Weight loss surgery is a major decision, and you will have questions. Here are several of the most common ones. As always, please check with your healthcare provider to determine their practices, guidelines and what they recommend for you. If your questions are not answered below, call 513 862 4957 or email us.
What weight loss surgeries are offered at Good Samaritan Hospital?
The majority of weight loss surgeries performed at Good Samaritan Hospital are Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy. These are performed using a laparoscopic approach. We also offer laparoscopic adjustable gastric banding.
Who will perform my weight loss surgery?
Drs. George Kerlakian and Kevin Tymitz perform the weight loss surgeries at Good Samaritan Hospital. Roux-en-Y Gastric Bypass Surgery has been performed at Good Samaritan Hospital since 2001, Sleeve Gastrectomy since 2008, and Laparoscopic Adjustable Gastric Banding since 2006.
Who else will take part in my care delivery?
A multidisciplinary team of TriHealth-employed dietitians, exercise physiologists, mental health providers and nursing caregivers help our patients achieve a complete lifestyle change. View a complete list.
Why is it significant that TriHealth Weight Management has been recognized as a Bariatric Surgery Center of Excellence by the American Society for Bariatric Surgery?
As a Center of Excellence, we are formally recognized for high-quality care in weight loss surgery. We are certified for excellence by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).
Paying for Surgery
Does insurance cover weight loss surgery?
We accept most insurance plans, and as an accredited Bariatric Surgery Center of Excellence, we are a provider for Medicare patients seeking bariatric surgery. Out-of-pocket payment arrangements can be made for patients whose insurance companies list bariatric surgery as an exclusion.
Why does it take so long to get insurance approval?
After your consultation is completed, it usually takes your doctor one to two days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about three to four weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.
What can I do to help the insurance process?
First be sure you have bariatric surgery benefits. Call your health insurance and verify that you have bariatric surgery benefits. After you consultation appointment we will also call your health insurance to verify your benefits and any additional criteria required for your surgery to be approved.
You will need to gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable.
What if my insurance carrier denies approval?
If your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.
Preparing for Surgery
If I want to undergo weight loss surgery, how long do I have to wait?
New evaluation appointments can usually be booked within a couple of weeks. The program requirements for weight loss surgery will vary among insurance providers and this will determine how long it will be before your surgery is approved.
What can I do before to speed up the process of getting ready for surgery?
There are several things you can do to speed up the process:
- Make a list of all the diets you have tried (a diet history) and bring it to your appointment.
- Bring any pertinent medical data to your appointment with the surgeon.
- Bring a list of your medications with dose and schedule.
- If you smoke, you will need to stop smoking. Surgical patients who use tobacco products are at a higher risk for complications after surgery.
What are the routine tests before surgery?
Certain basic tests are done prior to surgery, including:
- Complete Blood Count (CBC)
- Chemistry Panel, which gives a readout of about 20 blood chemistry values
- Additional testing includes vitamin and mineral levels
- Lipid panel
- Hemoglobin A1C
Other tests may be done if necessary:
- Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or additional psychiatric evaluation, may be requested when needed.
What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.
What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if there are problems that are related to the patient’s weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending bariatric surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average.
Will I be asked to stop smoking?
Patients are highly encouraged to stop smoking at least one month before surgery.
Will I have a lot of pain?
You may have some discomfort after your surgery. A number of medications will be administered to make you as comfortable as possible after your procedure. This will make it possible for you to get out of bed and start moving as soon as possible.
Will the doctor leave a drain in after surgery?
Normally there is no drain inserted during surgery. Patients having revisional bariatric surgery may possibly have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed one week after the surgery. Generally, it produces no more than minor discomfort.
If I have surgery, what can I expect when I wake up in the recovery room?
Some doctors will provide a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. Others prefer to use an infusion pump that provides a local anesthetic in the surgical site to control pain without the side effects of narcotics. As with any major surgery, you are in danger of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than one percent. Your doctors will have assessed you for risks and prepared accordingly. All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.
How soon will I be able to walk?
You will be up in a chair when you arrive on the nursing unit and walking the hallway at least one time the evening of surgery. The day after your surgery you will need to walk the hall five times a day. Upon leaving the hospital, you should be able to care for all your personal needs, but will need help with shopping, lifting, and transportation.
How long do I have to stay in the hospital?
The expected hospital stay (including the day of surgery) can be one to two days for a laparoscopic gastric bypass or sleeve gastrectomy. Laparoscopic adjustable gastric band is an outpatient procedure.
How soon can I drive?
For your own safety, you should not drive until you have stopped taking pain medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes seven to 14 days after surgery.
Life after Surgery
What happens to the lower part of the stomach that is bypassed (gastric bypass)?
In some surgical procedures, the stomach is left in place with intact blood supply. The lower stomach still contributes to the function of the intestines even though it does not receive or process food.
What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.
Will I be miserably hungry after weight loss surgery since I’m not eating much?
Most patients say no. In fact, for the first four to six weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous “eat everything in the cupboard” type of hunger.
What if I’m not hungry after surgery?
It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.
How long will I be off of solid foods after surgery?
Most surgeons recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred. Your dietitian and surgeon will provide you with specific dietary guidelines for the best post-surgical outcome.
Is there a problem with consuming milk products?
Milk contains lactose (milk sugar), which is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea.
Can I eat red meat after surgery?
We recommend that you should avoid red meat for the first several months. Red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.
Will I be allowed to drink alcohol?
It is suggested that you drink no alcohol for the first six months. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail. You will find that even small amounts of alcohol will affect you quickly.
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach. Initially, your doctor may suggest that medications be taken in liquid form or crushed.
Will I have to change my medications?
Your primary care doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For medications that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) . NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
Will I need to take vitamins after gastric bypass surgery?
Most surgeons and dietitians recommend a daily multivitamin, calcium, and vitamin B12 for the rest of your life. B12 injections are sometimes suggested once a month for the first year and every six months thereafter. B12 may also be taken orally, nasally, or sublingually (under the tongue) by most patients. The dietician will provide specific guidelines on necessary vitamin supplementation.
Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about six weeks.
Can I take birth control following gastric bypass surgery?
Sexually active women should use more than one method of contraception for at least 18 months after surgery. Due to malabsorption with gastric bypass, hormonal methods of contraception such as birth control pills or injections may be less effective. A barrier method such as condoms (male or female), diaphragms and spermacides should be used in conjunction with a hormonal contraceptive. Unplanned pregnancy during the first 18 months post surgery carries high risk. To determine the best methods of birth control for you, schedule a consultation with your Obstetrician/Gynecologist.
Is there a difference in the outcome of surgery between men and women?
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Will I have excess skin after surgery?
Many people who meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can “snap back.” Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.
Will I lose hair after surgery? How can I prevent it?
Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc supplement and a good daily volume of fluid intake. Most patients experience natural hair re-growth after the initial period of loss.