Frequently Asked Questions

Considering Bariatric Surgery

How will I know if I am a candidate for surgery?

We look at Body Mass Index (BMI), which is the weight over the body surface area squared. Patients who have a BMI of 35-40 and have obesity related co-morbidities are candidates for this surgery. Patients who have a BMI greater than 40, even if they don’t have co-morbidities, are also candidates for this surgery.

What are obesity related co-morbidities?

These include diabetes, hypertension, arthritis, degenerative joint disease, sleep apnea, low pack pain, gastroesophageal reflux disease, stress incontinence, high cholesterol and triglyceride levels and depression.

What are the pre-operative requirements to undergo either operation?

You must have a referral from a primary care physician, a dietician evaluation, a psychological evaluation.

You’ll also have to undergo a chest x-ray, an EKG and blood tests.

If you have a history of heart disease, if you’ve taken Fen-Phen in the past, if you’re over the age of 50, or other cardiac risk factors, you’ll require an echocardiogram.

What does laparoscopic surgery mean?

Laparoscopic surgery means that instead of making one large incision in your abdomen, the surgeon will make five small incisions in the middle and to the left side of your abdomen. These smaller incisions allow you to recover faster. You’ll also experience less pain, leave the hospital sooner and will be back to your normal activity sooner. In general, we start all our cases laparoscopically unless the patient has had previous surgery on their stomach.

Why is a six-month pre-operative weight loss program required?

We require patients to begin a diet and exercise program that allows them to lose some of their weight pre-operatively for three reasons:

• Patients who undergo weight loss before surgery have fewer complications during and after surgery
• This allows patients to truly understand the lifestyle changes that will occur after surgery and therefore make an informed consent about the diet and exercise programs that they will have to be on for the rest of their lives
• This allows us to identify the patients who are truly motivated and therefore who will be most successful following surgery

What will happen at my first consultation?

First, we will review your health history questionnaire (which you will receive in the mail from us). You will meet with the surgeon and dietitian. We will discuss the benefits and risks of the procedures and address all your questions. We’ll also arrange for some outpatient routine testing, which you may be able to get that day.

When will I meet the surgeon?

You will meet the surgeon at the information session. Your initial consultation will be done by the surgeon who will screen you for medical problems. Once the surgeon has determined that you’re a good candidate for this operation, and if you’ve met all of our criteria, you’ll then be given a plan for bariatric surgery.

What are the risks of the weight loss surgery?

In the simplest terms, gastric bypass delivers more weight-loss benefit but comes with greater risk of complications. Some patients simply aren’t comfortable assuming the risks of gastric bypass. On the other hand, some people dislike the idea of having a foreign body – that is, a gastric band – in their bodies. Sleeve gastrectomy reduces the stomach without the risks of intestinal bypass or the risks of a foreign body.

Another consideration is the amount of weight that you will lose. People who have a gastric bypass typically lose more than those who have sleeve gastric banding surgery. For example, if you are 200 pounds overweight, you will lose, on average, 80 pounds with a gastric band, 110 pounds with the sleeve gastrectomy and 120 to 140 pounds with a gastric bypass. If still being 120 pounds overweight is unacceptable to you, then you should have a gastric bypass or sleeve gastrectomy.

Ultimately, though, the choice is yours – and you need to feel comfortable with your decision.

Can my family and friends help me through this process?

We strongly encourage you to get your family and personal support network involved in your decision to pursue weight-loss surgery. They can help you through the decision by acting as a supportive sounding board. They can help you make good food choices and recover to your normal activities postoperatively.

Also, they need to be as prepared for life after surgery as you are. If you have a spouse and/or children, it’s essential that they be aware of the benefits and risks of what you’re undertaking and the lifestyle changes you’ll be making after surgery. Those who are closest to you have the best ability to help you be successful.

Why is it better to have laparoscopic versus traditional open surgery?

With laparoscopy, weight-loss surgeries are similar on the inside – but with less pain, shorter hospitalizations (one day for gastric banding and two days for gastric bypass and sleeve) and quicker recoveries for the patients. In fact, weight-loss patients who have laparoscopic surgery are able to breathe more fully and get out of bed the night of their surgery. They’re also able to do more activities at home more quickly. And laparoscopic patients experience fewer hernias and wound infections, too.

How long will I have to stay in the hospital?

Because we perform surgery laparoscopically, your hospital stay is likely to be shorter than with traditional open methods. If you have a gastric bypass or sleeve, you should be able to go home two days after surgery. If you have gastric banding, you should be able to go home the day after your surgery.

Pre Operation

Will my insurance cover the surgery?

Most insurers cover the surgery if it is medically necessary – and if you meet the NIH criteria, it is medically necessary.

