{Bariatric Surgery}

Frequently Asked Questions About Bariatric Surgery

Where do I start?
The first step is to attend an educational seminar, which you must do before scheduling a bariatric surgery consultation. You will learn a great deal about bariatric surgery at this meeting. You also will receive an information packet that includes a patient questionnaire and written exam.

Bariatric seminars are held at 6 p.m. on the first Monday of each month in the CityPlex Towers auditorium at 2448 E 81st Street, Tulsa, Oklahoma 74137.  There is a $25 materials fee that must be paid in advance to reserve a seminar spot. Please call us at (918) 505-3400 for mailing information.

For more information regarding a Bailey Medical Center Weight Loss Seminar, please call 918. 376.8580 or log on to www.BaileyBariatrics.com.

Can I bring someone with me to the educational seminar?
Yes, we encourage you to bring no more than one support person with you. We recommend this support person learn everything possible about bariatric surgery so they truly understand what a life change this surgery will be for you, should you and your physician determine you are a candidate.

Does my insurance cover gastric bypass surgery?
While many health plans cover the surgery, some still do not. To find out, call the member services number on your insurance card and ask if your plan covers gastric bypass surgery for medical necessity.

If insurance is a problem, you may want to find out more about CareCredit, a no-interest and extended-payment plan service that is available. Learn more at www.carecredit.com.

Do I qualify for surgery?
To qualify for bariatric surgery, you must meet the following criteria:

– You must be at least 100 pounds overweight or have a BMI of greater than 40 or a BMI of greater than 35 with at least two co-morbidities listed.
– You must have documentation of at least one physician-supervised diet plan in the past five years.
– You must have no history of major psychiatric illness.
– You must have no history of drug use or alcohol abuse within the past year.
– You must have a personal physician who will support your decision to undergo surgery and will actively follow you after the operation.
– You must be committed to participating in post-operative exercise and support programs.
– You must demonstrate complete understanding of this procedure, the risks and lifelong changes in eating habits required post surgery.

When can I schedule a consultation to discuss bariatric surgery?
After attending an educational seminar, you’ll need to gather your medical records from the past five years, obtain a support letter from your primary care physician and fill out the history, physical and demographic information in your patient packet. Once you return this information to our office, we will call you to schedule an appointment with the physician of your choice. If you have had a previous weight-loss surgery, you also will need to obtain those surgical records. We can usually schedule your appointment within two to three weeks of your educational seminar.

How long until I can have the surgery?
Once you consult with your physician, who determines that you are a candidate for bariatric surgery, you will receive several evaluations. You also may need some other testing that will be determined on an individual basis.

Once reports from your evaluations are received back in our office and everything is approved through your insurance, we can schedule surgery. Depending on how quickly your evaluations are completed and how quickly your insurance company clears your surgery, you could be ready for surgery in as little as three months. However, the timeframe is very individualized and often requires patience.

Why must I undergo evaluations?
Psychiatric and psychosocial evaluations will allow us to ensure there are no potential circumstances that might hinder your post-operative recovery and long-term success. Your physician will evaluate several things, including your expectations of the surgery, your psychological readiness and your ability to comprehend and carry out required lifestyle changes after surgery. Nutritional and exercise evaluations will help us establish the safest and most appropriate food and exercise program for you post surgery.

What bariatric procedures does Surgical Associates perform?
The weight-loss surgery techniques we perform are the open and laparoscopic Roux-en-Y procedure, as well as the Realize LapBand® System procedure.

Do I qualify for laparoscopic surgery?
Criteria for bariatric laparoscopic surgery are very individualized and must be discussed between you and your surgeon. Some determining factors are how much you weigh, what past abdominal surgeries you’ve had, and whether your body is conducive to the laparoscopic instruments that need to be used.

Where will my surgery be performed?
Our physicians perform bariatric surgery at Saint Francis Hospital in Tulsa and Bailey Medical Center in Owasso. However, if your surgery needs to be performed at another Tulsa hospital because of insurance reasons, that can be arranged.

What can I do to help prepare for my surgery?
Further information will be provided at the time of your consultation, but here are some things that you will need to do prior to your surgery to help ensure the best possible outcome:

– You must stop smoking well before surgery.
– Use of aspirin and/or non-steroidal medications before surgery will be discussed during your consultation visit.
– Weight loss is encouraged before surgery. This will assist in recovery, decreasing the chance of blood clots or infection.
– Exercise daily to strengthen and build muscles, which will assist you during recovery.
– Do deep breathing twice a day to enhance lung capacity in preparation for general anesthesia.
– A blood urine pregnancy test will be required as part of the pre-admission testing.

Will I be under anesthesia during surgery?
Yes, and qualified anesthesiologists have been selected to be part of our surgical team. You will have an opportunity to meet one of the anesthesiologists before surgery for an in-depth discussion of the anesthetic techniques, anticipated outcomes and potential complications. This is a time for you to ask questions and feel secure with understanding anesthetic technique.

