What is the oldest patient for whom weight loss surgery is recommended?
Patients over 65 require very strong indications for surgery and must also meet stringent Medicare criteria. The risk of surgery in this age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced.
Surgery has been performed on patients 16 and younger. There is a real concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success.
What is the youngest age for which weight loss surgery is recommended?
Generally accepted guidelines from the American Society for Bariatric Surgery and the National Institutes of Health recommend surgery only for those 18 years of age and older.
Bon Secours Surgical Weight Loss directors recommend surgery for patients 21 years of age or older. This change in age requirement was announced in Summer 2009. Why? Reviewing their patient outcomes, they found that patients 21+ were much more successful than patients 18-20.
How can I know that I won’t just keep losing weight until I waste away to nothing?
Patients may begin to wonder about this early after the surgery when they are losing 20-40 pounds per month, or maybe when they’ve lost more than 100 pounds and they’re still losing weight. Two things happen to allow weight to stabilize. First, a patient’s ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.
Does Bon Secours Surgical Weight Loss charge a program fee?
No, Bon Secours Surgical Weight Loss programs at Health Center at Harbour View, DePaul Medical Center, and Mary Immaculate Hospital do not charge a program fee.
Some bariatrics programs charge a fee of several hundred dollars. There is no such fee charged by Bon Secours Surgical Weight Loss Center.
What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.
How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces.
What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food – it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.
What if I have had a previous weight loss surgical procedure and I’m now having problems?
Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait at least 18-months after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon if you plan for pregnancy.
How soon can I drive?
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.
How soon will I be able to walk?
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.
If I have surgery, what can I expect when I wake up in the recovery room?
As with any patient undergoing a major surgery, you will be closely monitored for post-surgical side effects. Statistics show that the most serious complications, gastrointestinal leakage and deep venous thrombosis (blood clots), occur in less than one percent of all bariatric surgeries. The complication risks are greater in morbibly obese patients.
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. These risks are greater in morbidly obese patients.
Will the doctor leave a drain in after surgery?
Not typically. Because of the high level of skill of our surgeons, a drain isn’t typically needed. Sometimes patients will 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 surgery. Generally, it produces no more than minor discomfort.
How long do I have to stay in the hospital?
As long as it takes to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be 1-2 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass.
Will I have a lot of pain?
Every attempt is made to control pain after surgery so that you may begin to move about and become active as soon as possible. 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, your physician may prescribe a Patient Controlled Analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about your pain management options.
Does Laparoscopic Surgery decrease the risk?
Yes! Laparoscopic operations carry the some of the same risks as a surgical weight loss procedure performed as an open operation. But the post-surgical benefits and reduced complications are noteworthy. The typically include: less discomfort, shorter hospital stay, earlier return to work, decreased scarring, reduced occurrence of wound infections, hernias, and pneumonia, and less scarring.
Because of these benefits and the skill of our surgeons, they perform most of their procedures using laparoscopic methods.