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Preparation for weight loss surgery is very thorough and involves medical workup as well as psychological assessment and preparation. Depending on the complexity of your medical problems the average length of preparation is anywhere from three to six months. People with serious health problems that can potentially put their life at risk during or after surgery may need more thorough workup. This is especially important in case a psychiatric problem is identified.
Laparoscopic surgery involves operating through tiny incisions. A camera is placed inside your abdomen through one small incision, and the surgery is then performed by introducing surgical instruments through other small incisions. There are many benefits in having small incisions. You should have less postoperative pain, you will recover more quickly, and you will have much less chance of wound complications (infection, hernia) than if you had a large incision. You must understand, however, that at any time during a laparoscopic procedure, there may be a need to make a larger incision to complete the gastric bypass. Conversion to an open procedure can be due to scar tissue from previous operations, bleeding, differences in your internal anatomy that make the bypass more difficult, or even equipment failure. The chance of needing a conversion is less, than 1%. Remember, it is more important to have a safe operation than one involving small incisions only.
Most people leave the hospital after two
nights following surgery. You should have only mild to moderate pain
that is well controlled by over the counter pain medicine. You will wake up
from surgery with a drain coming out of your abdomen. Your diet is started
on the day following surgery with little sips of water, which will be
advanced to surgar-free clear liquids. The next day, you will be started on
You will be expected to start walking on the day of the surgery and you will rapidly advance your activity level (this is very important in decreasing the chances of some serious conditions including pneumonia and blood clots). Within a week or two you should be feeling less tired, and your mobility will be about the same as before surgery. Most patients will require about 2 weeks to return to work. You will not be on solid food for at least weeks to allow healing of the staple line on the stomach. You may experience a long period of time where solid or even soft food causes nausea, vomiting, and discomfort, especially if yoiu try to eat fast (similar to how you eat your meals now). Attending support group meetings is an excellent way to seek help, since most patients who had already undergone surgery will be happy to share their experience and advice.
Studies of sleeve and bypass patients reveal that they can expect to lose
between 60 to 70 % of their excess weight within12-18 months. Most will keep
off significant weight even beyond 5 years (>50% excess). Some very
motivated individuals may be able to maintain greater than 80% loss of their
excess weight. To these individuals the surgery is only the start of a
healthy new attitude that also combines:
Wise food choices to fill but not overfill (stretch) the new stomach pouch, and
A mild to moderate exercise program. Conversely, an unsuccessful person will likely make poor quality and quantity food choices as time passes.
Regular attendance of the support groups. These meetings reinforce the lifestyle changes and help to overcome certain difficulties you may face.
The initial time period (up to 12 months) after the surgery is when weight loss is easiest. Therefore, during this time it is of utmost importance that you focus on developing and solidifying new, healthy eating and exercise habits and work hard to eradicate old overeating patterns. Remember you should not go into this surgery thinking that this drastic surgery will ever allow you to eat like you do now and still lose weight. If you keep pushing the stomach pouch to accept significant volumes of food, then over time you will stretch your stomach and regain your weight.
In addition to improving overall quality of life, many post operative patients will see improvement or even resolution of medical illness brought on by obesity (including sleep apnea, diabetes, high blood pressure, and arthritis). Most will enter into a category of weight (BMI<35) in which the risk of major illnesses or sudden death is not much higher than in the general population.
You will be closely followed in the postoperative weeks, months, and years. You must be committed to these follow up appointments with medical, surgical, behavioral, and nutritional staff. Not only is safe weight loss dependent on these follow-ups, but so is your also your ability to permanently keep the weight off. Bypass surgery can finally give you the capacity to avoid food and begin the weight loss process, but long- term success will be dependent on modifications in your behavior, nutrition, and physical activity.
The gastric bypass procedure should be considered a permanent change. The bypass procedure involves cutting and reshaping your stomach and small intestine. Any reversal of it would be extremely difficult, but not impossible. A reversal procedure may be done laparoscopically, if the original surgery was also done that way, but chances are it may need to be done through a large incision and would pose significant medical risks.
Since the resected portion of the stomach is removed from the abdomen, there is no reversal procedure for the sleeve gatrectomy. In extremely rare cases, when the patient does not tolerate the changes caused by the sleeve configuration, conversion into a gastric bypass or other type of weight loss surgery is considered. These decisions are made on an indiviual basis after all the risks and benefits are carefully weighted.
