Frequently Asked Questions
About Weight Loss Surgery

Frequently Asked Questions About Weight Loss Surgery

OK, so what does this surgery involve?

What does it mean to have a surgery done laparoscopically?

After gastric bypass how long will I be recovering?

What can I expect for weight loss after gastric bypass?

If I don't like it, can a gastric bypass be reversed?

What are my risks with the gastric bypass procedure?

Can a gastric bypass procedure fail to provide me with significant weight loss?

Why would people gain their weight back after successfull weight loss?

Is it safe to become pregnant after weight loss surgery?

What about the excess skin? Will it go away with exercise?

How can I enroll in the program?

Is there a program fee to participate in the program?

 

OK, so what does this surgery involve?

Surgical treatments to promote weight loss have been around for many years. Many of the procedures involve making your stomach extremely small, and then limiting the small stomach's ability to empty. Therefore you feel full with much less food. Even if you wanted to eat more, you can't. You would make yourself sick trying.

Other surgeries for obesity involved bypassing much of your small intestine. When you bypass the small intestine, the body's ability to absorb calories is decreased. The problem is that if you bypass too much intestine, you can become extremely malnourished and develop life-threatening illnesses like liver failure. Surgery to bypass this much small intestine is therefore not done anymore.

Adjustable gastric banding   (LapBand® or Realize® Band)	Roux-Y Gastric Bypass	Vertical Sleeve Gastrectomy

Gastric bypass surgery combines a little of both the above procedures. In this procedure, the stomach is made extremely small (1-2 ounces), and then that small stomach is reconnected or bypassed to a point lower down on your small intestine.

Another surgery that is offered by us is called the adjustable gastric banding (Lapband or Realize band). In the adjustable gastric banding procedure a small silicone band is placed around the top portion of the stomach to create a small stomach pouch and more restriction to food passing.

Vertical sleeve gastrectomy is a procedure that has only recently been introduced as an accepted weight loss surgical intervention. It involves removing the majority of the stomach, leaving only a narrow tube behind, thus significantly reducing the capacity of the stomach.

Important to remember is that with either surgery, you will have a new relationship with food. Due to the smaller stomach, you will no longer be able to sit down at a meal and have a large or even averaged sized portion. For gastric bypass, the food you eat will not be completely absorbed due to the bypass of part of the small intestine.

 

What does it mean to have a surgery done laparoscopically?

Laparoscopic surgery involves operating through tiny incisions. A camera is placed inside your abdomen through one small incision, and the surgery is then performed by introducing surgical instruments through other small incisions. There are many benefits in having small incisions. You should have less postoperative pain, you will recover more quickly, and you will have much less chance of wound complications (infection, hernia) than if you had a large incision. You must understand, however, that at any time during a laparoscopic procedure, there may be a need to make a larger incision to complete the gastric bypass. Conversion to an open procedure can be due to scar tissue from previous operations, bleeding, differences in your internal anatomy that make the bypass more difficult, or even equipment failure. The chance of needing a conversion is less, than 1%. Remember, it is more important to have a safe operation than one involving small incisions only.

 

After gastric bypass how long will I be recovering?

IIf you are able to have the procedure done laparoscopically, you may be able to go home as soon as 48 hours after surgery. You should have only mild to moderate pain that is well controlled by medicine. You will have an IV pain pump that you control for the first 24-36 hours before you are switched over to pain medicine taken by mouth. You will wake up with a drain coming out of your abdomen. Your diet is started on the day following surgery with little sips of water, which will be advanced to surag-free clear liquids. The next day, you will be started on protein shakes.

You will be expected to start walking on the day of the surgery and you will rapidly advance your activity level (this is very important in decreasing the chances of some serious conditions including pneumonia and blood clots). Within a week or two you should be feeling less tired, and your mobility will be about the same as before surgery. Most patients will require about 2-3 weeks to return to work. You will not be on solid food for 4 weeks. You may experience a long period of time where solid or even soft food causes nausea, vomiting, and discomfort. Of course, if you need to have your operation performed through a large incision rather than the laparoscopic method, your overall recovery, especially out of the hospital may be slowed down significantly.

