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1. How do I get started? At St. Alexius NewStart we believe that education is crucial to a patient making their decision regarding bariatric surgery. We offer several free seminars each month and attendance is a requirement of the program prior to surgery. Please click here for the current seminar calendar. 2. Who is a candidate for bariatric surgery? Generally a person is considered a candidate for bariatric surgery if they have a BMI (body mass index) of 40kg/m2 or between 35-40 kg/m2 with a serious co-morbidity such as diabetes, hypertension or sleep apnea. Candidates must also have attempted other weight loss programs, understand the benefits and risks of bariatric surgery and be committed to making the necessary lifestyle changes. 3. Who is not a candidate for surgery? There is increasing research to indicate that bariatric surgery may be beneficial in some patients with a BMI of less than 35 kgm2. At this time our surgeons follow the NIH guidelines of a BMI of 35-40 with a serious co-morbidity or a BMI of 40 or above. There may be additional medical or surgical conditions which may contraindicate surgery. Some of those contraindications are as follows:
We will be happy to review your individual medical and surgical history to determine candidacy. 4. What are the risks of bariatric surgery? There are risks and complications, including death, associated with all major surgical procedures with severe obesity increasing the risks. It is of the utmost importance that you and your physician exchange information and discuss the benefits, alternatives and all the possible risks of obesity surgery to allow for an informed decision. Long-term weight loss varies for each patient and will depend upon diet and exercise. Patients need to recognize and understand that there is, and cannot be, any guarantee of an expected outcome. Patients who choose our program will learn more about the procedures, surgeons and understand that there is a caring qualified staff ready to assist in their weight loss. 5. Can I do anything to decrease my surgical risks? Pre-operative weight loss will help to shrink your liver and may make the surgery easier for the surgeon. Please feel free to contact a New Start dietitian or your primary care physician about a weight loss program prior to surgery. Exercise prior to surgery may also improve your cardiovascular and pulmonary status. Please discuss any exercise program with your physician prior to beginning. If you are a cigarette smoker, you will be asked to quit prior to surgery. Cigarette smoking increases your risk of post-operative complications such as blood clots and pneumonia. Cigarette smoking also decreases your ability to heal and increases the risk of an ulcer. Please consult with your physician regarding your medical stability for surgery. Optimal control of conditions such as diabetes or hypertension may decrease your surgical risks. 6. Why do I have to be on a diet prior to surgery? Studies have shown that pre-operative weight loss helps to shrink the liver. The liver is where our bodies store fat. Because the liver is in close proximity to the stomach, shrinkage of the liver makes it easier for your bariatric surgeon to perform the surgery. Your bariatric surgeon, dietitian, and nurse will be discussing the type and length of diet with you prior to surgery. 7. Will my health improve after bariatric surgery? A study By Dr. Walter Poires published in the Annals of Surgery in 1992 showed remission in diabetes following gastric bypass surgery. Another study published in 2004 in The Journal of the American Medical Association showed a 76.8% remission rate and improvement in 86 % of patients with Type 2 diabetes. A recent study published in the Journal of American Medical Association showed a 73% remission of Type 2 diabetes in patients who had Laparoscopic Adjustable Gastric Banding versus a 13% remission rate for patients who had medical management only. (JAMA 2008:299 (3):316-323) Following bariatric surgery patients may also see resolution or improvement in conditions such as hypertension, high cholesterol, sleep apnea, infertility, joint disease, and asthma. 8. Will I need to take vitamin supplements after surgery? The St. Alexius NewStart dietitian and your surgeon will discuss supplementation after surgery. All patients who have had bariatric surgery should take a daily multivitamin. Depending on the type of bariatric surgery and your individual medical circumstances you may also need to take Vitamin B12, thiamine, and/or calcium. 9. How long will I be in the hospital? All of our patients are admitted on the day of surgery. Laparoscopic Adjustable Gastric Band patients will generally be discharged after an overnight stay. The Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy patients will generally spend 2 nights in the hospital. 