Minimally Invasive and Weight Loss Surgery
Preparation for Surgery
- What are the routine tests before surgery?
- What is the purpose of all these tests?
- Why do I have to have a GI Evaluation?
- Why do I have to have a Sleep Study?
- Why do I have to have a Psychiatric Evaluation
- What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
- If I want to undergo a gastric bypass, how long do I have to wait?
- What can I do before the appointment to speed up the process of getting ready for surgery?
Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), a Chemistry Panel, and other chemistry tests to make sure a patient doesn’t have a medically treatable cause for their obesity. All patients but the very young get a chest X-ray and an electrocardiogram. A gallbladder ultrasound to look for gallstones is done if the patient still has a gallbladder and pulmonary function tests are done. Other tests, such as an echocardiogram, sleep studies, GI evaluation, or cardiology evaluation may be requested when indicated.
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to obesity. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery can increase 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, or abnormal blood fat levels.
Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.
The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.
Prior to weight loss surgery, underlying psychiatric disorders must be ruled out. Most psychiatrists will also evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.
6. What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
New evaluation appointments are usually booked 4-6 weeks in advance. Once a patient is seen, if the surgeon and patient agree it is appropriate, the patient is enrolled in our weight loss surgery program which is about 6 months.
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).
- Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
- Bring any pertinent medical data to your appointment with the surgeon - this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
- Bring a list of your medications with dose and schedule.
- Stop smoking. Surgical patients who use tobacco products are not candidates for surgery at Boston Medical Center.
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