Lap Band 01

As a new LAP-BAND" Adjustable Gastric Banding System patient, you are well on your way to successful weight loss. And as exciting as your decision to move forward with LAP-BAND' System surgery is, it's important to know that, after the procedure, you have a significant role to play in achieving a healthier, happier life. A New Beginning is designed to help you gel off to a great start.

Inside this booklet, you'll find the guidance you need to make required changes in your diet and behavior that will allow your post-surgery stomach to heal properly. (Healing is more important in these first few weeks than losing weight.) Some changes will have to be made immediately following your LAP.BANDr surgery. Others will need to fellow in the days and weeks ahead.

You'll also learn about LAP-BANDS System adjustments, and get an overview of what to expect during these simple follow-up appointments.

Plus, you'll discover the importance of connecting with your health• care professionals and surgeon, all of whom may have additional instructions for you.

It's important to work closely with them, communicate openly, and follow their advice carefully. Call them promptly with any symptoms you may notice that could indicate a complication — especially once you're home from the hospital. (You'll find a list of these symptoms on page 7) After your first adjustment, and once you've healed and are ready to transition to eating solid foods, Book 2, Living Healthily Ever After, will help you along the path to longterm weight loss.

Please note: The contents of this booklet are Allergan's recommendations only. Always defer to your doctor's opinion on post-surgery matters, especially if you receive any conflicting information or advice.

The transformation you're about to begin with the LAP-BAND'S System isn't likely to be only physical. We understand that weight loss through surgery can touch so many aspects of your life, and leave you with so much to think about, that your emotional progress will be just as significant as your weight-loss progress.

Your post-surgery lifestyle — exercising, follow-up doctor visits — may mean taking more time for yourself. And you deserve it. But having less time for family and friends may require setting boundaries that make you uncomfortable initially. Seeing you change how you look and what you eat may also make your loved ones uncomfortable, or be hard for them to accept at first.

You may start feeling differently about yourself. And within yourself. You may become more positive and confident, but may not be sure how to express this new you you're becoming. You may feel anxious.

People may start treating you differently, too. Maybe they'll notice you more. Show you more respect. And as good as this feels, it may also upset you to recall how people treated you when you were overweight.

Finding ways to express and address your emotions can help make your transition a more enriching, positive experience. You might try turning to your healthcare professionals.

Or a support group for LAP-BAND8' System patients. Or maybe you prefer to talk to a close friend, or to write your thoughts and feelings down in a journal. Choose the support that's right for you.

If you have not already, sign up for My LAP-BANDS Journey at lapband.com. It is a good place to get support. You'll find tools, tips and information to help you track your progress — and celebrate getting closer to your weight-loss goals.

It's time now to embrace your personal journey. We hope you find it emotionally and physically rewarding.

immediately after surgery

Now is a good time to set your expectations for the next several weeks.
You should know that the first month after surgery is a healing period. It is more important to let your stomach adjust to the LAP-BAND® System than it is to lose weight in the first few weeks. Don't worry if you don't see significant weight loss right away. Remember, for successful and healthy long-term weight loss, studies show that losing a steady one-to-two pounds per week — and no more — is optimal'

Weight-loss results will vary from patient to patient, and the amount of weight you lose will depend on several things. Most importantly, the LAP-BAND® System needs to be at the right fill level, and you need to be committed to your new lifestyle and eating habits. This doesn't happen overnight.

In general, you'll want to follow the advice of your surgeon and/or dietitian about the foods you eat. With their guidance, in a few weeks you will slowly be able to

to move to solid food — and start seeing steady weight loss.

Be aware of symptoms that may signal a potential complication. The LAP-BAND® System has been proven to be safe.' However, as with all surgeries, there are some potential risks for complications after surgery. It's important to know the difference between normal body reactions to the surgery — like soreness at the incision site, gas, and difficulty ingesting liquids — and signs and symptoms of a potential complication, listed at right. (See page 24 for more details.)

