Your Consultation

1. Bring to the appointment a list of prescription pharmaceuticals, over-the-counter drugs and herbal or vitamin supplements you are taking.
2. Prepare to review your medical history, providing the names and phone numbers of physicians you are seeing or have seen recently.
3. Tell your surgeon about any anesthesia complications that you or a family member has experienced. For example, some people may inhale food or liquids into their lungs as a result of the suppression of the normal throat reflexes that general anesthesia can cause. This is one of the reasons your surgeon will tell you to avoid eating and drinking within a certain period of time before surgery.
4. Obtain directions to the surgical facility.
5. Request a list of preoperative and postoperative instructions, which can include:

• Discontinuation of certain medications
• Showering recommendations
• A list of medications that must be taken before the procedure
• When to stop eating and drinking before the procedure
• A list of supplies that you will need after the procedure
• Which medications should be crushed after
• surgery and which can be taken whole

6. Find out what kind of support the surgeon's practice offers throughout recovery.
7. Request emergency contact phone number

Psychological evaluation

All our patients undergo a psychiatric evaluation to assess their psychological status prior to the Gastric Bypass. It is a requirement for a patient to see a psychologist in preparation for the surgery.

The psychiatric evaluation in preparation for surgery is recommended.

An evaluation by your usual medical doctor will not fulfill these criteria. The patient should have a routine psychiatric evaluation to rule out significant eating disorders or other major psychiatric illnesses that may affect the results of surgery.

Patients with inadequately treated depression need to be appropriately diagnosed and treated prior to surgery. Alcohol and drug abuse are also relative contraindications to surgery. The patient must not have unrealistic expectations of the outcome of surgery.

Nutritional evaluation

You’ve probably dieted for years, and you may even know so much about nutrition that you could write a book. Why do you need to see a dietitian?

Well, denial is a part of recovery. A dietitian identifies the type of eating behavior you have.

She can instruct you on the major changes you need to make after surgery. As you describe your eating pattern and verbalize your relationship with food, you help to identify potential danger zones after the surgery.

Most people turn to food for support, stress relief, comfort, and many other reasons. Right after the surgery, your emotional or situational triggers cannot be relieved with large quantities of food.

Your surgeon will refer you to a dietitian who is familiar with weight loss surgery patients. This person is a valuable source of information for what you can expect and the amount of food you can eat after surgery. She has a wealth of information on what other patients have experienced with their diets. So be sure to pay attention during this evaluation. The dietitian will give you helpful tips on what types of food to eat throughout the entire course of your recovery. She can also tell you how to eat after the surgery, how much to chew, and what to avoid.

With time, you may be able to eat more and turn to food for all the wrong reasons. A dietitian can help not with therapy but with good food choices and eating behavior tricks to prevent yourself from regaining weight after your surgery. The bottom line with weight loss surgery is that healthy choices keep your caloric intake to a minimum, and this is an important component of maintaining your weight loss.

When you reach a plateau in your weight loss, the dietitian may have tips on how to kick-start your weight loss again.

Keep a food log for several days and be perfectly honest. Include not only the foods you ate, but the quantity as well as the time you took to eat it. Go over this with your dietitian and identify areas that need work. Remember:
You’re a work in progress, and you should call in consultants when you need them.

Lab Studies

Preoperative laboratory evaluation should include a complete blood count (CBC), a complete chemistry panel, liver function tests, thyroid function tests, a lipid profile, coagulation tests, serum iron and total iron binding capacity (TIBC), vitamin B-12, folic acid, blood typing, and urinalysis.

Imaging Studies

• Chest radiography
• Ultrasonography of the gallbladder

Diagnostic Procedures

Upper endoscopy is performed to rule out intrinsic upper gastrointestinal disease, because, after gastric bypass surgery, the ability to nonsurgically visualize the distal stomach and the duodenum could be a challenge.

Medical therapy

A preoperative trial of weight loss is beneficial to ensure patient compliance with the postoperativediet protocol. Also, a preoperative liquid diet can shrink the liver, thus facilitating the surgical procedure.

Medications

Medications you are taking may interact with bariatric surgery or with medications that your surgeon will prescribe before and after your procedure. Be sure to tell your surgeon about any medications you are taking or plan to take throughout recovery. Vitamins, minerals and herbs can also interact with medications, so tell your surgeon about them as well.

Here are some examples of how surgery and surgery-related medications can interact with normal medications or food supplements:

• Aspirin, Coumadin, Plavix and vitamin E can increase the risk of bleeding at the time of surgery.
• Estrogen hormone medications such as birth control pills can increase the risk of blood clots.

After surgery, your stomach or the outlet of your new stomach will be smaller. Pills may irritate your new stomach pouch and cause nausea or pain, so you may be asked to crush your tablets for several weeks. You should check with your surgeon about which pills to crush and for how long. Some medications can't be crushed because they are "sustained release" and may need to be changed to a non-sustained release form.

