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Lap band Procedure Restricts Food ndash and Liberates Life

The pattern began in college and continued for more than 20 years. "Losing and gaining, losing and gaining – it was constant," says LaRayne Longtine of Fargo. "And each time I put the weight back on, I'd add a few extra pounds." By the time she'd reached her early 40s, LaRayne had several sizes of clothing in her closet and her BMI (body mass index) had moved to the obesity range. But it wasn't numbers alone that motivated her to seek a more permanent solution.

The pattern began in college and continued for more than 20 years. "Losing and gaining, losing and gaining – it was constant," says LaRayne Longtine of Fargo. "And each time I put the weight back on, I'd add a few extra pounds." By the time she'd reached her early 40s, LaRayne had several sizes of clothing in her closet and her BMI (body mass index) had moved to the obesity range. But it wasn't numbers alone that motivated her to seek a more permanent solution.

"In my family, there's a strong history of heart disease. My dad died of it when he was only 45," she says. "As I got older, that concerned me more and more, especially when I thought about my two kids – Quinn who's 10 and Aiden who's 6. I wanted be around for them."

But even with motivation, obese people attempting weight loss through diet alone face an uphill battle. Research indicates only 3 percent will be successful in taking the weight off and keeping it off for at least three years. The addition of bariatric (weight loss) surgery dramatically changes the statistic to 80 percent. "We now have excellent evidence and extensive statistics that fully support the surgical treatment of the disease of obesity, including the new lap band procedure," says Dr. Tim Monson, MeritCare bariatric surgeon and executive partner of MeritCare Surgical Services. Dr. Monson performs approximately 125 bariatric procedures per year and is one of three bariatric surgeons at MeritCare. In late 2006, MeritCare was named a Bariatric Surgery Center of Excellence by the American Society for Bariatric Surgery.

Now available: Lap banding

Popular for years in Europe and Australia, lap banding (laparoscopic gastric banding) ranks as the least invasive of the three common types of bariatric surgery: gastric bypass, laparoscopic gastric bypass and now lap banding. Unlike gastric bypass, in which the stomach is stapled and a portion of the small intestine rerouted, lap band requires no permanent changes to the digestive system.

In the 45-minute procedure performed under general anesthesia, the surgeon places an adjustable band around the upper part of the stomach, dividing the stomach into two portions – a small top portion and a large lower portion. When the top portion fills (and it doesn't take much food to fill it), the person experiences fullness. The food continues to move through the digestive tract in the usual manner, with nutrients being absorbed by the body.

The procedure typically requires a one-night hospital stay and one to two weeks of at-home recovery. Depending on the person's rate of weight loss, which is expected to be one to two pounds per week, the band can be periodically adjusted to increase or decrease restriction.

"… the first to sign up"

"I'd been thinking for years about gastric bypass surgery, but the invasiveness of the surgery bothered me. When I found out lap banding was an option, I wanted to be the first to sign up," says LaRayne. "I liked the fact it was minimally invasive. I also liked the idea that even though it restricts the amount you can eat, you can still eat whatever you like – you just feel full more quickly."

Though she wasn't MeritCare's first lap band patient, on Oct. 3 LaRayne underwent the procedure. In the months prior, she'd completed a series of appointments with MeritCare's bariatric team to ensure she was a good candidate (including documented weight-loss attempts and psychological/physical suitability) and had received approval from her insurance company. She also took the opportunity to make sure she had the full support of her husband, Mark Vollmers, and her MeritCare primary care physician, Dr. Mary Jo Lewis.

LaRayne knew from talking with Dr. Monson that surgery would establish a good first step, but more would be needed for lifelong success. Explains Dr. Monson: "I always tell my patients that lifelong success in weight-loss surgery has three parts. First, there's the initial operation, and you want to make sure that's done by people who are qualified and have a program in place to support you. Second, you need to incorporate exercise into your life, even if it's just walking. And third, you need to eat right, especially getting the sufficient protein and nutrients. If you want to be really successful, you do all three. If you do two of the three, you'll probably do okay. But if you're relying on the operation alone, you might not be so successful."

Lifelong success

A manager at MeritCare, LaRayne took seriously her responsibility for lifelong success. She made certain Dr. Monson was the right surgeon for her procedure by learning about his experience and his results. She met with a dietitian to learn about food choices. "We worked on visualizing and that's been a great help," says LaRayne. "I don't count calories or measure food, but I do visualize a small plate with appropriate portions." And she creatively incorporates exercise into her life. "Mark and my father-in-law are building a dance floor in our basement because the kids and I love to dance," she says.

By early December, LaRayne had lost 30 pounds and for the first time had cleared the biggest-size clothes from her closet. "I still have a long way to go before I get to my goal, but already I feel great," she says. "I move more easily, sleep better, have more energy, and just feel better about myself and the future. It frees my mind to know I'm not going to go back to my same old pattern."

There's freedom, too, in wanting to say yes, even to seemingly small requests. "Quinn has always wanted me to come and eat lunch with her at school and I just wouldn't do it because I felt like I was too fat," says LaRayne. "She asked me again for this spring, and for the first time, I said yes."

For more information about MeritCare's bariatric surgery program, please call (701) 234-2251 or go to meritcare.com (keywords: bariatric surgery). Also, bariatric surgery support sessions are held the last Wednesday of each month at 6:30 p.m. in the auditorium at MeritCare in downtown Fargo, 801 Broadway N.