Bariatric (Weight Loss) Surgery FAQs : Top Frequently Asked Questions

1.  Am I eligible for bariatric surgery?

The following are some general criteria for being a candidate for bariatric surgery:

• Body Mass Index (BMI): Bariatric surgery is available to those with a body mass index of 35 kg/m2 or above and a weight-related condition (diabetes, sleep apnea, high blood pressure) of 40 kg/m2 or higher.
• Health issues related to obesity: If treatment for problems like type 2 diabetes, hypertension, sleep apnea, or excruciating joint pain has not been successful, bariatric surgery may be suggested.
• Previous attempts at weight loss: Patients undergoing bariatric surgery frequently have a history of making unsuccessful attempts at weight loss by diet, exercise, or other medical procedures.
• Age and general health: When deciding who is eligible for bariatric surgery, age, and general health are also taken into account. Candidates should generally be in generally good health and between the ages of 18 and 65.

2. Do you have to lose weight before the surgery?

Yes, some individuals need to lose weight before undergoing the procedure, and can offer several advantages such as:

• It might help in belly reduction, which will facilitate an easier surgical procedure.
• It also reduces the possibility of complications developing during and after surgery.
• Patients who lose weight are likely to heal from surgical procedures more rapidly and have better long-term results.
• Lastly, patients who reduce weight before surgery have a higher chance of maintaining their weight loss over time.

If you are advised to lose weight before the procedure, you will start reducing weight and altering your diet through consultation with a dietician around three months before surgery. Depending on your weight, it might only be advised that you need to shed 5–10 pounds, or if you’re obese, you might need to shed up to 10% of your body weight.

3. What are the types of bariatric surgery?

The following are the types of bariatric surgery:

• Roux-en-Y Gastric Bypass Surgery: This is the gastric bypass approach that is most commonly used. This procedure is reversible but reversal can be risky. It works by limiting the quantity of food you can consume in one sitting hence, lowering the amount of fat and calories that are absorbed.
• Sleeve Gastrectomy: Approximately 80% of the stomach is removed during this procedure, leaving only a long, tube-like pouch. There is less space in this smaller stomach for meals. Additionally, it results in the reduction of the hormone ghrelin, which controls hunger and may decrease the urge to eat.
• Duodenal Switch Paired with Biliopancreatic Diversion (BPD/DS): Usually, this two-part procedure is carried out in a single setting. Performing a sleeve gastrectomy is the initial stage. In the second stage, the surgeon cuts the middle portion of the intestine and joins the final segment directly to the duodenum (the first segment of the small intestine).
• Sleeve Gastrectomy Combined with Single-Anastomosis Duodenal-Ileal Bypass (SADI-S): The SADI-S surgery consists of two phases, similar to BPD/DS, with sleeve gastrectomy being the first step. A part of the small intestine called the duodenum is directly attached below the new stomach sleeve in the second stage of the SADI-S surgery.

4. What tests do I need to go through before the surgery?

The procedures that you choose and the extent of your medical conditions will determine what has to be done before surgery:

• Get some blood collected for basic tests took check for organ functioning, hormone levels, vitamin levels, etc.
• Get an EKG (a basic cardiac test).
• To detect the presence of the bacteria H. pylori, which can lead to stomach ulcers, have a breath test.
• Patients who wish to undergo a sleeve gastrectomy must undergo an upper endoscopy to ensure that the procedure is suitable and essential.
• Reflux or heartburn can be a drawback in this procedure, so it should be taken into consideration.

You might be asked to undertake a pH probe or esophageal manometry, depending on your symptoms. Your esophageal muscles, which help in moving food down your throat and into your stomach, are examined during a manometry.

5. How long does the surgery take?

Performing a sleeve gastrectomy or gastric band takes approximately one to one and a half hours. 2-4 hours are required for the gastric bypass and 4-6 hours for the duodenum switch.

6. How long is the recovery period?

The healing phase for the incisions usually lasts for two to three weeks, while the healing period for the stomach staple line is six to eight weeks. Most people are comfortable while recovering and can resume a regular workout routine after a month. You should be able to restart your usual routine and feel less exhausted in a few weeks. Your stomach will still be healing, though.

7. How do I manage pain after the surgery?

The location of the incision or how your body was positioned during the procedure may cause you to experience pain. In addition, some patients report having pain in their neck and shoulders as a result of their body reabsorbing the surgical gas. If your discomfort keeps you from moving, let the care team know for solutions such as:

• Preoperative Counseling: Before bariatric surgery, patients are frequently given guidance on what to expect from their pain management team. This includes details about the type and duration of pain following surgery, as well as pain management techniques.
• Local Anesthesia: Pain management during and after surgery can be achieved through local anesthesia or epidural anesthesia. These approaches can lessen postoperative pain and reduce the need for systemic opioids.
• Non-Opioid Analgesics: To treat mild to moderate postoperative pain, non-opioid analgesics and nonsteroidal anti-inflammatory medicines (NSAIDs) may be used.
• Opioid Analgesics: After bariatric surgery, opioid analgesics are sometimes needed to treat severe postoperative pain.
• Patient-Controlled Analgesia (PCA): Within safe limits, patients can self-administer prescribed amounts of painkillers.
• To minimize the need for large dosages of opioids and provide more effective pain relief, multimodal analgesia involves using medicines with multiple modes of action.
• Early Ambulation and Mobilization: Following bariatric surgery, early ambulation, and mobilization are advised to assist lower the risk of problems such as deep vein thrombosis (DVT) and pneumonia, as well as to speed up recovery and enhance general health.

