Frequently Asked Questions About Surgical Weight Loss
What can I do before the appointment to speed up the process of getting ready for surgery?
- Select a primary care physician (PCP) 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 first appointment - 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.
Do I meet with a dietitian and behavioral counselor before and after surgery?
We require that patients consult with a dietitian before and after surgery. Counseling visits are required before surgery and after surgery as needed.
Will I be asked to stop smoking prior to surgery?
Patients must stop smoking at least six to eight weeks before surgery.
If I continue to smoke prior to surgery, what happens?
Smoking increases the risk of complicatins after surgery, can reduce the rate of healing, increases the rates of infection and interferes with blood supply to the healing tissues. Surgery will not be scheduled until nicotine level lab test is normal.
What should I bring with me to the hospital?
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 stained by blood or other body fluids.
- Post-op manual provided by the Weight Management Center
- Reading and writing materials
- Crossword and other puzzles
- Personal toiletries
Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait at least 12 - 18 months after the surgery before becoming pregnant. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint), and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.
Following surgery, what is done to minimize the risk of deep vein thrombosis/pulmonary embolism (DVT/PE)?
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 the patient moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs.
How long do I have to remain in the hospital following surgery?
As long as it takes to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be one to two days for a minimally-invasive gastric bypass and two to three days for an open gastric bypass.
How long will I be without solid foods after surgery?
Most surgeons recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred. Your dietitian will provide you with specific dietary guidelines for the best post-surgical outcome.
How soon can I drive after surgery?
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 seven to 10 days after surgery.
How soon will I be able to walk after surgery?
Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs but will need help with shopping, lifting and with transportation. There are less lifting restrictions with minimally-invasive surgery.
If I have surgery, what can I expect when I wake up in the recovery room?
The surgeon will provide a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. As with any major surgery, you are at risk for complications resulting from surgery. Statistically, the risk of death during these procedures is less than one percent. Your doctors will have assessed you for risks and prepared accordingly.
All abdominal operations carry the risks of 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.
Is a blood transfusion required?
Very rarely. If needed, it is usually given after surgery to promote healing.
Is there a difference in the outcome of surgery between men and women?
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
What are "adhesions" and do they form after this surgery?
Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.
What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:
- Immediately after surgery, the dietitian will provide you with special dietary guidelines. You will need to follow these guidelines closely. Patients begin with liquid diets, moving to semi-solid foods and later solid foods can be tolerated without risk to the surgical procedure performed. Allowing time for proper healing of your new stomach pouch is necessary and important.
- When able to eat solids, eat small meals through the day. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat proten sources should be eaten first. These should comprise about half the volume of the meal eaten. Foods should be cooked with limited fat and seasoned to taste. Avoid high calorie sauces, gravies, butter, margarine, excess mayonnaise or added empty calories.
- Drink two to three quarts or more of water each day. Water must be consumed slowly, one to two sips at a time, due to the restrictive effect of the operation. Water should be the main source of liquids but low calorie or calorie-free beverages may also be included. It is recommended that you avoid carbonated beverages.
- Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added three to four days per week, as instructed by your doctor.
Will I lose hair after surgery? How can I prevent it?
Many patients experience some hair loss or thinning after surgery. Consistent intake of protein and vitamin/mineral supplements is the most important prevention method.
How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one to two ounces or less in size (15-20cc). About 6 - 12 months after surgery, the stomach pouch and meal size will gradually increase to a half cup to a full cup of volume.
Is there a problem with consuming milk products?
Milk sugar (lactose) may not be tolerated after surgery. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea. It is the exception, rather than the rule that milk products are not tolerated.
Is there any restriction of salt intake following surgery?
No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.
Will I be miserably hungry after weight loss surgery since I'm not eating much?
Physical changes of weight loss surgery help you to feel satisfied on a small meal. Again, it is more typical to have decreased appetite after surgery.
Will I get a copy of suggested eating patterns and food choices after surgery?
The dietitian provides patients with materials that clearly outline their expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on patient compliance with making good food choices and following guidelines. You must do your part by restricting high-calorie foods, limiting added sugar and fats, and by following the guidelines set by your dietitian.
Will I get a copy of suggested eating patterns and food choices after surgery?
The dietitian provides patients with materials that clearly outline their expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on patient compliance with these guidelines. You must do your part by restricting high-calorie foods, by avoiding sugar, snacks and fats, and by strictly following the guidelines set by your dietitian.
Will I be able to take oral contraception after surgery?
Most patients have no difficulty in swallowing these pills.
Is it important to take calcium, iron, trace elements?
At follow up checks, lab work can be completed to monitor individual need for additional vitamin or mineral supplementation. It is important to take vitamin and mineral supplements per protocol after weight loss surgery to minimize deficiency.
Is there any difficulty in taking medications following surgery?
Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.
Will I have to change my medications following surgery?
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. 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 medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
Will I need supplemental vitamins following surgery?
Daily multivitamins are recommended for the rest of your life. A multivitamin, extra calcium +D, and B vitamins are recommended after surgery. You will be provided with the vitamin protocol or any individualized suggestions at your visits.
How can the insurance companies deny payment for a life-threatening disease?
Coverage may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity."
Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as one to five years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods. The majority of insurance companies are now requiring six months of pre-surgery medically supervised weight loss.
What can I do to help with the insurance process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.
Why does it take so long to get insurance approval for surgery?
The St. Mary's Weight Management Center's insurance specialist contacts every patient's insurance company. Insurance companies have different plans and criteria.
Additional Health Conditions/Concerns
What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. Medical review and evaluation before surgery is necessary to decrease risk of complications associated with medical issues for the best surgical outcome Medical issues will not likely rule you out as a surgical candidate. In fact, addressing these issues before surgery can decrease your chances of having a complication.
