Frequently Asked Questions
PREPARATION FOR SURGERY
What are the routine tests before surgery?
Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. Almost all patients will have a chest X-ray and an electrocardiogram. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus. Many surgeons ask for a gallbladder ultrasound to look for gallstones. 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 these tests?
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.
What can I do before my appointment to speed up the process of getting ready for surgery?
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. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
- 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 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.
Should I attend one of your seminars?
Our free seminars are for people seeking information about weight loss surgery. Attendance is required for all potential candidates prior to setting up a consult with our surgeon. You will have an opportunity to listen to a panel of post-bariatric surgery patients share their personal stories of recovery and success. Bariatric surgery is a major life-changing decision; a decision we feel affects and should be understood by important people in a potential candidate's life. We ask that if available, spouses or committed partners attend.
Will I have a lot of pain?
Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.
How long do I have to stay in the hospital?
As long as it takes to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be 1-2 days for a laparoscopic band, 2-3 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass.
How soon will I be able to walk?
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.
THE HOSPITAL STAY
What is done to minimize the risk of deep vein thrombosis/pulmonary embolism or 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.
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. Other ideas:
- Reading and writing materials
- Crossword and other puzzles
- Personal toiletries
LIFE AFTER SURGERY
What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:
Immediately after surgery, your doctor will provide you with special dietary guidelines. You will need to follow these guidelines closely. Many surgeons begin patients with liquid diets, moving to semi-solid foods and later, sometimes weeks or months later, solid foods can be tolerated without risk to the surgical procedure performed.
When able to eat solids, eat 2-3 meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten.
Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
Never eat between meals. Do not drink flavored beverages, even diet soda, between meals.
Drink 2-3 quarts or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added 3-4 days per week, as instructed by your doctor.
What resources are available to me for support after surgery?
The Bariatric Surgery Center at Penrose, in cooperation with our bariatric surgeons, offers a full complement of post-surgical nutrition and education classes to help you be successful.
Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait at least one year after the surgery before a pregnancy. 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.
Will smoking affect my surgery?
Patients are encouraged to stop smoking at least one month before surgery because smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues.
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 the surgery when they are losing 20-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still 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.
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 will choose to have plastic surgery to remove loose or excess skin after they have lost their 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 these excess skin folds. Ask your surgeon about your need for a skin removal procedure.
How long will I be off of solid foods after surgery?
For a short time following your surgery, you will be put on a liquid diet which is then followed by a soft textured meal plan. Your registered dietitian will proivde you with the specific dietary guidelines.
Why drink so much water?
When you are losing weight, there are many waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.
What is Dumping Syndrome?
Eating foods with a high sugar content can cause dumping in patients who have had a gastric bypass surgery. Your body handles the sugar by diluting with water which reduces blood volume resulting in an unpleasant feeling. You may breakout in a cold, clammy sweat, have a rapid heart beat followed by cramps and diarrhea. This state can occur from 10-20 minutes of eating and last as long as 60 minutes. You may even need to lie down until it goes away.
Will I be allowed to drink alcohol?
You will find that even small amounts of alcohol will affect you quickly. It is suggested that you drink no alcohol for the first year. Thereafter, check with your physician.
Will I need vitamin/mineral supplements?
Yes! Additional vitamins and minerals will be necessary for optimal health throughout your lifetime. The most commonly needed supplements include: multivitamins, sublingual or injected B-12 along with a calcium and vitamin D source. Your registered dietician will guide you.
Can weight loss surgery prolong my life?
If you have type II diabetes, an obesity-related health condition and are at least 100 lbs. over the ideal body weight, then there is good evidence that wieght loss surgery may significantly prolong your life. However, you must be able to comply with the lifestyle changes of daily exercising and diet to be successful.
Can weight loss surgery help other physical conditions?
According to current research, weight loss surgery can improve or resolve associated health conditions.
CMS COVERAGE FOR LAPAROSCOPIC SLEEVE GASTRECTOMY
The CMS Laparoscopic Sleeve Gastrectomy National Care Determination was completed on June 27, 2012. Please review the below Frequently Asked Questions ,keeping in mind that the decision allows for local Medicare administrators to approve coverage. Until clarity regarding local CMS coverage is achieved, performance of a LSG in a Medicare patient has potential for no reimbursement for surgeon and hospital alike. It is prudent to seek out local regional Medicare administrators regarding their policy prior to surgery and if you are denied after surgery, always request a peer-to-peer review. Also, you should approach your facility to review your own institutional approach to LSG coverage.
What is the CMS Decision?
On June 27, 2012, The Centers for Medicare and Medicaid Services (CMS) released their decision on coverage for the laparoscopic sleeve gastrectomy (LSG). The final decision will allow laparoscopic sleeve gastrectomy to be covered by intermediary Medicare administrators as a stand-alone procedure at their discretion. Final text below.
CMS Conclusions & Rationale for Decision:
The available evidence does not clearly and broadly distinguish the patients who will experience an improved outcome from those who will derive harm such as postoperative complications or adverse effects from LSG. However, taking into consideration the seriousness of obesity, and the possibility of benefit in highly selected patients in qualified centers, we believe that local Medicare contractor determination on a case-by-case basis balances these considerations in the interests of our beneficiaries. Our local contractors are in a better position to consider characteristics of individual beneficiaries and the performance of eligible bariatric centers within their jurisdictions. Therefore, Medicare Administrative Contractors acting within their respective jurisdictions will make an initial determination of coverage under section 1862(a)(1)(A) and we are not making a national coverage determination under section 1869(F).
How Did the CMS Decision Happen?
Sept 2011 CMS opens this national coverage determination reconsideration request to review the new evidence for laparoscopic sleeve gastrectomy. CMS is requesting public comment on whether there is adequate evidence, including clinical trials, for evaluating health outcomes of laparoscopic sleeve gastrectomy for the indications listed in the current Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination. After considering the public comments and reviewing relevant evidence, we will release a proposed decision memorandum. Instructions for submitting public comments can be found at http://www.cms.hhs.gov/InfoExchange/02_publiccomments.asp#TopOfPage