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OBGYN.net Broadcasting present Part VI of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op.
Roberta Speyer: "This is Roberta Speyer, publisher of OBGYN.net, and I'm back with you here in Frankfurt, Germany. It's two days post-surgery now, and it's hard to believe, Dr. Weiner, that I actually had surgery two days ago, I feel so good. We wanted to come back and do a little re-cap on the surgery and what's it been like for me. The first day was the hardest, of course. You wake up from anesthesia, you don't feel good, and you have a tube in your nose. Tubes are everywhere, in fact, but the care in your hospital was fantastic. I want to really commend you for having such a wonderful staff, which was very, very nice. Sometimes I actually thought it was a good thing that they spoke German because if we were in the United States, they'd be trying to make chit-chat with me, and I just wanted to sleep. I didn't want anyone talking to me, but the next day it was remarkable how much better I felt, and how quickly. Is that usually the case?"
Dr. Weiner: "Yes, this is a benefit of laparoscopic surgery. The day of surgery you are sleepy, you're in a small amount of pain, and drugs aren't necessary, but the next day you can get up and move. This is a benefit."
Roberta Speyer: "If we had done a procedure that was open surgery - a laparotomy - that wouldn't have been the case. I would probably still be in a lot of pain, or still laying down."
Dr. Weiner: "If you have open surgery, you have much more pain, plus you would still not be able to breathe so you wouldn't like standing up. So yes, it's so much better that you can move."
Roberta Speyer: "Yes, I'm leaving tomorrow. I'm going home on New Year's Day. It's really going to be a wonderful new millennium for me because I can look forward to losing weight, which has been probably the saddest part of my life, as well as the biggest struggle. The rest of my life is really great, so once I lose the weight, I'm sure that will be even more wonderful for me. I wanted to take a chance to maybe show you the scars because when I first looked at them, I was a little afraid of what I was going to see. It just amazed me that there really isn't any scarring."
Dr. Weiner: "These are small scars here."
Roberta Speyer: "Yes, and you used something close to glue, right?"
Dr. Weiner: "Yes, it's similar to glue."
Roberta Speyer: "And then down here is where the port is?"
Dr. Weiner: "That's also glued."
Roberta Speyer: "Can you see that? It's not painful, really - there's just a little bit of a sting. I was very surprised that it didn't cause me more discomfort than it did. The first thing I had was some tea, and I really have no hunger at all, so the fact that I haven't been eating hasn't bothered me."
Dr. Weiner: "And you have to check your weight?"
Roberta Speyer: "I've already lost weight. I've lost ten pounds, which is amazing. I think I'll stay here, because that is really remarkable. Is that typical? A very rapid weight loss in the beginning, because there's no food being consumed?"
Dr. Weiner: "In the first few weeks you'll lose twenty pounds, and in one year, one hundred pounds."
Roberta Speyer: "Wow, this will be really exciting. We're going to follow up, too. I come to Germany a lot for business for OBGYN.net, and I'm going to do my follow-up with Dr. Weiner. We're going to follow this and see how this year goes for me. I'm sure there are going to be some challenges ahead for me, as far as getting used to a new lifestyle, but what do you recommend for making the transition from the fluids with your patients? Is it best to just go slow and not push yourself and try to eat very small amounts?"
Dr. Weiner: "Yes, you have to change your eating completely by eating small amounts of food, chewing of your food well, and stopping when you feel full, but most patients have no hunger. They have very little hunger, they can eat only small meals, and then they're happier."
Roberta Speyer: "With some of the weight loss surgery there's quite a bit of reflux and vomiting. Is that something that I should be aware of, or that people encounter very much with the lap band, or is that well controlled as long as you don't' try to eat too much?"
Dr. Weiner: "No, not reflux disease. If you have reflux disease before surgery, then it will be better after surgery with a lap band, but in some cases if the band is closed down too much, you can have esophagitis caused by the stasis of the food. When you open the band, it gets better."
Roberta Speyer: "So is that one of the reasons that the adjustable factor of the band is superior to the ring?"
Dr. Weiner: "Yes. In some countries they are also using non-adjustable gastric banding, but this is a terrible procedure, in my opinion. Adjustable gastric banding allows doctors to adapt the band and the stoma size to the feeling of the patients and to the weight loss curve, and you can change it. You can open the band and you can close it - this is a large benefit."
Roberta Speyer: "Especially in the case of a younger patient, who may become pregnant."
Dr. Weiner: "Yes, for example, if she…"
Roberta Speyer: "I already have five, so don't count on it with me!"
Dr. Weiner: "But if somebody becomes pregnant, we can open the band and then after the birth of the baby, you can close it again, no problem."
Roberta Speyer: "What is the farthest out that patients have been followed with this procedure at this point in time, at the end of 1999? What is the longest patient that you have followed?"
Dr. Weiner: "In our clinic, five years, but in Europe we have experience since 1993 for laparoscopic adjustable gastric banding. With the open surgery procedure, the experience is much longer - we started in 1985."
Roberta Speyer: "You started with the adjustable band, but it was replaced?"
Dr. Weiner: "It was adjustable. The rubber band was developed in the eighties by the same company that also produced it, and then we made adjustments. They made it better by changing the sizes. Now we have this lap band in three sizes, and we have a safe technique with very good experience."
Roberta Speyer: "I'm very, very happy I did this. I know when they were wheeling me down to the surgery, I had that moment when I was thinking, 'why am I doing this?' But now that it's over, I really have to say that it was not as difficult as I feared it would be. I can already see that it's going to make a huge difference in my life, and it's going to improve it greatly. I'm really just delighted that I chose this procedure over any of the others. I think I'm going to have a much better outcome because of it."
Dr. Weiner: "I have one comment on the topic of pain. You really don't have pain, but it is important that we are using no-cutting trocars, or non-sharp trocars. We are using dilation techniques, the step system, and there is no cutting of your muscle."
Roberta Speyer: "That's the InnerDyne trocar, correct?"
Dr. Weiner: "This is the InnerDyne trocar, yes."
Roberta Speyer: "What is different about that than a traditional trocar? Why is that causing me less pain?"
Dr. Weiner: "There's no cutting of the tissue of the abdominal wall - it's only dilation. After removal of this trocar, of this step system, you have a very small defect and, therefore, less pain. This technique is also much safer. You have very little danger of organ injury or of muscular injury, so this is very safe technique."
Roberta Speyer: "The highest incidence of morbidity is trocar injury with this procedure, if you don't use this, isn't it?"
Dr. Weiner: "Yes. But we have this step system now, and morbidity is 0%."
Roberta Speyer: "Fabulous. Thank you very much. Thank you for taking on this case and doing such a wonderful job with me. I really appreciate it very much, doctor, and I'm looking forward to seeing you again. We'll be following up in the future with the new and improved Roberta!"
At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: http://www.inamed.com/contact/bio_patient.cgi. Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails. See Professor Rudolf Weiner's website about Weight Loss Surgery to see if this option is right for you. Visit www.profweiner.com.