Patient Resources

Bariatric Surgeon Q&A

Weight loss surgery is not for everyone, and should be considered carefully. Listed below are the top 10 bariatric questions commonly asked to bariatric surgeons by patients considering weight loss surgery.

10 Questions to Ask Your Bariatric Surgeon

Top 10 most commonly asked bariatric questions and answers.

1. Do I qualify for weight loss surgery?

The best candidates for surgical bariatric procedures are individuals who are severely obese with a body mass index (BMI) over 40, or 35 with obesity-related conditions, which we in the medical field call comorbidities, and in some cases, a BMI of 30 with severe comorbidities.

Examples of these conditions include diabetes, high blood pressure, obstructive sleep apnea, hyperlipidemia, fatty liver disease, infertility in females, arthritis, to name a few.

This criteria is from the NIH (National Institute of Health), and have been recently updated, after 30 years, to reflect the growing epidemic of obesity in the United States and advancements in bariatric surgery, effectively lowering BMI criteria for weight loss surgery, due to safety of bariatric surgery, especially laparoscopic or minimally invasive approach.

To learn more about bariatric surgery patient criteria, click here.

2. What type of medical tests do I need before surgery?

Surgeons in our practice will, at the initial encounter, will carefully review each patient’s individual medical history, their family history, in order to establish a customized, individualized plan of care, to allow for the safest, best outcome. We also will use patient’s individual health insurance as a general guide for requirements, as these may vary by insurance. At the very least, all patients at Advanced Laparoscopic Surgeons of Morris, LLC, are required to see a registered dietician (available on-site), have comprehensive blood work done, see a behavioral counselor, EGD to be done (endoscopy of the stomach). Clearance from primary care physician may be recommended, depending on the individual past medical history.

3. What risks are involved with the procedures?

Different bariatric procedures are accompanied by various risks, some same, some different, so you will need a detailed rundown of most common risks, complications, and alternatives before you can pursue treatment.

When meeting with the patient at the time of initial visit, once the type of procedure is decided upon, we address specific risks/benefits/alternatives at that very time. We use the American Society for Metabolic and Bariatric Surgery (ASMBS) risk calculator, which takes into account patients age, gender, medical problems, body mass index, previous surgeries, to provide our customers with the closest to real risk, involved in their procedure, so they can be well informed to make the decision.

To learn more, please follow the link below:
https://njbariatricsurgeons.com/surgical-risk-benefit-calculator/

4. How quickly can I expect to start losing weight?

Since all patients after surgery are placed on a special diet, which will be provided to them by one of our registered dietitians, weight loss happens very quickly.

As a general rule, we tell our patients that they will lose at least 10% of their weight in the first month after surgery, so it can be anywhere between 20-50 pounds, depending on the patient’s initial weight.

Most modern bariatric procedures make it “easier” to lose weight within a few weeks after the procedure by having the effect on the hunger hormone, called ghrelin. This hormone is decreased on average by 70% after sleeve gastrectomy and gastric bypass, which makes dieting less challenging.

More importantly, and we cannot emphasize that point enough, weight loss surgery journey is a marathon, not a sprint. It takes years to gain weight, years to try to lose it with diets, unfortunately unsuccessful in majority (95%) of them, and it will take at least 6-12 months to get to the goal weight. Having realistic expectations will help you to feel good about the outcome, no matter how long it takes.

5. Is the procedure reversible?

Some patients are concerned about “irreversibility” of certain procedures, sleeve gastrectomy in particular. We used to get that question a lot when VSG (Vertical Sleeve Gastrectomy) first came out – more than 15 years ago!

The way it should be looked upon is the following.

Obesity is a chronic, debilitating disease, and needs to be addressed permanently, not temporarily. Most of the patients who come to us for help, have the “obesity gene”, and therefore looking for a permanent solution, and have been struggling with weight problems their entire life.
Having a “normal portion size” stomach capacity of 6-8 ounces after sleeve gastrectomy allows our patients to live a healthy, normal life, and there is no need to be concerned, therefore, with “permanency” of the procedure. It also allows for reduction of the hunger hormone, called ghrelin, by a factor of 70% in majority of the patients. Leaving a larger stomach may lead to weight loss plateau, possible weight regain.

Some bariatric procedures, such as laparoscopic gastric band surgery are reversible or adjustable, but they, unfortunately cause other problems overtime, being a foreign body implant.

All these discussions take place during the initial visit, and we make every effort to customize the treatment plan, based on the individual patients needs and goals.

Please always ask our surgeon about different options available and which one is best for you..

6. How long is the recovery process after weight loss surgery?

Bariatric procedures are performed laparoscopically, or minimally invasively in our practice. Smaller incisions allow for less pain, shorter hospital stay, and in some cases can even be done as an outpatient (same day surgery) procedure. Most of our patients report that after 48-72 hours they do not need any pain medications, and therefore are allowed to drive, go shopping, start other activities of daily living, including exercising.

Return to work, which is part of the recovery time, is usually very quick, and for non-strenuous (desk job) is typically 1-2 weeks. Important thing to remember, however, is that recovery is not always about discomfort, but is about the new lifestyle, new diet, attention to your body needs, and that may vary person to person.

We also emphasize that surgery usually is done only once, and work, life can and should wait couple of weeks, to allow for the best outcome long term.

The length of recovery may also vary depending on your state of health. Age is not necessarily is a factor in recovery time, but some older patients may have more medical issues, which have to be factored into the decision about return-to-work schedule.

