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Here are some answers to the most frequently asked questions about
Laparoscopic Bypass Surgery. Also, please view
FAQs concerning the Gastric Banding procedure.
Q: What
are the tradeoffs with incision size?
A: There are pros and cons. Recovery after laparoscopic surgery is much faster and virtually scar and pain free. Length of hospital stay is reduced to days instead of weeks. Scarring is minimal. In general, laparoscopy virtually eliminates two common postoperative complications: wound infections and hernias. The frequency of bowel obstructions and leaks is increased.
Q:
How long does the surgery take through the laparoscope?
A: This varies widely and depends on the experience and skill of the surgeon. Our LBS surgeons routinely do this procedure in about 1 hour.
Q: I want my surgery through the
laparoscope, not a standard incision. Can you guarantee this?
A: We complete about 99% of our cases laparoscopically. It is always possible that a problem might occur, forcing the surgeon to enter the abdomen through a standard incision.
Q: Can the surgery be
reversed?
A: Yes, but it would take another
operation and it is not advisable.
Q: What
are the main risks of surgery?
A: As with any surgical procedure there are
risks. The most common complications are wound
infections, strictures, and hernias.
Q: Are
there long term risks after surgery?
A: Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur.
Q: Does LBS International offer other weight loss options?
A: Yes. We also offer the
Lap-Band surgery. In general the
Roux-en-Y Gastric Bypass is the procedure of choice, but certain patients may be better candidates for the
Lap-Band. Please contact us for a complete evaluation of your situation and what is best for you.
Q: Will
my overall health improve?
A: Morbid obesity can also cause serious health problems. Post surgery, many of our patients no longer experience many of the life threatening symptoms they did before their weight loss, i.e. sleep apnea, joint pain, back pain or high blood pressure. Most patients can stop taking medications for
hypertension and type II diabetes.
Q: Will
I be able to have children after the procedure?
A: Yes. Many of our patients have gone on to
motherhood. Ideally, pregnancy should be delayed until weight loss is maximal, usually 2 years after surgery. Weight loss makes women more fertile and decreases the likelihood of complications related to pregnancy.
Q: What
is dumping?
A: Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue, and sometimes abdominal cramps and
diarrhea - a phenomenon called 'dumping.'
Q: Will
I experience dumping?
A: Dumping will occur if a large amount of foods high in sugar and fats are consumed after the procedure has taken place. It is imperative to stick to the diet guidelines set forth by your doctor. Most patients learn to control this very well.
Q:
Will I be required to drink protein shakes?
A: No. The shakes ensure adequate protein and calorie intake after surgery, which is important for healing and other reasons. A liquid diet ensures that the pouch and opening will not be stretched early on when that is more easily accomplished. The shakes also interpose a significant change between the way you have eaten and the way we hope that you will eat in the future. Because the shakes are somewhat monotonous, once you switch to a low fat, more healthy diet it will be 'tasty' by comparison and therefore more likely to be preferred in the long run.
Q: How
long do I have to take Bariatric Advantage
vitamins?
A: For life, if you want to be safe. Indeed everyone ought to take a multivitamin as well to prevent the fairly common and widely varied deficiencies seen as people get older.
Q: How
much food can I eat after surgery?
A: The gastric pouch, although initially very small, has a hole in the bottom so that a reasonable amount of food can be eaten if taken slowly. As time passes the pouch enlarges and where initially only one or two bites could be taken without a sense of fullness, later a small adult meal can be consumed. As it becomes possible to eat more food it becomes also more important to have developed good habits with regards to food choices.
Q: Are
there specific foods or drugs that I should
avoid after surgery?
A: Except for the tiny hormone replacement pills most tablets should be crushed after surgery. Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue and sometimes abdominal cramps and
diarrhea - a phenomenon called 'dumping'.
Q: Why
don't people just keep losing weight?
A: Everyone who has gastric bypass surgery has a strong genetic capacity to use calories efficiently. So it is always possible to provide high calorie foods and induce weight gain. In practice what happens is that with time people are able to eat more at a time, they lose weight and require fewer calories just to move around and their metabolism becomes even more efficient that it was preoperatively so the weight stabilizes after one or two years.
Q: How can I prevent
stretching out my new stomach?
A: Don't eat after you feel full.
Q:
Does surgery affect how well I absorb my
medications?
A: Generally speaking not, but with certain medications it may be wise to check blood levels after surgery.
Q:
Will I ever eat normally again?
A: It depends on what you mean by normal. Most of our patients eat small, "normal" adult meals. Many overweight people eat more and make higher calorie food choices than the rest of the population. So it is possible that you were not eating 'normally' to begin with. After surgery although you can eat small amounts of anything, we hope that you will choose low fat foods for the most part. Also you will in general consume fewer calories than someone your size who was not previously overweight. Frequent small amounts of high calorie foods can cause you to gain weight.
Q:
What kind of exercise should I do after surgery?
A: We advocate increasing two kinds of exercise as part of a post surgical lifestyle change: 1) Increase the difficulty of unscheduled everyday activities. For example, try to walk
farther - a pedometer is helpful in this regard
- climb the stairs instead of taking the elevator; volunteer for small tasks that you might not otherwise choose. 2) Schedule workouts two or three or four times a week simply for the purpose of exercising. Although any activity is helpful, weightlifting is the most efficient for extra weight loss.
