Am I a candidate for bariatric (weight loss) surgery?

You may be a candidate for bariatric surgery if at least one of the following conditions applies to you:

• If you are at least 100 pounds overweight.
• If your body mass index (BMI) is over 40.
• If your BMI is between 35 and 40 and you also have medical problems such as
  diabetes, hypertension, sleep apnea, or arthritis of weight-bearing joints.

We generally evaluate those between the ages of 18 and 65. You must have a history of efforts
at weight loss with diets and exercise, and have the support of your primary care physician for your bariatrics surgery.

What tests are needed before surgery is done?

The usual tests will include an upper GI (or upper endoscopy), an ultrasound of the gallbladder, and blood tests. We ask for a letter of medical necessity from your primary physician. You may need consultations for cardiology and pulmonary clearance for surgery. We ask that you see a Temple dietician and a Temple psychiatrist or psychologist. We also ask that you attend our group educational meeting to learn more about your procedure and how to make it work well for you after surgery is done.

How long will I be in the hospital after surgery?

It depends on what procedure is done. After an adjustable laparoscopic band (Lap-Band) is placed, you will probably go home on the afternoon of the day after surgery. Laparoscopic gastric bypass patients usually go home on the second day after surgery. Open incision gastric bypass patients may go home from the second to the fourth day after surgery, depending on their recovery.

What about pregnancy after bariatric surgery?

We strongly recommend that you do not become pregnant for 12 to 18 months after surgery. Please recognize that a woman may become more fertile as she loses weight. If you do become pregnant after bariatrics surgery, it is very important that you are taking the proper amounts of vitamins and minerals, and to be followed by both our team and by your obstetrician. A reliable method of birth control should be used during this time.

What medicines do I have to take after bariatric surgery?

After a gastric bypass, we ask that you take multivitamins and calcium every day. Women who have not yet reached menopause may need to take iron supplements as well. You should take vitamin B12 once or twice a week by mouth (some people prefer to have monthly injections instead).

What will my diet be like after I have healed from my gastric bypass surgery?

Since you will have a small stomach pouch, we advise that you eat about 4 ounces (about half a cup) of food at a meal, and that you eat in a regular pattern of three meals a day. You should concentrate on proteins first, and then add vegetables and fruits. You should drink water or non-calorie containing liquids, and avoid carbonated beverages. We ask that you not drink liquids with your meals, since this can make the pouch empty more quickly and make you feel hungry too soon. Snacking in between meals should be with foods which are low in calories.

How much weight will I lose after bariatric surgery?

The average weight loss after a gastric bypass is from 50% to 75% of your excess body weight. This weight loss occurs over the first 12 to 14 months after your surgery.

The average weight loss after a Lap-Band is from 40% to 60% of your excess body weight. This weight loss (slower than after a gastric bypass) occurs over a 2 to 3 year period after your surgery. Typically, you would lose about 40% at one year, 50% at two years, and up to 60% of excess body weight at the third year.

The average weight loss after a vertical banded gastroplasty is from 30% to 50% of excess body weight, also over a 2 to 3 year period.

Can I regain the weight I will lose after surgery?

Yes, you can regain some of the weight you will lose after surgery. The surgery does contribute to your overall result. Your own behavior is very important in the overall result in what you eat, how often you eat, and how much exercise you do. We emphasize that the surgical procedure is a tool, which is used properly, usually produces good results. The surgical procedure does not automatically make you thinner.

We ask that you continue to follow-up with your surgical team and dietician on a long -term basis. After your weight loss stabilizes, you should continue to visit with us at least once a year.

Can I die as a result of having surgery?

Yes, you can. The national mortality rates for gastric bypass surgery range from 0.5% to 1% (about one in 200 to one in a hundred). Mortality after a Lap-Band ranges from 0.1% to 0.2% ( about one in 500). In addition to the surgical procedure itself, your physical and medical condition influences your risk.

Can I drink alcohol after bariatric surgery?

We do not recommend that you continue to drink alcohol on a regular basis. Alcohol can cause marginal ulcers in your stomach pouch, which could cause bleeding.

Can I use tobacco after bariatric surgery?

We strongly recommend that you stop smoking before your surgical procedure. We strongly recommend that you do not start again after surgery.

How long does it take to schedule surgery?

Usually, several months are needed for the evaluation, meetings, and the various tests. We ask that you not gain weight during this time. We prefer that you begin to lose weight before your surgery, as you begin to change your diet in accordance with our dietician's recommendations. Your weight loss before surgery will help your surgical team in performing your surgery as safely as possible.

Do you remove the gallbladder during surgery?

If your do not have any gallstones, we usually do not remove the gallbladder during your bariatrics surgical procedure. If you do have gallstones, you and your surgical team will discuss treatment options with you.

Do you have an exercise program after surgery?

Taking positive steps toward being physically fit can help speed your journey to the new you. We do offer an exercise program designed for your long-term recovery. Our certified personal trainer will teach you to develop god health habits and learn to exercise in a way that is safe for you. We utilize resistance exercises combined with a cardiovascular workout, which will improve your strength and endurance by building and retaining lean muscle mass. Exercising in a safe, comfortable environment with your peers is lots of fun and is great for your emotional well-being.

