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(A)
Preparation for Weight Loss Surgery
| Q.
How do I know if I qualify for weight reduction surgery |
A.
You qualify if:
» You weigh twice your ideal body
weight or You are overweight by 100 lbs or more
» You
have a BMI (body mass index) more than 40 or
» You
have a BMI more than 35 with co-morbidities (illnesses related
to being overweight).
» You are overweight for 5 years
or more
» You have failed to lose weight or sustain
weight loss under supervision
» You are willing to
comply with lifestyle and diet changes
| Q. How much weight will I lose ? |
A. Roux-en-y gastric
bypass is an effective tool in losing and maintaining weight.
Weight loss depends on you and how well you follow a good diet
and how often you exercise. On an average, people lose 65 –
70% of their excess weight at one year after gastric bypass.
While an estimated 0-3% of patients with >100 pounds of
excess weight will successfully lose weight through dieting,
80-85% of patients undergoing gastric bypass surgery will lose
weight and more importantly, keep it off. After 10 – 14
years, patients have maintained 50 - 60% of excess body weight
loss.
| Q. What are the routine tests before
weight loss surgery? |
A. Certain basic tests are
done prior to surgery. These include a complete blood count
(CBC), urinalysis and clinical chemistry panel including serum
TSH for thyroid gland function. Often a glucose tolerance test
is done to check for Type 2 diabetes, a common condition in
morbidly obese individuals. Adult patients will receive a chest
X-ray and an electrocardiogram. Women may have a vaginal
ultrasound to look for abnormalities of the ovaries or uterus.
We also ask for an abdominal ultrasound to check for a fatty
liver and gallstones and an upper GI Endoscopy to exclude hiatal
hernia, peptic ulcers etc. Other tests, such as pulmonary
functions, echocardiogram, polysomnography (sleep study) and
cardiology evaluations may be requested when indicated.
| Q.
What is the purpose of all these tests? |
A. 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 sudden death
post-operatively. If you are diabetic, special steps must be
taken to control your blood sugar. Because elevated blood sugar
increases cardiac stress, your heart function will be thoroughly
evaluated. Other tests will determine if you have liver
malfunction, breathing difficulties, excess tissue fluid
accumulation, electrolyte (salts and minerals) abnormalities or
abnormally high levels of circulating fats in your bloodstream.
| Q. Why do I have to have a GI Evaluation? |
A.
Patients with significant excess weight can have underlying
problems such as a hiatal hernia, gastro esophageal reflux or a
peptic ulcer without any symptoms. It is essential to know the
presence of these abnormalities since we may have to modify our
steps during surgery. In patients with acid reflux, up to 15%
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 treatment program can be
planned.
| Q. Why do I have to have a Sleep
Study? |
A. The sleep study detects a tendency for
abnormal cessation of breathing when asleep, called obstructive
sleep apnea, which is associated with airway blockage when the
pharyngeal and throat muscles relax. After surgery, you will be
sedated and will receive narcotics for pain relief, which
further depress normal breathing and reflexes. An undetected
airway blockage would be more dangerous while under the effect
of these drugs. It is important that your surgeon and
anesthesiologist have a clear picture of what to expect so they
and the nursing staff are prepared to prevent any post-surgical
complications.
| Q. What impact do my medical
problems have on the decision for weight loss surgery, and how
might they affect risk? |
A. Medical problems, such
as serious heart or lung problems, can increase the risk of any
surgery. On the other hand, if the 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 gastric bypass surgery if it is otherwise
appropriate, but those conditions will make a patient's risk
higher than average.
| Q. What are the risks of
gastric bypass surgery? |
A. All efforts in
preoperative evaluation are directed to identify high-risk
patients. While all efforts are made to eliminate complications,
still gastric bypass is a major surgery and is associated with
certain complications. Some of these complications are as minor
as draining a wound or difficulty in swallowing. More major
complications include bleeding, intestinal blockage or
obstruction, pneumonia, leaks that form abscesses, ulcers and
hernias. One life threatening complication is a deep vein
thrombosis. This is a blood clot in the leg that can travel up
to the lungs (pulmonary embolism) and possibly cause death.
Leakage from staple line is also a dangerous complication and
may require surgery. Risks of Gastric Bypass Surgeries
| Q.
Is there anything I can do before surgery to reduce the risk of
complications? |
A. Certainly. You can reduce some
risk by doing the following in the 4 weeks preceding surgery;
Quit smoking, Quit drinking alcohol, Decrease 10 percent of your
weight by taking high protein liquid diet. Doing this will not
only decrease the risk but will also optimize your surgery.
| Q.
Will I have to stop smoking? |
A. Patients are
encouraged to stop smoking at least one month before surgery.
Smoking increases the risk of lung problems and can reduce the
rate of healing. It increases the rate of incisional hernia and
leaks by interfering with the blood supply of healing tissues. |
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| Obesity
Surgery : |
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| Weight
loss surgery : |
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| Gastric Bypass : |
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| Gastric Banding : |
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| FAQ : |
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