Frequently Asked Questions About Bariatric 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. 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 percent 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.

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 in a matter of days. Once a patient is seen, if the surgeon and patient agree it is appropriate, the patient is enrolled in our weight loss surgery program. 

You can help speed up the process by selecting a primary care physician if you don't already have one, and establishing a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current.

You should also

• Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
• Bring any relevant 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 for at least two months before surgery. Surgical patients who use tobacco products are not candidates. Please note that resuming smoking after surgery is very dangerous and predisposes gastric bypass patients to ulcer formations that can be very difficult to treat.

Weight loss surgery is like other major surgeries. The best preparation is to understand the risks and potential benefits and to closely follow your doctor’s instructions.

• Understand the surgical process and what to expect afterwards.
• Talk to people who have had weight loss surgery (click here for information on support groups).
• Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your plans to maintain your weight loss after surgery.
• Start a journal about your experience. Record how you feel now, the obstacles you encounter, and the things you hope to be able to do after surgery.
• Get a letter of support from your family. It helps to know that you have people behind you, waiting to help.

Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with this procedure. If complications occur during the operation, your doctor may choose to perform open surgery. Your doctor must determine if you are an appropriate surgical candidate.

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:

• Bleeding
• Complications due to anesthesia and medications
• Deep vein thrombosis
• Infections
• Leaks from staple line breakdown
• Marginal ulcers
• Pulmonary problems
• Stenosis
• Internal hernia
• Band slip/erosion
• Failure to lose weight

If surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.  At Boston Medical Center all surgeries are scheduled as laparoscopic and fewer than one percent need to be converted to an open procedure.

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.

Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. While you are still in the hospital, you may have a patient-controlled analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.

For most surgeries, you will only have an IV placed for fluids. It is not typical for drains or catheters to be placed after bariatric surgery.

After surgery, you will be taken to the recovery room. You will spend a few hours there as you wake up from the general anesthesia. You will then be moved to your room where your family can see you. During the first night you will be connected to a continuous oxygen saturation monitor. Obesity, general anesthesia, and preexisting lung conditions (asthma, sleep apnea) make it likely that you will need oxygen the first night to keep your saturation above 90%. The night of surgery you will be asked to walk. This is very important to help prevent blood clots in your legs from forming. This condition is called a deep venous thrombosis or DVT. Wearing the lower leg compression devices while in bed also prevents DVTs.

It is normal to feel uncomfortable during the first few days after surgery, but each day you will feel stronger and more active. You will be given pain medication to ease your discomfort. Your nurse will teach you how to use your PCA (patient controlled analgesia) pump. This allows you to give yourself pain medication through your IV as needed. There is no danger of overdosing, and it allows you to control the pain yourself.

Your mouth might feel dry the first 24 hours after surgery. This is usually due to the medication administered during anesthesia. You will be allowed to swab your mouth, but not to drink anything until the first day after surgery.

While you are in the hospital, your surgeon, surgical residents, and nurses will provide your medical care. You might be assigned nursing or medical students as well. Your surgeon will visit you daily, so have questions ready. You will be visited by a dietitian while in the hospital. They will provide a written quiz, which you will be asked to complete. It is a good idea to involve family members in learning about the diet after surgery.

As long as it takes to be able to take care of yourself. Although it can vary, the hospital stay for all procedures (including the day of surgery) is typically two to three days.