Bariatric Surgery Questions and Answers

You are required to attend a seminar no matter how educated you are about surgery. Seminars are a starting point for a programmatic approach to your care. General insurance questions may also be covered. Seminars give the audience an opportunity to ask questions and hear from patients who have undergone weight loss surgery. Of course, questions from other individuals may help make you more informed. We want our potential patients to be as educated as possible so they can be certain weight loss surgery is right for them.

An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place.

The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists/psychologists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

We take many insurance plans and have years of experience working with all types. Please call your insurance company and verify with them whether or not they cover the bariatric procedure. You may call our office with questions following your inquiry to your insurance company and before you begin your paperwork.

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” Appeals are often possible when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments – such as dieting, exercise, behavior modification, and some medications – are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.

There are multiple reasons to stop smoking. Patients overall will have fewer complications if they no longer smoke. Smoking damages the lungs and this can lead to higher anesthetic risks and pneumonias following surgery. It takes about a month for the lungs to recover – so stop now! Moreover, smoking reduces the rate of healing, increases the rates of infection, and interferes with blood supply to healing tissues which increases your risk of forming ulcers. In addition, weight loss surgery is about improving your health. Smoking directly contradicts this goal.

The typical stay in the hospital is 1-2 nights after the gastric bypass and sleeve gastrectomy. Most LAP-BAND procedures do not require an overnight stay and can be done on an outpatient basis. These stays may need to be extended depending on each individual’s medical situation. The bottom line is that each patient stays until the surgeon feels that it is safe for the patient to go home.

Usually gastric bypass and sleeve gastrectomy patients return to work after two weeks. This should be discussed with your surgeon though. In addition, there is a lifting restriction of 15 lbs. or more for 4 to 6 weeks. Most LAP-BAND patients are back to work in 1 to 2 weeks.

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.

We strongly advise against becoming pregnant during the first 1-2 years following surgery. The reason is there is real potential for the fetus to suffer from the poor nutritional intake during the weight loss period. If a pregnancy was to occur during the initial weight loss period, the mother would have to take in high nutritional requirements to protect the baby. The mother will then typically not lose further weight during pregnancy and often will not lose any further weight after delivery. She will miss the benefits of weight loss surgery, so this waiting period is critical for gastric bypass and sleeve gastrectomy procedures. Patients undergoing the LapBand procedure can usually just have fluid removed from the band when you become pregnant, thereby allowing you to eat more normally. After the pregnancy is completed, the fluid can simply be placed back into the band. It is important to note that women can actually become more fertile as they experience weight loss. Fat produces estrogen which can cause hormonal imbalances and even infertility. As you lose weight, your hormone levels can become more regular and leave you with an increased chance of becoming pregnant! Please take precautions and talk with your gynecologist about contraception techniques to avoid pregnancy. After your weight loss is over (usually 1 year after surgery), pregnancy is safe following bariatric surgery. Many of our patients have gone on to have routine pregnancies, deliveries and very healthy babies.

As one of the more common gastric bypass side effects, about 80 percent of our patients will experience temporary hair loss. The trauma and anesthesia from any surgery, a lack of protein, chemicals in the body from the rapid weight loss, and stress are all contributing factors in causing temporary hair loss. Coloring or perming the hair in addition can cause more damage to your already fragile hair condition. The temporary hair loss usually starts about 3 to 4 months after surgery and continues on for 3 to 6 months. To help keep hair loss at a minimum, there are several things you can do. For this and some other gastric bypass side effects, double up on your multivitamin (one in the morning and one at night), make sure you are getting enough protein, and drink lots of water. Water helps dilute the toxins from the rapid weight loss. The hair follicles return to normal after the weight loss subsides and virtually everyone has re-grown their hair once their weight stabilizes.

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.

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can “snap back.” Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen (Advil, Motrin), Naproxen, Aleve, indomethacin, Celebrex or other similar medications should not be taken after surgery. It is okay to take Tylenol.

After gastric bypass and sleeve gastrectomy: These surgeries alter the way your body absorbs many vitamins and nutrients. It is important to take supplements the rest of your life to avoid the deficiency problems that can develop without supplementation. Most vitamins and minerals can be replaced with a good adult multivitamin. This will have the full complement of water-soluble and fat-soluble vitamins, iron, zinc, and other minerals needed. The vitamin supplement should be chewable during the first three weeks, but afterwards can be in pill form. The second supplement needed is calcium. Calcium is absorbed in a part of the intestine that is bypassed, so it takes additional supplementation to avoid the thinning of bones and potential fractures that can occur. The preferred calcium supplement is Calcium Citrate with Vitamin D-3 and the recommended intake is 1500mg daily. The third supplement is Vitamin B-12. This vitamin is normally absorbed from the diet after it combines with a protein called intrinsic factor. This complex is then absorbed in your lower intestine. Intrinsic factor is made in the bypassed stomach and therefore Vitamin B-12 can no longer be absorbed in the diet or in pill form. Vitamin B-12 is important to help prevent anemia and also functions in spinal cord nerve function. To prevent deficiency, supplementation must occur a different way than pill form to be absorbed. Options include daily sublingual tablets (under the tongue), nasal spray, or monthly injections. After Lap-Band: Gastric banding does not alter the absorption of the foods you eat. However, you will be eating less. We recommend a simple multivitamin once daily and 1500 mg of calcium citrate with Vitamin D-3 for our patients who have the Lap-Band procedure.

We offer several support group meeting options every month. We encourage you to attend the meetings both before and after surgery. The meetings allow the opportunity to discuss various health topics, get information from guest speakers, and talk with individuals going through the same experience.

After we have verified you have bariatric surgery coverage, an appointment with the doctor is scheduled. The first visit is mostly informational, where we learn about you and you learn more about us. You then have a complete physical examination with us and are scheduled for appropriate pre-operative testing. As you go through this process, our office assists you in obtaining insurance approval for surgery. When this is accomplished, your final visit is made to go over all your remaining questions, review all your pre-operative test results, and again go over the goals, risks, options, and benefits of surgery in detail prior to surgery. The length of the entire process can varies somewhat depending on your insurance carrier’s requirements and speed of approval. In general it takes two to three months.