An Overview of the Weight Loss Surgery Process

Initial Patient Education and Interview:
At your first office appointment, we ask you to provide your medical history and health insurance information. You will also watch a video which explains the disease of morbid obesity, the operations available to address this disease, as well as the expected outcomes and potential risks of surgery. You will meet your surgeon, who, after an initial medical interview, will answer any of your questions about surgery. If you chose to participate in the weight loss surgery program, you will then be asked to agree to an understanding detailing your and our responsibilities in the program.

Pre-operative Evaluation:
You will be asked to obtain the necessary pre-operative evaluation and clearance from specialists. Most insurance carriers require psychological evaluation, which will be arranged for you. An obligatory nutritional evaluation and counseling session will also be arranged. Depending on your medical condition, evaluation by specialists in pulmonary medicine, cardiology, or endocrinology may be necessary. During this time, our office will work on obtaining approval from your insurance carrier to proceed with surgery.

First Support Group Meeting:
Healthy Steps Bariatric and Metabolic Center participates with a local bariatric support group that meets monthly. It is intended for all individuals who — a) are interested in learning more about bariatric surgery, b) have gone through bariatric procedures, and/or c) are in need of the help and support of like individuals with weight-related problems. There is no charge for an individual to attend these support group meetings and you may attend as many as you like. We require that all bariatric candidates must attend at least one support group meeting before surgery.

Pre-operative Visit:
Approximately two weeks before surgery, patients will undergo a detailed physical examination at our Mendocino Avenue office where counseling will be completed and a consent form signed. Pre-operative anesthesia and hospital interviews are arranged, and any necessary fees will be collected.

Day of Surgery:
Patients are admitted to the hospital approximately two hours before scheduled surgery. After undergoing the procedure, the patient will proceed to the Recovery Room until they awake from anesthesia. They will then proceed to the surgical ward. A few patients, due to complexity of medical conditions, will require stays for a day or two in our ICU.

Hospital Stay:
Each patient reacts differently to the surgery and may have varying degrees of pain or discomfort. Each patient is given a PCA (a “pain button”) that directs an intravenous dosing of pain-killers for this purpose. Other things you can expect in the first day or two include compression stockings on the lower legs (to prevent blood clots), a bladder catheter (to monitor urine output), and an intravenous line to administer fluids. You will be encouraged early on to take deep breaths (using a Spirometer) and to get out of bed & walk – these are the best measures you can do to speed your recovery. If your recovery is proceeding well, you will start a clear liquid diet 24 hours after surgery and be allowed to go home after 48 hours.

First Two Weeks After Surgery:
Recovery from laparoscopic bariatric surgery is usually rapid, but care must be taken to allow your “inner plumbing” to heal adequately. A clear liquid diet is continued for 2 weeks following surgery.  Some gastric band patients may be advanced more quickly, depending on their progress at the first follow-up appointment.  After this, pureed and soft foods can be started with the approval of your surgeon and dietician, whom you will visit two weeks after surgery. Daily walking is encouraged during this phase, but nothing more strenuous until after your check-up with your surgeon.

Advanced Diet and Activity:
If you are doing well at your two-week check-up, you will be approved and encouraged to engage in a physical training (exercise) program which will help with your weight loss and toning your skin. At your dietician’s instruction, your diet will be advanced. Some guidelines to remember about your diet:

  • Keep yourself hydrated, being sure to drink a minimum of 48 oz of water per day.
  • Avoid snacking between meals. Find interests/employment outside the home to get yourself away from the refrigerator and the temptation to “graze.” You should eat 3 meals per day of a balanced 1/4 cup total volume with an additionally healthy snack (e.g. carrot sticks or turkey jerky) in the mid/late afternoon.
  • Eat protein first and foremost at every meal. With your overall total intake now much less, eat what your body requires first — 60g protein per day.
  • Eat slowly and chew completely – enjoy your meal!

Vitamins:
You will need to take vitamins every day for the rest of your life. One well-balanced multivitamin is probably sufficient, making sure that it contains 100% MDA for iron and B12 as a minimum. You should also ensure you take additional calcium – at least 1200mg per day.

Support Group:
After surgery, you are strongly encouraged to come share your experiences, as often as you would like, with others preparing for and having gone through this surgery. The support and education may help you along your own journey.

Plastic Surgery:
Eighteen months or so down the road, after maximum weight loss, a certain percentage of patients (about 30%) notice that they have excess skin, usually in the abdomen and under the arms. If this applies to you, let your surgeon know at your follow-up appointment and arrangements will be made for evaluation with a plastic surgeon for potential removal.

Long-Term Follow Up:
Both your surgeon and your dietician expect to see you for regular follow-up: at one month, three months, six months, and twelve months following your operation, then every six months after that. This has been found to be effective in helping you “stick with the Program” and identify problems that may require attention (such as a vitamin deficiencies). You should know that WHENEVER you have a serious problem that you even THINK is related to your gastric bypass surgery, your surgeon should know and stands ready to help you.