Why should I consider “Single Incision” approach for the Lap Band?
- Single Incision approach is cosmetically superior to the traditional 5 incision approach. The single incision used is truly a single incision for many patients and typically the incision is less than 1 inch length and well hidden in the belly button. So after the incision heals it is well hidden with no visible scars!
- The surgical technique of how the band is placed isn’t any different from the traditional approach and therefore the Single incision approach theoretically is a safe procedure as is the traditional technique.
- With one incision instead of five incisions the potential for post operative pain is less in the Single incision approach.
What are the routine tests before surgery?
Routine tests performed include a complete blood count, chemistry panel, lipid profile, thyroid function tests, iron, vitamin levels, liver function tests, clotting profile and urine analysis. A chest X-Ray and pulmonary function tests will be ordered to determine the health status of your lungs, as well as an electrocardiogram to determine if your heart is strong and prepared to handle the stresses associated with surgery. A psychological evaluation, nutritional consult and exercise evaluations are also performed. Ultrasound may be performed in some patients. Selective patients may require sleep study, specialist evaluations and endoscopy.
What is the purpose of all these tests?
An accurate assessment of your health is required before undertaking any surgery. The best way to avoid a complication during and after surgery is to know your state of health prior to having the surgery and optimizing your health to the best state possible prior to the surgery.
We will evaluate and determine if your thyroid function is adequate because untreated hypothyroidism can lead to sudden death following surgery. We also look for signs of diabetes, liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts and minerals in body fluids, and abnormal blood fat levels. Some of these laboratory and diagnostic tests will help validate co-morbidities and improve your chances to gain insurance approval.
Do I need endoscopy prior to surgery?
Not all patients will be required to have an endoscopy but when it is determined necessary it must be performed prior to having your surgery. Patients who have significant gastrointestinal (GI) symptoms such as upper abdominal pain, heartburn, belching sour fluid may have serious underlying problems, such as a hiatus hernia, gastro esophageal reflux, or a peptic ulcer. Patients having symptoms of gastric reflux may have early changes in the lining of the esophagus that could predispose them to cancer. It is important to identify these changes so that a suitable surveillance program can be planned for the future. If required your endoscopies will be scheduled with AIBL surgeon Dr. Ganta.
Why might I need a Sleep Study?
Some patients experience signs and symptoms of sleep disorders and are not aware that a problem may exist. The sleep study detects a tendency for abnormal cessation of breathing associated with airway obstruction when the muscles relax during sleep. This condition is referred to as Sleep Apnea. After surgery you will receive sedatives and medications that will help control your pain. Pain medication can depress your normal respiratory drive and protective reflexes, therefore increasing the possibility of an airway obstruction. Sleep Apnea can make this situation life threatening. Undiagnosed and untreated sleep apnea will increase the complication rate significantly. We need to have a clear picture of what to expect prior to your surgery in order to prevent, or better handle a complication if it should arise. Our office can assist you with arrangements to have the sleep study performed quickly.
Why do I need a Psychological Evaluation?
We do not believe that people with weight problems are crazy! The psychological evaluation helps determine your understanding and knowledge of the surgery, and ability to follow the basic post-operative weight loss plan. Many insurance companies require the evaluation prior to giving approval for surgery. Most importantly, you will find that the psychologist may be helpful in defining your personal goals and expectations.
How long does it take to schedule surgery?
Ordinarily, surgery is scheduled within about 2 weeks once insurance approval is received and financial arrangements are made. Insurance approval is a prerequisite for many people requesting weight loss surgery. You will receive a telephone call from our office informing you that insurance approval was received. They will provide you with available dates for surgery and you will be asked to select the surgery date that best meets your schedule (we recommend that you do not wait more than about 90 days to have your surgery following approval, or re-approval may be necessary). Once a surgery date is selected, you will be prepared for surgery with preoperative testing and preoperative education.
Why does it take so long to get insurance approval?