Q: Will I need plastic
surgery after I lose weight to remove loose
skin?
A: Some of our patients are thrilled with their new look and want plastic surgery to look their very, best. Whether plastic surgery is desirable depends on how old you are (skin is less elastic with age) how much weight you lose (the more
weight loss, the more loose skin) and individual differences in elasticity. Loose skin bothers some more than others, but there is nothing shameful about wanting to look your best. We work with some of the finest plastic surgeons in the world to help our patients get the finest results.
Q:
What causes some people to regain their weight?
A: Most often it is forgetting that weight
control is a lifelong project. But obviously the
genetic pressure to gain is greater in some than
others and although we cannot currently
recognize it the surgery may be better for
certain types of obesity than it is for others.
The long-term success rate is better than 90%.
Q: Is this experimental surgery?
A: Not at all. This is the "Gold Standard" of weight loss surgery. It is recognized and accepted by the American College of Surgeons, American
Academy of Family Practice and virtually every organization, worldwide, concerned with health or obesity issues.
Q: How many of these procedures has your group done?
A: Our group includes the originator of the Laparoscopic Roux-En-Y. Our surgeons have done thousands of these procedures.
Q: What are the routine tests before weight loss
surgery?
A: Certain basic tests are done prior to surgery:
A full blood count, urine analysis, and a
biochemistry analysis, which gives a readout of
about 20 blood chemistry values. Often a Glucose
Tolerance Test is done to evaluate for diabetes,
which is very common in overweight persons.
Patients may require an X-ray and
electrocardiogram. Many surgeons ask for a
gall bladder ultrasound to look for gall stones.
Other tests, such as pulmonary function testing,
echocardiogram, sleep studies, gastrointestinal
evaluation, cardiology evaluation, or
psychiatric evaluation, 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 surgery
increases 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.
Q: Why do I have to have a Gastrointestinal
Evaluation?
A: 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.
Q: Why do I have to have a Sleep Study?
A: You may or may not need a sleep study. 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.
Q: What impact do my medical problems have on
the decision for obesity surgery, and how do the
medical problems affect risk?
A: 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 obesity surgery if it is
otherwise appropriate, but those conditions will
make a patient's risk higher than average.
Q: What can I do before the appointment to speed
up the process of getting ready for obesity
surgery?
A: Select a general practitioner if you don't
already have one, and establish a relationship
with him or her. Work with your doctor to ensure
that your routine health maintenance testing is
current. Foaa prostate spe
Bring any pertinent medical data to your appointment with the
bariatric 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.
Q: Does Laparoscopic Surgery decrease the risk?
A: We believe that laparoscopic surgery is now safer than open
surgery. The infection rate is near zero, as is the
rate of abdominal wall hernia. Additional
benefits of laparoscopic surgery are; less
discomfort, shorter hospital stay, earlier
return to work and reduced scarring.
Q: Will I have a lot of pain?
A: 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, a Patient
Controlled Analgesia (PCA), which allows you to
give yourself a dose of pain medicine on demand,
may be used by your doctor. Various methods of
pain control, depending on your type of surgical
procedure, are available. Ask your surgeon about
other pain management options.
Q: How long do I have to stay in the hospital?
A: As long as it takes to be self-sufficient. Although it can vary, the
hospital stay (including the day of surgery) is
usually between 1- 4 days depending on the
procedure.
Q: Will the doctor
leave a drain in after laparoscopic surgery?
A: Depending on the
procedure, patients may have a small tube to
allow drainage of any accumulated fluids from
the abdomen. This is a safety measure, and it is
usually removed a few days after the obesity
surgery. Generally, it produces no more than
minor discomfort.
Q: If I have laparoscopic bariatric surgery, what can I
expect when I wake up in the recovery room?
A: Some doctors will provide a Patient Controlled Analgesia (PCA) or
a self-administered pain management system, to
help control pain. Others prefer to use an
infusion pump that provides a local anesthetic
in the surgical site to control pain without the
side effects of narcotics.
Q: How soon will I be able to walk?
A: Almost immediately after surgery doctors will require you to get up
and move about. Patients are asked to walk or
stand at the bedside on the night of surgery,
take several walks the next day and thereafter.
On leaving the hospital, you may be able to care
for all your personal needs, but will need help
with shopping, lifting and with transportation.
Q: How soon can I drive?
A: For your own safety,
you should not drive until you have stopped
taking narcotic medications and can move quickly
and alertly to stop your car, especially in an
emergency. Usually this takes 7-14 days after
surgery.
Q: What is done to
minimize the risk of deep vein thrombosis (DVT)/pulmonary
embolism (PE)?
A: Because a Deep Vein
Thrombosis originates on the operating table,
therapy begins before a patient goes to the
operating room. Generally, patients are treated
with sequential leg compression stockings and
given a blood thinner prior to surgery. Both of
these therapies continue throughout your
hospitalization. The third major preventive
measure involves getting the patient moving and
out of bed as soon as possible after the
operation to restore normal blood flow in the
legs.
Q: What should I
bring with me to the hospital?
A: Basic toiletries (comb,
toothbrush, etc.) and clothing may be provided
by the hospital, but most people prefer to bring
their own. Choose clothes for your stay that are
easy to put on and take off. Because of your
incision, your clothes may become stained by
blood or other body fluids. Other ideas:
Reading and writing materials
Personal toiletries
Bathrobe
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