We generally schedule surgeries one to two months from the time of insurance approval, and two to three months from the time of a patient’s first appointment, depending on individual circumstances. Appointments can be scheduled by calling (770) 919-7050.
It depends on your insurance company and on your particular plan. We try to maximize your chance of being approved in our initial submission to your insurance company. Although more insurers (including Medicare) are covering the Duodenal Switch (DS), approval can be more difficult than for the Roux-en-Y Gastric Bypass (RNY).
Most weight loss takes place during the first 10 to 18 months following surgery. Within three months about a third of a typical patient’s excess body weight will be lost, with about half the weight gone within six months. The pace of weight loss starts out fast and slows over time to about a pound a week. By about 18 months after surgery most patients have stopped losing weight because their bodies have adjusted to the changes.
This varies according to the patient’s health status and medical hstory. All patients will have comprehensive blood work, upper GI or upper endoscopy, pulmonary clearance and a psychiatric evaluation to assess their state of mind and expectations. We also require an ultrasound of the gallbladder. Any specific health issues (such as cardiac or kidney disease) will be evaluated by appropriate specialists and studies.
No. We use general anesthesia for our operations, so you’ll be completely asleep, feeling nothing, with a machine breathing for you. In addition, anesthetic medication is injected into the incision sites. After the procedure patients use a pump to personally control their own pain medication. Pain is generally very well controlled.
That decision is made once the surgery is under way. If it is accessible we will remove it, which happens in about 90 percent of cases.
The gallbladder is always removed during the DS procedure. In RNY operations, gallbladders are removed if significant gallbladder disease is present or observed during surgery. Patients whose gallbladders are not removed take medication for about six months to significantly reduce the chance of forming gallstones later.
We do not use drainage tubes (drains), nasal (NG) tubes or ventilators unless special circumstances require. Only patients with severe sleep apnea or other serious conditions (about 2%) recover in the ICU.
Patients who have DS or RNY will usually spend two nights in the hospital. Lap-Band and Lap Sleeve Gastrectomy both usually require just a one-night stay.
Patients go home on a liquid diet for three weeks. This includes protein drinks and pureed foods. After the first three weeks you can begin soft foods. We’ll give you plenty of education about this before and after surgery.
Your WellStar bariatric surgeons will want to see you regularly following your surgery (at 1 week, 1 month, 3 months, 6 months, 12 months and annually thereafter). We recommend a visit with your primary care physician soon after surgery and at 6-month intervals.
Vitamin deficiencies are the most common. These are typically corrected with supplements and/or enzymes. Bleeding, leaks and blood clots are more serious complications but occur very rarely. Over time some patients experience hernias or obstructions, but these are unusual as well.
Dumping occurs when rich, sugary foods move quickly through the stomach into the small intestine. Symptoms typically occur about a half hour after eating and can include nausea, diarrhea, sweating or fainting. Dumping is rare with the Duodenal Switch (DS), but may occur more often with the Roux-en-Y Gastric Bypass (RNY). Dietary adjustments usually solve the problem. Both the DS and RNY can reveal underlying lactose intolerance. Your doctor will discuss ways of managing this problem such as using milk substitutes, taking supplements, restricting dairy or choosing thicker dairy foods like yogurt over thinner choices like milk.
Very few of our patients (about one percent) experience this problem. Every patient who undergoes the Duodenal Switch has slightly reduced protein absorption capability and needs to focus on getting enough protein. In a very small percentage of patients surgery may have to be changed or reversed if the problem is not corrected. Early identification is essential, which is one reason for ongoing medical follow-up. A protein deficiency following one of the other bariatric operations typically results from failure to follow a proper post-surgery diet, rather than from an absorption problem.
Theoretically it is possible, but in reality few changes are necessary. To avoid possible absorption problems, we discourage extended-release medications in favor of other forms of the same medications delivered in multiple doses throughout the day.
Complication and morbidity rates are comparable. Duodenal Switch patients avoid some problems associated with Roux-en-Y, such as dumping (a metabolic reaction to rich, sugary foods) and marginal ulceration (gastric ulcers at the surgery site). DS patients have a greater chance (about one percent) of protein malnutrition, vitamin malabsorption, loose stools and foul-smelling gas. Weight loss with the DS averages 80-85% of a patient’s excess body weight and is better sustained long-term than with the RNY, which averages 70-75%. The DS carries a significantly lower risk of weight regain than the RNY in the years following surgery.
You can expect to be out of work for about two weeks to give the incisison sites time to heal. Depending on your job and how you are feeling you might need more time. This can only be decided once surgery is complete.
Not generally, but you will want to tell any doctor treating you that you have had bariatric surgery. Some patients wear a “Medic Alert” bracelet for this reason. If you have Roux-en-Y Gastric Bypass or Lap-Band and are injured in a motor vehicle accident, inserting an NG (nasogastric) tube can be dangerous and should not be attempted without radiologic guidance. This is another good reason for a “Medic Alert” bracelet.
You’ll be walking right away. We recommend working up to 20 minutes per day. After about two weeks you will be cleared to do other types of exercise with the goal to increase muscle mass, maintain energy levels and lose weight. We will provide you with a set of recommended exercises.
Sixty-four ounces a day, or around eight glasses, is a good goal. Avoid beverages with calories, carbonation, caffeine or high levels of citric acid. You can drink flavored waters that contain a small number of calories.
Yes, there are several around the area each month for those considering surgery and those who have had it. Call our office at (770) 919-7050 for details.