Frequently Asked Questions about Weight Loss Surgery
How do I know if I am a candidate for surgery?
Candidates for surgery are those men and women who have tried unsuccessfully to lose a sufficient amount of weight with diet and exercise, are about 100 pounds overweight and have deteriorating health problems due to the excess weight. Also, the National Institutes of Health states the criteria for surgical intervention is a body mass index (BMI) of 40 or above. Those individuals with a BMI of 35-40 with a pre-existing co-morbid condition, such as diabetes, or heart disease, are also eligible candidates.
What are the different types of procedures?
Combined Restrictive and Malabsorptive Procedures: This is the Roux-en-Y Gastric Bypass and the distal gastric bypass, which limits the amount of food that can be consumed and alters the absorption of calories.
Malabsorptive Procedures: This is the Biliopancreatic Diversion with Duodenal Switch, which primarily alters the absorption of calories.
What is the difference between open surgery and laparoscopic surgery?
- Open surgery is through an incision large enough to do surgery without the need of a monitor or video. Some patients require this approach due to prohibitive previous surgeries. This is usually not the case but in rare cases it is necessary.
- Laparoscopic surgery allows the surgeon to work through small incisions where small tubes (portals) are placed for access. The surgeon operates using a video monitor. This is called minimally invasive because the incisions are small. The impact of minimally invasive surgery is much less allowing you to discharged the next day and return to normal activities quickly.
- Robotic Surgery is very much like laparoscopic surgery. The abdomen is accessed in the same manor. The difference is that the surgery is done with instruments controlled by the surgeon through the robot. The view is up close, precise, and in 3D. Robotic surgery can be an advantage in some patients. The results are similar to the laparoscopic surgery. Your surgeon will discuss with you which approach is best for you.
What are the potential risks of surgery?
As with any surgery, risks are involved. These risks may be higher as this is a second bariatric surgery, which usually carries more risk than a first time bariatric surgery. The surgeon will discuss the potential risks with you, and you will be educated in recognizing symptoms of complications. The benefits of the distal gastric bypass surgery should outweigh the risks. This program will involve a close follow up schedule.
How long will I be in the hospital?
Most patients after primary bariatric surgery go home the next day in the early afternoon. However, everyone is different. You will be discharged when you meet certain criteria with regard to ambulation and intake by mouth. Patients who undergo open surgery may stay longer. Patients who undergo revison surgery may stay longer. Everyone goes home only when they are ready.
How long before I start losing weight?
Weight loss will begin soon after surgery.
Is it possible to regain weight?
Yes. It is very important that you follow your surgeon and dietitian’s recommendations and guidelines regarding food consumption.
Will my insurance cover my surgery?
Most insurance companies will cover weight loss surgery, however you must check with your company to determine if you have the benefit for obesity in your policy and whether second bariatric surgeries are covered. Most insurance companies have specific guidelines and criteria for your surgery to be approved.
Are there any medications that I need to avoid after surgery?
Yes, you will find them listed in this manual under medications.
Why should I follow a special diet?
It is important to follow this diet to heal properly and maximize weight loss in a healthy, appropriate way. With the Distal Gastric Bypass, there will be more malabsorption than with the Roux-en-Y Gastric Bypass and diet and supplementation is critical to your life long health.
Why should I avoid carbonated beverages?
Carbonated beverages contain carbon dioxide. When carbon dioxide enters the pouch, it warms up, releasing gases. This can cause discomfort and stretching.
Why do I have to separate my liquids and solids?
Your pouch is too small to allow both liquid and solids. If you drink with your meals, you are at risk for nausea and vomiting because it fills the pouch up too fast. Also, if you drink with your meals or too soon after eating, you will flush the food from your pouch faster, which will cause you to be hungry sooner. This may cause excessive snacking and an intake of additional calories.
May I continue to drink caffeinated beverages?
Caffeine can increase blood pressure and heart rate. It is also a stimulant and can increase hunger. Tannic acid found in coffee and tea may increase your risk of developing ulcers.
What is Dumping Syndrome?
Dumping only occurs with the gastric bypass. It can usually be avoided but requires special attention to dietary sugar. Dumping syndrome is the body’s response to simple sugars that enter into the intestine. With the gastric bypass the pylorus muscle is bypassed. That muscle controls food entering the intestine. . With this procedure, when sugar is consumed, it is dumped into the small intestine too quickly. This causes a spike in Insulin that drops your sugar level in the blood. The sugar in the intestine cause fluid to shift from the blood into the intestine. As the blood sugar drops rapidly, a set of symptoms including shakiness, dizziness, sweatiness and a rapid heart rate may occur. The insulin response to the sugar causes symptoms of hypoglycemia, (low blood sugar). You can experience some of these symptoms if you eat high fat foods, food high in sugar, or drink liquids with your meals.
