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Weight Reduction Surgery: FAQ
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Surgery

Weight Reduction Surgery: FAQ

Below you will find a list of frequently asked questions about our program and bariatric surgery.

General Bariatric Surgery Questions

What is bariatric surgery?
Bariatric surgery is a term that refers to surgical procedures used to reduce the size of the stomach and promote weight loss in morbidly obese individuals.

What bariatric procedures are offered at Montefiore Medical Center?
The bariatric procedures offered at Montefiore Medical Center include the Roux-en-Y gastric bypass, gastric band, and sleeve gastrectomy.

How does bariatric surgery work?
During a bariatric surgery your stomach is permanently made into a smaller pouch. When eating, the pouch fills quickly and gives a feeling of fullness much sooner. Therefore restriction is used to promote weight loss.

Is bariatric surgery safe?
All bariatric surgeries have been found to be safe procedures to promote weight loss. There are risks associated with all surgical procedures. .Come to one of our free seminars to learn more.

Is bariatric surgery an easy solution for weight loss?
Bariatric surgery is not a "quick fix" for weight loss. It takes dedication and patience to endure and complete the needed tests and appointments required prior to surgery. Success after bariatric surgery involves a complete healthier lifestyle transformation. This transformation should start taking place prior to surgery. To be considered a candidate for surgery you must have tried multiple weight loss attempts in the past.

Will my age be a factor of whether I am candidate for bariatric surgery?
We have performed bariatric surgery on patients of varying ages. The surgeon will review your medical history and previous weight loss attempts to better determine if you are a candidate for surgery.

Can I smoke prior to bariatric surgery?
You must stop smoking at least 2 months prior to surgery. Smoking increases your risk during and after the bariatric operation. Smoking can make the lungs more sensitive during surgery and may possibly lead to pneumonia. Additionally, smoking can also slow the healing process. Your surgeon may delay your surgery until you stop smoking. Some patients may even require blood or urine testing for nicotine levels before surgery. We strongly encourage you to see your primary care doctor to establish a smoking cessation plan.

Are there additional surgical options for people who have already had a bariatric surgery?
If you have gained a significant amount of weight since you had your original bariatric surgery there are surgical options. Not all patients are candidates for these procedures. You will need to meet with a surgeon to better determine if you are a candidate for any of these procedures. After you meet with a surgeon and it is determined you are a candidate you will need to complete pre-surgical appointments similar to those you completed at the time of your first bariatric procedure

Insurance Questions

Does insurance cover bariatric surgery?
Most major insurance carriers cover bariatric surgery, however some policies vary. Not all insurance companies cover all bariatric procedures. It is important to check with your insurance company before you move forward with the pre-surgical process.

Do I need a referral to come see a bariatric surgeon?
You will need a referral from your primary care doctor to see a bariatric surgeon regardless if your insurance requires one. The referral is required when you arrive for your first appointment with the bariatric surgeon.

What if my insurance changes during the work-up process?
It is important that you notify our office if your insurance plan changes during your work-up process. Different insurance plans have different requirements for surgery; therefore you may need additional tests. You will need to maintain your insurance coverage after your procedure because follow-up care is an important part of your success with surgery.

Path to Surgery Questions

How long does is the work-up process for bariatric surgery?
The time frame from your first seminar until the day of surgery is typically 3 to 8 months. Your time frame will depend on your insurance requirements and the time it takes you to get the required pre-operative testing completed.

What is a 6 month supervised diet? How do I know if I need one?
Also referred to as "weight management", the 6 month supervised diet is a requirement by some insurances or a requirement by our program when a patient has limited previous diet attempts. A patient is required to come for 6 consecutive calendar months to complete this requirement. If a month is missed or skipped the weight management process will be started back at the first month. The insurances that require a 6 month supervised diet include: Aetna, Fidelis, 1199, HIP/HIP CMO, Neighborhood, GHI, Heathplus (requires 12 months), and Wellcare (must be done with PCP). During your first appointment with the registered dietitian your previous weight loss attempts will be assessed, if you have limited attempts you may be required to complete this process.

Do I need a psychological evaluation before surgery?
Yes, all patients who undergo bariatric surgery require a psychological evaluation. We will provide you with a list of recommended psychologists at your first appointment with the surgeon; however you may also use your own psychologist/psychiatrist.

What other specialists will I need to see before I can have bariatric surgery?
The additional specialists you will need to see prior to having bariatric surgery will depend on your medical history and current weight. Patients are commonly referred to a pulmonologist, cardiologist, and gastroenterologist.

What is H. Pylori and how is it treated?
H. Pylori, also known as Helicobacter pylori, is a type of bacteria commonly found in the stomach and is linked with stomach ulcers. It is important to treat H. Pylori prior to having a bariatric surgery to prevent complications after surgery. H. Pylori can be treated with antibiotics prescribed by your bariatric team.

What is an EGD (esophagogastroduodenoscopy)?
An EGD is a test used to look inside your stomach and the first part of your intestine for abnormalities. It involves a scope being inserted through your mouth while you are sedated. Not all patients will need an EGD; your bariatric surgeon will determine if its necessary.

What if I gain weight during the pre-surgical process?
We recommend that you start making lifestyle change prior to surgery in efforts to lose weight. If a substantial amount of weight is gained during the process that is not related to medications your surgery may be postponed.

