Bariatric surgery

What kind of medical problems are considered to be indications for gastric bypass surgery?

Problems commonly seen with morbid obesity which are expected to improve significantly with weight loss include sleep apnea, diabetes, high blood pressure, and high cholesterol. Other problems associated with obesity which may improve after operation are depression, arthritis or other musculo-skeletal disorders, and psychosocial functioning.

What is a medically supervised diet?

A medically supervised diet includes management of weight loss attempts by a physician directed diet and exercise program, participation in a dietitian supervised group or individual program or treatment with medication prescribed by a physician in conjunction with a diet and exercise program.

What will happen if I am eligible and wish to proceed with surgery?

Once you have been determined to be eligible for surgery, and your surgery has been authorized by your insurance agency, you will be given a date for a preoperative history and physical exam. Studies to assess the status of your heart, liver, kidney and respiratory function will be ordered and the date of your operation will be set. You will be given instructions for a clear liquid diet and bowel preparation for the day before surgery and instructions regarding your current medications.

How long does the surgery take?

Both the laparoscopic and open methods of surgery take about four hours, though it may take longer in either case if you have had previous abdominal surgery or if your anatomy makes the surgery difficult.

How long will it take for me to recover?

If you have the laparoscopic method, you can expect to be in the hospital for two to three days after the surgery and may be able to return to most of your usual activities as soon as seven to ten days later. Patients undergoing the open method may be in the hospital for five to ten days after surgery and return to most activities four to six weeks later. You will be advised to avoid strenuous activity for six to eight weeks following surgery by either method. These estimates are for patients who have not sustained any operative or post-operative complications.

Most patients will feel tired, less energetic and sore for several weeks following either operative method as these are major operative procedures and you will be losing weight as well as healing wounds.

What foods will I be able to eat?

You will be given full instruction in your post-operative diet and a booklet with the diet recommendations before your operation. The diet consists of clear liquids for several days after operation and then a "full" liquid diet consisting of low-fat, low-sugar milk product containing drinks and soups for several weeks after operation. Your diet will be advanced to puree foods, high in protein and fiber, about one month after surgery; and then to soft meats, fruits, vegetables and grains.

You will be advised to take approximately two tablespoons of food or fluid every 15 minutes in the immediate post operative period, advancing to approximately 1/2 cup of puree food over every hour at least six to eight times a day as you recover. You should chew all solid food well when advanced to this stage at about eight weeks post-operatively. Drinking liquids immediately after eating should be avoided to prevent pain or vomiting. Sweet foods are to be avoided in order to prevent "dumping syndrome" which includes nausea, flushing, diarrhea and dizziness.

Vitamin supplements are a lifelong requirement and are begun after discharge from the hospital.

What can I expect in terms of weight loss?

Most patients experience fairly rapid weight loss in the first three to six months following surgery. Weight loss slows, but generally continues up to 12 to 18 months after surgery, averaging 66% to 80% of excess body weight by some reports. At that time, the stomach pouch has stretched to hold more food and it is critical to adhere to the low fat, low sugar diet and exercise recommendations you will receive in order to maintain your weight loss.