. This means that approximately one out of every 200 patients who have sleeve gastrectomy may die within 30 days of their surgery.

Long-term complications can include stricture, GERD, ulcers (smokers and those who take anti-inflammatories can expect increased risk!), gallstones, staple line disruption, weight re-gain, and vitamin/ mineral deficiencies.

Nutritional complications are few, and can generally be avoided with mandatory life-long supplementation of a daily multivitamin with iron, calcium citrate twice daily with vitamin D, and occasionally, B12. We will check your vitamin levels every six months for the first two years and annually thereafter.

For more information about the gastric sleeve procedure or to schedule a free consultation with Dr. Provost, please call our office at 888-715-4330.

Click here to learn more about the dietary changes and average weight loss after gastric sleeve surgery.