Water and liquids and walking. Right after your operation, you can take an occasional sip of water or suck on an ice cube. Any more than this may cause you to be nauseated or regurgitate. The day after your operation, you can drink a little more water. But again, take only a small amount at a time. In the next few days, along with water, choose clear, thin, broth-type liquids that have enough calories to help compensate for the food you're not able to eat. You can drink low calorie liquids and eat low calorie.

Jell-O that you let melt in your mouth before swallowing. If you're unable to keep any fluids down, cutting back on how much you're drinking should help. But if frequent or persistent regurgitation occurs, report it to your doctor immediately.

In these first few days, you'll also want to walk around as much as you comfortably can to regain your strength and prevent blood clots. For more physical exercise, give yourself two or three weeks' time to recover first — and then take it slow. While you may be ready to resume all your normal activities and start a new exercise program in four to six weeks, you should consult your doctor beforehand to ensure that your planned activity level is appropriate to your stage of recovery.

And what about food?

After surgery, you will require a new, temporary diet for recovery. Your surgeon and/or dietitian can help you with the eating and lifestyle changes you need to make, so be sure to discuss these changes with them thoroughly.

A new diet is essential to your recovery progress. It allows your newly shaped stomach to heal completely and allows the LAP-BANDS System to remain in the right position. It may take a month or more for this healing to happen. During this time,

especially in the early weeks, you'll want to keep from stretching the small stomach pouch above the LAP-BAND® System. Regurgitation can stretch this pouch — and can also increase the chance of your stomach tissue slipping up through the LAP-BAND® System. So be sure to see page 13 to learn what you can do to help keep yourself from regurgitating.

Why would I start regurgitating?
Almost all LAP-BAND® System patients will regurgitate at least once in their first week or two after surgery. But regurgitation at this early stage is a matter of not being able to keep liquids down.

As you get used to living with the LAP-BAND® System, regurgitation should stop or become much less frequent. One or two episodes of regurgitation in the first couple of weeks are fairly common, but even so, they should only occur when you've taken in too much liquid and/or when you've been drinking too quickly. More persistent or unexpected regurgitation should be reported to your doctor to rule out the need for an adjustment or the possibility of a potential complication.

Note- the information is meant to be an overview. Your surgeon may give you more specific instructions. Be sure to follow the instructions your doctor gives you.

week one and two

Stick to a liquid diet.
The goal during this early postoperative period is to protect the small stomach pouch. Continue drinking water to keep hydrated, and add thin liquids that can be tolerated.

Recommended liquids during this phase include: • Clear broth or soup (with no vegetables, meat or cream) • Low-fat milk • Low-fat yogurt • No-sugar-added Popsicles

week three and four

Add pureed foods to the menu.
In the third and fourth weeks, you may start having slightly textured foods. Aim for the consistency of baby food. This will help you transition to more solid foods later. Because protein is so important to help you maintain muscle while you are losing weight, eat protein-rich foods first, and then move on to fruits and vegetables.

Note: Foods in this stage may include:

• Pureed skinless chicken or fish
• Mashed potatoes
• Low-fat yogurt or pudding
• Jell-0
• Pureed vegetables

week five

Enjoy soft foods, but chew well.
Your meals can now include tender, cooked foods such as fish and ground turkey. Make it a habit to chew these foods thoroughly. (If you have dentures, be sure to cut your food into small pieces beforehand.) If you don't follow these precautions, you could experience nausea, stomach irritation and swelling — even an obstruction at the opening of the stomach. Advancing to heavier foods may also cause vomiting — which can increase the chances of band or stomach slippage, or stretching of the small stomach pouch above the band.

If you have any of these problems with soft foods, stop eating them and go back to the liquid diet you had earlier. Then you can slowly add soft foods again. And by all means, ask your doctor or dietitian for advice specific to your situation.

