FAQs

Weight-loss surgery alters the body’s digestive process by limiting the amount of food the stomach can hold and/or by limiting the absorption of nutrients. The most common procedures are restrictive, malabsorptive or a combination of both procedures. Restrictive procedures reduce the amount of food the stomach can hold, but don’t interfere with the body’s normal digestion of food and nutrients. Malabsorptive procedures bypass most of the small intestine so that fewer calories and nutrients are absorbed. Combined procedures restrict food intake as well as the amount of calories and nutrients the body absorbs.
Candidates are at least 100 pounds overweight. That translates to a body mass index of 40 or over. You should have previously attempted to lose weight through traditional methods, including dieting, nutritional counseling and commercial or hospital-based weight-loss programs. Candidates may have a body mass index of 35 and over if they have medical problems that are associated with obesity, such as hypertension and diabetes. People with an inflammatory disease, severe heart or lung disease, esophageal, stomach or intestinal problems, cirrhosis or who are pregnant are not candidates.
The two most common operations are adjustable gastric banding and gastric bypass. With both procedures, the size of the area in stomach where food collects is reduced. The adjustable gastric band (also known as the LAP-BAND System® in the U.S.) is less invasive than gastric bypass and is often done laparoscopically. By placing an adjustable band around the stomach the surgeon creates an upper pouch. As the name suggests, the band can be adjusted in follow-up, outpatient procedures to ensure that the pouch is the right size to control weight loss. During Roux-en-Y gastric bypass, a surgeon creates a small pouch at the top of the stomach using staples. The small intestine is then rearranged and connected directly to the pouch, creating a bypass of the small intestine. The band is adjustable; the bypass is not adjustable. The band is reversible; the gastric bypass is irreversible.
That depends on the procedure and the individual. With the adjustable gastric banding procedure, weight loss progresses steadily over a 2- to 3-year period and then stabilizes. The final result is usually between 50 percent and 60 percent of the excess weight. After four years, studies show the level of weight loss is equal to that achieved by gastric bypass surgery. After gastric bypass surgery, weight loss usually exceeds 100 pounds or up to 70 percent of the excess body weight, but it generally levels off in one to two years. A regain of up to 10 percent of your excess body weight is common. With adjustable gastric banding, weight gain is minimal. Ultimately, one’s goal weight should be determined by the individual with his surgeon and should be the recommended weight based on the patient’s height.
The most common complication associated with adjustable gastric banding is the enlargement of the stomach pouch, which can occur if the stomach slips up through the band. However, modifications to the technique have been made to prevent this from occurring. There have also been cases where the band erodes into the stomach. Research has found that patients who undergo a gastric bypass have longer operative times, more blood loss and longer hospital stays when compared to patients who have adjustable gastric banding.4 Up to 5 percent of patients undergoing gastric bypass may experience leaking, bleeding, wound infection or blockage in an artery in the lungs. In addition, because a portion of the digestive tract is bypassed, the absorption of essential nutrients is reduced and medical complications can result.
A patient’s medical history and weight are used to determine which surgery is the best option. It is also important to talk with your surgeon to decide which option is right for you.
Weight-loss procedures cost from 20,000 to 35,000 dollars. Medical insurance coverage varies by state and insurance provider. In February 2006, Medicare expanded its coverage to include, laparoscopic adjustable gastric banding and open and laparoscopic Roux-en-Y gastric bypass. However, these surgeries are covered by Medicare only if performed in a hospital or by a practice that is judged by the Surgical Review Corporation to be a Center of Excellence, so be sure to verify that your surgeon is affiliated with one of these centers.
Weight-loss surgery can eliminate or improve most obesity-related medical complications, including diabetes, hypertension, high cholesterol, sleep apnea, reflux and osteoarthritis, as well as stress incontinence, dermatitis, muscle and joint pain. Improvements in body image and a reduction in the symptoms of depression have also been reported. Weight loss may also be associated with improved fertility and more favorable pregnancy outcomes.
