How safe is this surgery?
No surgery is without risk, and bariatric surgery has particular risks. During the consultation visit, these risks will be discussed in detail so that an informed decision can be made. All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.
Does laparoscopic surgery decrease these risks?
No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring.
Will I have a lot of pain?
You will have pain after surgery. Your health care team will talk to you about your pain often. Using the numeric pain scale, you will be asked to rate your pain on a scale of 1 to 10 with 10 being the worst pain you have ever felt. We want your pain to be 5 or less.
Ask your surgeon about pain management options.
How long do I have to stay in the hospital?
You will likely go home the day after your surgery if you are:
- Drinking all your fluids
- Doing well walking
- Going to the bathroom
- Not having uncontrolled nausea or vomiting
Will the doctor leave in a drain after surgery?
Most patients will have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed before you are discharged from the hospital.
After surgery, what can I expect when I wake up in the recovery room?
Pain will be addressed at your doctor’s direction. As with any major surgery, you are at risk for surgical side effects, including blood clots. Statistically, the risk of death during these procedures is less than one percent. Your doctors will have already carefully assessed you for risks and prepared accordingly.
How soon will I be able to walk?
You will be required to walk the evening of your surgery. You will be sore, but this is the best way to speed up your recovery.
Walk every two to four hours in the hospital, and at home after discharge. Patients who do this feel remarkably well one week following surgery.
How soon can I drive?
Do not drive until after you stop taking pain medicine and are pain free for twenty-four hours.
What do I need to do to achieve success after surgery?
The basic rules are simple and easy to follow:
- Exercise is key to weight loss and weight maintenance after bariatric surgery. Start with fifteen to thirty minutes each day after surgery. Slowly add to your time to do sixty minutes or more each day.
- Immediately after surgery, your doctor will provide you with special dietary guidelines. You will need to follow these guidelines closely. Allowing time for proper healing of your new stomach pouch is necessary and important.
- When able to eat solids, eat three meals per day, no more. Protein in the form of lean meats (chicken, turkey and fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
- Never eat between meals. Do not drink flavored or carbonated beverages; even diet soda, between meals.
- Drink two to three quarts or more of water each day. Water must be consumed slowly, one to two mouthfuls at a time, due to the restrictive effect of the operation.
Why is exercise so important?
When you have weight-loss surgery, you lose weight because the amount of food energy (calories) you’re able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for sixty minutes will tell your body that you want to use your muscles and force it to burn the fat instead.
What is the right amount of exercise after weight-loss surgery?
Many patients are hesitant about exercising after surgery, but exercise is an essential component of post-surgical success. Exercise actually begins on the afternoon of surgery--the patient must be able to get out of bed and walk. The goal is to walk a little farther the next day, and progressively farther each day after that, including the first few weeks at home. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient's overall condition. Some patients who have severe knee problems can't walk well, but can swim or bicycle. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.
What if I’ve had a previous weight-loss surgical procedure and I'm now having problems?
Contact your original surgeon. He or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.
What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, the stomach is left in place with its blood supply intact. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. Though it does not receive or process food, the lower stomach still contributes to the function of the intestines by absorbing Vitamin B12, and affects hormone balance and motility of the intestines in ways that are not entirely known.
How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one 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 can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 4-8 ounces per meal per day.
What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it’s hard to see other than as a tiny bright spot. Because titanium and stainless steel are inert in the body, they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they won’t be affected by MRI or set off airport metal detectors.
What if I'm not hungry after surgery?
It's normal not to have an appetite for the first three months after weight-loss surgery. If you are able to consume liquids reasonably well, your appetite should increase with time.
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid, crushed or capsule form.
Will I be able to take oral contraception after surgery?
Most patients have no difficulty in swallowing these pills.
Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about six weeks.
Important: Refer to "Can I get pregnant after weight-loss surgery?" below.
Can I get pregnant after weight-loss surgery?
