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Frequently Asked Questions
Laparoscopic
Gastric Bypass Surgery
We follow the guidelines of
the National Institutes of Health and American Society for
Bariatric Surgery. The following patients are accepted as
candidates for weight loss surgery:
You can determine your BMI
using the Center for Disease Control's BMI calculator by
clicking here.
Does the doctor remove my gallbladder?
Our surgeon feels it is unnecessary to remove your gallbladder
unless there are signs or symptoms of a diseased gallbladder.
You will, however, be treated post-operatively with medication
to decrease the risk of developing gallstones, which can occur
from rapid weight loss.
How long will I be in the hospital?
The usual stay is 2 days for gastric bypass surgery. Lap band
procedure is usually performed as an outpatient, in some cases,
overnight.
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When may I return to work?
It
depends on the type of work you perform. If sedentary, most
patients are able to return to work in 1-2 weeks. It may take
4-6 weeks if physical labor is involved.
Will I lose my hair?
Gastric Bypass
patients may experience hair loss or hair thinning within 4-8
months after surgery. However, this is usually a temporary
condition and our staff can help you with this. Lap band patients
do not usually experience hair loss.
What is the mortality rate?
The
national mortality rate for lap band surgery is .05%. The
national mortality rate for gastric bypass surgery is .5%.
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How will my diet change?
The
quantity of food you will be able to eat will change
significantly. Soon after your surgery, you will be eating up to
one ounce of protein 3 times a day. Other foods will be added as
you tolerate them. You may be unable to tolerate certain foods,
especially those containing sugar and fat. The types of food and
amount of sugar and fat you can tolerate vary from person to
person. You will be required to meet with a nutritionist who
will give you a comprehensive diet to follow.
Are vitamins necessary after surgery?
Vitamins will be required for the rest of your life. Immediately
after surgery you will begin taking a chewable multi-vitamin
daily. After one month you will add vitamin B12 and
calcium citrate.
What is the average weight loss after
gastric bypass surgery?
Typically at 3 months, 35% of
your excess weight is lost, 60% at 6 months, and 75% after one
year. Weight loss results vary with each individual.
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Is pregnancy possible after surgery?
Yes. In fact, surgical weight loss often increases fertility in
those who have had difficulty conceiving in the past. However,
pregnancy must be avoided 12-18 months after surgery,
until your weight has stabilized.
Will my insurance cover the surgery?
Depending upon your type of insurance plan there may be an
exclusion for weight loss treatments, including surgery. Other
plans will have certain requirements before agreeing to pay for
the surgery, such as a history of failed medically-supervised
diets and the need for a psychological evaluation, just to name
a few. Not all plans have the same requirements. You can call
your health care insurer to find out if your plan covers either
the lap band of bariatric Roux-en-Y surgery.
When do I pay?
Your program fee will
be collected in two segments. The first portion will be
collected at your consultation with the bariatric nurse at Lee
Health Solutions. The remainder will be collected at your
pre-operative education class. Any applicable physician co-pays
and/or deductibles will be collected by your doctor before the
surgery. If you are not using insurance, the fees must be paid
in full before you receive the services.
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What impact do my medical problems have on
the decision for surgery, and how do the medical problems affect
risk?
Medical conditions, such as serious heart or lung
problems, can increase the risk of any major surgery. If the
problems are related to the patient's weight, the problems also
increase the need for surgery. In other words, the surgeon will
usually recommend weight loss surgery in spite of severe medical
problems if it is appropriate otherwise. However, he will
estimate your risk as higher than average upon initial
consultation.
If I want to undergo gastric bypass
surgery, how long do I have to wait?
Once a patient is
seen (if the surgeon and patient agree it is appropriate), the
operation can usually be scheduled within 8 weeks.
Why so long?
A lot happens after you
make the decision to move forward with the surgery. If you are
trying to have your insurance pay for the surgery, you need to
get authorization at this time. Once you get authorization, we
can give you a surgical date, but we have to allow enough time
for any additional medical clearances that are needed. There is
also a mandatory pre-operative education class that you must
attend. Your surgery will be cancelled unless you attend the
class.
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What can I do before the appointment to
speed up the process of getting ready for surgery
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If you don't already have a primary
doctor, find one and establish a relationship. Work with
that physician to get "caught up" on your routine health
maintenance testing: for women this is a bi-annual exam and
pap smear and if you are over 40, a mammogram. For men this
might include a PSA, but you should ask your doctor about
this test.
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Write out your diet history and bring it
with you to the consultation. Bring any pertinent medical
information with you. This should include reports of special
tests (echocardiogram, sleep study, etc.) or a hospital
discharge summary if you have been in the hospital. It
should also include all progress notes related to your
medically-supervised weight loss attempts. Most
insurance policies require 6-12 months of consecutive,
medically-supervised weight loss attempts within the prior
24 months as criteria for approving the surgery.
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Bring a list of your medications with dose
and schedule.
What if I have had a previous surgical
weight loss procedure and I'm having problems?
Contact
your original surgeon. It is vastly preferable for the original
surgeon to take care of a surgical problem because he or she is
most likely to know the correct solution based on the knowledge
of your surgical anatomy.
Should I donate my own blood, to have it on
hand in case I need it at the time of the operation?