Find out how many years of experience they have in the field, the number of operations they have performed and how many times they have performed a specific procedure. The surgeon you choose should be experienced with the procedure you are considering. You should also determine if they are board-certified, and if they are members of the American Society for Bariatric Surgery. Discuss their commitment to follow-up, because weight-loss surgery often involves lifetime follow-up. The doctor should be working with all of the aspects of management and assessment in a clinical, multidisciplinary setting. The affiliate hospital and their office facilities should be able to accommodate large patients and be able to support all of the components of their programs.
First, a rigorous medical and psychological screening process, performed by a team of doctors, will determine if you are a candidate. This process helps to identify the aspects of your health that will improve following surgery, as well as the aspects that may increase the risks associated with surgery. You will also want to come to a complete understanding of the significant, lifelong, lifestyle changes you must commit to, including diet, exercise, limiting alcoholic intake and smoking cessation, if necessary.
That depends on the procedure. Patients who undergo laparoscopic adjustable gastric banding tend to stay in the hospital for a little more than one day, while the average hospital stays for patients who undergo a laparoscopic gastric bypass is closer to three days. Hospital stays for patients who undergo open gastric bypass surgery can exceed three days. Recovery times differ too. In one study, patients returned to normal activity in about one week after laparoscopic adjustable gastric banding and over 18 days after laparoscopic gastric bypass.
Lifetime follow-up is recommended, with at least three follow-up visits during the first year. Adjustable gastric banding requires more frequent visits for band adjustments. You will need to adopt a healthy lifestyle, including a new nutrition plan and regular exercise, although exercise restrictions may be in place until you are healed. Because of the decrease in food intake, constipation may occur. A laxative may be recommended. You may want to consider or may require reconstructive operations after your weight stabilizes. Medications can be prescribed as needed. However, your doctor may tell you to avoid aspirin and nonsteroidal anti-inflammatory drugs, which can irritate the stomach.
When to call the doctor’s office:
  • Fever more than 100.4 F
  • Pain that is not relieved by pain medication
  • Persistent nausea and vomiting
  • Bleeding
  • Redness, pain or drainage from the incisions
  • Absence of bowel movements and gas.
  • Excessive diarrhea
  • If you have any question or medical problem we want to hear it first. Specially in the early days after the surgery
When to go to the ER Signs and symptoms
  • Dehydration
  • Fever with abdominal pain
  • Nausea and vomiting for more than 12 hrs.
  • Not tolerating liquids
  • Sudden onset of abdominal pain
  • Shortness of Breath
  • Chest pain
This answer is for both sleeve and gastric bypass patients. After the surgery the size of the stomach is very small due to the surgery, swelling and the process of healing. With time the swelling decreases and the wall of the stomach become softer and can adapt better to larger amounts of food. If you slowly increase the amount of food you eat, you will increase the capacity of the stomach to accept more food without causing you trouble. But the stomach will not necessarily increase in size.
No, the pouch will not explode or burst once you have healed. If you over fill your new stomach you will vomit and have pain. However, if you do not follow dietary directions after surgery and you overeat causing retching and vomiting there is a higher risk of a leak.
After the pouch is created during the surgery the rest of the stomach will remain inside your body. It will continue to produce gastric juices. The juices will empty in the small bowel and later mix with the food coming from the pouch thru the roux limb. It will not die or shrivel up. It is healthy and can be used again to reverse a gastric bypass.
It is wise to wait at least one year before you get pregnant. The great majority of weight loss happens during the first year. It is not good for a baby that is trying to develop to be inside a mother that is losing a lot of weight. It takes your body a year to adapt to your new anatomy. After a year, you should be familiar with how to take the multivitamins and we will monitor your blood work. Before you get pregnant is a good idea to let your gynecologist and your surgeon know so they can plan appropriately. Infact, a lot of morbidly obese women are not fertile and don't use any protection. After the surgery you most likely will be fertile and can become pregnant. We have seen this as soon as a month after the surgery.