Ten to fourteen days following your initial surgical consultation, a letter will be sent to your insurance carrier initiating the approval process. The time it takes to get an answer can vary from about 4-6 weeks or as long as they can dawdle without being asked. Our pre-certification nurse will regularly follow-up on the approval requests. It is extremely helpful when you get behind the process and call your carrier frequently to inquire about the status of your request. Eventually, they get the picture that you are serious and eager to get a response.
How can insurance coverage be denied for a life threatening disease?
Coverage may be denied because there is a specific exclusion in your policy for obesity surgery, or the “Treatment of Obesity”. A policy exclusion means that you have no coverage for weight loss surgery. Insurance carriers may state that they do not cover treatment for obesity. It is important for them to understand that we are not treating “obesity”; we are treating an entirely different disease known as “morbid obesity”.
Coverage may also be denied for lack of “medical necessity” or not meeting the insurance company requirements for coverage. A therapy is deemed to be medically necessary when it is needed to treat a serious or life threatening condition. Morbid Obesity has alternative treatments such as dieting, exercise, behavior modification, and some medications that insurance carriers require candidates to have tried prior to seeking surgery as an option for treatment. Medical necessity denials frequently hinge on the insurance company’s demand for participation for 3-6 months in a physician directed supervised weight loss program. The best approach to these demands is to try to produce as much documentation as possible and submit along with the letter. Once you have successfully jumped over all obstacles, it is more difficult for you to be denied.
What can I do to help speed-up the approval process?
First, provide us with all the information (diet records, medical records, medical tests) necessary to prepare your request for coverage. Letters from your personal physician and consultants attesting to the “medical necessity” of surgical weight loss treatment is particularly valuable in persuading your insurance carrier to cover your surgery. Also obtain all medical records from your physician for the past five years. Insurance company needs your records documenting your height, weight as well as any physician supervised weight loss records. When one or several physicians corroborate the necessity of treatment it is more difficult for the carrier to contradict them. The best chance of approval is when we submit a complete package with all the information the insurance company is looking for. The sooner you provide us with all the necessary documents the sooner we can submit and get the approval.
Secondly, about two weeks after the letter of medical necessity is submitted to your carrier, call them regularly (once a week) to ask about your status.
Does Laparoscopic Surgery decrease the risk?
No. Laparoscopic surgery carries the same risks as the same procedure performed utilizing the open technique. The benefits of laparoscopy are less discomfort, shorter hospital stay, earlier return to work, and reduced post-operative scarring. The complications related to the incision such, as infections in wound and hernia in the incision are much less with the laparoscopy.
How long does the surgery last?
Typically, the gastric bypass requires a total time in the operating room of 2-2 1/2 hours. The operation itself takes about 2 hours. If your family will be waiting they should understand that the operation might not begin immediately, so they should not watch the clock. If the surgeon did not come out to speak to your family after 4 hours they may contact the person at the desk to get an update.
Will I have a lot of pain?
Every attempt is made to control pain after surgery and make it possible for you to move about quickly. This will help prevent post-operative problems and speed the recovery process. There are several post-operative pain management strategies you and your surgeon will discuss during your pre-operative consultation that will help manage your pain after surgery. Most of our patients are pleasantly surprised at how little discomfort they experience after surgery.
How long do I have to stay in the hospital?
Typically, the hospital stay (including the day of surgery) is 2-3 days for a Laparoscopic Gastric Bypass, Duodenal Switch and 5-6 days for Open procedures. Most Lap-bands and Stomaphyx are performed as an outpatient. Sleeve Gastrectomy requires an overnight stay.
Will I have a drain?
Most patients will have a small tube-like drain inserted into the abdominal cavity, which allows accumulated fluids from the abdomen to flow out into a small reservoir. It may produce minor discomfort that can be lessened by applying warm compresses to the drain site. The drain is usually removed 2-7 days following your surgery.