In the Weeks and Days Before Your Procedure

• Purchase any supplies that you will need for recovery.
• Follow your surgeon's instructions regarding medications.
• Recruit an "escort" — a close friend or relative — who can drive you home after surgery and possibly stay with you for several days afterward. The after-effects of anesthesia will likely impair your ability to drive and perform normal functions such as meal preparation, personal hygiene and even walking. You may also need emotional support as your incisions heal and you become accustomed to your new body.
• Fill any postoperative prescriptions.
• Stop smoking for at least 30 days before bariatric surgery. Smoking can make the lungs more sensitive during surgery and may possibly lead to pneumonia. Smoking can also slow the healing process by narrowing the blood vessels and thus restricting the flow of blood to the healing sites. Many surgeons will not operate on patients if evidence exists that they are smokers and even go so far as to require blood or urine testing for nicotine levels before surgery.
• Inform your surgeon if you become sick the day before surgery.
• Refrain from alcohol use for at least 48 hours before bariatric surgery.
• Have a support group in place to help with your aftercare needs.

The Night Before Your Procedure

• Pack your bag with any personal items you might need.
• Remove credit cards and other valuable items from your wallet or purse.
• Leave all jewelry at home.
• Bring a container to hold your eyeglasses or contact lenses.
• Bring comfortable clothes to wear after the procedure.
• Bring all educational materials that your surgeon and nutritionist gave you. This often contains information and instructions about postoperative care.
• Follow your bariatric surgeon's instructions regarding avoidance of eating and drinking before surgery.

The Day of Your Procedure

• You will receive a list of discharge instructions, as well as medication instructions.
• You will receive emergency contact information.
• Be certain to have someone stay with you for the amount of time that your surgeon recommends.

What can you expect during the surgery?

Patients are placed under general anesthesia, which means they are not awake for the the procedure and feel no pain. A tube is inserted through the nose and into the upper stomach and connected to a suction machine, which will help in the healing process following surgery.

During the procedure, the stomach is made smaller by dividing it into a smaller upper section and a larger lower section. The surgeon uses surgical staples to seal off the upper part of the stomach from the remainder of the stomach. This creates a small pouch at the top of the stomach that is about the size of a walnut and is able to hold about 1 ounce (30 ml) of food.

The surgeon then cuts the small intestine and sews part of it onto the pouch. This arrangement allows food to bypass most of the stomach and the first section of the small intestine, known as the duodenum. Instead, the food travels from the surgically created pouch through the new connection (known as a Roux limb) and directly into the second segment of the small intestine, known as the jejunum. This limits the amount of calories absorbed into the body.

In rare cases, the gallbladder may also be removed (cholecystectomy) during a gastric bypass to prevent formation of gallstones that sometimes result from rapid weight loss. However, this is more often achieved through medications that dissolve these stones.

Gastric bypass surgery usually takes about four hours to complete. The incisions will be closed with stitches or surgical staples and then covered with a sterile bandage. The patient will have the stitches or staples removed at a later time during a follow up visit.

Lifelong commitment

As in all treatments for obesity, successful results will depend on your motivation and the actions you take. Our specialists will support you along the way and you will be required to attend regular follow-up appointments for the rest of your life to ensure that your weight loss is maintained and to monitor your general health and wellbeing, as well as to pick up any potential problems early.

Monitor your diet

All treatments for obesity require a lifestyle change. Our staff will provide you with after-surgery guidance to ensure you maintain your diet and nutrition plans, this will reduce the risk of any problems occurring after surgery and will maximise your weightloss. It is important that you follow our recommendations to manage your diet and stick to the recommended food portions, so that you do not experience any unpleasant side effects. Our dietitian will advise you on how to manage your eating habits.

Take regular supplements

If you have had obesity surgery, especially bypass surgery, you will be required to follow a wellbalanced diet and take nutritional supplements and medications for the rest of your life. Some bypass surgery patients develop nutritional deficiencies such as anaemia, osteoporosis and metabolic bone disease – although these can be avoided if a balanced diet and daily vitamin and mineral supplements are taken. Our specialists will closely monitor you to ensure that any potential problems are picked up early.

Our specialists will discuss with you the impacts of surgery with you before a decision about whether to operate is made. You will also have a contact point within the hospital to ensure that any problems you have are dealt with as quickly as possible.

You may experience one or more of the following changes as your body reacts to the rapid weight loss in the first three to six months:

• Nausea
• Body aches
• Feeling of tiredness similar to flu
• Feeling cold
• Dry skin
• Hair thinning or hair loss
• Mood changes
• Changes in bowel movements
• Constipation
• Loss of muscle mass

Patients should contact their physician if they experience any of the following:

• Fever
• Chills
• Redness or swelling at the incision site
• Bleeding or other drainage from the incision site
• Increased pain at the incision site

Physicians monitor gastric bypass patients closely for several years after surgery. Continued attention to weight loss and diet is essential for a successful outcome, and the patient is likely to consult with a registered dietitian or other dietary expert in planning appropriate meals. Patients may participate in support groups or use other methods to help adjust to their new lifestyle.

As people lose weight over the next one to two years they may develop excess skin. These patients may benefit from plastic surgery aimed at correcting the condition.

Lifestyle Changes