It is strongly recommended that women wait at least two years after the surgery before a pregnancy. Approximately 18 months to two years post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.
Is there a difference in the outcome of surgery between men and women?
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Will I be asked to stop smoking? Why?
Patients are highly encouraged to stop smoking at least three months before surgery. Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases rates of infection, and interferes with blood supply to the healing tissues. It’s possible your surgery could be canceled if you don’t comply.
How do I know that I won't just keep losing weight until I waste away to nothing?
Patients may wonder about this early after the surgery when they are losing 20 to 40 pounds per month, or when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight-loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.
What can I do to prevent excess hanging skin?
Many people heavy enough to meet the surgical criteria for weight-loss surgery have stretched their skin beyond the point from which it can snap back. Some patients choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective.) However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Your surgeon can refer you to a plastic surgeon to discuss your need for a skin removal procedure.
Will exercise help with excess hanging skin?
While exercise is good in so many other ways and is highly recommended, unfortunately many patients may still be left with loose skin.
Will I be miserably hungry after weight-loss surgery since I'm not eating much?
Most patients say no. In fact, for the first four to six weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger. This is usually caused by the types of food you're consuming, especially starches (rice, pasta, potatoes). Be sure not to drink liquid with food since liquid tends to wash food out of the pouch.
Will I have to change my medications?
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight-loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight-loss surgery. Usually no change in dosage is required.
Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines like ibuprofen, naproxen, etc.).
NSAIDs may create ulcers in the small pouch or the attached bowel. If you have gastric bypass you may take Tylenol. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight-loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
What is a hernia and what is the probability of an abdominal hernia after surgery?
A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20 percent of patients develop a hernia. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common. The chance of an abdominal hernia after laparoscopic surgery is less than one percent.
Will I lose hair after surgery?
Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Most patients experience natural hair re-growth after the initial period of loss.
Will I be left with any scar tissue?
Scar tissue, or adhesions, is formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.
What is Candida Syndrome?
Some patients have a type of yeast present on the surface of their skin, intestine or vagina at the time of surgery. This leads to overgrowth in certain circumstances. A whitish coating may occur on the tongue or throat. This syndrome is associated with a frothy mucous, nausea, difficulty swallowing, sore throat, loss of taste and appetite, and occasionally abdominal bloating and diarrhea.
Candida is promoted by the use of most antibiotics and some other medications, by stress, by reduced immune response, and by diabetes. There are several effective medications now available for treating the overgrowth of Candida.
What is sleep apnea?
It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.
What is the youngest age for which weight-loss surgery is recommended?
Although generally accepted guidelines from the American Society for Bariatric Surgery and the National Institutes of Health indicate surgery for those 18 years of age and older.
The concern is that younger patients have not reached full developmental or emotional maturity that is necessary to make this type of decision. It’s important that young weight-loss surgery patients have clear understanding of the lifelong commitment to the altered dietary and lifestyle changes necessary for success.
What is the oldest age for which weight-loss surgery is recommended?
This is reviewed on a case by case basis. Those on the higher end of the age spectrum require very strong indications for surgery and must also meet stringent Medicare criteria. Typically the risk of surgery in this age group is increased and the benefits, in terms of reduced risk of mortality, are reduced.
Can weight-loss surgery prolong my life?
Weight-loss surgery may significantly prolong your life if you are:
- Suffering from Type 2 diabetes (or other serious obesity-related health conditions)
- At least 100 pounds over your ideal body weight
- Able to comply with recommended lifestyle changes (daily exercise and low-fat diet)
Can weight-loss surgery help other physical conditions?
According to current research, weight-loss surgery can improve or resolve associated health conditions, including:
|Condition||Percentage found in preoperative individuals||Percentage cured two years after surgery|
|Diabetes or insulin resistance||34 percent||85 percent|
|High blood pressure||26 percent||66 percent|
|High triglycerides||40 percent||85 percent|
|Sleep apnea||22 percent in males, one percent in females||40 percent|