Immediately following WLS, only sips of liquids are allowed. Over the next four weeks, the consumption amount is increased gradually with fluids including water, protein drinks, clear broth, sugar-free jello and sugar-free ice pops. Soft foods are started about four weeks after the operation. After about 6-8 weeks, patients are allowed to eat regular, healthy foods. We want our patients to engage in normal social eating, while enjoying foods that you like. We don't see this as a diet but more just common sense eating behavior. Once healed, care must be taken to let your stomach adapt to its new environment. Vitamin supplementation will be necessary, especially in patients who have undergone malabsorptive procedures (gastric bypass and bilio-pancreatic diversion with duodenal switch – BPD-DS).
Dumping syndrome is the body’s intolerance to foods high in sugar and fat. These foods empty quickly from the stomach into the intestine causing nausea, clamminess, sweating, cramping, pounding heartbeat, light-headedness and diarrhea. Symptoms may last between 20 minutes and 4 hours. To avoid dumping syndrome, avoid high sugar foods, eat protein at every meal and avoid drinking with or for 30 minutes after a meal.
No, the content of sugar is high and protein is too low and it is not a good choice. You should only be drinking the protein shakes approved by your dietitian.
The most important thing to remember is that you shouldn’t drink any liquids with calories. This will prevent you from losing weight and can make you regain weight.
In general, sodas are not recommended for general health reasons but there is not a specific indication why you can’t drink them as long as you drink the ones with no calories.
As a note, sodas will increase the amount of gas and burping.
Caffeine can irritate your stomach right after surgery and should be avoided during the first 4-6 weeks after surgery. After that time, a limited amount is fine.
Having a drink social is ok however, it's important to understand a few things:
1. Alcohol will increase the risk of developing ulcer.
2. The absorption of alcohol is faster and you will feel the effects with smaller amounts.
3. Surgery will not make you an alcoholic but many bariatric patients have compulsive behaviors and are at hight right of transfer addictions.
4. Alcohol is also a liquid with calories (converted to sugar in the body) which should be avoided so as to not gain weight..
This is not a disease. It’s a reaction from your body to the type of food and amount that you eat and how fast this passes from the stomach to your small intestine. The most common cause is foods that are high sugar and fat. You will develop nausea, vomiting, diarrhea, palpitations and flushing. This could last for 20 minutes to several hours.
Not everybody will develop dumping syndrome and it may not last forever. It can be more common shortly after surgery and with time your body may adapt to your new anatomy and you won’t experience it again. Most people only have dumping syndrome when they eat a food that triggers it.
We consider that a treat. As indicated in this manual, those are thing that you can eat but we recommend you eat them in very small amounts and no more than once a week. Remember, sugar free cookies and ice cream is still cookies and ice cream and still have a lot of calories.
Yes, vitamins are essential for us to maintain good health.
After any of the surgeries, the amount of food you eat is so small so it makes you prone to vitamin and protein deficiencies.
Vitamin deficiencies can cause death if they are not corrected in time.
A multivitamin is recommended even for people that have not had weight loss surgery.
Proteins are the base of our body, they help us heal, maintain muscle and health.
It is important to have an intake of about 60-80 grams a day. If you can meet this goal with food then a protein shake is not necessary. If you cannot eat enough protein via food you will need to supplement with a protein shakes or bars until you can eat more protein. This will likely be necessary for serval months after surgery
Constipation is the difficult passage of hard, dry or pasty stools. You may experience bloating, abdominal discomfort and straining. In the first few days it is common to experience this problem. Make sure you are drinking plenty of liquids (at least 64oz.).If the problem continues for more than 3 days, take an over the counter laxative. We prefer Milk of Magnesia or Miralax. Four weeks and later after surgery Add fiber to your diet. Add a little at a time so your body gets used to it. Drink plenty of water and other sugar-free liquids. Get plenty of exercise. Fiber Supplements: fiber supplements can help normalize bowel patterns. Examples include Metamucil, Benefiber, Citracel. Use as directed.
