Why do I need a psychiatric evaluation before surgery?
There are two reasons. First, because your insurance company may require it. And second, because we need to assess how well you understand the surgery and its risks, and whether you have the ability to make a lifelong commitment to maintaining the benefits of the procedure.
How long does the surgery take?
It depends on your physical condition and the type of procedure you have. It can take anywhere from 50 minutes to three hours.
What kind of staples are used in the surgery?
They are made of stainless steel or titanium, and are so small they appear to be little more than a bright spot.
Will the staples set off metal detectors?
No.
What happens to the part of the stomach that’s bypassed?
In some procedures it is left in place with the blood supply intact; in others, it may shrink.
How big does the stomach pouch eventually get?
It varies. While the pouch typically starts at about an ounce, it can expand to anywhere from three to seven ounces.
Do men and women respond differently to the surgery?
Not significantly. Both respond well, though men tend to lose weight a little faster than women.
How old do I have to be to have weight-loss surgery?
The American Society for Bariatric Surgery and National Institutes of Health recommend patients should be at least 18, although some have been as young as 16. This is primarily because younger patients may not have matured physically to the point that their body can handle the procedure or emotionally to the point that they can make a decision this important.
Is there an age limit?
No, although for patients over 58, the surgical risks tend to increase while the benefits tend to decrease.
Can weight-loss surgery help me live longer?
Research shows that it can significantly reduce life-threatening conditions. If you have a serious obesity-related condition, are at least 100 pounds over your ideal body weight, and are willing to make the appropriate lifestyle and diet changes, weight-loss surgery does have the potential to help you live longer.
After Surgery
How long do I have to stay in the hospital?
Once again, it depends on the type of procedure. With laparoscopic surgery, you can expect to be in the hospital for one to three days; with other procedures, it may be three to five days.
When can I go back to work?
That depends on your general health, the type of surgery, and the progress of your recovery. Most patients are back on the job within four to six weeks, though for some it can be as little as seven to 10 days.
What kind of exercise regimen should I follow after surgery?
Exercise is an important part of your recovery. Typically, patients begin walking the day of their procedure – they walk a little more the next day, a little more the day after that, and so on. As you get stronger, you should aim to reach 20 minutes of aerobic exercise per day.
How long should I wait before getting pregnant?
We recommend that you wait at least 18 months after surgery. By then, your body should be strong and stable enough to carry a properly nourished fetus. However, we also recommend that you consult your doctor if you are planning a pregnancy.
Can I take medications?
At first, your doctor may recommend taking pills in liquid or crushed form. But after that, most pills and capsules should easily pass through the stomach pouch. It is also unlikely that your dosage will have to change.
Are there any limitations on the medicine I can take?
Diuretics and over-the-counter pain medicine should be avoided. The former causes your kidneys to lose potassium; most weight-loss patients already experience a reduction in potassium intake just because they’re eating less. The latter can cause ulcers in the small stomach and bowel.
Can I start smoking again?
We recommend strongly that you don’t. It increases the potential for lung problems after surgery, can stall the healing process, promotes infection and interferes with the blood flow to tissues that are healing.
When can I resume sexual activity?
It depends on how well and how fast your wound heals, and on your threshold of discomfort. Patients commonly experience a reduced desire for the first six weeks after surgery.
Should I worry about losing too much weight?
That may be a source of concern at first, when you’re losing 30 or 40 pounds per month. But don’t worry. The body’s natural processes will generally keep you from losing too much. Your weight will begin to stabilize as you gradually take in more calories and nutrients, and there will be a slow expansion in the size of the stomach pouch over time.
Will I have a problem with excess skin after surgery?
In some patients, the skin may not be able to snap back – especially among those who lose a truly large amount of weight. Although cosmetic surgery can help reduce the excess skin, insurance often does not cover the procedure unless you can demonstrate that the skin interferes with the body’s ability to function in a normal, healthy fashion.
Will I lose my hair after surgery?
Some patients experience either hair loss or thinning, typically in the first four to eight months after surgery. In most cases, though, it comes back naturally. You can help prevent hair loss by getting enough protein with meals, by taking a zinc supplement and by drinking sufficient fluids during the day.
How soon can I start driving again?
You should wait to start driving at least one week, and possibly two, after surgery. It depends on when you stop taking medications and when your ability to move and react quickly is restored.
Diet and Eating
When will my appetite start to return?
Usually, you won’t have much of an appetite for a month or two after surgery. But as long as you can take liquids, there’s no reason to believe your appetite won’t come back in time.
How long until I can eat solid foods?
Surgeons usually recommend at least four weeks. You’ll start with liquid foods, followed by semi-solid or pureed foods, then move to more solid foods. It’s really dependent upon how well you are healing.
Will I ever be “starving hungry” again?
Although your appetite will usually return within two months, it is unlikely you’ll experience that intense urge for food. In cases where you do feel hungrier than usual, it’s usually a function of what you’re eating – starches, for example. Also, you should avoid drinking water when you eat; it washes food out of the pouch.
How much water should I drink?
You should drink two to three quarts per day, and drink it slowly, in small mouthfuls.
Why do I have to drink so much?
As you lose weight, waste products can accumulate. Some of these materials form crystals, which in turn can cause kidney stones. Drinking a lot of water helps you get rid of these substances and promotes healthier weight loss. It also helps fill you up, and thus reduces the urge to eat between meals.
How much protein do I need?
About 40 to 65 grams daily. But since how much you need can depend on the kind of surgery you had, it’s best to ask your doctor for a recommended level.
What are the best sources of protein?
Chicken, turkey, fish, tofu and low-fat cheese and cottage cheese are just some of the protein-rich foods you can enjoy.
Can I have milk products?
It is probably best to avoid them. Milk has lactose – milk sugar – that passes undigested until it reaches the lower bowel. Bacteria then acts upon it, causing cramps, gas and diarrhea.
Can I eat red meat after surgery?
You can, but we recommend waiting several months – and even then, you should be careful. Red meat contains a lot of gristle that holds it together; this, in turn, can keep you from chewing it into the small bits necessary for digestion. So it can end up clogging the outlet of your stomach pouch and prevent food from passing through.
Do I have to cut back on salt?
Not unless your doctor tells you to watch your intake.
Can I still eat spicy foods?
Yes, but wait at least six months after your surgery.
Can I drink alcohol?
We recommend waiting a year. Then, with your doctor’s approval, you can enjoy a glass of wine or a small cocktail. But be careful – even the smallest amounts of alcohol will affect you quickly.
Will I need nutritional supplements like vitamins?
Yes. You’ll probably have to take a daily multivitamin for the rest of your life. B12 injections are sometimes required monthly for the first year, and then once every six months (you can also take them orally or under the tongue). And your surgeon may recommend other supplements such as calcium, iron and female hormone replacements.
Risks and Complications
What are some potential complications of weight-loss surgery?
They include gallstones, liver problems, hernia, staples in the stomach pouch that pull loose, leakage, blocked bowel and other risks typically associated with any surgery.
What is the “dumping syndrome”?
It is a rare condition faced by some weight-loss patients that occurs when the contents of the stomach are “dumped” too quickly into the small intestine. It is caused by eating sugars or foods that contain many small particles, which the body dilutes by drawing excess fluid from your bloodstream into your intestine. This can produce cramping and diarrhea that may last up to an hour; often, the only way to ease the discomfort is to lie down. It can also reduce blood pressure because of the rapid increase in blood sugar that causes your body to release too much insulin.
How can I avoid this condition?
To begin with, don’t eat the foods that trigger it – especially sweets. Also, eat several small meals a day that are low in carbohydrates and drink liquids between meals rather than with meals.
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