Questions Frequently Asked About Bariatric Surgery
Who qualifies for surgery?
If you have a body mass index (BMI) greater than 40, or a BMI greater than 35 with significant co-morbities, you may be a candidate. Patients should be between 21 and 65 years of age, have documented weight loss attempts, and have at least a three-year history of severe obesity. The best way to find out if you qualify is to call us at 812/450-7419.
Does health insurance cover this procedure?
Yes, in a majority of cases. Severe obesity is a medical problem. It is covered by most insurance companies. We will work with you to facilitate the process.
What preoperative tests are required?
Several tests are required, including a CBC (complete metabolic profile) blood test, urinalysis, pregnancy test, chest xray, EKG (electrocardiogram), psychological evaluation, nutrition evaluation and exercise evaluation.
An EGD (esophago-gastro-duodenoscopy) is also required. Many morbidly obese patients have undiagnosed reflux that requires treatment before bariatric surgery. Ideally, problems are identified and treated before surgery, because it is more difficult to evaluate the stomach after it is surgically divided. This does not prevent bariatric surgery in the future. Note that stomach cancer is not associated with gastric bypass.
What should patients do prior to surgery?
Follow all preoperative instructions.
THE SURGICAL PROCEDURE
Will the surgery be laparoscopic or open?
If your BMI is less than 50, you could be a candidate for minimally invasive laparoscopic surgery. The open technique is available for all patients. With an open surgery, your incision will be about 10 inches long.
What happens during the surgery?
Stomach Divided - The surgeon will completely separate the stomach into two sections and secure each section with a surgical stapler. The newly created stomach pouch will be 15-30 ml (1/2 - 1 oz.). The surgeon will not remove the other portion of the stomach, because it continues to secrete important juices for digestion. Also, past experience shows that removal of this organ is associated with more operative problems.
Intestine Bypassed- The “roux” limb will vary from 75-150 cm. Most likely, it will be closer to the 150 cm length.
Vagus Nerve Left Intact - The vagus nerves produce acid to help your body break down food. These nerves are left intact during the procedure. Some surgeons prefer to cut these vagus nerves to minimize ulcers, but this is not the standard of care. You will still have acid in your digestive tract to break down the food.
Liver Biopsy Possible - If your preoperative liver enzymes suggest liver pathology, or if your liver appears unusual at the time of surgery, the surgeon will do a liver biopsy.
Gastrostomy Tube Placement Possible - A gastrostomy tube is used only during revision surgery or if complications are noted during surgery. If one is placed, it is removed after your nutrition intake is adequate (minimum of 2 weeks).
How long will I be in surgery?
The open procedure with gallbladder removal takes about 2 ½ hours while the laparoscopic procedure can take 3-4 hours.
Where will the surgery take place?
Deaconess Weight Loss Solutions will schedule your surgery at Deaconess Hospital.
Is rapid weight loss dangerous?
Yes. Usually this danger is because patients don’t consume the essential nutrients during this time period. Deaconess Weight Loss Solutions will work with you on a regular basis to prevent this from happening. Essentially, this danger is eliminated if you follow the recommendations of the dietitian.
How soon should I walk after surgery to prevent blood clots?
Any surgery on morbidly obese patients is risky because of the potential for blood clots in the legs. To reduce this risk, you will begin standing at your bedside the evening of surgery and walking the very next day.
What will I do to prevent pneumonia?
You will do deep breathing exercises called incentive spirometry beginning immediately after surgery. These expand your lung spaces to prevent collapse and fevers.
How do people die from gastric bypass surgery?
Most deaths occur when blood clots travel from the legs to the lungs. This event is called a pulmonary embolism (PE). It happens most commonly within the 2 weeks following surgery. Even before your surgery occurs, we will start measures to prevent clots from forming, thus reducing your risk of PE.
How will sleep apnea or asthma affect me during and after the surgery?
These conditions increase your likelihood of needing postoperative breathing support (ventilator). If you have sleep apnea and are using BIPAP or CPAP, please bring your unit with you to use postoperatively.
Can ulcers form after surgery?
Yes. To reduce the risk of ulcers, you will take an antacid medication after surgery. Also, you should avoid non-steroidal anti-inflammatory drugs (NSAID) for the rest of your life.
How long is the recovery process?
Recovery Room - You will be in the recovery room about 1-2 hours before being transported to your hospital room. Less than 5% of patients go to the ICU (intensive care unit). That will be influenced by how your breathing occurs during and after surgery.
