Before Surgery
Before gastric bypass surgery, an initial visit will be scheduled followed by several preoperative visits during the months before surgery.
Initial Visit
On the day of your initial visit, expect to take in a lot of information. We recommend bringing a family member or friend. It is a good idea to bring a pen and paper to take notes, so you can remind yourself later about what was discussed.
The initial appointment typically lasts about 2 hours and involves meeting separately with the surgeon, physician assistant, dietitian, and insurance specialist. After signing in, we will check your height and weight, and take a ‘before’ photo.
You will then meet with the physician assistant, who will review your medical history, perform a brief physical exam, and review some aspects of the surgery.
We need to know about all of your medications, so please bring with you an up-to-date list or the actual medications you are taking.
The surgeon will review your medical history, describe the surgery and its benefits and possible risks, and answer any questions that you may have.
The dietitian will review your dietary history and help you get started on the preoperative 800-1200 caorie/day diet and discuss the following:
- Managing your food diary
- Reading and understanding food labels
- Healthy food choices and portion sizes
- Understanding calories from fat, carbohydrates, protein
- Habits to improve
Our insurance specialist will meet with you to discuss specific health insurance requirements.
At the end of your initial appointment, you will schedule your next preoperative appointment/visit. Patients are usually seen every 6-8 weeks after the initial visit before surgery to properly prepare them for surgery.
An appointment with our psychologist is also made at this time. This evaluation usually takes place at the second visit.
You may be scheduled for a sleep study if the information on your questionnaire or the results of your physical exam indicate that you may have untreated sleep apnea.
Preoperative Visits
Most insurance companies require at least 6 months of primary care physician (PCP)-supervised monthly documented diet notes before they consider approving gastric bypass surgery. We consider this time to be a "window of opportunity” to help patients get as healthy as possible prior to surgery. Remember, it is the patient’s health problems that increase the risks of surgery, not necessarily the surgery itself.
During this time, patients who smoke should quit smoking. Patients may also start to lose weight even before surgery. Patients are also encouraged to increase their levels of activity. All of lifestyle changes will help patients increase their health and decrease their risks from surgery.
After the initial patient evaluation and visit, we like to see patients every 6 to 8 weeks during the months prior to the anticipated surgery date.
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It is very important to keep each preoperative appointment.
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Skipping the preoperative appointments is a sign that you are not making a commitment to this surgery and the life changes involved.
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Referrals from your PCP and a co-pay are usually required at these visits.
1. Food diaries
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At the first office visit and subsequent visits, patients are given food diaries to complete.
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Patients are to bring these with them to every visit to our office. You will receive a new one at each visit.
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We will not operate on patients who do not bring in their food diaries as assigned.
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Honest and complete food diaries are necessary before surgery to ensure long-term dietary changes and portion control.
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Food diary compliance demonstrates motivation, commitment, and willingness of the patient to make the changes necessary to succeed. They can sometimes be used to support the 6-month diet history necessary for insurance approval.
2. Weight loss
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For many patients, the best way to improve their health before surgery is to achieve some weight loss. This is especially true in patients with central (abdominal) obesity, sleep apnea, heart disease, and other life-threatening health problems.
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Between the initial visit and preoperative visits, patients must be careful not to gain any weight, and some patients may need to lose weight.
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Weight loss before surgery has these benefits:
3. Quit smoking
It is very important that patients quit smoking before surgery – the sooner, the better. This improves health and helps decrease the risks of life-threatening complications.
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Smoking can increase the risk of dying, blood clots, pneumonia, and being on a ventilator (breathing machine).
4. Sleep study evaluation
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Sleep apnea is a life-threatening condition that is often undiagnosed. It is important to treat this prior to surgery. Many patients being evaluated for bariatric surgery are already being treated for sleep apnea (with a CPAP machine) and do not have to repeat a sleep study.
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If your score on the Epworth sleep scale is high, then we will help you schedule and set up the sleep study exam.
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If the sleep study demonstrates that you have sleep apnea, you will most likely need treatment, which includes nasal continuous positive airway pressure (CPAP) at night when sleeping.
5. Primary care physician (PCP) visits/history and physical exam/
screening studies
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We recommend that patients schedule an appointment with their PCP to obtain a full history and have a complete physical exam.
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Patients with weight problems are at high risk for numerous life-threatening health problems.
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We also recommend that patients undergo appropriate screening exams as recommended by their PCP. These include:
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Colonoscopy in men and women age ≥ 50
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Mammogram (women age ≥ 40) every 1 to 2 years starting at age 40 or as recommended by your PCP
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PAP smear for women– every 1 to 3 years based on history or as recommended by your PCP.
6. Cardiac evaluation
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Obesity, high blood pressure, diabetes, and high cholesterol are all risk factors for heart disease.
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Some patients, especially those with a history of heart disease, may require further testing and treatment, which can include –
7. Pulmonary evaluation
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A number of patients will need to have a pulmonary evaluation before surgery, to determine if lung function is adequate.
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This can include pulmonary function tests (PFTs), a visit to a pulmonologist (lung medical specialist).
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The tests that may be needed are determined by any symptoms of breathing problems, the recommendations of your primary care physician, and possibly by request of your insurance company.
8. Preoperative chest X-ray
A chest x-ray is required of most patients before surgery.
9. Support group attendance
We strongly recommend that patients attend at least one support group meeting during the months before surgery. It is a chance to review information in a group, to involve friends and family, and to meet patients who have the surgery to ask questions about any concerns that you may have.
10. Upper GI X-ray series
Patients that have had previous stomach surgery (weight-loss surgery) will need this to be evaluated.
11. Upper endoscopy
Patients who have had previous stomach surgery (weight-loss surgery) will need to undergo this evaluation. Also, patients being evaluated for Lap-Band will need this
12. Hematology consult
Patients with a history of blood disorders or blood clots (deep venous thrombosis [DVT] or pulmonary embolism) may need to be evaluated by a hematologist before surgery.
Most patients will not need all of the evaluations just described.
We, along with your PCP, will determine whether you need various tests.
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