It is important that you be an informed and thoughtful participant in the decision to perform this operation, because it is a major operative procedure that will change your lifestyle permanently. We highly encourage you to purchase the book Weight Loss Surgery for Dummies as a reference. This book is an excellent source of information before and after your surgery. It can be purchased through Amazon.com, at a local book store, or in our office for ($16). If you are interested in Lap Band surgery then the book Lap Band for Life is another excellent reference. There are numerous and helpful web sites available. In addition, please try to attend a pre-operative information seminar and/or support group meetings prior to your surgery to learn more about our program and procedures.
Reference the “Bariatric Patient Checklist for Surgery” for complete details on the steps to surgery. The first visit with the surgeon usually consists of collecting the medical data and history to determine if you are a weight loss surgery candidate. Often time patients are well educated at the time of their first visit and decide that they want to proceed with surgery. If this is the case with you, you will be scheduled for evaluations and tests as necessary based upon your medical history. After the first visit with the surgeon we will see you back on a weekend for a small group information session after you have decided to go ahead with the evaluation process. At the second office visit we encourage you to bring your loved ones with you as we begin to discuss in more detail the risks and benefits weight loss surgery. We feel that it is imperative that you have family members involved in this important decision making process. Upon receiving the evaluations, a letter will be sent to your insurance company to obtain prior authorization. This process is known as proving “medical necessity.” Once we have obtained prior approval from your insurance company you can be scheduled for surgery. If your insurance company does not have benefits for weight loss surgery, then a cash pay option is available. This option offers a comprehensive fee that includes surgery, hospitalization, anesthesia charges as well as surgery complication insurance (BLISS Care). If you are interested in this option we can direct you to low interest rate financing.
We will schedule you to come into the hospital on the morning of surgery, with the exact time to be determined by the schedule of operations for that day. After surgery you will have a tube in your bladder (called a Foley catheter), and a couple of IVs. You will have stockings that intermittently compress your lower legs to reduce the chance of forming blood clots (referred to as deep venous thrombosis or DVT) in your legs. A drain will also be left in the abdomen that will be removed four to five days after surgery. If there is concern about your being strong enough to breathe on your own after your surgery, we will continue to assist your breathing efforts with a ventilator. This means that the endotracheal tube (breathing tube) that was placed into your trachea (windpipe) when you went to sleep for surgery will be left in place when you go to the ICU. While the endotracheal tube is in, we will give you medicine as needed to sedate you in order to ensure that you are comfortable. Usually patients are strong enough by the morning after surgery to have the endotracheal tube removed. Almost immediately after surgery, or once the endotracheal tube is removed, we will demand that you start to do breathing exercises. You will also be assisted in sitting up at the side of your bed. You won’t feel like doing these things, but they reduce the chance of pneumonia and developing clots in the legs. We will also help you walk as soon as possible. Usually the morning following the surgery we will do an x-ray study where you drink a contrast solution to ensure that there are no leaks or obstructions. The Foley catheter will be removed from your bladder when you are moving around well. Patients are usually started on (sugar-free) clear liquids on the morning of the swallow study. Patients usually feel well enough to go home the next day after gastric banding and three to four days after gastric bypass surgery. Most of the care done after discharge relates to management of your diet. Patients usually go home on a Stage II diet (small portions of nutrient-enriched liquids-things you could drink through a straw). They advance to a Stage III diet (pureed table food/soft foods-things you could eat without teeth) at the time of their first clinic visit and go to a Stage IV diet (small amounts of regular food) if they are doing well at the time of the second clinic appointment. Some patients will experience loose or frequent bowel movements after the Gastric Bypass, Patients sometimes have trouble eating anything in the first couple of weeks at home. If you have this trouble, remember that the first priority is to take in liquids to keep up your fluid status and the second priority are to take in protein. This trouble almost always passes on its own. If it does not, we will arrange a test to evaluate the problem.