Generally not, as most patients lose very small amounts of blood
during the surgery. Even those who have unexpected bleeding
during surgery do not usually lose enough blood to warrant
transfusion. The main downside to autologous donation (giving
one's own blood for use in surgery) is that it is necessary to
wait several weeks for your body's blood supply to build back up
after donation. However, this is a personal choice and yours to
make.
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My doctor doesn't believe in surgery for
weight loss. What should I say to him/her?
First try to
understand the origin of the negative opinion:
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Has the doctor seen bad outcomes in his
patients after lap band or bariatric surgery? Bad outcomes do
happen, but in appropriately selected patients the risk of
surgery is less than the risk of continuing with morbid
obesity.
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Does the doctor simply not know much about
the operation? Physicians are like other people in that they
do not trust what they do not know. Weight loss surgery is
only now becoming widely accepted, and many physicians do
not have much exposure to it.
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Is the doctor prejudiced against
overweight
people? Again, physicians reflect the general culture (for
better or worse). This is the only situation in which it is
probably appropriate to select another doctor.
Once you understand the objection as well as
possible, ask your doctor two questions:
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Is the weight a significant medical
problem? Does it put you at significant risk for development
of weight-related medical problems? This is
automatically "yes" in people with a BMI >40.
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What treatment does the doctor propose?
The sad fact is there is no therapy other than surgery that
has demonstrated significant weight loss for more than two
years in morbidly obese patients.
What is the right amount of exercise after
weight loss surgery
Many patients are hesitant about
exercise after surgery, but in reality exercise is an absolutely
essential component of success after this surgery. Exercise
actually begins on the afternoon of surgery. The patient will be
assisted out of bed and expected to take a short walk. The goal
is for the patient to walk farther on the next day and
progressively farther every day after that, including the first weeks
at home.
We generally release the patient from medical
restrictions and encourage the patient to begin exercise about
four weeks after surgery. Most patients with lap band surgery are
released sooner. The doctor will assess each person individually
before lifting medical restrictions.
The type of exercise is to some extent
dictated by the patient's overall condition. Some patients who
have severe knee problems can't even walk well, but almost all
can swim or bicycle. Many patients begin with low stress forms
of exercise, and we encourage them to progress to more vigorous
activity when they are able. Sexual activity is OK from
two weeks onward, again as dictated by comfort level.
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How can I know that I won't just keep
losing weight until I waste away to nothing?
Patients may
begin to wonder about this early after surgery when they are
losing 20-40 pounds per month, or maybe when they've lost more
than 100 pounds and are still losing. Two things happen to
stabilize your weight. First, the number of calories you burn
each day (ongoing metabolic needs) decreases as you lose the
load of extra weight. Second, in the months following gastric
bypass, you will naturally increase the calories and nutrients
you consume each day. Basically, the stomach pouch and the
attached small intestine learn to work together better, along
with slight expansion in pouch size over a period of months. The
bottom line is, in the absence of a surgical complication,
patients are very unlikely to lose weight to a point of
malnutrition.
How big will my stomach pouch really be in
the long run?
The stomach pouch is created to hold
approximately one ounce. In the first few months it is rather
stiff due to natural surgical inflammation. From about 6-12
months after surgery, the stomach pouch expands a bit and
becomes more pliable as the inflammation subsides. Most patients
end up with a meal capacity of about 3-7 ounces.
What can I do to prevent lots of excess
hanging skin?
Unfortunately, the majority of people who
have gotten heavy enough to merit gastric bypass surgery have
stretched their skin beyond a point from which it can "snap
back."
Is plastic surgery necessary?
Every
person is different; there are many factors involved. Things
like age and skin elasticity will play a big part in assessing
if surgery will be needed or desired by the individual.
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Will exercise help?
Exercise is good
in so many other ways that we definitely recommend a regular
exercise program, but the reality is that most patients are left
with large flaps of loose skin even with exercise.
Will I be miserably hungry after surgical
weight loss, since I'm not eating as much?
Most patients
say no. In fact, for the first 4-6 weeks patients have almost no
appetite. Over the next several months the appetite returns but
it tends not to be a ravenous, "eat everything in the cupboard"
type of hunger.
What if I am really hungry?
Usually
this is caused by the types of food you are consuming,
especially starches (rice, pasta, potatoes). Also be absolutely
sure not to drink liquid with food (liquid washes food out of
the pouch). There may also be a psychological problem with the
lack of food in your life. We offer a monthly support group to
assist you through the many changes you will make in your
lifestyle. We also have scheduled guest speakers to provide
additional information on nutrition, exercise, plastic surgery
and much more.
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Will I have to change my medications?
Many medications (for blood pressure, diabetes, and so forth)
may be stopped at some point after gastric bypass. For
medications that need to be continued, the vast majority can be
swallowed, absorbed and work the same as before gastric bypass.
Usually no change in dose is required.
Two classes of medications that should be used
only in consultation with your surgeon are diuretics (fluid
pills) and NSAIDs (most over-the-counter pain medications such
as ibuprofen, naproxen, and their cousins). The issue with
NSAIDs is that they can create ulcers in the small pouch or the
attached bowel. Most diuretic medicines make the kidneys lose
potassium and, with the dramatically reduced intake experienced
by most gastric bypass patients, they are not able to take enough to
compensate. If a person's potassium level gets too low, it can
lead to fatal heart rhythm problems.
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