Rarely some patients may require the need for a gastrostomy tube. This is inserted during surgery into the detached stomach. The tube will help keep the detached stomach from expanding and stretching out the new staple lines following surgery. Patients who are having revision surgery may occasionally have this tube in place after surgery. This tube is usually removed the second post-operative week once the staple lines have had a chance to begin the healing process.
How soon will I be able to walk?
Patients are asked to walk or stand at the bedside on the night of surgery and take several walks the next day and thereafter. On discharge from the hospital you will be able to care for all your personal needs, but will need help with shopping and transportation.
How soon can I drive?
We recommend that you do not drive until you have stopped taking prescribed narcotic pain medications and can move quickly to stop your car in an emergency. This is for your own safety and the safety of others on the road. Expect not to drive for 7 to14 days after surgery.
Can I drink carbonated beverages after surgery?
Many patients find that when they drink carbonated beverages they are uncomfortable from the gas that the drink produces. Carbonated beverages may stretch your pouch. However if you are following the post-operative guidelines you will find that any flavored drinks between meals are to be avoided. This includes carbonated sodas. Drinking flavored sodas may activate your hunger mechanism and cause you to snack. They also hamper the water intake necessary to hydrate your body.
Why can’t I eat red meat after surgery?
We recommend that you avoid it for the first several months because red meats contain a high level of meat fibers or gristle that hold the piece of meat together, and prevents you from separating it into small parts when you chew. It can plug the outlet of your stomach pouch and prevent anything from passing through. This can be very uncomfortable and cause nausea and vomiting. We advise patients to avoid red meats until their stomach is functioning very well, usually after at least 3-6 months following surgery.
What is Dumping Syndrome?
Dumping occurs in about 10% of the Gastric Bypass patients. Dumping is not an issue with any other weight loss surgery option. Refined sugars and candy consist of many small molecules that tend to draw fluid into the intestine. After the gastric bypass a condition called “dumping syndrome” may occur. This happens when sugar is taken on an empty stomach, passes rapidly through the stomach into the intestine, and draws a large amount of fluid into the bowel. The physiology is complicated, but the result is a condition much like shock: one turns ghostly pale, breaks out into a profuse sweat, feels butterflies in the stomach, a rapid pulse, and a feeling of prostration. Nausea and vomiting, cramps and diarrhea may follow. Most people who have this reaction never try to sneak another candy bar. We believe that this occurrence may not be a bad effect when you’re trying to lose weight. Negative reinforcement can go a long way in teaching you to pay attention to what is best for your body and health. The problem of dumping is avoided by avoiding sweets, candies, and fruit juices on an empty stomach. Certain dressings, barbecue sauce, and mayonnaise may also cause problems and need to be avoided.
What is the problem with milk products?
To digest milk sugar (lactose) our bodies need an enzyme called lactase that may be in short supply in the lower small intestine. Milk and milk products are more difficult to fully digest after gastric bypass. As they move through the digestive tract and settle into the lower segments of the colon bacteria causes milk sugars to ferment. The fermentation process will cause a buildup of gas, cramping, and diarrhea that may be quite uncomfortable. Milk can be treated to make it more tolerable, however it’s best to try to avoid it all together. Many prepared foods such as those products found in boxes or frozen entrees contain milk sugar as an additive. It is important to learn to be a label reader so you can avoid foods that could potentially cause you discomfort.
What can I do to use the “tool” successfully?
The basic principles or the keys to success are quite simple and easy to follow. As long as you follow the guidelines you have done your best.
- Eat no more than 3 meals per day.
- Eat protein first, every meal.
- Drink water – 64-oz. /day minimum.
- Avoid all liquids with calories except recommended protein shakes.
- Do not drink 30 minutes before and 30 minutes after a meal
- Exercise regularly.
- Absolutely no snacking.
Why drink so much water?
When you are losing weight there is a heavy load of waste products to eliminate. These waste products are excreted mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently. In addition, water fills your stomach and helps prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it is because you did not drink enough water in the hours before.