Can I drink alcohol?
Alcoholic beverages should be avoided for the first year and then should be limited for the following reasons:
- Alcohol is high in calories.
- Many alcoholic beverages are carbonated, and carbonation should be avoided.
- Weight loss surgery patients become intoxicated on less alcohol due to the rapid rate of absorption.
- Alcohol is irritating to the stomach and can increase your risk for ulcers.
Why do I have to drink so much clear liquid?
Water dilutes the blood and causes lack of hunger helping with your weight loss. When losing weight, there is a heavy load of waste products to eliminate, mostly in the urine. These waste products can cause formation of kidney stones. Drinking water helps the body efficiently remove these waste products. Also, dehydration can occur if water consumption is insufficient.
Will I need to lose weight before surgery?
You may be asked to lose weight prior to surgery. There are several reasons for this. This will help get back on track with diet and supplementation, it will support your medical need claim to the insurance company and will aid in shrinking your liver and make the surgery safer. When you meet with the surgeon, if weight loss is recommended or required, you will be informed at that meeting.
You will also be meeting with the dietitian to discuss diet and supplementation before and after surgery.
How long after surgery is it safe to attempt pregnancy?
Due to your rapid weight loss and potential for malabsorption, we advise that you wait 1 ½ years after surgery before attempting pregnancy. This will be safer for you and your baby.
How will I prevent pregnancy in the first 1 ½ years after surgery?
We do ask that you hold all estrogen containing forms of birth control for 30 days prior to surgery and 30 days after surgery to decrease your risk of blood clots so you will need to use an alternate method of birth control. Please discuss various forms with your GYN prior to and after surgery.
How soon after surgery can I exercise?
This depends on how you define exercise. Exercise begins almost immediately after surgery. Under most circumstances patients are expected to deep breathe 10 times per hour, and walk every two hours. At home, we expect you to continue this deep breathing to help prevent blood clots and pneumonia. You can do this by using your incentive spirometer and taking 10 deep breaths while you are awake. We want you to walk in and out of the house, up and down the stairs, and do any activity you did before with the exception of driving, lifting more than 10 lbs, or straining by holding your breath (valsalva). After you are seen at your one week visit and as you heal, you can progressively increase the intensity and frequency of your exercise. You are encouraged to increase your walking distance (this can be done on a treadmill or an elliptical). Your surgeon will see you at about four weeks (sometimes this is a nurse practitioner). It is likely that your surgeon will release you back to unrestricted activity. This will be determined based on your progress. Most patients return to work in two to four weeks.
How should I exercise?
Generally, we like you to exercise 2.5 to 3.0 hours per week. This amounts to about 30 minutes five times per week. This is considered the minimum. Your exercise should include aerobic, anaerobic (resistance), and stretching exercises. Aerobic results in improvement of cardiovascular health. Anaerobic exercise improves muscle tone, hypertrophy, and strength. It also results in the most calories burned. Flexibility is important to prevent injury.
Please be careful not to injure yourself by progressing too quickly. At the same time, keep in mind that what we are recommending is the minimum. More exercise is always better if it is done safely. Learn what is available in your community and discuss it with your surgeon.
Walking is a great and natural exercise. Under age 60 your goal should be the equivalent to 10,000 steps a day. It sounds like a lot but it really is not. In addition, you deserve 250 minutes a week of moderate exercise. Any exercise will do as long as you are taking into account any limitations from conditions you may suffer. Both aerobic and anaerobic exercise is recommended. Your exercise does not have to be rigorous.
Is everyday walking like what I do at work or walking my dog considered exercise?
Not really! You should take time out for yourself that is specifically for you and your exercise. Everyone has 30 minutes. You are worth it.
Will I lose muscle mass?
Part of losing weight includes the loss of some muscle tissue. However, starting a progressive exercise program early will minimize this problem and can actually result in gaining muscle mass.
Will exercise help extra skin?
Yes and no. The extra skin that results from weight loss occurs no matter how you lose weight. The amount of extra skin is directly proportional to the amount of weight you lose and your genetics. If you are central (your fat is around your organs) you will have less skin than someone who is peripheral (the weight is carried on the hips and extremities). An example of a central adipose distribution is the apple shape. An example of peripheral adipose distribution is the pear shape.
There will come a time when you have lost most of the fat between your muscle and your skin. What remains results in skin that sags. Unfortunately, there is no amount of exercise that can take away that extra skin. You may want to consider plastic surgery. To get the best results, you should be out of surgery at least a year and have lost 60% of your excess body weight before you consider plastic surgery.
Contact our office at (217) 214-5800 for more information.