Hospitalization - Most patients stay in the hospital for 3 days, on average. Some laparoscopic patients are able to go home after 2 days. You are not required to have a bowel movement before going home.
Off Work - For open surgeries, the expected recovery period is 6 to 8 weeks, but you will be able to do most activities of daily living by 2-3 weeks after surgery. For laparoscopic surgeries, most patients are back to full activity by 3 weeks after surgery.
What will I use for pain relief?
You will use a PCA (patient controlled anesthesia) with morphine or demerol. Anesthesia may administer an epidural medication for immediate postoperative pain control.
What are some common side effects after surgery?
Nausea, vomiting, hernia at incision site, infection at incision site, general fatigue and diarrhea are common after surgery, but all resolve or can be fixed relatively easily.
What kind of medical equipment will be used after surgery?
IV - You will have an intravenous (IV) line in place during and after surgery.
Nasogastric Tube - Most patients do not have a nasogastric (NG) tube. If an NG is necessary, we will place it through your nose into the small bowel limb (not the divided portion of the stomach) during surgery. We will remove it after the x-ray study on postoperative day 1 is okay.
Urinary Catheter - You will have a urinary catheter. We will remove it after you are ambulating on postoperative day 1.
Drain - We will remove the drain before you leave the hospital.
Binder - For open surgeries, you will wear a binder for approximately 4 weeks after the surgery. Most patients say it feels good to support their incision, however there is no proven benefit for wound healing if you wear one.
Equipment for Special Needs of Obese Patients - Many patients worry that the hospital won't have equipment and supplies to meet the needs of larger patients. The bariatric center has worked extensively with the hospital to make sure that you will have everything you need to be comfortable.
What about eating and drinking after surgery?
Water & Other Liquids - After your UGI (upper GI x-ray) on postoperative day 1 is okay, you can drink. Your bariatric diet will begin at this time. Your nurse will let you know when to start drinking and help you keep records of how much you consume.
Coffee & Soft Drinks - Caffeinated drinks dehydrate your body and should not replace other fluid supplements, such as juice or water. Carbonated beverages can cause painful gas and potentially unwanted pressure on the staple lines. This could cause leaks. Soft drinks that are “flat” are more acceptable after you begin your lifetime diet.
Alcohol - Alcohol could cause you to become dehydrated after surgery, and it is possible to become intoxicated more rapidly than normal since your absorption is now altered.
"Dumping" Syndrome - Before surgery, foods are gradually released from the stomach into the small bowel. After surgery, food enters the small bowel almost immediately. When you eat pure or refined sugars (high caloric foods), fluid rushes into the intestine to aid in their digestion. This action is associated with flushing, sweating, palpations, abdominal pain and diarrhea. The degree of dumping depends on the amount and type of food. It usually subsides in 30 minutes. Try to learn what foods cause these symptoms, so you can avoid them in the future.
Hunger - Your stomach pouch will fill after a very small amount of food or liquid. This will cause a sense of fullness. You should not feel hungry or deprived of food.
Vitamins - You must take vitamins for the rest of your life. Your lifetime supplement regimen will include iron, calcium and a general multivitamin. These vitamins come in a chewable form to avoid trouble swallowing. Vitamin B12 is included in the multivitamin and rarely requires additional supplementation.
What about smoking after surgery?
You should avoid smoking, because it can stimulate stomach secretions and irritate the stomach lining.
Will I regain the weight?
It is possible to regain weight. However, it is difficult, if not impossible, if you follow the instructions for exercise and proper nutrition. Eating high caloric foods on a constant basis throughout the day can destroy all of our hardwork.
Can the pouch stretch to allow my eating capacity to increase with time?
It can stretch only a minimal amount because of the manner in which the stomach is divided.
What about the extra skin I will have after losing excess weight?
After 18 – 24 months, most patients will plateau with respect to their weight loss, and referral to a plastic surgeon will be an option for excision of extra skin.
When can I have sex after surgery?
When it is comfortable.
When can I get pregnant after surgery?
You should wait until your weight has stabilized. This typically occurs around 18 months postoperatively.
Are support groups recommended?
Yes. As a matter of fact, Dr. Burry requires all patients to attend a support group meeting prior to surgery to talk to patients who have already experienced gastric bypass. After surgery, support group members will be a great resource as you adapt to your new lifestyle.