How much does the surgery cost if my insurance doesn’t cover it?

We currently do not offer a cash payment option for bariatric surgery.

What happens before surgery?

You will have an initial consultation with your surgeon to discuss any health issues and surgical options. Any pre-surgical tests will be ordered either by the surgeon or your primary care physician. Some of the diagnostic tests may include:

• Bloodwork and other laboratory testing
• Chest X-ray (CXR)
• Electrocardiogram (EKG)
• Cardiac tests
• Psychological evaluation
• Respiratory/Sleep study testing
• Radiological testing (barium swallow, mammography, chest x-ray)
• Gynecological evaluation
• Esophagogastroduodenoscopy (EGD)
• Colonoscopy

Your care team will provide you with educational information highlighting diet and nutrition, post-operative information, and the risks of surgery. We encourage you to include any family members or friends in this education process, so they can help you and support you to reach your weight loss and lifestyle change goals.

Day of Surgery

What happens the day of surgery?

On the day of your surgery, it is important that you arrive at the hospital with plenty of time to check in and prepare. After you check in at registration, you will be directed to the surgical preparation area. A nurse will meet you to walk you through the process, review your medical records, take your vital signs, perform a brief physical exam and make sure that everything is ready. Sometimes additional testing may be ordered.

As surgery approaches, we recommend and provide a licensed massage therapist to help ease any tension you may have. Our therapists offer aromatherapy and head phones with your favorite music as well to help you relax. Your anesthesia team will discuss your anesthesia and administer the appropriate form of anesthesia for you.

What happens in the operating room?

Once you are prepped for surgery, your surgeon, nurse and anesthesiologist will take you in to the operating room. Inside the operating room, you will be cared for by a team of physicians, nurses, anesthesiologists and skilled technicians. The total time required for your surgery will vary from patient to patient depending on the type and complexity of your procedure.

What happens in the recovery room?

After surgery, you will be transported to an area called the Post Anesthesia Care Unit (PACU) or recovery room. Nurses will check your vital signs and monitor your progress.

After your stay in the PACU, you will be moved to your hospital room to begin your recovery.

Can my family be at the hospital the day of the surgery?

On the morning of surgery, your coach, family member or friend will be able to stay with you until you’re ready to be transported to the operating room. At this point, they will be escorted to a family waiting area where they will wait for you to come out of surgery.

Once your operation is complete, a member of the surgical team will contact your coach, family member or friend. At this point, they will be able to speak with your surgeon to discuss your procedure.

How can I best prepare my body for surgery?

There are some important ways you can prepare for surgery; be as active as you can. If your physician approves it and you’re physically able, start walking every day. If you’re using tobacco, stop. This is critically important, as you can’t have weight-loss surgery if you’re actively using tobacco. And the longer you quit before surgery, the easier it will be not to resume after surgery.

Try to eat as healthfully as you can. Taking in less fat before your surgery will make your surgery and recovery easier.

Post Operation

What happens during recovery?

During your first week home, you are encouraged to walk around your house (or outside) often. You will be on a liquid diet as prescribed by the postoperative diet plan. Bottom line: You need to sip fluids all day. While activity is encouraged, you shouldn’t be doing any strenuous activity or lifting anything more than about 20 pounds.

How quickly will I lose weight?

Many patients will lose a lot of weight in the first weeks following surgery. This is usually a combination of the low-calorie liquid diet and the surgery. However, the most important thing we look at is how well you are healing. Early weight loss is not an indicator of long-term weight loss. However, when you lose weight early, it is very encouraging. Most of your weight loss will be over the first 18 months, with about half of the total occurring in the first five months.

Is the postoperative diet difficult to follow?

Most patients do fine following the postoperative diet plan. It is very different from your preoperative diet. But the surgery will help you adhere to the small portions and consume less sweet and fatty foods.

Can I get pregnant after this surgery?

Yes, but there are some caveats. First, it will be essential to ensure that you’re nutritionally sound prior to doing so. Second, you should not get pregnant during the phase of rapid weight loss. Therefore, we recommend not getting pregnant for the first two to three years after your surgery. We also need your obstetrician to be comfortable treating you.

Can I regain the weight?

If you don’t follow the postoperative diet plan, you can regain some or all of the weight you’ve lost. Most patients are able to follow the plan and maintain their healthy weight.

How many follow-up visits?

You will be seen in our office in one to two weeks, one month, three months, six months and one year following your surgery. During these visits, we will monitor your recovery and provide additional nutritional counseling. We will also perform routine blood work and any other testing you may need.

When should I call the office?