10. Will there be follow-up expected of me? Yes, absolutely! Follow-up with the surgeon generally occurs at approximately 1 week after bariatric surgery. For patients who have Roux-en-Y Gastric Bypass or the Sleeve Gastrectomy are seen again at 1 month, 3 months, 6 months, and 1 year following surgery and then annually. Patients who have had Laparoscopic Adjustable Gastric Banding are scheduled for their first adjustment at 4-6 weeks after surgery and then scheduled to come back at regular intervals to evaluate if further adjustment is needed. Your bariatric surgeon will want to know immediately if you are experiencing any problems. The St. Alexius New Start program also provides additional support and follow-up to help you in your weight loss. You will be able to talk with a dietitian at your visits with the surgeon, at a scheduled consultation or via phone. The dietitians also facilitate Nutritional Lifestyle Management Classes as you progress through milestones (3 months, 6 months and annually) in your weight loss journey. We also provide several support groups for psychological and emotional support and strongly encourage attendance. Click here to view support group schedule. 11. How soon will I be able to return to work? All patients are seen approximately one week after surgery. At this point you and your surgeon will decide when it is suitable for you to return to work. Generally, the Laparoscopic Adjustable Gastric Band patients can return to work 1 week after surgery and the Laparoscopic Roux-en-Y Gastric Bypass patients and the Sleeve Gsstrectomy patients can return to work in 2 weeks. Your bariatric surgeon will discuss your particular work situation with you. 12. How much weight loss can I expect? After Laparoscopic Roux-en-Y Gastric Bypass (RYGB) the expected weight loss is about 70% of excess body weight. Most patients will lose most of their excess weight in the first year and then gradually plateau. Some patients may experience approximately a 20% weight regain but usually maintain 60-70% loss of excess body weight long term. After Laparoscopic Adjustable Gastric Banding (LAGB) the expected weight loss is 30-50% of excess weight. With a gastric banding procedure it is imperative that patients follow-up for band adjustments. The expected weight loss following a Laparoscopic Sleeve Gastrectomy is generally 50-60% of excess body weight. Long-term studies are not yet available so late weight regain is a possibility and may require conversion to another bariatric procedure. Please remember that bariatric surgery is only a tool. The patient in conjunction with their surgeon and the bariatric program support must learn to utilize that tool effectively by making the necessary lifestyle changes such as following nutrition guidelines and an exercise program. 13. What do I do about excess skin? Following any significant weight loss you may experience excess skin in areas such as the abdomen, arms and thighs. For some patients this excess skin may be bothersome from a cosmetic standpoint or may lead to such things as chronic skin rashes and irritation. Should you decide that you would like to consider plastic surgery, it is recommended that you consult a plastic surgeon to determine the type of procedure needed and for any medical necessity for the procedure. 15. Can I get pregnant after bariatric surgery? Patients should not get pregnant for the first 12-18 months following bariatric surgery when the most rapid weight loss is occurring. Weight loss can improve fertility issues so birth control is strongly advised. If you become pregnant it is important to have communication between your bariatric surgeon and your obstetrician regarding prenatal care. 15. How much does the surgery cost? If you have health insurance that covers bariatric surgery, the cost will vary depending on your insurance plan. St. Alexius NewStart will be happy to verify your insurance benefits for coverage and financial information such as deductibles and co-pays. However, as the subscriber you are ultimately responsible for your benefits. If your insurance does not cover bariatric surgery and wish to pay for surgery, the costs for each of the procedures is as follows and includes the surgeon fees, anesthesiologist fees, and hospital fees. There will be some additional fees that can vary on an individual basis. We will be happy to discuss those with you via phone or e-mail.
St. Alexius NewStart provides all of your pre-operative and post-operative education, dietitians' services and support groups at no additional charge to you or your insurance company. The New Start program representatives or financial counselor will be able to refer you to some financial institutions to discuss other financing options.
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