What happens immediately after surgery?
An important requirement of your immediate post-operative care involves moving, walking, coughing and deep breathing. The more you move and walk, the less risk you face of blood clots or pneumonia, and your energy will return much more quickly.

Frequent use of a breathing device called an incentive spirometer (provided during your pre-operative visit) may help prevent pulmonary complications. You may also use an abdominal binder that supports the abdominal muscles and incision. You will be given further instructions on this before and after your operation.

Immediately following surgery, you will be on a very restricted liquid diet. This will be discussed with you in detail prior to surgery so you can shop for the types of food you will be able to eat.

How long will I be in the hospital?
The surgery itself usually takes between 60 and 90 minutes. Most people are in the hospital one to two days for open surgery and two to three days for laparoscopic surgery. You will be discharged from the hospital only when your surgeon determines it is safe for you to return home. Discharge time may vary from patient to patient.

Will I have scars after surgery?
The laparoscopic procedure requires five, 1/2-inch incisions. However, severity of scarring varies from patient to patient.

What diet changes will I need to make after surgery?
The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by surgeon, and it is important that you adhere strictly to your surgeon’s recommended guidelines.

You will receive specific instructions regarding your recovery and nutritional guidelines prior to leaving the hospital. The following suggestions are offered to help you change your eating habits:

– Eat slowly and eat quality protein first (avoid red meat for at least the first couple of years).
– Chew foods until they reach a “mushy” consistency.
– Take small bites.
– Focus on each bite, and pay attention to taste.
– Learn when to stop – one more mouthful may cause discomfort.
– Learn to recognize the “feeling” of fullness. It may be a feeling of pressure in the center of your abdomen or a faint (or strong) feeling of nausea.
– Do not drink liquids just before, during or just after meals.
– Use your own chewing capacity to liquefy foods.
– Do not lie down after a meal.
– Eat a maximum of three meals and minimum of one meal a day.
– Exercise.
– Drink water.
– Omit desserts and other items with sugar listed as one the first three ingredients.
– Omit carbonated drinks, high-calorie nutritional supplements, milk shakes and high-fat foods with high fiber content.
– Avoid alcohol.
– Limit snacking between meals.
– Take daily vitamins (liquid or chewable for the first four weeks).
– You should not take aspirin/non-steroidal anti-inflammatory drugs. You may take Tylenol or Extra Strength Tylenol.

How long will I follow up with my surgeon after surgery?
Unless otherwise indicated, your visits to Surgical Associates will be at two weeks, four weeks, three months, six months and one year post surgery. You will be advised to follow up with your primary care physician for any health concerns not related to your surgery.

What about support after the surgery?
Surgical Associates has a support group of patients who have had bariatric surgery and meet to talk about problems and challenges they are facing, changes that are happening in their lives, and how they are dealing with these changes. We feel the support group is an important part of the recovery process and enjoy the unique commitment by our entire team to the long-term health and success of our patients.

The support group meets at 6 p.m. on the second Tuesday of each month in the ninth floor lobby of the Warren Building at 6465 S. Yale, Surgical Associates main office.  Support group meetings feature guest speakers and also allow time for personal growth. You are required to attend at least one support group meeting between consult time and your surgery but are encouraged to attend as many as possible. We also offer an online support group for our patients.

For more information regarding a Bailey Medical Center Weight Loss support meeting, please call 918.376.8580 or log on to www.baileybariatrics.com.

When can I exercise after surgery?
Post-surgery exercise will help increase your weight loss and also can help your skin retain elasticity, so you are encouraged to start back on your pre-operative exercise plan as soon as possible after surgery. However, you must avoid weight lifting or strenuous exercise for at least six weeks. Walking and water exercises are great post-surgery work-out options.

Can I get pregnant after surgery?
It is strongly advised that women of child-bearing age use the most effective forms of birth control during the first 16-24 months after weight-loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

How soon can I go back to work?
Most people with “desk jobs” can start back to work, at least part time, after three weeks. Keep in mind that you will be very tired for the first two to three weeks after surgery, so you may need up to six weeks before returning to work. This time off also allows you to get your food and water regimen down before you begin participating again in everyday activities. This is your “new beginning,” so it is very important to feel comfortable with your routine before returning to work and other obligations.

What about excess skin? What happens to it?
Excess skin is a result of lost elasticity, which depends on many different factors. Exercise always helps to tighten and tone the skin, but genetics mostly determine its elasticity. People that have more weight to lose will naturally have more excess skin post weight loss.

Will I need surgery to remove the excess skin? Does Surgical Associates do the surgery?
Not everyone requires surgery to remove excess skin – this is mostly a personal choice. However, the skin can cause rashes or make it difficult to do everyday activities. These problems should be shared with and documented by your physician, and if needed, you will be referred to a plastic surgeon who specializes in this type of surgery.

Will my insurance cover surgery to remove excess skin?
At this time, most insurance companies do not cover excess skin removal. Some health care plans do cover this surgery if you have physician documentation that proves it is a medical necessity. However, you will need to check with your individual insurance plan.