The what and why of LAP-BANDS System adjustments.
Adjustments are in-office procedures that give you and your doctor more control over ensuring healthy weight loss. They enable customization of the LAP-BAND" System to meet your particular needs. For example, if the band is too tight, you'll choose liquid calories and may not lose weight or experience too much regurgitation. If it's too loose, this could mean that you won't lose enough weight each week to reach your weight-loss goals. The LAP-BAND'S System journey is different for each person, as is the exact amount of fluid required to make the new stomach opening the right size.

The adjustment procedure is done by inserting a fine needle into the access port under the skin of your abdomen. You may feel a pricking sensation similar to when you give blood.

Adjustments can be made either in the hospital or in a doctor's office. Your surgeon may use fluoroscopy to assist in locating the access port, to guide the needle into the port and to view the insertion of the needle. Fluoroscopy may also be used after the LAP-BAND" System has been adjusted, to evaluate your pouch size and stomach size. Ideally, post-adjustment, the band should be just tight enough for you to lose weight gradually. You can learn more about achieving this balance —or being "in the Green Zone" — in Book 2.

Note: Only a clinician trained and authorized by Allergan Health can adjust the LAP-BAND" System. Never let an untrained clinician or a nonmedical person do it. To avoid causing adverse reactions or damage to the LAP-BAND'S System, never try to make any adjustments yourself.

The what and why of LAP-BANDS System adjustments.
Adjustments are in-office procedures that give you and your doctor more control over ensuring healthy weight loss. They enable customization of the LAP-BAND" System to meet your particular needs. For example, if the band is too tight, you'll choose liquid calories and may not lose weight or experience too much regurgitation. If it's too loose, this could mean that you won't lose enough weight each week to reach your weight-loss goals. The LAP-BAND'S System journey is different for each person, as is the exact amount of fluid required to make the new stomach opening the right size.

The adjustment procedure is done by inserting a fine needle into the access port under the skin of your abdomen. You may feel a pricking sensation similar to when you give blood.

Adjustments can be made either in the hospital or in a doctor's office. Your surgeon may use fluoroscopy to assist in locating the access port, to guide the needle into the port and to view the insertion of the needle. Fluoroscopy may also be used after the LAP-BAND" System has been adjusted, to evaluate your pouch size and stomach size. Ideally, post-adjustment, the band should be just tight enough for you to lose weight gradually. You can learn more about achieving this balance —or being "in the Green Zone" — in Book 2.

Note: Only a clinician trained and authorized by Allergan Health can adjust the LAP-BAND" System. Never let an untrained clinician or a nonmedical person do it. To avoid causing adverse reactions or damage to the LAP-BAND'S System, never try to make any adjustments yourself.

Your first adjustment.
When implanting the LAP-BAND® System, it's typical for a surgeon to leave the band empty to allow healing to occur around your new upper stomach. During this time — which lasts the first few weeks after surgery — be especially careful to avoid regurgitation, because it puts unwanted pressure on this area.

Once you've had a chance to live with the LAP-BAND& System for a few weeks, you and your surgeon may want to make an adjustment to the LAP-BANDs System to meet your specific weight-loss needs. Your first adjustment usually takes place four to six weeks after surgery, but this can vary from patient to patient.

You and your surgeon can determine the timing and level of restriction that's right for you. Key considerations will include your weight-loss goals, the amount of food you can comfortably eat, your exercise routine, and how much saline is currently in the LAP-BANDs System.

Note: To get the best results, you may need additional adjustments in the months to come. An ideal saline "fill" level should result in the LAP-BAND& System being just tight enough to let you lose weight gradually. In other words, you should be able to eat enough to get the nutrients you need while still reducing the overall amount you need to feel satisfied.

