Weight Loss Surgery FAQ
If you have questions regarding bariatric surgery, please read some of our frequently asked questions below. If you have any other concerns that aren’t listed here, please don’t hesitate to contact us.
Preparation for Surgery
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels. I take only the most calculated of risks. And, I am known for being ”the safest practice around” for a reason. I will not take risks with your health and safety. Nothing is worth a short-cut in your work-up. RUN from those who guarantee surgery ”ASAP” I am the opposite. It is worth the time to know how to make surgery as safe as possible. My excellent safety record can attest to this fact.
I require the following labs: CBC, Chem-13, Lipid Panel, TSH, and UA.
I require the following consults:
- For everyone: Pulmonologist evaluation and surgical clearance — with PFT’s with DLCO. This is a comprehensive medical evaluation to determine the state of your medical health and your surgical safety potential. This is done by a doctor who specializes in more advanced medical conditions and has experience and training in critical care.
- For everyone: Psychiatric professional clearance. This is to get a trained-opinion if you are stable, cooperative, and ready for a life-long commitment. Any psych professional is reasonable and you can use your own, if they are comfortable doing this type of evaluation.
- If 50 years of age or greater: Cardiologist evaluation and clearance, with some sort of evocative stress test. The risk for notable heart disease in my patient population, if over 50 years of age, is agreed upon by all. This will give us the ultimate surgical, risk-stratification and make everyone feel better about allowing you to go to surgery.
- If reflux (GERD) for 5 years or more: I require an upper endoscopy (EGD). We are considering operating on your stomach… so if you have reflux issues for 5 or more years, I think we should “take a look at it” before surgery.
- If you used Fen-Phen for at least 3 months: you need an echocardiogram to make sure you do not have heart valve issues. Very unlikely, but possible.
Patients, who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned. As noted above, if you have reflux (GERD) for 5 years or more: I require an upper endoscopy (EGD).
The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it. Your pulmonary evaluation will help to clarify this picture. I do not require all of my patients to be screened for this. But, selectively, it may prove to be a useful work-up for you.
The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan. I think it is essential for a number of reasons. But, most important is to help you make sure that you are ready for: a life-long commitment, a permanent change in your daily life, and the risks and benefits of bariatric surgery. It is a good thing for you to have the chance to discuss these issues with a professional.
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient’s weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending bariatric surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average. We need to understand your medical issues to make sure we work to minimize their impact on your surgery and recovery. And, personally, I love to know what we are starting with so I can know what we can help to make better!
New evaluation appointments are usually booked 4-6 weeks in advance. Once a patient is seen, if the surgeon and patient agree it is appropriate, the operation can usually be scheduled within 6-8 weeks.
Why so long? The work-up and insurance approval process is essential and rarely a quick process. As described above, we take no short-cuts in your work-up. And, in the insurance realm, every insurance has different routes to surgery. We are experts in making it quicker. But the rules are not easily changed. A number of insurances require 3-6 months of medically-supervised weight-loss. Obviously, this takes time. We do have a ”FastTrack” program for those who qualify. And, as an aside, I know of a lot of ”get you in quick and run to the operating room” surgeons. I do not recommend such an approach for obvious reasons.
Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current.
Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
Bring any pertinent medical data to your appointment with the bariatric surgeon — this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
Bring a list of your medications with dose and schedule.
Stop smoking. (Surgical patients who use tobacco products are at a higher surgical risk and I do not operate on smokers. We will help you quit.)
Start working on getting your labs and consults completed prior to your appointment with me. For details on what to do in preparation for your appointment, visit our Pre-Operative Information page.
No. Laparoscopic operations carry the same risk as open operations. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work, and reduced scarring. There is a lower risk of significant wound infections. I essentially always use the laparoscopic approach as my initial access.
Every attempt is made to control pain after surgery to make it possible for you to move about and become active. This helps avoid problems and speeds up recovery. Often several drugs are used together to help manage your post-surgery pain. If you have a Bypass, a Patient Controlled Analgesia Pump (PCA) (which allows you to give yourself a dose of pain medicine on demand) will be used early post-operatively. Various methods of pain control, depending on your type of surgical procedure, are available. For all procedures, we also almost always use a temporary, implantable, pain-pump that drips local anesthetic into your wounds for 2 to 3 days. It helps minimize narcotic use and its attendant problems.
As long as it takes to be self-sufficient. Although it can vary, the hospital stay for Bypass surgery is 2 days on average. For the Band procedures, most people go home the same day. I do not answer to anyone in my decisions on when you can go home… so you leave when you are ready and it is safe. If you need to stay, you stay.
After a Bypass or Sleeve procedure, I always leave a JP drain for about 5-7 days. It causes minimal to no discomfort, is easy to remove, and is not a “big deal.” I have used them in bariatric surgery for over 1500 major cases and been very pleased with their effectiveness and usefulness. It is a very good, extra, easy-to-use, safety and monitoring system.
With the Bypass and Sleeve, I use either a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. In addition, with all bariatric surgery procedures, I use an infusion pump that provides a local anesthetic in the surgical site to control pain without the side effects of narcotics. We make major efforts to control nausea and it is rarely a big problem in my patients.
As with any major surgery, there is a risk of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than 1 percent. Your doctors will have assessed you for risks and prepared accordingly. All abdominal operations carry the risks of but are not limited to bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.
Read about the Safety of Bariatric Surgery Study
The FDA has approved two gastric banding devices:
- Lap-Band by Allergan, Inc.
- Realize Adjustable Gastric Band by Ethicon Endo-Surgery, Inc.
Gastric Banding is not recommended for everyone. You should review your specific case with your surgeon to determine the right option for you. Gastric Banding is FDA approved for adults only.
There are potential risks and complications with gastric banding surgery. Although these problems rarely occur, we want you to know the facts. After gastric banding surgery, potential risks include band slippage, erosion and deflation, port-site infection, reflux, obstruction of the stomach, dilation of the esophagus, infection or nausea and vomiting may occur. Surgery complications may result in reoperations.
Almost immediately after surgery we will require you to get up and move about. We want you up and walking within 1.5 to 2 hours after surgery — so get ready to move!! You will be in your own room or the recovery/independence stage of our recovery room by then. On leaving the hospital, you should be able to care for all your personal needs, but will need help with shopping, lifting and with transportation for a few days.
For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 3 days after Band surgery and 5-7 days after Bypass and Sleeve surgery.
The Hospital Stay
Because a DVT originates on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with sequential leg compression stockings and given a blood thinner prior to surgery. Both of these therapies continue throughout your hospitalization. The third major preventive measure involves getting you moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs. We require 6 (minimum) walks per day. If you have activity limitations, you will be similarly “mobilized” to account for these limits.
Basic toiletries (comb, toothbrush, etc.) and clothing may be provided by the hospital, but most people prefer to bring their own. Choose clothes for your stay that are easy to put on and take off. Because of your incision, your clothes may become soiled, so nothing too precious. Other ideas: Reading and writing materials, DVD player, I-Pod, crossword/sudoku and other puzzles, personal toiletries, a bathrobe.
We are happy to answer any additional bariatric surgery questions you may have. Please give our bariatric team a call at the Denver Center for Bariatric Surgery at (303) 280-0900.