Helping you prepare for surgery

Patients who have weight loss surgery are able to lose—and keep off, on average—around 50 to 70 percent of their excess body weight. Patients can also experience a significant decrease in weight-related illnesses, including, in many cases, remission from type 2 diabetes.

Combining bariatric surgery with personal dedication and hard work can give patients:

• Added energy to participate in daily life
• More years to be with friends and family
• Improved self-image and confidence
• Enhanced physical conditioning and endurance for sports and other activities
• Control over health and health care spending

As with any surgical procedure, there are risks involved with bariatric surgery, including bleeding, infection, blood clots or death. Each type of weight loss surgery has its own specific risks, which your bariatric surgeon can discuss with you. The safety of bariatric surgery improves each year. It is now safer than gallbladder surgery. Spectrum Health bariatric surgeons have an excellent record of quality and successful operations.

More than 95% percent of the surgeries we perform are laparoscopic. Our bariatric surgeons are able to use small incisions, tiny tools and flexible video equipment to avoid making a large incision in the abdomen. Laparoscopic operations carry the same risk as an open operation, but the benefits include less discomfort, shorter hospital stay, earlier return to work and reduced scarring.

While rare, there are surgeries that start laparoscopically but are converted to open procedures after the surgery begins. This decision is made when the surgeon determines that proceeding laparoscopically will result in a less satisfactory outcome than an open approach.

While post-surgical pain is to be expected, every attempt is made to control pain so you can become active early in recovery. This helps avoid problems and speeds recovery. Sometimes several drugs are used together to help manage post-surgical pain. Your surgeon will discuss other pain management options with you if neccessary.

In a typical patient, bariatric surgery can cause a 50 to 70 percent reduction, on average, in excess body weight over three years. If you are willing to commit to lifestyle changes, including diet and exercise, you should be very pleased with your results. More importantly, bariatric surgery is a conduit to a healthier life.

Extreme obesity often negatively affects quality of life. Several studies have shown substantial improvement in quality of life after bariatric surgery.

The comprehensive Spectrum Health surgical weight loss program can help you leave behind:

• Diabetes
• High blood pressure
• Heart and circulatory problems
• Osteoarthritis and other joint problems
• Sleep apnea and respiratory problems
• Medications and frequent doctor visits

There is also good evidence from scientific research that weight loss surgery may significantly prolong life.

Evidence continues to mount that bariatric surgery can help eliminate type 2 diabetes, a dangerous and potentially deadly disease. Surgery leads to a large improvement in insulin sensitivity (a two- to threefold increase) and can offer lasting remission. In fact, more than 50 percent of patients who undergo bariatric surgery experience long-lasting remission from type 2 diabetes.

Patients who are 100 or more pounds overweight and haven’t been successful at losing weight through diet, exercise and behavior modification may be eligible for bariatric surgery.

Body mass index (BMI) is another important consideration. Surgical weight loss candidates usually have a BMI of 40 or higher, or a BMI of at least 35 as well as other obesity-related health conditions, such as:

• Diabetes
• High cholesterol
• Hypertension
• Arthritis or degenerative joint disease
• Sleep apnea

Both men and women generally respond well to bariatric surgery. In general, men lose weight slightly faster than women do because they have more muscle mass, an indicator of a higher metabolism.

We evaluate patients on an individual basis to determine whether the benefits of surgery outweigh the risks. 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.

The first place to start is by contacting your original surgeon. He or she is most familiar with your medical history and can make recommendations based on knowledge of your surgery and anatomy. If you have contacted your original surgeon and feel you need a second opinion, or if you are unable to locate your original surgeon, feel free to contact our office for a consultation. Our surgeons can perform revisions on previous bariatric surgeries.

• The first step is to register for a free surgical weight loss seminar, where you will be presented with more information about the process and have a chance to ask questions.
• 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 (such as Pap smears for women and prostate screening for men) is current.
• Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
• Bring a list of your medications with dose and schedule, as well as any relevant medical data or test results.
• Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.

To avoid complications, an accurate assessment of your physical and psychological health is needed before surgery. Certain basic tests are done prior to surgery:

• Dietary assessment
• Psychological evaluation
• EKG

Other testing may include:

• Lab tests (such as blood or urine)
• Gallbladder ultrasound to look for gallstones
• Pulmonary function testing
• Sleep studies
• GI evaluation
• Cardiology evaluation

Psychological testing is necessary to ensure that you have a clear and full understanding of the potential risks, complications and benefits associated with weight loss surgery; that you have realistic expectations regarding weight loss; and that you are adequately motivated and committed to the basic recovery plan and lifestyle changes necessary with bariatric surgery.

Because a DVT can originate on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with leg compression stockings and given a blood thinner prior to surgery. Both of these therapies continue throughout your hospitalization. After surgery, you will be encouraged to move and get out of bed as soon as possible to restore normal blood flow in your legs.

Medical problems such as serious heart or lung problems can increase the risk of any surgery. On the other hand, if these problems 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. Interventions to help minimize the risk may be recommended before surgery.

Although it can vary, the hospital stay (excluding the day of surgery) can be one to two days.

In the Roux-en-Y gastric bypass, the stomach pouch is created at 1 ounce or less in size (15 to 20 cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6 to 12 months after surgery, the stomach pouch expands. Many patients end up with a meal capacity of 6 to 8 ounces.

The basic rules are simple and easy to follow:

• Before surgery, our dietitian will provide you with special dietary guidelines to begin after surgery. You will need to follow these guidelines closely. Our bariatric surgeons begin patients with liquid diets, moving to semi-solid foods. Solid foods can eventually be tolerated without risk to the surgical procedure performed.
• When able to eat solids, eat three to four meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. Foods should be cooked without fat and seasoned to taste.
• Never eat between meals.
• Drink 2 quarts (64 oz.) or more of water each day.
• Exercise aerobically every day for at least 30 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added three to four days per week, as instructed by your doctor.

Most pills or capsules are small enough to pass through the new stomach pouch. For the first four weeks after surgery, your doctor will recommend that medications be taken in liquid form, chewable or crushed.

It is strongly recommended that women wait at least 18 to 24 months after the surgery before becoming pregnant. Approximately 18 months post-operatively, your body should be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. Consult with your Spectrum Health bariatric surgeon as you plan for pregnancy. The pregnancy will need to be followed closely by a physician who understands the surgical impact on your metabolism, as well as a dietitian who can monitor for adequate nutrition, vitamins and minerals.

You will not be alone in your quest for better health. Additional tools for weight loss success are offered through exercise programs and ongoing nutrition education. Support groups are ready and waiting to celebrate your successes and encourage you through the tough times. In addition, we are available as a resource to help you or guide you as needed on your weight loss journey.