- How much weight do I have to lose before surgery?
- When can I have surgery?
- Which bariatric procedure should I have?
- When will I get my operating room date?
- How much weight can I expect to lose?
- Will I regain weight after a gastric bypass?
- How long will I be in the hospital?
- Can I have my gastric bypass surgery done laparoscopically?
- Will I have much pain after the surgery?
- What will I be able to eat after the surgery?
- Will I need plastic surgery after the surgery?
- Will my insurance cover the cost of the gastric bypass procedure?
- How much time should I take off from work after surgery?
As of April 1, 2009, we no longer have a specific weight loss requirement. We do, however, encourage ongoing weight loss, and have a "no weight gain" policy from program entry. Some insurers do have specific weight loss requirements, so it is important to check your insurer's guidelines.
No fair estimate can be given, but you will be given an appointment with Bariatric Surgery staff after you have completed the first five steps of our Steps Before Surgery. Some patients complete these steps in a timely fashion and receive an appointment within three months after attending the Introduction to the DHMC Bariatric Surgery Program meeting.
Which bariatric procedure should I have?
We perform the sleeve gastrectomy and Roux en Y gastric bypass procedures. Most patients will benefit from either procedure. There are some situations where one procedure would be preferred over the other. The bariatric surgery team will help you choose the procedure best for you. For example, if you have type 2 diabetes or severe reflux, the gastric bypass is the ideal procedure. If you have Crohn's disease, or have had multiple hernia repairs, the sleeve gastrectomy is preferred.
You will be given a date after you are approved by your insurer. After you meet with the surgeon for consultation, your records are sent to your insurer for approval. We are unable to make estimates as to when you will have surgery. The date is subject to change, but generally is within a week or two of the original date.
The majority of patients lose about one-half to two-thirds of their excess body weight (or approximately one-third of your current weight) with gastric bypass, about one-half with adjustable gastric banding. By excess body weight, we mean the weight above your ideal body weight. For example, if you are a 5'5" female, your ideal body weight is about 125 pounds. If your current weight is 375 pounds, you are 250 pounds above your ideal body weight. These 250 pounds are your excess body weight. If you lose two-thirds of this excess weight, you would lose about 150 pounds. Your final weight would then be approximately 225 pounds.
Very few people reach their ideal body weight. However, after the surgery your weight will be at a much healthier level if you follow dietary and exercise recommendations.
Bariatric surgery is currently the most reliable method used to treat severe obesity. Using diet alone, nearly all patients with significant short term weight loss regain the lost weight. After surgery, maximum weight loss generally occurs 12-18 months after surgery. You may regain a small amount of weight two to five years after bypass surgery, but is generally less than the initial weight lost, provided you follow a sensible, caloric restricted diet, and exercise on a regular basis. It is possible to regain all the lost weight if you return to previous eating habits. NO weight loss is guaranteed after gastric bypass. Regular exercise is important for long term weight maintenance. Currently, there is no "cure" for obesity.
The average length of stay for gastric bypass is one to three days.
At present, there is NO BMI limit for laparoscopic gastric bypass surgery. However, patients who have had prior extensive abdominal surgery via an upper abdominal incision are not laparoscopic candidates. Prior abdominal incision surgery makes the laparoscopic approach much more difficult. Patients who have had an open gallbladder removal, hysterectomy, or cesarean section are candidates for laparoscopic gastric bypass or gastric banding.
The nurse practitioner will decide, in consultation with the surgeons, if you are a good candidate for laparoscopy.
Patients who have a laparoscopic approach generally have very little pain. Pain is managed with a PCA (patient-controlled analgesia) pump by which you self-regulate the amount of pain medication by pushing a small button for the first day after surgery. You will transition to a liquid pain medication before you leave the hospital. Most of our laparoscopic patients do not require pain medication after discharge.
You will follow the gastric bypass diet after your surgery. Once you have recovered from the surgery, you will generally be able to eat the same types of food as before, but in much smaller amounts. Generally, portion sizes will be approximately one cup of food at a meal. It should take you 20- 30 minutes to eat a meal.
Not all patients require plastic surgery to remove excess fat. However, some patients with a very large amount of abdominal fat may have a large drooping fat fold in the lower abdomen after surgery. This could become a hygienic issue as it is difficult to keep clean. If so, we would recommend plastic surgery. There may be sagging skin almost anywhere on the body after weight loss, such as the face, chest, torso, buttocks, upper arms and legs. Most insurers will not cover the cost of surgery on the face, arms and legs.
We do not recommend removal of excess abdominal fat (panniculectomy) until 18 months after the surgery as this is the period of maximum weight loss. Surgery purely for cosmetic reasons is unlikely to be covered by insurance, whereas medically indicated reasons (such as hygiene problems) may be covered. Check with your insurer as to coverage criteria. It is important to keep in mind that gastric bypass and gastric banding are done for health and not cosmetic reasons.
Many insurance providers will pay for gastric bypass surgery if the indications are appropriate. Appropriate indications endorsed by the National Institutes of Health include a BMI over 40 or a BMI over 35 with obesity-related medical conditions such as diabetes, sleep apnea, and hypertension. Contact your insurer as soon as possible to learn if gastric bypass is a covered procedure. Some insurers have very specific guidelines, such as a six month to one year period of medically supervised dieting on a monthly basis by your primary care clinician, and will deny coverage if the guidelines are not met.
After you complete all program requirements, and see the surgeon, your documentation will be submitted for approval. You will be contacted by Patient Financial Services once your are approved, so that a surgery date and pre-operative class can be scheduled.
As of February 2006, Medicare does not cover the cost of bariatric surgery at DHMC. DHMC has provisional status with the Surgical Review Corporation for Center of Excellence and hope to have approval by 2010.
How much time should I take off from work after surgery?
We recommend that you take 3-4 weeks off after surgery. You will be adjusting to a new way of eating smaller amounts of food, and will be progressing your diet from liquids to solid foods. An earlier return to work is possible in certain situations.
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