FAQs

A candidate for weight loss surgery is an obese patient whose BMI is between 35-40 with co-morbidities, or a BMI greater than 40 without co-morbidities. Co-morbidities are medical issues that include high blood pressure, diabetes, high cholesterol or sleep apnea. Based on new criteria for LAP BAND surgery only, a candidate is an obese patient whose BMI is between 30-35 with co-morbidities or between 35-40 without co-morbidities.

 

BMI stands for body mass index and is a calculation that uses weight and height to get an approximate body surface area.

 

Adjustable Gastric Banding: Adjustable gastric banding is a procedure in which a band is placed around the uppermost part of the stomach, separating it into small and large portions. The diameter of the band is adjustable for a customized weight-loss rate, as your individual needs can change as you lose weight. To modify the size of the band, its inner surface is inflated or deflated using a saline solution. The band is connected by tubing to an access port, which is placed well below the skin. After the operation, the surgeon controls the amount of saline in the band by entering the port with a fine needle through the skin.

Gastric Bypass: Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. Stapling creates a small stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food eaten and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed.

Sleeve Gastrectomy: During a sleeve gastrectomy, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. This procedure limits the amount of food you can eat and helps you feel full sooner. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body. The majority of sleeve gastrectomies use a minimally invasive laparoscopic technique.

 

Depending on their starting BMI, we expect most patients to get down to a BMI of approximately 30, which puts them on the borderline between mildly obese and overweight. We do not expect all patients or even the majority of patients to actually get to an ideal body weight.

 

The weight loss surgery process involves, first and foremost, the patient attending an information session. These sessions are where you receive a lot of information, much of it specific: the surgeon, the hospital and the types of procedures being performed. Other non-operative weight loss options are also discussed, so the patient gets an overview of their options. The sessions include a question and answer period so patients can ask specific questions.

After the information session, the patient then usually meets with the surgeon to discuss the surgery, and decide if they are a candidate for surgery. We then schedule all of the tests that are required and we also pursue whether their insurance covers the procedures. Some insurance companies require monitored weight loss for a certain period of time, anywhere between one month and six months.

Patients then meet with a nutritionist; that's when they'll find out their exact post-surgery dietary requirements: what they are expected to eat, what they need to watch out for as far as vitamin and mineral deficiencies, etc. Then they return to the surgeon’s office and schedule the surgery.

 

Your life is going to change in tremendous ways. When you lose 100 or 150 pounds, you are a different person. You’ve left somebody behind and most of the time that is a very positive change. Health issues should greatly improve, how you interact with those around you should greatly improve - patients socialize more, you can see them start to enjoy things that they never did.

 

The recovery from weight loss surgery varies depending on the type of surgery. With some surgeries you can go home the same day, or only need one night in the hospital. With gastric bypass, you may need two or three days in the hospital because it’s a slightly more involved operation. Recovery is very quick. Once you’re home, you should be off pain medications within a week of the surgery. Usually within two weeks of the surgery you’re back to normal functions.

 

There are very few reasons why a patient would not be an appropriate candidate for a weight loss surgery; these can be discussed at the consultation with your surgeon. Every surgeon has certain criteria that a patient needs to meet in order to have surgery. Certain health conditions or health risks – perhaps you have a severe heart condition – are some of the reasons that you may not be approved for surgery. A major reason that a surgeon may not deem you a suitable candidate for the surgery is that you may not be willing to make the lifestyle changes that are necessary. Often, it doesn’t rely on the patient’s medical conditions, it relies on the patient’s willingness to make the lifestyle changes that are necessary.

 

Weight loss surgery is covered by some insurance companies. Some insurance companies have exclusions against weight loss surgery. As long as you have bariatric (weight loss) coverage and bariatric benefits, it’s a matter of meeting their criteria in order for you to be covered for the procedure.

 

The two that you always hear most with weight loss surgery are anesthesia-related. Death - with gastric band surgery, it’s very low, no more than any general surgery - and bleeding. Another very low, rare complication is pulmonary embolism, which is a blood clot that is generally started in your calves and goes up to your lungs.

With gastric bypass surgery, you can have the complications of a leak, because you have areas that are divided and rerouted. Any time that you have a new connection that leaks, peritonitis can develop. Patients who are older (i.e. over age 70) would probably not be good candidates for surgery because their chance of handling a complication or serious problem is not as good as a younger patient. Other issues that can develop in the future include a blockage or obstruction, which results in strictures, that may need to be stretched or dilated.

With gastric banding, there are two very specific long term problems. One is called erosion of the band, in which the band actually erodes or eats through the lining of the stomach and ends up on the inside of the stomach. This is very rare and happens less than .01% of the time. If it does occur, the band has to be removed. The other complication is slippage of the band. The band slides from the upper portion of the stomach down to the lower portion of the stomach. The reason that happens most often is that the patient experiences vomiting. We can deflate the band and, nine times out of 10, we can prevent slippage.

 

Physician support is always available; patients are welcome to call the offices at anytime. More importantly, we offer support groups to our patients; these groups are available at least twice a month. Support groups are very effective at bringing pre-op and post-op patients together, so that those who haven’t been through the procedure, start to get a feel for what the patients who have already had surgery sound like, look like, and what they’re going through. Support is very important, especially in the early phases after surgery, but it’s important even before surgery - you need to start to understand the changes are that you’re going to experience in your life, even before you have weight loss surgery.