7. Will weight loss surgery affect my ability to become pregnant?

Some female patients who have obesity may also have problems with their hormones, affecting fertility, even before surgery. Some of the obese female patients have to see fertility specialists in order to get pregnant.

Statistics of successful weight loss surgery are very encouraging for patients who may have experienced these problems in the past, with improvement or resolution of these issues in 75-100% of the cases, typically being quoted. We at Advanced Laparoscopic Surgeons of Morris have personally seen and helped many couples, who previously were unsuccessful in having a child, to be able to have a family! But we strongly recommend to give surgery at least 12-24 months to work, before embarking on the pregnancy journey.

Reason for the wait is the following: extreme weight loss can have an impact on your hormones and nutritional intake. It is in the best interest to wait till weight is stable and nutritional intake is fully optimized, typically by 1 year after surgery. Getting pregnant earlier may also lead to not reaching your goal weight / lowest weight, and more weight gain during pregnancy.

8. I had previous surgeries, including open surgeries. Am I still a candidate for laparoscopic weight loss surgery?

Laparoscopic surgery has been around for over 30 years. It has come a long way since then, including development of multiple special instruments, specifically designed to allow for safe completion of the minimally invasive surgery (MIS) , without having to make a big incision, called open laparotomy. Occasionally, we have patients who had previous open surgery, such as open gallbladder removal, or hernia, or colon removal, or cesarean section for females, which is quite common nowadays. All these surgeries leave more scar tissue, called adhesions, on the inside, when compared to laparoscopic procedures. But with the aid of special instruments, we can dissect/cut through these adhesions/scar tissue safely, in order for us to see the stomach or any other organ in the abdomen, for that matter, and perform the requested procedure, whether it’s sleeve gastrectomy, gastric bypass, gastric band or revisional surgery. It does add some additional time to the total time of the procedure, but since the patients have been medically optimized for surgery, as we discussed previously in sections before, additional time under general anesthesia is safe.

9. What dietary changes will I need to make?

In order to be successful with weight loss surgery both short term and long term, dietary/eating changes need to take place, regardless of the procedure chosen, whether it’s sleeve gastrectomy, gastric bypass or gastric band.

All of them require making dietary changes before (preferably)and after the procedure. In our practice patients will be typically scheduled to see a registered dietician early in the process, so they have plenty of time to be educated about the changes to their eating habits needed, have time to sample/select the protein supplements that they like and will be interested in taking for a while. All patients are provided with a dietary guide, available online, have access to free online support groups, recipes, etc. On average, post-surgery patients are placed on liquid protein diet for 2 weeks, soft diet for weeks 2-4 and are allowed to advance to regular diet after 30 days.

But rest assured, you will find out what your recommended individual diet plan is, when you get to meet one of our registered dieticians, so that you know what to expect.

We also want to address the mystery of diet before surgery, at least in our practice Advanced Laparoscopic Surgeons. We do not require patients to be placed on liquid diet for 2 weeks prior to surgery, as many other bariatric practices do. We find that that leads usually to non-compliance, increased hunger before surgery.

Our approach is more of educational type – we urge patients to start making recommended dietary changes, practice mindful eating, etc. That in itself leads to weight loss prior to surgery and better results afterwards.

10. Will insurance cover my procedure?

Advanced Laparoscopic Surgeons of Morris, LLC, participated in majority of insurance plans, in order to service our customers.

We have a very robust process in place, which allows us to verify insurance benefits, for the most part, even before patients are seen. What that means is that after you are seen, examined and made a determination on the procedure type, required clearances, evaluations and that you are, indeed, a good candidate for surgery, you will be meeting with our insurance specialist to go over your individual insurance policy, coverages and requirements. All required appointments will be made there and then, if you want to proceed and you will be given a surgery date!

Unfortunately, especially nowadays, very few, if any insurance companies cover surgery at 100%, which means that you may be responsible for a portion of the bill. We will make every effort to provide you with as close as possible estimate to the correct amount, that you may have to pay.

The way to look at it, in our opinion, is the following: you are embarking on a journey, which will give you a new lease on life. How can you put a dollar amount on that? Life is priceless! Everything in life, especially nowadays cost more money, but we pay it anyways, because we have to move forward.

Surgery is your way of getting there and we at Advanced Laparoscopic Surgeons of Morris are here to make it happen for you.

Sometimes we find out that your insurance (your employer) does not want to pay for bariatric surgery – they exclude the coverage. When this happens, we can help you to still get the surgery you need and want, but you may have to consider self-pay options. We will be happy to provide the quotes for you at the time of evaluation, but only after we exhausted all of the insurance options. Again, it is hard to put a dollar amount on your health and only you can make that final decision, if the “price is right’ to get your life back!

Advanced Laparoscopic Surgeons of Morris has put numerous resources at your disposal to help provide you with the information and support you need to make an informed decision about weight loss – particularly about bariatric surgery.

Allison Lost over 80 lbs after Sleeve Gastrectomy

Lost over 85 lbs

Dr. Abkin is a master at his craft…

“Dr. Abkin was so friendly and explained each procedure thoroughly. I never felt forced or not heard, which really made me feel very comfortable with going forward with the surgery. Well a year later and I’m reflux free and still losing weight and extremely happy with all my services from him and his staff! I have referred him several times to my friends and co workers and will keep referring him!”

Jennifer

Sleeve Gastrectomy Revision

Success Stories

Samantha Allison Judith Danil Nicole Jennifer

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