8. Are there any risks and benefits involved in the surgery?

Bariatric surgery poses some risks such as:

• Infection
• Bleeding and Blood clots
• Gallstones
• Adverse reactions to anesthesia
• Bowel obstruction
• Leaks from the surgical site
• Nutritional Deficiencies: Following bariatric surgery, patients may not get enough iron, vitamin B12, calcium, or vitamin D.
• Dumping Syndrome: After consuming specific foods, especially those heavy in sugar or fat, some people may develop dumping syndrome (a condition marked by rapid gastric emptying). This condition can induce symptoms like nausea, vomiting, diarrhea, weakness, and vertigo.
  Changes in bowel habits
  Psychological changes

Benefits:

• Significant weight loss
• Improved health condition
• Quality of life gets enhanced
• Results that last long
• Reduction in mortality

9. What is a leak?

When there is a hole in the gastrointestinal tract, usually near the location of the surgical treatment, it is referred to as a “leak”. Bariatric procedures include reshaping the digestive tract to facilitate weight loss, such as by cutting the small intestine or forming a smaller stomach pouch. Leaks can happen during or after surgery because of the complexity of these operations.

Surgical technique, fragility of the tissue, insufficient blood flow to the tissues, and postoperative complications including infection or erosion are some of the factors that might cause leaks.

If leaks are not identified and treated, they may cause fatal consequences such as sepsis, infection, abscess formation, peritonitis, and inflammation of the stomach lining. Fever, elevated heart rate, bloating, abdominal pain, nausea, vomiting, dysphagia, and difficulty breathing are some signs of a leak.

10. How much weight can I expect to lose?

This procedure generally enables patients to lose a significant amount of weight in the first year, typically between 60% and 80% of their excess body weight. Usually, the initial decrease in weight is followed by gradual weight loss during the following years. Comparable weight reduction results can be obtained with gastric sleeve surgery, another popular choice; patients typically lose 50% to 70% of their extra weight in the first year after surgery.

11. Will I regain the weight that I lost after the surgery?

Large residual stomach (pouch) size, progressive rise in residual stomach volume, increased consumption of sugars and portion sizes, emotional eating, and binge eating are some of the possible reasons for weight rebound or insufficient weight loss.

12. Will I be able to return to my regular diet after bariatric surgery?

To avoid postoperative complications such as vomiting, dehydration, and larger food getting lodged in the gastrointestinal tract, a patient must start eating a complete liquid diet as soon as possible after surgery and continue it until their first postoperative appointment. Patients must always consume tiny sips of sugar-free fluids. Water, skim milk, low-sodium clear broths, strained cream soups, protein shakes, sugar-free drink mixes, and decaf teas and coffee are all appropriate components of a liquid diet.

13. What are the best vitamins to take after bariatric surgery?

Bariatric supplementation is advised by doctors for individuals undergoing bariatric surgery to guarantee enough nutrition after the procedure. These additional components could consist of:

• Gastric Bypass: Doctors advise patients undergoing the surgery to take a comprehensive multivitamin, calcium supplemented with vitamin D, iron, vitamin C, vitamin D, and vitamin B12.
• Gastric Sleeve: Patients undergoing gastric sleeve surgery would be required to take iron, and calcium supplemented with vitamin D, vitamin B12, and vitamin C. It can be suggested to try others.
• Gastric Band Surgery: Patients undergoing gastric band surgery are usually advised to take a complete multivitamin and calcium along with vitamin D. It can also be suggested to try others.

When you eat less food, these vitamins help you meet your nutritional demands.

14. How does bariatric surgery reverse diabetes?

By altering your digestive tract (stomach and sometimes the small intestine), bariatric procedures limit the amount of calories you can consume and absorb. Additionally, they may reduce the signals of hunger that reach your brain from your digestive system. Numerous obesity-related metabolic conditions, such as diabetes and fatty liver disease, can be treated and prevented with the help of these methods.

The following bariatric surgeries have been effective in successfully changing metabolism and either improving or reversing Type 2 diabetes:

• Gastric Bypass Surgery: The stomach is divided into two chambers. The larger chamber is bypassed and cannot let in food, whereas the little chamber is directly attached to the small intestine. Rerouting the intestines affects the metabolization of insulin, which has a major impact on diabetes unrelated to weight loss.
• Sleeve Gastrectomy: Laparoscopic technique in which the digestive tract is not rerouted, but 80–90% of the stomach is removed and the remaining portion is shaped like a sleeve. This restricts food intake and lessens hunger.

15. Can you have bariatric surgery after a heart attack?

The severity of the heart attack, the patient’s general health, and the guidance of their medical team are some of the factors that determine whether or not a patient can undergo bariatric surgery after having one.

• Stability of Heart Condition: The healthcare team prioritizes stabilizing the heart condition before surgery.
• Heart Attack History: Before bariatric surgery, patients with a history of heart attacks would probably have a complete cardiac evaluation to determine their risk of future cardiac events.
• Medical Clearance: A multidisciplinary team of healthcare professionals, including cardiologists, surgeons, and anesthesiologists, will provide their approval before bariatric surgery following a heart attack.
• Customized Approach: Since each case is different, the decision to proceed with bariatric surgery following a heart attack will be determined by the patient’s age, complications, lifestyle, and objectives for both weight loss and general health improvement.
• Lowering Risk: If bariatric surgery is decided to be necessary, measures to reduce the possibility of cardiac issues developing during the procedure may be undertaken. These measures might involve the use of less invasive surgical methods or the improvement of perioperative care to ensure proper cardiac monitoring and assistance.