What is "Dumping Syndrome?"
Eating sugars with high concentration of sugar can cause an adverse reaction called dumping syndrome after gastric bypass surgery. Your body processes food too concentrated in sugar by diluting them with water (drawing liquid to the intestines) which can reduce blood volume and cause a shock-like state.
Concentrated sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling. You break out in a cold clammy sweat, turn pale, feel "butterflies" in your stomach and have a pounding pulse.
Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable - you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it. Although all foods that have some sugar in them are not "off limits." Ask your dietitian about what to look for to decrease your chance of experiencing dumpingsyndrome.
What is a hernia and what is the probability of an abdominal hernia after surgery?
A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.
What is phlebitis and is it preventable following surgery?
Phlebitis is undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:
- Early ambulation
- Special stockings
- Blood thinners
- Pulsatile boots
What is sleep apnea (SA)?
Sleep apnea is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after weight loss. In most patients, there is a complete resolution of symptoms by six months following surgery.
What is the "Candida Syndrome?"
Some patients have a type of yeast present on the surface of their skin, intestine or vagina at the time of surgery. This leads to overgrowth in certain circumstances. A whitish coating may occur on the tongue or throat. This syndrome is associated with a frothy mucous, nausea, difficulty swallowing, sore throat, loss of taste and appetite and occasionally abdominal bloating and diarrhea. This is a very rare occurrence and can be treated with medication.
Can weight loss surgery help other physical conditions?
According to current research, weight loss surgery can improve or resolve associated health conditions.
- Diabetes or insulin resistance
Percentage found in preoperative individuals: 34%
Percentage cured 2 years after surgery: 85%
- High blood pressure
Percentage found in preoperative individuals: 26%
Percentage cured 2 years after surgery: 66%
- High triglycerides
Percentage found in preoperative individuals: 40%
Percentage cured 2 years after surgery: 85%
- Sleep Apnea
Percentage found in preoperative individuals: 22% in males, 1% in females
Percentage cured 2 years after surgery: 40%
What are the routine tests before bariatric surgery?
Certain basic tests are done prior to surgery, such as a Complete Blood Count (CBC), certain vitamin and mineral levels, Urinalysis and a Chemistry Panel, which gives a reading of about 20 blood chemistry values. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated.
What is the purpose of all the routine tests before bariatric surgery?
An accurate assessment of your health is needed before surgery to avoid complications related to medical issues that are attributed to carrying excess weight. For example, 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 before surgery to optimize blood sugar control to decrease risk of infection and promote proper healing after surgery.
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, vitamin or mineral deficiencies or abnormal blood fat levels.
Why do I have to have a GI evaluation?
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.
Why do I have to have a psychological evaluation?
The most common reason a psychological evaluation is ordered is that your insurance company requires it. Most psychologists and behavioral counselors 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. Our program wants you to achieve successful long term weight loss.
Why may I have to have a Sleep Study?
The sleep study detects a tendency to stop 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 before it is a major complication. Our medical physician will determine if you need a sleep study prior to your surgery.
What is the right amount of exercise after weight loss surgery?
Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery - you will be encouraged to get out of bed and walk. The goal is to walk further on the next day and progressively further every day after that, including the first few weeks at home.
Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient's overall condition. Some patients who have severe knee problems can't walk well, but may be able to swim or bicycle. Begin with stress forms of exercise and progress to more vigorous activity when able.
What's so important about exercise after surgery?
Exercise will help you maintain your muscle mass while you are losing weight. Daily aerobic exercise for 20 minutes will communicate to your body that you want to use your muscles/maintain muscle and lose body fat.
Can weight loss surgery prolong my life?
There is good evidence from scientific research that when you have serious obesity-related health conditions, are at least 100 lbs. over ideal body weight and comply with lifestyle changes (daily exercise and healthy diet and vitamin/mineral protocol), weight loss surgery may significantly prolong your life. It is also pertinent to pursue weight loss surgery to avoid future health complications related to diseases attributed to excess weight.
Does minimally-invasive surgery decrease the risk of surgery?
Somewhat. Minimally-invasive operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring. Another benefit, laparoscopic surgery decreases the risk of incision-site infection.
How can I know that I won't just keep losing weight?
Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery.
The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition. Weight loss will be faster in the beginning months and slow to optimal body weight. Attending regular follow up appointments is important to monitor your overall health as you lose weight after weight loss surgery.
If I want to undergo a gastric bypass, how long do I have to wait?
Depending on your insurance company requirements, it may take from three to six months from the time of initial contact with our office until the time your surgery is approved.
Is sexual activity restricted after surgery?
Patients can return to normal sexual intimacy when wound healing and discomfort permit.
What can I do to prevent lots of excess hanging skin?
Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients do not have much excess skin after surgery. Hydration, a healthy diet and exercise will assist with reducing loose skin. Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from skin folds. Ask your surgeon about your need for a skin removal procedure.
What happens to the lower part of the stomach that is bypassed?
The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12, and contributes to hormone balance and motility of the intestines in ways that are not entirely known.
What is the oldest patient for whom weight loss surgery is recommended?
Patients over 65 require very strong indications for surgery and must also meet stringent Medicare criteria. Surgery risk in this population is increased, and the benefits, in terms of reduced risk of mortality, are reduced. St. Mary's does not perform this surgery on patients 65 or older.
What is the youngest age for which weight loss surgery is recommended?
Generally accepted guidelines from the American Society for Bariatric Surgery and the National Institutes of Health indicate surgery only for those 21 years of age and older. Lifelong commitment to altered eating and lifestyle changes are necessary for success. This center performs surgery on patients who are 21 years or older.
What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples typically seen or used on exterior incision sites with other types of surgery. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples, and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors. There are no staples used on the incision on the outside of the body that will require removal.