Unlikely, but over the long term you could gain back weight. Undoubtedly,
this surgery will give you dramatic weight loss results through the power to
reject large volumes of food, and these results should last a lifetime. But
this surgery's ultimate success, to a large part, is dependent on you.
Some patients in time can learn to "out eat" the bypass. These patients may cause significant stretch of the tiny stomach pouch to allow them to eat much more than is reasonable (these patients are always trying to eat to much at one setting). Some patients may not be able to shed the overeating of high sugar or carbohydrate foods. This is particularly seen in patients who don’t have or eventually lose the "dumping syndrome". These eating patterns will obviously cause weight regain as sugar items are quite easily passed and absorbed by the intestine and converted to fat by the body. Studies show that patients who exercise regularly and attend support groups are less likely to regain significant amount of weight.
As many as 50 percent of patients may regain a small amount of weight
(approximately 5 percent) two years or more following their surgery.
However, longitudinal studies find that most bariatric surgery patients
maintain successful weight-loss long-term. ‘Successful’ weight-loss is
arbitrarily defined as weight-loss equal to or greater than 50 percent of
excess body weight. Often, successful results are determined by the patient,
by their perceived improvement in quality of life. In such cases, the total
retained weight-loss may be more, or less, than this arbitrary definition.
Such massive and sustained weight reduction with surgery is in sharp
contrast to the experience most patients have previously had with
non-surgical therapies.Frequently they do not put adequate effort into
making the required behavioral changes and do not stay involved in the
recommended follow-up treatment. Patients who no longer pay attention to
their eating habits are at a great risk for regaining their weight.
Patients who fail to maintain their weight loss may also have psychological issues that make them dependent on food and/or weight, such as the use of food for comfort or to deal with personal problems. In addition, significant stress can occasionally develop when a person who has been overweight for many years suddenly becomes thinner. For instance, some people may not find themselves as happy as they thought they would be, may feel uncomfortable receiving attention from the opposite sex, or may feel anxious about no longer being able to use their weight as an excuse for not doing or achieving certain things.
Partners of individuals who lose large amounts of weight may feel threatened by their significant other's increased attractiveness, and can attempt to sabotage their weight loss. For all of the above reasons, close follow-up is crucial for your success. It can identify not only nutritional and medical problems, but also the behavioral and psychological issues that could lead to your failure to keep weight off.
It is strongly advised that women of childbearing age use the most
effective forms of birth control during the first 16 to 24 months after
weight loss surgery. The added demands pregnancy places on your body and the
potential for fetal damage make this a most important requirement.
If you have an adjustable gastric band and you become pregnant, the band may be released and you may have a normal pregnancy without difficulties. The band can be readjusted again after you finished breast feeding.
With significant weight loss excess skin will develop. The notion that
excess skin will improve with exercise is unfortunately a misconception.
Most patients have some loose or sagging skin, but it is often more
temporary than expected. You will have a lot of change between 6 and 18
months after surgery. Your individual appearance depends upon several
things, including how much weight you lose, your age, your genetics and
whether or not you exercise or smoke. Generally, loose skin is well-hidden
by clothing. Younger women often enjoy better cosmetic results because of
the elasticity of their skin.Many patients wear compression garments, which
can be found online, to help with appearance.
The amount of excess skin that forms after bariatric surgery is highly variable. In some individuals a large hanging skinfold develops on their abdomen and underneath skin infections may develop. Removing the excess skin is possible and the best results are seen if a dedicated plastic surgeon performs the surgery. Unfortunately, this surgery may be classified as cosmetic and not necessarily covered by insurance.
Inquiries about the Program can be made by calling 781-418-1900.
If you are interested in becoming a candidate for this procedure, you must begin by watching our ONLINE Weight Loss Surgery Information Seminar Program. If you remain interested, you may then proceed on.
Most insurance plans will require a referral through your primary care doctor. You can find out whether you need a referral by calling your insurance carrier or primary care doctor. Be aware that you must be evaluated by all the members of our group, which include a behavioral psychologist, a dietitian, a cardiologist, a pulmonologist, and then finally a surgeon.
This whole process may take many months.
Due to the complexity of the workup and the postoperative care, we need to charge a program fee. Currently the program fee is $500.00, which is payable when you are scheduled for surgery.
You may find answers to typical questions on the website of the American Society of Metabolic and Bariatric Surgery.
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