What are the routine tests before weight loss surgery?
Certain basic tests, such as a full blood examination (FBE) are performed as part of your initial assessment. In addition, many patients suffer from gastric symptoms so may require barium swallow prior to surgery and often a glucose test is done to evaluate blood sugar levels. Other tests, such as pulmonary function testing, chest x-ray, echocardiogram, sleep studies, gastrointestinal evaluation, cardiology evaluation, or assessment by a psychologist may be requested when indicated.
What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery to minimise the chance of complications and this will be determined by your surgeon.
Why do I have to have a Gastrointestinal Evaluation?
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.
What can I do before the appointment to speed up the process?
- 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. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA)
- Make a list of all the diets you have tried (a diet history) and bring it to your doctor
- Bring any pertinent medical data to your appointment with the bariatric (weight loss) surgeon – this would include reports of special tests or hospital discharge summary if you have been in the hospital
- Bring a list of your medications with dose and schedule
Laparoscopic Bariatric Surgery
Does Laparoscopic Surgery decrease the risk?
No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopic surgeries are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring.
Will I have a lot of pain?
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.
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 between 1- 8 days depending on the procedure. This will be determined by your surgeon/doctor.
Will the doctor leave a drain in after laparoscopic surgery?
Patients may have a small tube to allow drainage of any accumulated fluids from the abdomen post-operatively. This is a safety measure, and it is usually removed a few days after the surgery. Generally, it produces more than minor discomfort.
What can I expect when I wake up in the recovery room?
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.
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.
How soon can I drive?
For your own safety, you should not drive until you have stopped taking narcotic medications. Consult your doctor as to when you are able to drive.
How to minimize risk of deep vein thrombosis (DVT)/pulmonary embolism (PE)?
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.
What should I bring with me to the hospital?
Personal toiletries and clothing for your stay that are easy to put on and take off.
How much does the gastric band procedure cost?
We recommend that you contact a Bariatric (weight loss) surgeon. There are surgeons listed under the “find a doctor” locator on the home page of this website. They will be able to discuss the costs of gastric band surgery.
Do I qualify for weight loss surgery?
The fact that you are perusing this website implies that you are concerned about your weight. If your BMI is >30 you would be suitable for weight loss surgery particularly if you have signs of obesity related disease such as high blood pressure, diabetes, joint trouble or sleep apnoea (see section on Obesity and Health).
How do I know which procedure is right for me?
In each individual’s case, your surgeon will inform you of the available options, but it is important to know that you are alone in making this decision. There are many facets of the treatment program that would need to be taken into account such as you current BMI, the safety profile of a particular procedure, the ability to comply with the lifestyle modification required, etc. Your surgeon and others in the DWLS team will discuss these issues with you.
Is the procedure dangerous?
In general, the procedures are extremely safe; however as in any operation, there is a very small risk of complication that varies with the procedure concerned (see section on types of surgery for further detail).
Are there any special rules about eating after having a 'lap band'?
Yes, you will need to follow a liquid and puree diet in the first few weeks after your surgery. After this time, your lifelong eating habits will need to change to include chewing well, eating slowly, not drinking and eating at the same time and most importantly learning to eat mindfully. AT DWLS, our dietitians will guide through all of these stages and offer you advice as needed.
Do I have to see everyone in the team?
At DWLS, we utilize a holistic multidisciplinary approach in order to achieve the best results for our patients. The benefits of this approach have been widely accepted and it would be in the patient’s best interest to be assessed appropriately and thoroughly.
Do I need to have Optifast/meal replacement therapy?
In most instances, patients will be advised to undertake Optifast meal replacement therapy during the pre-operative period. This is usually only for 2 weeks prior to surgery and significantly helps in reducing the amount of fat deposited within the abdomen and liver, making tissues less fragile/prone to injury and decreasing technical difficulty with the surgery.
How much does the procedure cost?
If your level of cover allows for bariatric surgery, you will only be required to pay a gap / program fee. Your insurance company will cover most of the medical and hospital fees. For details regarding the fee structure and costs for uninsured patients please contact us. We strongly recommend private health insurance coverage for weight loss surgery and ongoing care.
Can I claim through my private health insurance?
All fees excepting any gap payments should be covered by your insurer if your level of cover is adequate.
What if I don't have private health cover?
see question 7 above.
What are the routine tests before weight loss surgery?
These include assessment of nutritional parameters such as physical characteristics e.g. height, weight, BMI (body mass index), hip and waist circumference, blood tests including the assessment of essential nutrients such as Vit D/B12/Folate, etc. In some instances there may be a need for an electrocardiogram or ECG (electrical trace of the heart), chest x-ray, sleep studies or an echocardiogram (ultrasound of the heart). These will be discussed in further detail during your assessment.
What is the purpose of all these tests?
These tests are performed to ascertain any pre-existing disease that would need to be corrected or addressed prior to surgery. They also allow the definition of a baseline value against which a patient’s progress can be monitored.
What should I bring with me to the hospital?
An overnight bag containing a change of clothes, toiletries, sleepwear as well as all your regular medications if you are taking any, are all that is required.
How much weight will I lose and how long will it take?
In the initial stages weight loss should occur at 0.5-1 kg per week which would then taper to a more gradual rate reaching a level close to or at your target weight at approximately 2 years. This however can be variable with some patients reaching their target weights earlier and vice versa. It is important to appreciate also, that in order to maintain good health weight should be gradual and too rapid a rate of loss may indicate a problem. Overall, the amount of weight you may lose or the % excess weight loss is expected to be different depending on the procedure you have performed, particularly in the early years.