Adjustable Gastric Band

The LAP-BAND® System, your healthcare team, And You

Success is a team effort.
As you move forward, keep in mind that the 20 LAP-BAND® System doesn't work on its own. Success comes when you, your healthcare team and your LAP-BAND®' System all work together. And the partnerships you develop with your surgeon and clinicians are the key to that success. Communicating with them when questions or concerns arise — and following their advice and instructions — is always the right thing to do. They can even recommend post-surgery support groups that may be available to you in your area.

Your new beginning will only continue. This is a new beginning for you.

And with the right healthcare support and lifestyle changes, it's one that can lead you to a healthier weight and a happier life. We wish you lots of success — and Book 2, Living Healthily Ever After, has been created to help you achieve it.

Need additional support?
We're here for you.
The LAP-BAND'; System comes with free online support. My LAP-BAND® Journey works in tandem with the LAP-BANDS System. It provides valuable tips, user-friendly progress-tracking tools, and useful information to help you at every step of this transformational journey. Sign up today at lapband.com.

Frequently asked QUESTIONS

Will I be sick a lot after the operation?
If you feel nauseated or sick on a regular 24 basis, it may mean you need to chew your food more thoroughly. Or follow your new diet's rules more strictly. However, feeling sick could indicate a problem with the placement of the band — so contact your doctor if you feel sick regularly. In either case, chew your food slowly and as thoroughly as you can to help prevent vomiting or regurgitation — which can cause the small stomach pouch to stretch or lead to slippage of part of the stomach through the band. These scenarios could reduce the success of the operation or require an adjustment (to remove some of its fluid content). In some instances, another operation may be required.

How long is the average recovery period?
The average hospital stay is less than 24 hours. Typically, it takes about one week before you can return to work. You can start preparing yourself by making sure you get out of bed and move around in the first two days after surgery — even if you're just able to take a few steps at first. In the first one to two weeks, walking is recommended as a simple, safe way to start getting exercise and building up stamina. You can also try other light forms of exercise — for example, moving your arms up and down or, while seated, raising or stretching your legs. But give yourself at least a full month before you attempt anything more strenuous, like light aerobics. And always check with your doctor about the amount and type of exercise that is best for you.

Is it okay if I drink alcohol?
Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.

What should I expect at my first adjustment appointment?
You should expect to discuss your eating and exercise habits, and your rate of weight loss. This discussion will help determine whether or not it is the right time for you to have an adjustment. If it is, you can expect the following:
• A pre-adjustment evaluation of your 26 pouch size and stoma size. (This isn't always done: your surgeon may or may not evaluate your pouch size and stoma size before the adjustment.)
• Adjustment of your LAP-BAND System
• Evaluation of your pouch size and stoma size after the procedure to confirm that the proper adjustment was made. (This may be done under fluoroscopy, or your surgeon may simply confirm that you can comfortably take a sip of water.)

How would I know if the LAP-BANDS System is "too tight" or "overfilled"?
If the adjustment results in too tight a stomach opening, you could have a hard time eating most foods. Sometimes this causes people to avoid solid food and instead drink liquid meals — but this can result in weight gain, especially if the liquid is high in calories. If the LAP-BANDS System is too tight, it can cause reflux symptoms ("heartburn"), particularly at night. It can also cause frequent vomiting. The opening into the larger stomach could become completely blocked and prevent you from being able to keep any food or fluids down. Should you develop these symptoms, notify your surgeon at once.

Will I be in pain after the procedure?
You may feel some pain around the incision sites, especially under the skin of the abdomen where the access port is placed. You may also experience pain and discomfort in your joints and shoulders. This pain is caused by gas — different from intestinal gas — that's lingering in the body after being used to inflate the abdomen during surgery. It will go away, but it's important to walk around after your surgery to allow it to dissipate.

Will I suffer from constipation?
There may be some reduction in the volume of your stools. This is normal because with decreased food intake, you eat less fiber —and it shouldn't cause severe problems. If difficulties do arise, speak with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Drinking six to eight glasses of water a day is a good idea, anyway.