Do I need medical clearance for bariatric surgery?
You will need medical clearance prior to bariatric surgery. You should obtain this from your primary care doctor and provide it to our office at least 2 weeks prior to your bariatric surgery. The medical clearance should include your medical history, current medications, and a plan for your current medications the day of surgery and the days following surgery.

During and After Surgery Questions

Are the bariatric procedures done laparoscopically?
All bariatric procedures performed at Montefiore Medical Center are done laparoscopically. Laparoscopic surgery, also called minimally invasive surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions.

Will I be put to sleep during my bariatric surgery?
Yes, you will receive general anesthesia before your surgery. A breathing tube will be inserted after you are put to sleep to secure your airway in the event of breathing difficulties.

How long will I be in the hospital after bariatric surgery?
The time you will be in the hospital varies depending on the type of the procedure you choose and your individual recovery process. Patients who have the gastric band are typically in the hospital only one night, while patients who have the Roux-en-Y gastric bypass or the sleeve gastrectomy may be in the hospital 2 nights or greater.

How long does the bariatric operation take?
The actual time of the operation may vary. The gastric band usually takes less than an hour, the sleeve gastrectomy about an hour, and the Roux-en-Y gastric bypass about 2-3 hours. If you have had previous operations the length of your surgery may be longer.

How soon after surgery can I exercise?
Activity is a very important part of your recovery and weight loss process. Activity helps prevent pneumonia, blood clots, and constipation while increasing weight loss. For these reasons, your exercise program will begin while you are in the hospital. You will get out of bed and into a chair a few hours after your surgery. You will be expected to start walking in the hospital hall the day after your surgery. When you leave the hospital you should walk at least 30 minutes per day. You will not be able to do strenuous activities (ie. swimming, running, dancing) until 4-6 weeks after surgery. It is important your surgeon tells you when these things are safe. You will not be able to lift anything greater than 10 lbs for one month (this includes children and pets).

Will I be on a special diet after bariatric surgery?
Immediately after bariatric surgery you will be on a special diet to ensure your new stomach heals appropriately. You will start with clear liquids, advance to purees, and finally reach solid foods. When you meet with the registered dietitian for your individual preoperative appointment, you will receive a detailed packet on the diet for after surgery. You should not have the mindset that you will be on a diet for the rest of your life, but rather that you are living a healthier lifestyle.

Will my insurance cover my medications and vitamins after surgery?
Your insurance should cover your medications after surgery. Some insurances only cover certain brands of medications, so you may have to call the office for another prescription if the specific drug brand is not covered. Not all insurances cover vitamins after bariatric surgery. You should expect to pay for some vitamins out of pocket.

How soon after bariatric surgery can I become pregnant?
You must avoid becoming pregnant for the first 2 years after bariatric surgery. Pregnancy can be very dangerous for both you and your baby during the first 2 years after surgery. Pregnancy during this time may result in birth defects. The rapid weight loss that may occur after surgery can increase fertility. For this reason, you need to take every precaution to prevent pregnancy.

Do I have to take vitamins after bariatric surgery?
One of the major commitments of bariatric surgery is to take vitamins for the rest of your life. Vitamins are crucial after bariatric surgery for several reasons. You will be eating much less, and you may absorb things differently. The recommended vitamins are a multivitamin, calcium (2 daily), and iron (only Roux-en-y gastric bypass). Serious problems can occur if you do not take your vitamins and minerals every day. Some of these problems include weak and broken bones, anemia, fatigue, dizziness, inadequate blood stores, tingling of hands/feet, nerve damage, and difficulty walking.

Will I experience emotional changes after bariatric surgery?
Emotional changes may occur after bariatric surgery. Some patients, but not all, feel like they are on an emotional roller coaster after surgery. Many patients think surgery will lead to happiness; however this is not always true. People commonly cope with their feelings with food; however after surgery your new stomach will not be able to handle the increased amounts of food associated with emotional eating. If you feel like you are an "emotional eater" now, you should seek treatment from a psychologist to improve your success after surgery process.

Are support groups available?
The Weight Reduction Surgery Program offers support groups to patients before and after surgery. You will be required to attend at least 2 support groups prior to surgery; however we encourage you to continue attending the groups after surgery.

Is it important that I get my vitamin labs checked after bariatric surgery?
Vitamin and mineral levels must be monitored in your blood. Your vitamin levels will be checked every 3 months for the first year and then yearly thereafter. Although you may be taking all of the prescribed vitamins sometimes your vitamin levels may still be low. It is important to monitor the need for additional supplementation.

Will I experience nausea, vomiting, or constipation after bariatric surgery?
Nausea, vomiting, and constipation can occur after bariatric surgery. Eating too fast, eating certain foods, or drinking with meals may cause nausea or vomiting. Most patients, at some point, will vomit. If you have continuous vomiting you should call your surgeon immediately or go to the emergency room.

Constipation after bariatric surgery is not uncommon and is more likely to occur if you are taking iron supplements. It may be necessary to take a stool softener for the first month or so after surgery until you can drink more fluids and eat more fiber. Stool softeners are available over-the-counter. You should not take laxatives on a regular basis.

Will my insurance cover plastic surgery after I reach my goal weight?
Many plastic surgery procedures are not covered by insurances after weight loss surgery. If you are interested in plastic surgery you should check with your insurance carrier prior to surgery to find out if it is covered.

When will I follow-up with my surgeon after surgery?
You will follow-up with your surgeon the first week after surgery, a month after surgery, and 3 months after surgery. At that point you may start following up with one of our physician assistants. You will see one of the physician assistants 6 months after surgery and yearly thereafter.