Can I have my surgery done laparoscopically?

The Lap-Band procedure is designed for a laparoscopic approach. Nearly all of them are placed laparoscopically, unless your surgical team finds that the condition of your abdomen, liver, or stomach is unsuitable for the laparoscopic approach.

Many of the gastric bypass procedures are done laparoscopically. However, for some an open incision for the gastric bypass may be better and safer. Your surgical team will discuss your options with you, as well as the risks and benefits of a laparoscopic or an open incisional approach with you.

Will I lose my hair after surgery?

Some temporary hair thinning may occur during periods of rapid weight loss. This may begin several months after a gastric bypass, and may continue for several months. If you develop hair thinning, your hair should re-grow when the rapid phase of your weight loss stabilizes. You can help this process by avoiding hair treatments and permanent, and also by maintaining your protein intake. You can reduce hair loss by maintaining your protein intake. Avoiding hair treatments and permanent during this period is advised. Biotin and zinc supplements may also help.

Will I need plastic surgery after my weight loss?

We recommend that you wait until your weight loss stabilizes before having plastic surgery. This usually means that 14 to 18 months should pass after your gastric bypass. Your surgical team can discuss the likelihood of your needing plastic surgery with you before you have your bariatrics surgery.

I have had a previous bariatric surgical procedure, but have regained weight. Can I have another procedure?

"Redo" surgery is possible, but not everyone should have it. The risks and potential complications are higher than for first-time bariatrics surgery. We will look carefully at your individual situation, and make recommendations to you. Since what you eat, how much you eat, and how you exercise plays such an important part in your overall weight loss, we ask that you do your part as well. In general, redo surgery should be considered if you are following recommended diets and exercise, and you are still having a problem. 

Pre-operative Nutrition

You will receive diet instruction and our red book at the group teaching class. Our red book describes types of weight loss surgery, what to expect during and after your hospital stay and and diet information.

After you have attended this class you will meet with the dietitian for nutritional assessment and individualized diet instruction. Your past weight history, diet history and food intake patterns will be reviewed. Your body measurements and weight will be taken. This is the ideal time to ask any questions that you have about the diet so be sure to read the diet before you meet with your dietician. If you are taking dietary supplements please bring them to this meeting.

Post-operative Nutrition

During your hospital stay you will receive a visit from our clinical dietitian who will review your diet with you. You may want to bring your red book to the hospital for this review.

After surgery you will follow a liquid diet. any liquids containing sugar, carbonation (soda) and caffeine need to be avoided. You will add protein-based liquids to your diet during the liquid phase. You will then add pureed foods to your diet, gradually incorporating “regular  foods into your diet. The length of time of the diet progression varies from person to person but in general, most people are eating small amounts of soft (non-blended) foods by post-operative week 4 or 5. All weight loss surgical procedures restrict the amount of food that you can eat at one time. It is vital that you eat nutritional foods after your surgery to help heal the incision and to maintain your health. You will need to supplement your diet with protein supplements, vitamins and minerals. Supplemental requirements can vary from person to person and needs to be tailored for each individual. Your dietician will determine which supplements are appropriate for you and will provide a list of products to choose from.

 

What types of foods will I NOT be able to eat after surgery?

• Sugary-foods, such as candy, ice cream, syrups, cookies and cakes.
• High-fat foods, such as chips, fried foods, sausage, and cream soups or sauces.
• Starchy foods, such as pasta, rice and doughy breads.
• Fibrous foods, such as corn, popcorn, and nuts.

All of these foods may make you sick or not be well tolerated after surgery.

What is dumping syndrome?

Dumping syndrome results from the rapid passage of food into the small intestines and subsequent shift of fluid into the intestines. This can be caused by eating sweets, fried, fatty or greasy foods, eating too much at one meal or by drinking fluids with your meals. Symptoms include cramping, sweating, flushed appearance, dizziness, weakness, headache and eventually diarrhea. The best way to avoid dumping syndrome is to follow our dietary guidelines.

When do I stop taking my vitamin and mineral supplements?

Never. It is critical that you take your supplements for the rest of your life. You will need to have your blood checked several times in the first year and every year for the rest of your life to make sure you are absorbing your vitamins and minerals adequately.

What can/should I do before surgery?

Neither Gastric Bypass or Lap band surgery by itself will cure obesity. Initially, you will lose weight but long-term success depends on your lifestyle choices. Developing a healthy lifestyle before surgery is the first step in your weight loss journey. The following guidelines should be incorporated as soon as possible-preferably today.

• Reduce or avoid soda (even diet soda). all beverages should be calorie-free.
• Eat less fried foods, added fats, and high-fat fast foods.
• Eat more fruits and vegetables.
• Increase your awareness of eating patterns and behaviors. Chew your foods thoroughly and eat meals slowly.
• If you eat in response to boredom, find alternative activities to occupy your time.

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