What Medicines will I Need to Take After Weight Loss Surgery? The only medicines you will need because of the surgery itself will be vitamins with iron and a source of calcium (If you are not already on a calcium supplement, TUMS is an easily accessible source of calcium that is chewable and easy to take). Occasionally patients develop low iron or Vitamin B12 levels and are then prescribed appropriate supplements. You should otherwise continue to take the same medicines that you took before your operation, and any changes in these medications will be handled on an individual basis. Ask your doctor about any medications you must take. If they are large, they will need to be crushed (and mixed with pudding or applesauce) or broken into smaller pieces before you try to swallow them. How Can I be Sure I’ll Lose Weight and How Can I Keep the Weight Off? You must combine the surgery with a commitment to adopt healthy and intelligent eating habits as well as an exercise program. Even after successful surgery and significant weight loss, some patients will ultimately regain some or all of the lost weight. This problem is often due to overeating and is seen in patients who have forgotten to pay attention to their eating habits. Therefore, to maximize the chances for long-term success, people interested in this surgery should give it a lot of consideration. They must be prepared to make lifelong changes in dietary and social habits. Anything less than total commitment will carry a high likelihood of failure in the long run. Furthermore, unless there is a strong motivation to make these lifestyle changes, patients will feel unhappy even if they achieve good weight control. Long discussions with family, friends, and even clergy prior to proceeding with surgery are highly encouraged. NO ONE WILL BE CRITICIZED if they have second thoughts and wish to postpone or cancel surgery, even at the last minute. Can these operations be reversed? The band or the bypass is not meant to be reversed. Although in the case of the bypass it is possible to revise the pouch so it will once again empty to the lower stomach. This does not, however, return the patient to the condition that existed before the surgery. Once the stomach has been operated on in this way, its function is altered forever. The band can be more easily removed but of course major surgery is required and weight regain is almost always inevitable. Will I Have Any Restrictions on Activity After Surgery? During the first two weeks after surgery you will not be allowed to do any activities that would involve straining your abdominal muscles (walking is encouraged and going up/down stairs is OK). If you are doing well at your one month follow-up, you will be released to full activity. Full activity does include an exercise program and also includes sexual activity, if this is not uncomfortable. Will I Lose Any Hair? Hair loss can accompany rapid and significant weight loss. The most common reason for hair loss is poor intake of protein. Lack of the mineral zinc can also lead to hair loss. Generally speaking, patients who have not been eating enough protein will show some hair loss between three and six months after surgery. We have had no patients go bald from this operation, and virtually everyone has re-grown their hair once they have been able to eat enough protein or take some protein and vitamin supplements. We encourage you to begin your vitamin supplements one week after surgery. This can reduce or lessen the frequency of hair thinning and loss. Can I Get Pregnant After the Operation? Normal pregnancy is quite possible after the Can Other Procedures be done in Combination with the Gastric Bypass? Some people request other operations such as belly button hernia repair or tubal ligation at the same time as weight reduction surgery. Your surgeon will be able to discuss with you the advisability of performing the additional procedure in question. We will be certain to ask you about symptoms of gallbladder disease. Several studies have shown that one-third of people who have rapid weight loss form gallstones, and you may already have them as a result of previous diets. You may also develop them as a result of weight loss from this operation. Before surgery you will have an ultrasound on your gallbladder to see if there are gallstones present. If gallstones are present, we generally remove the gallbladder at the same time as surgery. If no gallstones are present, we usually leave the gallbladder. If gallbladder symptoms develop after surgery removing the gallbladder is easily accomplished Will I Develop a Lot of Flabby Skin? Loose skin frequently occurs after rapid and significant weight loss. The most common places for it to occur are on the abdomen, under the arms, and on the insides of the legs. The more weight you lose, the more likely you are to develop loose, extra skin. Starting one year after surgery, when your weight has stabilized, it may be appropriate to consider having the excess skin folds removed. Arranging for such a surgery can be further discussed as the need arises. Unfortunately exercise is generally not helpful in reducing the amount of flabby skin.
There are four major concepts that every patient must fully comprehend before undergoing
You are likely to have questions that aren’t addressed in this handout, or perhaps the handout has We look forward to helping you reach your weight loss goals!
The health and medical information presented on this web site is for educational purposes only and is not intended as a substitute for medical care. If you have a medical question about any of this information, please consult your physician or a health care professional. Every reasonable effort has been made to ensure the accuracy and reliability of the information presented on this web site. Trinity Hospital of Augusta and Trinity Bariatric and Weight Loss Center make no guarantee or promise, express or implied, as to the accuracy or reliability of the information presented. This information is subject to change without notice and cannot be guaranteed to be current. |
