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Preparing for Weight Loss Surgery

Posted Aug 24 2008 1:49pm
ANNOUNCER: Choosing to have weight loss surgery is a big decision. And the first step in this process is finding the right surgeon. Many patients first turn to their primary care physician for a referral. But some patients find a surgeon through their social network and people who have had surgery are often willing to share their experience.

EMMA PATTERSON, MD: They'll tell their friends and family where they had the surgery. They'll usually highly recommend that person, and so often patients will find a surgeon through another patient.

ANNOUNCER: Another resource is the American Society for Bariatric Surgery (ASBS), a professional organization that provides education and support programs to patients and health care professionals. The society's website lists surgeons all across the country. Once patients find a weight-loss surgeon, it's important to ask about education and surgical experience.

EMMA PATTERSON, MD: Nobody wants to be the surgeon's first procedure of anything. I think any bariatric surgeon should be a member of the ASBS. I think, at the extreme, a full one- or even two-year fellowship, so extra training after their surgery training in doing this kind of surgery.

ANNOUNCER: Patients should also confirm that the surgeon is affiliated with a hospital where plenty of weight loss surgeries are performed. The doctor's individual record is important too.

EMMA PATTERSON, MD: The patient certainly should ask the surgeon how many they've done, what their results have been in terms of deaths, major complications. You want the rate to be low or similar to the national standards, or the lower the better

ANNOUNCER: A surgeon's support team is also important.

MARC BESSLER, MD: Does he have a team around him of nutritionists, nurses to help out, appropriate support staff, and then the hospital that he's working at, so that you can get not only good surgical care, but good anesthesia care, good heart and lung doctors, good medical doctors of other types, should you need them.

ANNOUNCER: Additionally, patients must consider the financial costs of weight loss surgery.

DANIEL G. DAVIS, DO: The cost of weight-loss surgery depends on the patients' insurance companies. Each state has different providers and each provider has their different criteria.

MARC BESSLER, MD: Fortunately, more and more insurance companies are covering weight loss surgery. The costs associated with this would be prohibitive for many patients. For banding, the cost can range from $15,000 to $25,000. For gastric bypass, that's $25,000 to $35,000.

ANNOUNCER: In addition to the healthcare provider, weight loss surgeons and their office staff can assist patients explore their insurance and financing options.

DANIEL G. DAVIS, DO: Patients who do not have weight loss surgery as one of their benefits in their insurance plan, can opt to self-pay, and usually the surgeon, as well as the hospital, will work with that patient to bring down the cost of the procedure itself.

EMMA PATTERSON, MD: So for patients who don't have health insurance to cover the surgery, there's often financing available.

ANNOUNCER: During the week before surgery, patients may meet with the surgeon, nurse and dietitian for a pre-op review. At home, patients should make preparations for their recovery, like stocking their refrigerators with liquids and pureed foods.

ANNOUNCER: On the night before surgery patients should try to relax.

EMMA PATTERSON, MD: They're going to be feeling a variety of emotions that night before, and even the morning of surgery. They're going to be excited, yet anxious, perhaps scared, perhaps really scared. And so it's best if they can get a good night's sleep.

ANNOUNCER: The symptoms patients will experience after surgery depend on the type of weight loss surgery they've had.

MARC BESSLER, MD: A patient, after a gastric banding, can really expect to come to the recovery room having some discomfort and requiring medication for treatment of that discomfort. They can expect to be getting out of bed shortly after surgery, to sit in a chair, to start drinking liquids, and to generally start feeling better and better over the course of a couple of hours. While it is major surgery, patients tend to recover pretty quickly with the laparoscopic approach and can often go home the same day.

ANNOUNCER: Gastric bypass patients will also require pain medication for any discomfort they experience after surgery. It is common for gastric bypass patients to be admitted to the hospital for two or three days after bypass surgery. Hospitalization for adjustable gastric band patients is usually less than 24 hours.

MARC BESSLER, MD: What you can expect is in the hospital is, for the first day, to be on intravenous fluids without having anything to eat or drink. We actually order that our patients be out of bed within six hours after surgery. It helps your lungs expand better; it helps reduce the risk of getting blood clots in the legs, which is one of the complications after gastric bypass.

ANNOUNCER: On the day after gastric bypass or adjustable gastric band surgery, patients will likely have an X-ray to determine that there are no complications.

MARC BESSLER, MD: After surgery in some centers, you'll be getting an X-ray study to make sure things are healing well, or your doctor may have enough experience and enough comfort that he doesn't feel the need to get a routine X-ray, and you'll only get one if there is a sign of a problem.

ANNOUNCER: Regardless of which type of surgery is performed, for several weeks the patient will be on a modified diet of liquids, pureed foods and then eventually soft foods.

Day by day, patients' discomfort should lessen. But if a patient starts experiencing pain he or she should contact the surgeon as this could a sign of complications. Patients should plan on making a series of post surgery visits to their doctor's office.

EMMA PATTERSON, MD: They should expect a visit within the first month. Probably anywhere from one week to a month after surgery, they'll expect to be seen to see how that they're doing with their diet, with mobility, with the healing of the incisions and just general recovery from surgery.

ANNOUNCER: Approximately four to six weeks after surgery, patients who had adjustable gastric band surgery will likely receive their first adjustment, although the exact time will vary from patient to patient.

In the weeks following surgery, patients will experience improvement in their comorbities, the conditions triggered or directly caused by their obesity.

EMMA PATTERSON, MD: Most of the medical problems significantly improve, and generally they're improved or resolved in about 80 percent of patients. And that includes diabetes, high blood pressure, sleep apnea, high cholesterol, the pains from degenerative joint disease and many other medical problems.

ANNOUNCER: With these conditions resolving and their weight loss continuing, patients should begin to experience significant improvement in their quality of life.

EMMA PATTERSON, MD: As they lose weight after surgery and get more energy and physical ability to do things, their life is expanding again, they're able to actually go and do those things again, and just enjoying life.

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