If you are a woman who can have children you will need a pregnancy test

This is mandated by most health care facilities. It does not matter if you don’t think this is possible — too often we find someone is pregnant and we have to delay the operation.

Routine blood tests

We need to make certain you do not have anemia. So most surgeons will ask for a CBC (Complete Blood Count).

A basic metabolic panel may be ordered for you to check electrolytes

— especially if you are taking medicines that interfere with this — such as some medications for high blood pressure (HCTZ –hydrochlorothiazide, diamox, lasix).

Non routine tests prior to getting Lap-band surgery

Non routine blood tests

If you are taking blood thinners such as Warfarin (Coumadin) this medication will be stopped before Lap-band surgery, but the surgeon will probably ask for another test to see how how well you clot your blood. These include PT/PTT and INR. If you take aspirin or Plavix (clopidogrel bisulfate) you may be asked to discontinue these medications, or not –depending upon circumstances. The surgeon may ask for the blood clotting tests, or even a bleeding time. If you are not taking these medications, and do not have a history of bleeding problems (bleeding a lot with other operations, minor trauma, or dental surgery, or inherited bleeding problems) these tests may also be ordered. If you have never had surgery, some surgeons or their anesthesiologists will ask for these tests as routine, others will not.

Sleep studies

A sleep study is to check for sleep apnea. This is not a routine test, but there is a high incidence of sleep apnea among patients who are obese. Sleep apnea is not snoring, sleep apnea is where you stop breathing during the night — typically because the excess weight. If you have sleep apnea it is important to diagnose this and treat it.

The National Heart Lung and Blood Institute has some good information and can be found here:

Who Needs a Sleep Study?

Here are some guides per their recommendations:

If you often feel very tired during the day — even though you spent enough time in bed to be well rested—talk to your doctor. This is a common sign of a sleep disorder. A number of sleep disorders can disrupt your sleep, leaving you sleepy during the day.

Other common signs of sleep disorders include the following:

  • It takes you more than 30 minutes to fall asleep at night.
  • You awaken often during the night and then have trouble falling back to sleep, or you awaken too early in the morning.
  • You feel sleepy during the day and fall asleep within 5 minutes if you have an opportunity to nap, or you fall asleep at inappropriate times during the day.
  • Your bed partner claims you snore loudly, snort, gasp, or make choking sounds while you sleep, or your partner notices your breathing stops for short periods
  • You have creeping, tingling, or crawling feelings in your legs that are relieved by moving or massaging them, especially in the evening and when you try to fall asleep.
  • You have vivid, dreamlike experiences while falling asleep or dozing.
  • You have episodes of sudden muscle weakness when you’re angry, fearful, or when you laugh.
  • You feel as though you can’t move when you first wake up.
  • Your bed partner notes that your legs or arms jerk often during sleep.
  • You regularly feel the need to use stimulants to stay awake during the day.

Describe your signs and symptoms to your doctor. It’s important to note how tired you feel and whether your signs and symptoms affect your daily routine. Early signs of sleep disorders aren’t easy to detect during routine visits. There are no blood tests for sleep disorders, and the doctor isn’t watching you sleep.

If you have sleep apnea most surgeons will want you to spend the first night after Lap-band surgery in the hospital where you can be monitored by the nursing staff. While Lap-band surgery is not a problem with sleep apnea, it is after surgery when you still have residual anesthesia on board that can make sleep apnea worse, and possibly lead to problems.

Beware, however, that a sleep study is not a routine requirement. It is a requirement for some patients who have these symptoms. If you are concerned, talk with your surgeon and your primary care physician about this. There are a number of sleep centers that can diagnose and treat these disorders. If someplace wants a test for everyone, whether you have these symptoms or not, be careful. Talk about your symptoms with your surgeon and primary care physician to determine if you need to have a sleep study. This is a test that is important, but beware of centers that order this for everyone and have an economic stake in getting the test.

Cardiac Stress Tests

If you have heart disease (had a heart bypass, or a stent placed, or recent angioplasty, or had a heart attack), or symptoms of heart disease, you will be asked to be cleared by a cardiologist to help assess risk before you have your operation. The extent of the tests ordered are individual in nature, and based upon your health history. Again, some centers, that have an economic stake in ordering a “stress test” will order this on everyone. There is a difference if your cardiologist orders the tests, or your primary care physician, and if the center you contacted has an economic stake in ordering the test. Be skeptical, and always talk with your primary care physician and your surgeon if you are concerned.

If there is any question, based on an EKG, or other test, you may be asked to have more invasive tests to rule out cardiac issues. These are best determined by a cardiologist.

Beware again of centers that have the “stress test” in their center and ask that you get one without a history of heart disease, or other issues. Tests should be determined on clinical history and not based on a center making money from ordering a test.

Endoscopy

This is not a routine test. It is not required for a routine Lap-band surgery. Again, this is a test that should be ordered if you need it. There are economic incentives to order this for all patients (surgeons get a fee when they do endoscopy) – but reasons to order this test for someone who has never had a stomach issue are rare. After Lap-band surgery endoscopy can be ordered on a yearly basis to make certain there is not an erosion of the band (1/3 of all erosions are asymptomatic).

The Bottom Line

It is your health, and placement of a laparoscopic adjustable band (Realize or LAP-BAND) is major surgery — even if it is done with small incisions or one incision – is still a major operation. Your health is of utmost importance to your surgeon. But some corporate centers will order a lot of unnecessary and potentially invasive tests because they make money ordering them (or charge you extra).

Before getting the Lap-band it is important to know what you may need before surgery, and what you will not need. A frank and open discussion with your surgeon and your primary care doctor should take care of this. If your surgeon is employed by a band center that offers these tests, they may have more of an incentive to order more tests than are needed. Ordering every test for every person is not good medicine — careful and watchful medicine is good medicine.