Why must I exercise on a regular basis?
Following surgery, weight loss occurs because the amount of food energy (calories) that you are able to eat is much less than what is needed for your body to operate. Your body will make up the difference by burning your reserves or unused tissues. There are two sources of energy it will choose to take from. First, your body will seek unused muscle for its source of energy followed by your fat stores. Your body recognizes your fat store as a precious resource and will only take from those areas if faced with no other choice. If, you do not exercise daily your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for 30 minutes will communicate to your body that you want to keep your muscles and force it to burn the fat instead.
Will I have Nausea and Vomiting?
After gastric restriction, if one gets a full feeling and continues to eat, chances are that an episode of vomiting will result. Most patients have this happen several times and quickly learn to follow instructions to eat slowly, chew food well, and avoid that last bite when fullness occurs. Typically following the surgery, a profound feeling of satisfaction follows the fullness within a few minutes and further eating cause’s nausea and vomiting.
What can I expect with my bowel habit?
After restrictive surgery, the amount of food consumed is greatly reduced and the quantity of roughage consumed may be much smaller. Correspondingly, the amount of bowel movements will be diminished, causing less frequent bowel activity and constipation. Diarrhea, bloating, cramping, malodorous stool or flatus may occur following gastric bypass surgery or duodenal switch. Prescribed medications and dietary changes can be used to help alleviate discomfort. Make sure to drink plenty of water.
Will I lose hair?
During the phase of rapid weight loss, calorie intake is much less than the body needs and protein intake is marginal. The body is in a panic state similar to what would happen during a period of starvation. One of the side effects, in some persons, is inactivation of 30 – 40% (rather than the usual 10%) of hair follicles, causing noticeable amounts of hair to fall out. This is a transient effect and resolves when nutrition and weight stabilize. We advise patients to avoid hair treatments and permanent dyes and be sure of adequate protein intake. Sometimes a zinc supplement will help and Minoxidil (a drug to prevent and reverse hair loss) may be tried.
How can I prevent loss of my muscle mass?
When the body is in a panic state and trying to combat starvation, it hoards its precious fat until any other usable fuel has been burned. Practically, the body will prefer to bum muscle mass before consuming its precious fat If muscle is not regularly used for exercise, like every day, it will be consumed to meet energy needs. Loss of muscle mass is preventable. It is very important during active weight loss following surgery (or even when on a diet), to exercise vigorously every day. We recommend at least 30 minutes a day 7 days a week of aerobic activity. Devote particular attention to upper body strength. Many persons find that after a few weeks or months of regular daily exercise that they actually begin to enjoy it and start to work out even more. Fairly vigorous exercise, for more than 30 minutes a day, can greatly enhance fat-burning and hasten weight loss. It also builds a healthy and beautiful body.
How much weight will I lose?
The outcome of surgery depends largely upon the patient’s response in terms of healing and complications, motivation to follow instructions after surgery as well as your own body response to the whole process. Inevitably the body adjusts itself to the surgery and the weight loss slows down and reaches a plateau. In some patients this happens earlier than others. However, it is impossible to predict how much a patient will lose after any surgery and weight loss is not guaranteed.
What about pregnancy?
Pregnancy can happen following weight loss surgery, therefore, requiring special warning. Many severely overweight women are infertile because the fatty tissue soaks up the normal hormones and makes some of its own as well. This completely confuses the ovaries and uterus and causes a lack of ovulation. As weight loss occurs, this situation may change quickly. It is important to avoid conception during the phase of weight loss – about 18 months after surgery.
You will not be able to provide adequate nutrition to both yourself and a fetus during pregnancy. This requires special attention to contraception, even by those who think that it can’t happen. “Natural” infertility may not last – in fact; it can go away in one night! Birth control pills may not be absorbed well and so even when you are taking them there is a risk of contraception failure. Talk to your physician about other options such as Nuvaring or a patch.