What are the most important things to know before selecting a surgeon?
Experience, commitment and collaboration are critical. Because of the many health problems that obese patients have, most of the procedures are considered high risk. The surgeon’s experience therefore, is crucial.
Other important determining factors are your care team’s knowledge about bariatric surgery and its collaboration between specialties. Bariatric surgery isn’t just about losing weight. We believe that successful outcomes are best achieved when patients are educated by a multidisciplinary team that includes nurses, dietitians and psychologists.
What are the routine tests before surgery?
Certain basic tests are done prior to surgery:
- A complete blood count
- Urinalysis
- Chemistry panel
- Gallbladder ultrasound
The chemistry panel gives results of about 20 blood chemistry values. Many surgeons also ask for a gallbladder ultrasound to look for gallstones.
Other tests may be requested when indicated and include:
- Chest X-ray
- Electrocardiogram
- Pulmonary function testing
- Echocardiogram
- Sleep studies
- GI evaluation
- Cardiology evaluation
- Psychiatric evaluation
What is the purpose of pre-operative bariatric surgery tests?
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to understand their potential in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively.
If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated.
These tests will determine if you have:
- Liver malfunction
- Breathing difficulties
- Excess fluid in the tissues
- Abnormalities of the salts or minerals in body fluids
- Abnormal blood fat levels
Why is a gastrointestinal evaluation necessary?
Patients with significant gastrointestinal symptoms such as:
- Upper abdominal pain
- Heartburn
- Belching
- Sour fluid
They may be symptomatic of underlying problems including:
- Hiatal hernia
- Gastroesophageal reflux and/or
- Peptic ulcer
Up to 15 percent of reflux patients may show early damage in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify this so a suitable surveillance or treatment program can be planned.
Why must I complete a sleep study?
The sleep study detects a tendency for sleep apnea. The abnormal stopping of breathing usually associated with airway blockage when the muscles relax during slumber. This condition is associated with a high mortality rate.
Sleeping after bariatric surgery
After surgery you will be sedated and will receive pain narcotics, which further depress normal breathing and reflexes. Airway blockage also becomes more dangerous at this time. It’s important that your surgeon has clear expectations of the procedure so he can decide how to handle possible irregularities.
Why do I need a psychiatric evaluation?
The most common reason a psychiatric evaluation is ordered is to fulfill insurance company requirements. Most evaluations focus on a patient’s understanding and knowledge of the risks and complications associated with weight-loss surgery and their ability and commitment to follow the basic recovery plan.
What impact do medical problems have on bariatric surgery?
Medical problems such as serious heart or lung problems can increase the risk of any surgery. Conversely, 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 bariatric surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
How long is the process of undergoing bariatric surgery?
New evaluation appointments are typically scheduled two to three months in advance. Following this initial visit, the patient will participate in a series of compliance visits in an effort to learn more about successful diet and exercise strategies. These are required by insurance and our program in order to ensure success post-operatively.
Once a patient has completed this process, and if the surgeon and patient agree the operation is appropriate, the procedure is usually scheduled within six weeks after receiving authorization from insurance.
What can I do to speed up the process of getting ready for surgery?
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 is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
- Prepare a diet history of all previous weight-loss attempts to show your surgeon.
- Bring all pertinent medical data to your surgical appointment, including reports of special test results (echocardiogram, sleep study, etc.) and or hospital discharge summaries.
- Bring a complete list of medications including dose and schedule.
- Stop smoking. Patients who use tobacco products are a much higher surgical risk.