Will I need to take vitamin supplements?
If you're not getting enough vitamins from three small meals a day, your surgeon may advise you to take supplements. (At your regular checkups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid and iron.)

What about other medications?
You should be able to take prescribed medications. You may need to use capsules, or break big tablets in half or dissolve them in water so they do not get stuck in the stoma. Always ask the doctor who prescribes your drugs about this. Your Ljsurgeon may tell you to avoid 11 taking aspirin or other nonsteroidal anti-inflammatory pain relievers. -1sarar That's because they may irritate the stomach, causing need for removal of the LAP-BAND'" System.

Do I need at least 2 or 3 cc of fluid in the band for it to work?
The LAP-BAND r System is designed to suit your individual needs. Because every person is different — some people need less fluid and some need more — there is no set formula to determine how much you need. Do not compare someone else's fluid fill to yours. Your doctor needs to evaluate you and will consider: • The size of your small upper pouch
• The size of the opening (stoma) to the lower pouch
• Your weight-loss progress
• How and what you eat

What is the most important thing I need to know about adjustments?
Do not be in a hurry to have one too soon. The LAP-BANDS System offers you a way to achieve steady and safe weight loss. Finding the right balance between losing weight gradually and receiving adequate nutrition is optimal. It's what we call being "in the Green Zone," and the purpose of adjustments is to help you get there. You should be able to eat small amounts of food with comfort. If you are too restricted, you will find it hard to get adequate nutrition. Also, you could have symptoms such as reflux ("heartburn") or vomiting.

How much does an adjustment cost — and will my insurance pay for it?
The answers to these questions will vary. Ask your clinical coordinator or office manager.

One final point : It is important that you ask your surgeon all the quest ns you ma have about obesity surgery and the LAP-BAND" Adjustable Gastric Banding System. It is also essential that you follow his or her advice.

A Brief Description of Relevant Indications for Use, Contraindications, Warnings and Adverse Events for the LAP-BAND® System. Indications:
The LAP-BAND® System is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs. or more over their estimated ideal weight. The LAP-BAND®. System is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise, and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.

Contraindications:
The LAP-BAND ®' System is not recommended for non-adult patients, patients with conditions that may make them poor surgical candidates or increase the risk of poor results, (e.g., inflammatory or cardiopulmonary diseases, GI conditions, symptoms or family history of autoimmune disease, cirrhosis), who are unwilling or unable to comply with the required dietary restrictions, who have alcohol or drug addictions, or who currently are or may be pregnant.

Warnings: The LAP-BAND® System is a long-term implant. Explant and replacement surgery may be required at some time. Patients who become pregnant or severely ill, or who require more extensive nutrition, may require deflation of their bands. Patients should not expect to lose weight as fast as gastric bypass patients, and band inflation should proceed in small increments. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to an increased risk of band erosion.
Adverse Events:
Placement of the LAP-BAND® System is major surgery and, as with any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient's inability to tolerate a foreign object implanted in the body. Band slippage, erosion and deflation, reflux, obstruction of the stomach, dilation of the esophagus, infection, or nausea and vomiting may occur. Reoperation may be required. Rapid weight loss may result in malnutrition, anemia, or other complications that may require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or esophageal dilation. Important: For full safety information please visit www.lapband.com or call 1-800-624-4261.

CAUTION: This device is restricted to sale by or on the order of a physician.

References: 1. LAP BAND AP Adjustable Gastric Banding System, Directions For Use. Allergan, Inc; 2007.
2. O'Brien PE, et al. lap-Band: Outcomes and Results. J Laparoendosc Adv Surg Tech A. 2003;13(4):265-270.

Acknowledgements
A New Beginning was created with the help of LAP-BAND" System patients and the LAP-BAND" TOTAL CARE" Program —a set of clinical and operational best practices that provides your healthcare team with the tools, information and support to give you the best care possible. Developed exclusively by Allergan, the program is based on the worldwide experience of successful LAP-BAND® System surgical practices.

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