What You Should Know Before Bariatric Surgery

STEP 1: AM I A CANDIDATE?

Only your surgeon can truly determine if you are a candidate for weight loss surgery. However, there are a few things you can check to begin the process: For one, you can calculate your body mass index (BMI) which is a calculation based on your height and weight that helps us determine if you meet current criteria to qualify for this type of operation. BMI greater than 40 kg/m2 or greater than 35 kg/m2 with other medical conditions are the current guidelines.

Second, if you are considering weight loss surgery, it is very helpful at this time to give your health insurance company a call to see whether you are approved for coverage of weight loss surgery. Please feel free to call our office at (646) 859-1400 to speak with our reimbursement and insurance specialist at any time with questions regarding this part of the process.

Please note that most insurances will require documented proof of six months of weight loss attempts (diet and exercise), and this should be initiated immediately. Usually, your primary care doctor can document this. On the other hand, do not delay visiting your surgeon as the approval process for weight loss surgery can take quite a while.

Finally, if you have other medical conditions (diabetes, sleep apnea, hypertension, etc), now would be the time to set up an appointment with your respective medical doctors to make sure your treatments are up to date, and to make sure your doctors know you are considering weight loss surgery. If you do not have a primary care doctor to see, please feel free to see us first and we will recommend a physician for you. PLEASE KEEP in mind that only your surgeon can determine if weight loss surgery is right for you, and if you seek a medical consult prior to visiting with the surgeon, you may still require a return visit to that same doctor.

STEP 2: ATTEND INFORMATION SESSION and CALL for APPOINTMENT

You may call our office at any time to obtain date and time information on our group sessions ((646) 859-1400​​​​​​​). The best way to learn about weight loss surgery is to attend one of our information sessions. Held once every 4-6 weeks, our surgeons will hold group sessions where they will describe an overview of all of the types of operations we perform. At these sessions, you will not only have the opportunity to talk to the surgeon, but to other peers considering weight loss surgery and to those who have already undergone their operation.

Once you have completed an online questionnaire and returned it, and have attended an information session, please call our office to schedule an appointment with one of our surgeons at your convenience.

IT IS EASY TO SET UP AN APPOINTMENT : Simply call our office at (646) 859-1400​​​​​​​. Our administrative assistant, Stella, will be glad to answer any of your questions and schedule your appointment at your convenience.

STEP 3: OFFICE VISITS

During your initial office visit, your surgeon will help you decide if weight loss surgery is right for you. Most importantly, if you are a candidate for surgery your surgeon will determine which operation is optimal for you. Before you leave the office, your surgeon will perform a physical exam, check your height and weight, and then order a number of tests and other medical consults specific to you. Standard lab tests will be ordered including blood counts, chemistry profiles, liver function tests, as well as special nutrient, vitamin, and cholesterol levels. In addition, you will be asked to have a chest x-ray and an electrocardiogram. You will then be asked to visit with our nutritionist and our psychologist.

Depending on your other medical conditions, you may be asked to visit with a primary care physician, a gastroenterologist, a cardiologist, a pulmonologist, and/or an endocrinologist. Finally, if you have sleep apnea, you may be asked to be evaluated by the Mount Sinai Center for Sleep Medicine. Telephone number is 212-241-5098.

At this visit, you will also meet with our patient liaison who will assist you in the process of obtaining insurance approval for your surgery.

STEP 4: COMPLETE INSURANCE APPROVAL and RECOMMENDED CONSULTS

In some cases, insurance approval can take several months. During this time, you will complete all of the recommended consults and pre-operative workup requirements. Each of the consultant’s recommendations should be faxed to our office (212-650-9981​​​​​​​). Once approval is obtained and you are cleared for surgery you will require a second visit to our office within 30 days of your scheduled date. At this visit, you will receive specific instructions and information about your surgery date, and all informed consents will be signed.

STEP 5: DAY OF OPERATION

Remember to only drink liquids for six days prior to surgery, and then not to eat or drink anything from 8pm on the night before.

Arrival at the hospital: You will need to arrive at the hospital two hours prior to your scheduled start time. You will enter through the doors located on Madison Avenue at 100th street and head to the second floor of the Guggenheim building to the Mount Sinai patient registration desk.

Family members: Family may accompany the patient through the registration process. There is a comfortable family waiting area on the same floor for your convenience.

Pre-operative holding area: You will be brought into the pre-operative holding area where you will meet the operating room nurses as well as the anesthesia team. After confirming all of your paper work, and after reviewing the anesthesia process with you, they will bring you into the operating room.

Anesthesia: General anesthesia is used, meaning you will be completely asleep. In addition, a breathing tube will be placed through your mouth and you will be connected to a breathing machine throughout the operation. At the end of the case, this breathing tube will be removed. In special circumstances, it will be safer to leave the breathing tube in for a while, and your anesthesiologist will make the final decision on when to remove it. Your anesthesiologist will explain to you all of the details regarding your anesthesia medicines.

Operation: Your surgeon will perform the operation laparoscopically unless he feels it is safer to make a small incision. While asleep, you will have a urinary catheter placed, as well as special compression boots around your lower legs to help prevent the risk of a blood clot. The duration of each operation varies, and you surgeon will outline your specific procedure.

STEP 6: RECOVERY and FOLLOW-UP APPOINTMENTS

Recovery room: Immediately following surgery, you will be brought to the recovery room. The anesthesia team will monitor your breathing and control your pain medicine. You will be given a special pump, called Patient Controlled Anesthesia (PCA) to self-administer the optimal dose of pain medicine. You will remain in the recovery room for several hours until the anesthesia team feels it is safe to release you.

Hospital room: Upon release from the recovery room, you will either go to a regular bed, a step-down bed, or to the intensive care unit. The room you go to will depend on the course of your operation and the immediate recovery and will be decided on by both your surgeon and by your anesthesiologist.

Hospital Stay: Your hospital visit will depend on the type of operation you have, and each patient’s visit is individualized. In general, on the same day as your operation, we want you to be out of bed, and walking when you feel ready. In addition, we want you to concentrate on taking deep breaths to fill your lungs with air. To encourage deep breaths, you will use a device called an incentive spirometer.

On the first day after your operation, you may undergo a special x-ray called fluoroscopy. This will help your surgeon visualize your esophagus and stomach and help reassure that there are no leaks. Once this study is normal, you will be allowed to start on a liquid diet that is low in concentrated sweets. If this goes well, on the second day, you will be allowed to consume pureed foods.

Discharge home: Depending on the type of operation you have, most patients are home by the end of the second day, but from time to time a third or fourth hospital day is needed. In some circumstances, it may be possible to go home the same day as your operation, but this is for certain patients undergoing a LAP BAND only, and this is a decision made on an individualized basis after the procedure. Most Lap Band patients will go home on the day after surgery.

Congratulations, you are on your way to losing weight.

Follow-up: It is extremely important for you to follow-up, not only with your surgeon, but with all consultants involved with your care. Your surgical post operative visits will be scheduled for 3 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, and then a yearly visit until your 5th year. We strongly encourage that you follow-up with the same surgeon who performed your operation as the success of your weight loss and well-being will depend on it.

In the months and years following your operation, it is optimal to continue to follow up with your surgeon, nutritionist, psychologist, and our support groups on a regular basis.