Weight Loss Surgery: Long-Term Results

Gastric Banding Surgery Problems

Regaining weight — or not losing weight — also happens with gastric banding surgery. It’s likely because of liquid calories (sodas, juices) or easily digestible snack foods.

“The band only restricts portion size, it doesn’t affect calories. If you eat chicken, fish, fruits and vegetables at three meals a day, you will be successful with the band,” says Courcoulas. “If you’re drinking too much soda or juices or snacking on soft snack foods, you won’t lose weight.”

“After surgery, overeating can cause aggressive vomiting — which can affect the surgery,” says Madan. “It can cause the band to slip. If it slips, another operation is required to fix it.”

He outlines other mechanical problems that can occur:

• Chronic overeating will stretch the stomach pouch (part of the stomach above the band). That may cause a stomach stitch to become torn and the band to slip. Surgery can correct this problem.
• If the band is too tight, it can erode. “When it erodes, it goes into the stomach layers and becomes infected and needs to be removed,” says Madan. “The patient may have to undergo another bariatric surgery or will most likely gain the weight back.”

Time for Skin Reduction After Weight Loss Surgery?

With extreme weight loss, loose skin can be a big problem. Up to 70% of patients have skin reduction surgery (also called body contouring, or panniculectomy when referring to the tummy), says Courcoulas.

With gastric bypass, skin reduction surgery is usually done two years after surgery, she says. With gastric banding, body contouring is usually done three years postsurgery. Insurance typically covers the procedures if they are considered medically necessary, she explains. “That’s if loose skin causes hygiene problems, pain, sexual function problems. If the surgery is considered cosmetic, it won’t be covered.”

It’s nothing you can check before having weight loss surgery, she adds, as insurance companies must see after-surgery photographs to make their decision.

In medical centers that do significant numbers of bariatric surgeries, the plastic surgeons are often adept at getting insurance approval, Courcoulas adds. “They are very expert at packaging services. If a bariatric patient needs a hernia repair, for example, they package it with skin removal. We work really hard to service the needs of patients because we know it’s tight with insurance.”

For many patients, however, plastic surgery isn’t really necessary, she says. “The patient who loses 80 to 100 pounds — if they were shaped well before surgery, are young, their skin is elastic, they exercise — they may not need it. But someone who loses more weight — if they are older — they will need it. It depends on age, size, skin elasticity, and how much tolerance they have for a little loose skin.”

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