When you leave the hospital, we will give you discharge instructions explaining your early postoperative recovery. As a general rule, in the first month following surgery, you should call the office immediately (day or night) for any of the following reasons:

• Nausea and vomiting
• Fever greater than 101º Fahrenheit
• Increased pain
• Inability to drink
• Light-headedness
• Generally not feeling as well as you did earlier in your recovery
• Any questions or concerns
• Changes to Day-to-Day Life

What should be my diet consist of?

Regardless of which procedure you choose, weight loss surgery will help control hunger and make you feel satiated with a much smaller amount of food. The goal is to eat three small (4-ounce or half-cup) meals each day. These meals will be largely protein based with some fruits and vegetables; overall, they should be ordinary foods. Very tough or chewy foods, such as meats and bread, will often give people difficulties. Foods that contain a lot of sugar or carbohydrates should be avoided after gastric bypass surgery, as it may cause dumping syndrome. Occasionally, some people will develop dislikes or problems to very specific foods; these vary from patient to patient.

Do I need to take supplements?

You will need to take a multivitamin and calcium supplement daily. During the rapid weight loss phase, you will also drink protein shakes, which many patients substitute for one of their three daily meals. Although the procedures performed have only a modest effect on absorption of nutrients, your blood work will be checked frequently to identify any additional supplements that may be needed. On average, patients need to take one to two supplements daily in addition to the multivitamin and calcium.

What should my exercise schedule consist of?

The goal of weight loss surgery is to help patients live a healthier, more active life. After recovery from surgery, you should have no physical limitations because of the procedure. On the contrary, regular exercise is strongly encouraged because it will improve your weight loss outcome. Most patients lose the physical limitations placed upon them by their weight and can do activities and exercise they were not able to do before surgery.

Will by bowel habits change?

This is a very common question and concern for people contemplating weight loss surgery. Just as people have a wide variety of bowel habits before surgery, there are a wide variety of bowel habits afterward, too. Some patients experience constipation, usually from not taking in enough fluids. Others experience loose bowels or gas, which can also be related to diet. However, research regarding the degree of bowel habit changes has shown that these changes do not take away from the positive overall weight loss experience following surgery. In other words, most patients are happy to deal with these changes in exchange for the weight loss!

Will there be nausea and vomiting?

In general, patients who have gastric bypass or gastric sleeve surgeries should not have nausea or vomiting if they are following the prescribed diet plan. Nausea and/or vomiting are most commonly caused by patients eating too fast, too much or too often. Poor food choices can also lead to nausea or vomiting. If this is not the case, then nausea and/or vomiting can be an indication of a problem that needs to be brought to our attention. Occasionally, the opening created by the surgery becomes too small and needs to be dilated with a minor procedure for gastric bypass patients.

What is dumping syndrome?

Following gastric bypass surgery, eating foods which have a lot of sugar or carbohydrates should be avoided as it may cause dumping syndrome. This is caused by these foods entering the intestine at a point where they would normally (before surgery) have been broken down already higher in the intestine (which is now bypassed). The body misinterprets how much sugars have been eaten and reacts by sending fluids into the intestine and producing extensive amounts of insulin in the blood. This can cause abdominal cramping or bloating, pain, lightheadedness, clammy skin, generalized weakness, a severe drop in blood sugar and even loss of consciousness. This usually occurs minutes to a few hours after eating.

What are the risks of alcohol and tobacco?

We strongly recommend avoiding alcohol and tobacco following bariatric surgery. Tobacco use can contribute to the development of an ulcer after weight loss surgery, which is why we strongly recommend avoiding it. The empty calories in alcohol will reduce your total weight loss, which is why we strongly recommend avoiding it. What’s more, alcohol’s effects can also be dramatically increased after weight loss surgery, with much smaller quantities causing profound intoxication. Extreme caution must be used with the consumption of alcohol after weight loss surgery. In general you should completely avoid all alcoholic beverages for at least a year following surgery.

Is there a risk of hair loss?

Some hair loss can occur during rapid weight loss. This may be due to a mild nutritional deficiency, hormonal changes with weight loss or a combination of the two. We will usually prescribe additional nutrition supplements if hair loss is experienced. The good news is that when the weight loss slows down, the hair loss reverses in almost everyone.

Will I have loose skin post-surgery?

After massive weight loss, your skin will be looser than it was prior to the weight loss. Your skin’s natural ability to snap back to the shape of your underlying body tissue will determine how loose your skin ends up being. Everyone is different. Sometimes, this loose skin can result in rashes or infections. Other times, people just think the skin is too loose.

The medical reason to remove the extra skin is the presence of rashes or infections. However, you should know that many insurers consider this to be cosmetic surgery and will not cover it.