 

What can I expect for weight loss after gastric bypass?

Studies of bypass patients reveal that they can expect to lose between 60 to 70 % of their excess weight within12-18 months. Most will keep off significant weight even beyond 5 years (>50% excess). Some very motivated individuals may be able to maintain greater than 80% loss of their excess weight. To these individuals the surgery is only the start of a healthy new attitude that also combines:

1. Wise food choices to fill but not overfill (stretch) the new stomach pouch, and
2. A mild to moderate exercise program. Conversely, an unsuccessful person will likely make poor quality and quantity food choices as time passes.
3. Regular attendance of the support groups. These meetings reinforce the lifestyle changes and help to overcome certain difficulties you may face.

The initial time period (up to 12 months) after the surgery is when weight loss is easiest. Therefore, during this time it is of utmost importance that you focus on developing and solidifying new, healthy eating and exercise habits and work hard to eradicate old overeating patterns. Remember you should not go into this surgery thinking that this drastic surgery will ever allow you to eat like you do now and still lose weight. If you keep pushing the stomach pouch to accept significant volumes of food, then over time you will stretch your stomach and regain your weight.

In addition to improving overall quality of life, many post operative patients will see improvement or even resolution of medical illness brought on by obesity (including sleep apnea, diabetes, high blood pressure, and arthritis). Most will enter into a category of weight (BMI<35) in which the risk of major illnesses or sudden death is not much higher than in the general population.

You will be closely followed in the postoperative weeks, months, and years. You must be committed to these follow up appointments with medical, surgical, behavioral, and nutritional staff. Not only is safe weight loss dependent on these follow-ups, but so is your also your ability to permanently keep the weight off. Bypass surgery can finally give you the capacity to avoid food and begin the weight loss process, but long- term success will be dependent on modifications in your behavior, nutrition, and physical activity.

 

If I don't like it, can a gastric bypass be reversed?

The bypass procedure should be considered a permanent change. The bypass procedure involves cutting and reshaping your stomach and small intestine. Any reversal of it would be extremely difficult, but not impossible. A reversal procedure may be done laparoscopically, if the original surgery was also done that way, but chances are it may need to be done through a large incision and would pose significant medical risks.

 

What are my risks with the gastric bypass procedure?

Risks can be classified as intraoperative (during the operation), early postoperative (first week), and late postoperative (after leaving the hospital).

Intraoperative risks are similar to that for any surgery. They involve risks related to the anesthesia, bleeding that may require transfusions, and injury to surrounding abdominal structures that can occur with surgery. Most of these injuries are non-life threatening, but may delay your recovery significantly.

Early postoperative risks may include death, bleeding, wound or intra-abdominal infection, lung problems including pneumonia, heart problems including heart attack, and blood clots. One of the more serious and recognized problems with this surgery is called anastomotic leak. Any place that the bowel is cut and then fashioned back together is called an anastomosis. A leak of bowel contents is possible from any of these places. Leaks may be managed with drain placement,  bowel rest (nothing to eat) and antibiotics, or they may require another operation to fix the problem. The incidence of death is <0.05%, with other major complications including leak around 2%.

Late postoperative risks can be from many sources. The wounds still carry a risk for infection or hernia. You may have significant problem with your ability to tolerate solid foods due to pain, nausea, or vomiting. You may develop reflux, ulcers, bowel obstructions, gallbladder stones, diarrhea or strictures (narrowings) of the anastomosis (areas where the stomach or small intestine are sutured or stapled together). Many problems can be corrected, but some may require a second operation. Many will experience nutritional disturbances in the postoperative period (malnutrition, vitamin deficiency, calcium deficiency, anemia). Most are controlled with supplements, diet change and close follow up.

