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Our Frequently Asked Questions section refers to United States-based generally standard and accepted practices. As always, please check with your physician to determine their practices, guidelines and what they recommend for you.
1. 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 18 years of age and older. Surgery has been performed on patients 16 and younger. There is a real concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success.
2. 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. The risk of surgery in this age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced.
3. Can Weight Loss Surgery prolong my life?
Yes, weight loss surgery has been shown in two recent publications to prolong life. There is good evidence from scientific research that if you have Type 2 diabetes (or other serious obesity-related health conditions), are at least 100 lbs. over ideal body weight, and are able to comply with lifestyle changes (daily exercise and low-fat diet), then weight loss surgery may significantly prolong your life.
4. Can weight loss surgery help other physical conditions?
According to current research, weight loss surgery can improve or resolve associated health conditions.
|Condition||Percentage found in
|Percentage cured 2 years after surgery|
|Diabetes or insulin resistance||34%||85%|
|High blood pressure||26%||66%|
|Sleep apnea||22% in males, 1% in females||40%|
5. How Does Surgery Reduce Weight?
Surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient's stomach and intestine. After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today's bariatric surgeons have access to a substantial body of clinical data to help them determine which surgeries should be used and why.
Today, the American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:
1. Restrictive procedures that decrease food intake.
2. Malabsorption procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
When you feel full, you are more likely to have reduced feelings of hunger and will no longer feel deprived. The result is that you are likely to eat less. Restrictive weight loss surgery works by reducing the amount of food consumed at one time. It does not, however, interfere with the normal absorption (digestion) of food. In a restrictive procedure, the surgeon creates a smaller upper stomach pouch. The pouch, with a capacity of approximately 1/2 to 1 oz. (15 to 30 ml), connects to the rest of the stomach through an outlet known as a "stoma”, which is formed by the band. In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss.
During recovery, patients must adhere to the strict specific dietary guidelines and restrictions their surgeon prescribes. While these guidelines may vary from one surgeon to the next, it is important for each patient to follow the guidelines. When the time comes to resume eating "regular" food, the patient must learn to adapt to a new way of eating. At each meal, they are restricted to consuming approximately 1/2 to a full cup of food before feeling uncomfortably full. Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can defeat the purpose of the surgery. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids. Failure to achieve the expected level of weight loss is usually the result of a patient failing to comply with the recommended dietary and behavior modifications, such as increased exercise and regular support group attendance.
As weight loss surgery was developed, before the band was available, restriction alone has not always achieved the excess weight loss surgeons and patients anticipated. For this reason, procedures that alter digestion, known as malabsorption procedures, were developed to work in conjunction with restrictive approaches. Some of these techniques, such as the gastric bypass, involve a bypass of the small intestine, thus limiting the absorption of calories. On balance, malabsorptive or malabsorptive/restrictive procedures have resulted in an overall increase in the loss of excess weight. The risk of complications and side effects generally increases with the lengthening of the small intestine bypass. You and your surgeon must determine the risks and benefits over your lifetime with the type of weight loss surgery you choose.
6. How effective is Weight Loss Surgery?
The actual weight a patient will lose after the procedure is dependent on several factors. These include:
In general, weight loss surgery success is defined as achieving loss of 50% or more of excess body weight and maintaining that level for at least five years.
Clinical studies show that, following gastric bypass surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure.
7. Risk of Surgery
Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with this procedure. If complications occur during the operation, your doctor may choose to perform open surgery. Your doctor must determine if you are an appropriate surgical candidate. 1% need to be converted to an open procedure
1. What are the routine tests before surgery?
Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), a Chemistry Panel, and other chemistry tests to make sure a patient doesn’t have a medically treatable cause for their obesity. All patients but the very young get a chest X-ray and an electrocardiogram. A gallbladder ultrasound to look for gallstones is done if the patient still has a gallbladder and pulmonary function tests are done. Other tests, such as an echocardiogram, sleep studies, GI evaluation, or cardiology evaluation may be requested when indicated.
2. 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 obesity. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery can increase 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.
3. 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.
4. Why do I have to have a Sleep Study?
The sleep study detects a tendency for abnormal stopping of 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.
5. Why do I have to have a Psychiatric Evaluation?
Prior to weight loss surgery, underlying psychiatric disorders must be ruled out. Most psychiatrists will also evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.
6. 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. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
7. If I want to undergo a gastric bypass, how long do I have to wait?
New evaluation appointments are usually booked 4-6 weeks in advance. Once a patient is seen, if the surgeon and patient agree it is appropriate, the patient is enrolled in our weight loss surgery program which is about 6 months.
8. What can I do before the 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).
1. Does Laparoscopic Surgery decrease the risk?
No. Laparoscopic 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.
2. 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.
3. How long do I have to stay in the hospital?
Although it can vary, the hospital stay (including the day of surgery) can be 1-2 days for a laparoscopic gastric bypass and sleeve surgery and banding surgery is completed as an outpatient.
4. Will the doctor leave a drain in after surgery?
Most patients will have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed a few days after the surgery. Generally, it produces no more than minor discomfort.
5. If I have surgery, what can I expect when I wake up in the recovery room?
After surgery, you will be taken to the recovery room. You will spend a few hours there as you wake up from the general anesthesia. You will then be moved to your room where your family can see you. During the first night you will be connected to a continuous oxygen saturation monitor. Obesity, general anesthesia, and preexisting lung conditions (asthma, sleep apnea) make it likely that you will need oxygen the first night to keep your saturation above 90%. The night of surgery you will be asked to walk. This is very important to help prevent blood clots in your legs from forming. This condition is called a deep venous thrombosis or DVT. Wearing the lower leg compression devices while in bed also prevents DVTs.