Dehydration will occur if you are not drinking enough fluids. Some symptoms of dehydration include dark and strong smelling urine, dry mouth, nausea, fatigue and headache. This is especially common the first few weeks after surgery. It is very important to prevent this from happening by drinking fluids. As a minimum you should drink 64oz. of liquids. You will not be able to drink a lot at one time so it is important that you sip on your drink all day long or an average of 4oz every hour.
Prolonged diarrhea, lasting more than 2 days, can lead to dehydration. Dehydration is dangerous and must be treated promptly to avoid serious problems. It is important to drink more fluids than usual, at least 80oz. a day. If the problem continues for more than 2 days and you also develop nausea, vomiting or fever please call or go to the nearest emergency room. Do not attempt to treat the diarrhea with antidiarrheal medications.
Many reasons can cause this problem including dehydration, medications, changes in blood pressure, low blood sugar, etc. Dizziness and light-headedness are usually temporary symptoms and will be resolved as the body adjusts to your new lifestyle. Check with your primary care doctor regarding your medications. Also if you have the option, check your blood sugar.
The typical causes of fatigue are inadequate sleep, poor nutrition, low fluid intake and lack of exercise. Other causes that should be considered include nutritional deficiencies, high carbohydrate meals and psychological issues.
This occurs with overstimulation of the pouch, usually due to overeating and/or over-drinking during meals. As a result, the body produces large quantities of saliva. Saliva fills the stomach pouch, moves into the throat and eventually moves up into the mouth. Drinking warm liquids 30 minutes before eating may help reduce this. Remaining upright after a meal may also help. Frothing will resolve itself after the pouch heals and the body adapts to a smaller stomach.
Gas is a common problem. Typical causes of gas are dried beans/peas, lactose (the sugar found in milk), sugar alcohols, carbonated beverages, chewing gum and drinking through a straw. If gas makes you uncomfortable, try eliminating potential causes. You may also try over-the-counter products that help reduce gas (Gas-X) and eliminate odor (Devrom). Increasing the amount of physical activity will also help pass the gas.
Hair loss is not caused by the surgery itself. It is caused by the stress that rapid weight loss causes on your body. This usually happens between 3 to 6 months after the surgery but can happen before or after that. Most commonly this is noticed by you but not by the people around you. It will stop and your hair will grow back. Taking biotin may help reduce the amount of hair loss but nothing will completely stop it.
THIS IS NOT NORMAL.
You can develop nausea and vomiting the day after the surgery and can be due to the anesthesia or swelling in your stomach this will improve with time.
We won’t discharge you from the hospital until you are able to drink enough fluids to keep your body hydrated. In the first couple of weeks after the surgery, the most common reason to have nausea and vomiting is when the patient doesn’t follow the dietary instructions. If you experience vomiting, please stop drinking at least for 3 hours and then go back to a liquid diet. Start with very small zips and slowly increase the amount of liquid taken as tolerated. If you continue with this problem please call.
Stomach sounds are produced by the fluid and air that is in your intestines. When your intestine is moving it pushes air against the fluid and produces the sound. After surgery many patients develop an increase in the sound of their stomach because their intestines move faster and contain more air, especially after a gastric bypass.
Exercise will not damage the surgery on any of the hookups that we made; there are no restrictions toward activity. Your level of comfort should guide the amount of exercise you do. If a specific activity or exercise causes pain you should avoid doing that and try it again at a later time. Walking is the best activity during the initial post operatory period. Walking will help avoid complications and speed up the recovery.
The excess skin on a patient that has lost a large amount of weight will retract to some degree depending on your skin type and elasticity. Exercise will help you look better but will not make your skin retract.
Yes, there are no restrictions to participate in contact sports. You will need to wait for the healing process.

Sign-up for our Mailing List!

Receive up-to-date news from LiveHealthyMD

WordPress Video Lightbox Plugin