What is done to minimize the risk of DVT/PE?
Obesity predisposes to DVT or deep vein thrombosis. This can occur following prolonged periods of inactivity seen in conditions such as certain hereditary disorders, a sedentary lifestyle, air travel or following surgery including weight loss surgery. It is reported to occur in about 1% of procedures. This involves clot formation in the deep veins of the legs/thighs that can impair circulation. Fragments of clot may then dislodge and travel to the heart or lungs in the bloodstream leading to PE or pulmonary embolism. This is significant as it can impair circulation and oxygen exchange and is reported to occur in about 0.5% of cases. In order to minimize the risk of this occurring; all patients wear a sequential calf compression device that intermittently compresses the calf/thigh muscles within which the deep veins travel. In addition, patients will receive a daily injection of a blood thinning agent under the skin (like an insulin injection). Hence, using a combination of sequential compression, daily injections and early mobilization, the chance of thromboembolic complications developing is substantially reduced.
Does laparoscopic surgery decrease the risk?
Studies have shown laparoscopic surgery to have shown a lower risk of DVT/PE, in that the procedure affords early mobilization as there is less pain from abdominal incisions.
Will I have a lot of pain?
In general, most patients will have a degree of discomfort following an operation at the very least. Pain relief is provided for by drugs administered intravenously or by mouth once oral intake is commenced. In addition, the use of local anaesthetic within skin incisions helps reduce pain (generally these are only used for laparoscopic procedures) in the first few hours following surgery. Specifically, in relation to the gastric band a small proportion of patients notice some discomfort in relation to the port site (where the port is attached to the underlying muscle).
How long will it take to recover from the surgery?
Following laparoscopic surgery, it is anticipated that all patients will be able to walk within a 24 hour period. With open surgery however, this is likely to be later but is encouraged to occur as soon as possible. The degree of complexity with a particular procedure would dictate the overall length of stay in hospital, hence an overnight stay with the gastric band and 3-5 nights with a sleeve or bypass. Similarly, open surgery would dictate at least a week in hospital.
How much time off work am I going to need?
In general, laparoscopic surgery would allow patients to return to work within 10-14 days and open surgery necessitate a longer period off work (up to 1-2 months). The exact details would need to be discussed with your Surgeon/team based on the previous level of activity, nature of employment and of course assumes an uneventful post-operative course.
How soon am I going to able to drive?
Following laparoscopic surgery, most patients should be able to drive within a week following discharge from hospital. However, with open surgery it is recommended to, not do so until a month following surgery as a major abdominal incision may inhibit sudden corrections to be made whilst driving.
Are there any foods I will not be able to eat after surgery?
It is very important to maintain good nutrition after your surgery and this includes eating foods from all the food groups. Our experience tells us that every patient is different and we encourage our patients not to exclude any foods and to try all foods. Some people may experience some difficulty with some foods. Individual food intolerances are discussed with your dietitian.
Is it normal to vomit or regurgitate after a meal?
NO! Regurgitation may occur as a result of eating too quickly, not chewing well enough or from not being ‘mindful’ when you eat. It may also be a sign of the band being too tight or of a mechanical obstruction. At DWLS, during review appointments, the team works to identify the triggers for regurgitation and ensure that these do not continue.
Will I be able to get enough nutrients from the small amount of food eaten?
Current research indicates that there are certain nutrients which are very difficult to get in sufficient quantities , which results in nutritional deficiencies. As such, standard practice for all DWLS patients is to commence on a daily multivitamin supplement from the time of surgery. At DWLS we monitor the levels of all nutrients using routine blood tests and your dietititan will tailor your vitamin and mineral supplementation according to your needs.
Does the band or other procedure limit physical activity?
No, the band or other procedure does not limit physical activity, which is generally encouraged. If the procedure is performed by open surgery, then recovery following this will of course be more gradual.
Will I have enough energy to exercise if I only eat a small amount of food?
Yes! If you follow our dietary advice and recommended plans you should receive all the nutrition you need to conduct daily activities and exercise. Indeed with ongoing weight loss you will actually have more energy to exercise as you will be carrying less weight.
Is the gastric band port visible?
No, the gastric band port is not visible. However, there may be a subtle prominence to the left side of the abdomen where the port is situated, in the skin contour (as a lump) which will be more noticeable (by the patient alone) as weight loss is achieved.
What about all that excess skin when I lose weight?
If the degree of weight loss required to achieve good health is significant to produce excess skin folds, consideration may then be given towards cosmetic surgery (‘body lift’) procedures. This is only usually apparent a few years following sustained weight loss and can be discussed with the team following which we can refer you to a suitably qualified Plastic Surgeon.
Can I still become pregnant?
Weight loss surgery will not interfere with your ability to become pregnant. In many instances, the improvement in lifestyle, health, appearance and self confidence encourages relationships.
Can I drink alcohol after the procedure?
At DWLS we encourage adherence to the Australian Dietary Guidelines and limitation of alcohol. Alcohol is a source of calories and in addition to it’s other health effects, it contributes many calories which is not beneficial when trying to lose weight.
Will the surgery interfere with my medications?
The surgery will not interfere with your ability to take your regular medications. Depending on the indications, in many cases e.g. diabetes, high blood pressure, etc, you may not the need to continue these or may need to reduce the dosage.
How much restriction will I have after surgery?
In the immediate period following surgery, it is recommended to remain on a diet of fluids for 14 days following which various solid foods can slowly be introduced on a trial basis. Once the swelling around the operation site inside the abdomen has subsided, it is anticipated that the ideal portion size tolerated would be around ¾ – 1 cup per meal.