Other complications/risks include:

1. Kidney stones
2. Abdominal cramping/gas
3. Dumping syndrome - inability to tolerate sugar and/or simple carbohydrates in anything but small quantities. Similar symptoms are experienced after consuming meals too fast. The condition is seen in about 70-80% of patients in their first year after surgery. Patients may experience a range of symptoms including abdominal pain, bloating and cramps, diarrhea, weakness, dizziness, headache, and low blood sugar levels. Dumping tends to function as an aid to weight loss for many patients because of the foods they will need to avoid. Most (but not all) patients eventually resolve dumping symptoms by 2 years.
4. Neuropathy - from poor absorption and no replacement of certain vitamins
5. Osteoporosis - from poor absorption of calcium
6.  Miscarriage or birth defects – females of child bearing age need to avoid pregnancy during the period of acute weight loss (at least 18 months). After that period, it will be safe for you and your fetus to sustain a normal pregnancy.
7. Liver function abnormalities
8. Redundant skin folds from weight loss - a very common condition that may need to be dealt with by another operation (plastic surgery).  This surgery may be classified as cosmetic and not necessarily covered by insurance.
   

 

Can a gastric bypass procedure fail to provide me with significant weight loss?

Unlikely, but over the long term you could gain back weight. Undoubtedly, this surgery will give you dramatic weight loss results through the power to reject large volumes of food, and these results should last a lifetime. But this surgery's ultimate success, to a large part, is dependent on you.
Some patients in time can learn to "out eat" the bypass. These patients may cause significant stretch of the tiny stomach pouch to allow them to eat much more than is reasonable (these patients are always trying to eat to much at one setting). Some patients may not be able to shed the overeating of high sugar or carbohydrate foods. This is particularly seen in patients who don’t have or eventually lose the "dumping syndrome". These eating patterns will obviously cause weight regain as sugar items are quite easily passed and absorbed by the intestine and converted to fat by the body. Studies show that patients who exercise regularly and attend support groups are less likely to regain significant amount of weight.

 

Why would people gain their weight back after successfull weight loss?

Frequently they do not put adequate effort into making the required behavioral changes and do not stay involved in the recommended follow-up treatment. Patients who no longer pay attention to their eating habits are at a great risk for regaining their weight.

Patients who fail to maintain their weight loss may also have psychological issues that make them dependent on food and/or weight, such as the use of food for comfort or to deal with personal problems. In addition, significant stress can occasionally develop when a person who has been overweight for many years suddenly becomes thinner. For instance, some people may not find themselves as happy as they thought they would be, may feel uncomfortable receiving attention from the opposite sex, or may feel anxious about no longer being able to use their weight as an excuse for not doing or achieving certain things.

Partners of individuals who lose large amounts of weight may feel threatened by their significant other's increased attractiveness, and can attempt to sabotage their weight loss. For all of the above reasons, close follow-up is crucial for your success. It can identify not only nutritional and medical problems, but also the behavioral and psychological issues that could lead to your failure to keep weight off.

 

Is it safe to become pregnant after weight loss surgery?

It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

If you have an adjustable gastric band and you become pregnant, the band may be released and you may have a normal pregnancy without difficulties. The band can be readjusted again after you finished breast feeding.

 

What about the excess skin? Will it go away with exercise?

With significant weight loss excess skin will develop. The notion that excess skin will improve with exercise is unfortunately a misconception. Younger women often enjoy better cosmetic results because of the elasticity of their skin.

The amount of excess skin that forms after bariatric surgery is highly variable. In some individuals a large hanging skinfold develops on their abdomen and underneath skin infections may develop. Removing the excess skin is possible and the best results are seen if  a dedicated plastic surgeon performs the surgery. Unfortunately, this surgery may be classified as cosmetic and not necessarily covered by insurance.

 

How can I enroll in the program?

Inquiries about the Program can be made by calling 781-279-1123.

If you are interested in becoming a candidate for this procedure, you must begin by attending our Weight Loss Surgery Information Seminar. If you remain interested, you may then proceed on.

Most insurance plans will require a referral through your primary care doctor. You can find out whether you need a referral by calling your insurance carrier or primary care doctor. Be aware that you must be evaluated by all the members of our group which include a behavioral psychologist, a cardiologist, apulmonologist, a nutritionist, and then finally a surgeon.

This whole process may take many months.

 

Is there a program fee to participate in the program?

Due to the complexity of the workup and the postoperative care, we need to charge a program fee. Currently the program fee is $500.00, whic is payable when you are scheduled for surgery.