It is normal to feel uncomfortable during the first few days after surgery, but each day you will feel stronger and more active. You will be given pain medication to ease your discomfort. Your mouth might feel dry the first 24 hours after surgery. This is usually due to the medication administered during anesthesia. You will be allowed to swab your mouth, but not to drink anything until the first day after surgery.
While you are in the hospital, your surgeon, physician assistants and nurses will provide your medical care. You might be assigned nursing or medical students as well. Your surgeon will visit you daily, so have questions ready. You will be visited by a dietitian while in the hospital. They will provide a written quiz, which you will be asked to complete. It is a good idea to involve family members in learning about the diet after surgery.
6. How soon will I be able to walk?
Almost immediately after surgery your surgeon 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.
7. How soon can I drive?
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 7-14 days after surgery.
1. 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.
2. 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 ride home that are easy to put on and take off. Because of your incision, your clothes may become stained by blood or other body fluids. Please remember that ECHN is not responsible for lost belongings. Other ideas:
1. What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:
2. What's so important about exercise?
When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for 20 minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead.
3. 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 - the patient must be out of bed and walking. 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. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.
4. Can I get pregnant after weight loss surgery?
If you are a woman you will have an increased chance of becoming pregnant. It is difficult to maintain a healthy pregnancy during the rapid weight loss phase (first year after surgery for bypass patients). If you are planning to have a gastric bypass, we recommend that you postpone pregnancy plans for at least one year after surgery or until your weight is stable.
5. What if I have had a previous weight loss surgical procedure and I'm now having problems?
Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.
6. What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, 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.
7. How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the gastric bypass surgery, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces.
8. 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 you will have in your skin or staples you use in the office. 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.
9. What if I'm not hungry after surgery?
It's normal not to have an appetite for the first few months after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.
10. Is there any difficulty in taking medications?
During the first few months after surgery we recommend patients crush their medications or take them in a liquid form. Medications that cannot be crushed are long acting medications usually designated by "XR" or "CR" after the name of the medication. These will be converted to the shorter released medication which can be crushed. There are some psychiatric medications (such as cymbalta) that cannot be crushed and are too big to take in the immediate post operative period. Before surgery, please check with your personal physician and mental health provider (as aplicable), and/or your pharmacist, to see which medications can and cannot be crushed.
11. Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.
12. 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.
13. Will I be asked to stop smoking?
We require patients to stop smoking and be tobacco free for at least two months prior to their surgery. Smoking after weight loss surgery can be particularly dangerous, especially after gastric bypass as it can cause ulcers to form that are painful and difficult to treat. Occasionally these ulcers can perforate, requiring emergency surgery.
14. 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.
15. 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, such as recurrent yeast infections that are not well treated with medications. Ask your surgeon about your need for a skin removal procedure.
16. Will exercise help with excess hanging skin?
Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with large flaps of loose skin.
17. Will I be very hungry after weight loss surgery since I'm not eating much?
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 bad type of hunger.
18. What if I am really hungry?
This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.
19. Will I have to change my medications?
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 non-steroidal anti-inflammatory (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.
20. 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. When we were doing weight loss surgery primarily open (through a large incision), approximately 20% of patients developed a hernia. Now that we do virtually all procedures laparoscopically, the hernia rate is less than 1%.
21. Is blood transfusion required?
Infrequently: If needed, it is usually given immediately after surgery.
22. What is phlebitis and is it preventable?
Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:
23. Will I lose hair after surgery? How can I prevent it?
Many patients experience some hair loss or thinning after surgery. This usually occurs between the third and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc supplement and a good daily volume of fluid intake. An oral supplement, biotin, has been shown to help some patients.
24. Does hair growth recover?
Most patients experience natural hair regrowth after the initial period of loss.
25. 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, especially when the procedure is performed laparoscopically.
26. What is sleep apnea (SA)?
It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.
1. How long will I be off of solid foods after surgery?
You will be given a handout on the diet stages by the dietician. You will be on Stage 3 diet (high protein liquid diet) for the first two weeks. Stage 4 (high protein solid foods) follows and is until the sixth week after surgery. At that point, the patient is advanced to Stage 5 which includes a wide variety of healthy foods.
2. What are the best choices of protein?
Eggs, low-fat cheese, low-fat cottage cheese, tofu, fish, other seafood, chicken (dark meat), turkey (dark meat).
3. 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. Water also fills your stomach and helps to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.
4. What is Dumping Syndrome?
Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass or BPD where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a shock-like state. 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, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal.
5. Is there a problem with consuming milk products?
Milk contains lactose (milk sugar), which in some, is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea.
6. Why can't I snack between meals?
Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake, defeating the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to regain of weight.
7. Why can't I eat red meat after surgery?
You can, but you will need to be very careful, and we recommend that you avoid it for the first several months. Red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.
8. How can I be sure I am eating enough protein?
60 grams a day is generally sufficient. Check with your surgeon to determine the right amount for your type of surgery.
9. Is there any restriction of salt intake?
No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.
10. Will I be able to eat "spicy" foods or seasoned foods?
Most patients are able to enjoy spices after the initial 6 months following surgery.
11. 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 3 to 6 months. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail.
12. What vitamins will I need to take after surgery?
We recommend a daily multivitamin as well as calcium (calcium citrate) for the rest of your life.
13. Will I get a copy of suggested eating patterns and food choices after surgery?
Yes, we provide 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 surgeon.