Metabolic and Weight Loss Surgery | Duke Department of Surgery

d u k e c e n t e r f o r m e t a b o l i c & w e i g h t l o ss s u r g e r y
Finding the Right Fit: Lap-Band Care at Duke
their new anatomy, as well as focus on their
diet and starting an exercise routine.
Good candidates for the Lap-Band
System are people with a body mass index
(BMI) of at least 35 with one or more comorbidities, such as diabetes, sleep apnea,
or hypertension, or people with a BMI of at
least 40. Certain patients with a BMI of 30to-35 may be candidates for this procedure
as well, but this would need to be discussed
with their individual surgeon. Patients should
be prepared to make dietary and lifestyle
changes in order to be successful, as well
as be ready to adhere to frequent follow-up
with band adjustments.
What to Expect
By Erica Sudyk, PA-C
L
osing weight is among the most
popular resolutions that people make
at the start of a New Year, however,
it is also among the most commonly broken
New Year’s resolutions. That may sometimes
be because a program of diet and exercise
is not always the most effective option. The
Duke Center for Metabolic and Weight
Loss Surgery is a center of excellence that
specializes in weight-loss surgery options to
fit people in all stages of obesity.
For people looking to lose as little as 30
pounds, the Lap-Band System may be the
right solution. The Lap-Band—or adjustable gastric band—is an inflatable band
that is placed around the top portion of the
stomach, reducing the amount of food taken
in. This allows you to feel full faster and
for a longer period of time. A small port is
placed underneath the skin; the Lap-Band is
adjusted by placing a needle in the port and
adding or withdrawing fluid to tighten or
loosen the band.
This is a minimally invasive procedure,
which means tiny incisions are made, allowing
patients minimal scarring and minimal pain
after surgery. The Lap-Band procedure is
usually performed as an outpatient procedure;
patients will need a few weeks to adjust to
Most patients will lose 30 to 50 percent
of their excess weight, with most weight
loss occurring within the first year. Ultimate
weight loss success will depend on compliance with diet and lifestyle changes. In addition to weight-loss, many patients experience
significant improvements in obesity related
complications including heart disease, type 2
diabetes, sleep apnea, and joint pain.
Adjustments are made to ensure the
band is kept in the proper range of restriction to facilitate weight loss. Patients come
in for adjustments every four weeks during
their first year after surgery to maximize the
weight loss benefit from the band. During
the second year, adjustments are every four
to eight weeks, depending upon when needed. After the third year, adjustments are done
on an as needed basis. The band may need to
be tightened if a patient gains or loses weight,
is eating larger portion sizes, or has excessive
hunger throughout the day. The band may
need to be loosened if a patient has heartburn, difficulty swallowing, or pain.
Adjustments are performed in both our
Durham and Raleigh clinics. Our clinic uses
an imaging technique called fluoroscopy to
make adjustments. Patients enter the procedure room and are asked to stand in the fluoroscopy machine. After accessing the port,
patients swallow, which shows how tight the
band is so fluid can be added or removed to
get the band in the right amount of tightness. Fluoroscopy allows for a more accurate
adjustment to the band, thus supporting the
weight loss effort.
At Duke, we are willing to see our
patients at any point throughout their surgical process—from the pre-operative stage
to over 10 years post-surgery. We are also
happy to see patients trying to get their band
habits back on track, or patients who did not
have their band surgery done at Duke. It is
very important that patients maintain consistency with the provider who is adjusting or
caring for their band. Each patient and band
has its nuances; returning for care with the
same provider establishes a rapport and ensures that their provider knows their band’s
nuances the best. h&h
Erica Sudyk has been a physician assistant with the
Duke Center for Metabolic and Weight Loss Surgery since 2010. She is involved in the pre-operative
and post-operative care of patients, as well as assisting
surgeons during operations, and runs the Lap-Band
adjustment clinic in both Durham and Raleigh,
where she manages the long-term care of Lap-Band
patients. She also serves as a Clinical Instructor in
the Duke University School of Medicine Physician
Assistant Program. She earned her Masters of
Health Science degree in Physician Assistant Studies
from Duke University School of Medicine, and holds
a BS in Radiologic Science and a BA in Exercise
and Sports Science from UNC-Chapel Hill.
In addition to the Lap-Band System,
Duke Weight Loss Surgery performs
Roux-en-Y Gastric Bypass, Sleeve
Gastrectomy and Duodenal Switch.
The bariatric surgeons at Duke are also
highly trained in minimally invasive
general surgery.
For information, contact:
DUKE CENTER FOR METABOLIC
AND WEIGHT LOSS SURGERY
Alfonso Torquati, MD
Dana Portenier, MD
Ranjan Sudan, MD
Jin Yoo, MD
Philip Omotosho, MD
Chan Park, MD
Erica Sudyk, PA-C
Durham Office:
407 Crutchfield Street
Durham, NC 27704
Telephone: (866) 637-0711
Raleigh Office:
1212 Cedarhurst Drive, Suite 102
Raleigh, NC 27609
Telephone: (919) 862-2715
www.DukeWLS.org
To learn more, attend a free
seminar held regularly throughout
the Triangle
Originally published in Health & Healing in the Triangle, Vol. 17, No. 4, Health & Healing, Inc., Chapel Hill, NC, publishers. Reprinted with permission.