Bariatric Surgery FAQs

• What is obesity?
• What are the co-morbidities?
• What are the surgical procedures for obesity offered at Mercy?
• Are there complications to obesity surgery?
• How can you help make your surgery a success?

What is Obesity?

Obesity is complex, medical disease, which affects more than 4 million people in the United States and the number is increasing. It is not a moral problem due to a lack of will power. Studies have shown that conventional weight loss measures i.e. diets, medications, behavioral modification and exercises programs have a 95% failure rate. Obesity occurs due to many contributing factors such as heredity, cultural, environmental, socioeconomic and physiological. Morbid obesity is defined as:

1. 100 # above ideal body weight.
2. Body mass index (BMI), (Wt in Kg/ Ht. in m2) of 40 or more.
3. Those with a BMI of 35 – 40 and several co-morbidities.

What are the Co-morbidities?

1. Diabetes (Sugar)
2. Hypertension (High blood pressure)
3. Sleep apnea
4. Degenerative joint disease (DJD)
5. Venous stasis disease
6. Infertility, loss of menstrual periods with masculinization
7. Shortness of breath with exercise
8. High cholesterol, lipid and triglyceride levels
9. Gastro esophageal reflux disease (GERD)
10. Incontinence of urine or stool
11. Increased risk of cancer
12. Joint or back problems
13. Enlarged Liver (abnormal liver test)
14. Arthritis
15. Blood clots
16. Cardiovascular disease
17. Depression and other psychological issues

What are the Surgical Procedures for Obesity Offered at Mercy?

All the procedures are done by the minimally invasive approach known as laparoscopic. We offer different procedures because each patient is individual and the level of assistance and/or medical problems are unique to the individual. We encourage you to learn about all procedures, reflect on your personal needs, and speak with your surgeon in order to determine which procedure would be most beneficial for you. Please remember that no procedure is a cure, but a tool.

All procedures require your commitment to a lifelong change in eating habits, exercise, support group attendance and at least a five year follow up plan.

Adjustable Lap-Band

This procedure is purely restrictive in which a band is placed around the upper most part of the stomach. This band divides the stomach into two portions, one small and one larger portion. The food is regulated by the small opening so that the patient feels full faster thus eating less calories. The anatomy is not changed and digestion and absorption occurs naturally. If necessary this band can be adjusted in order to make the opening between the two stomach portions smaller or larger.

Roux-en-Y Gastric By-pass

Currently known as the gold standard in the medical field. This procedure works by restricting the stomach size by creating a small pouch, by malabsorption via by-passing a portion if the small intestine, and by producing the dumping syndrome when sugar, high fat or greasy foods are consumed.

Gastric Sleeve

This procedure was the first step in the biliopancreatic diversion, duodenal switch and the by-pass. Research is beginning to show that the second portions of those surgeries were not needed because the patients lost their weight and became healthy. The stomach size is surgically decreased by 2/3. Can be either a two step (BMI > 60 or severe medical complications) or as a single procedure.

Are there complications to obesity surgery?

Yes, as with any surgery there are potential risks and complications. The more obese the patient the higher risk of complication. The immediate risks are leaks, infection, pneumonia, blood clots of the legs or lungs, and rarely death. Long term risk for all procedures may be weight regain if diet changes and increased exercise are not maintained.

How can you help make your surgery a success?

Please remember these surgeries help you help yourself and the ultimate success is up to you. Start following these rules even before your surgery.

1. NO sweets
2. NO high calorie liquids i.e. milkshakes, soda, beer
3. NO fatty junk food i.e. chips, crackers, popcorn
4. NO fried foods
5. Exercise by walking a minimum of 1 hour per day
6. Stop smoking
7. Attend information session, classes, and support groups.

Bariatric Surgery Requirements

Please note that each case is individual and the surgeons may add or delete some tests or consultations. However, all results of tests and reports must be received prior to submission to your insurance company for approval.

1. Medical necessity letter from your medical doctor.
2. Psychological evaluation
3. Medically supervised diet history
4. Blood work
5. Chest x-ray – radiology test that looks at your heart and lungs
6. EKG – demonstrates the electrical activity of your heart
7. Certificate of attendance for information session.
8. Sleep test – this determines if you stop breathing during sleep.

Some patients may also need:

1. Cardiology consult
2. Pulmonary consult
3. Endocrinology consult
4. Cardiac echo – sing sound waves to look at your heart and measures its function. We can also see your pulmonary artery pressure.
5. Stress Echo – using exercise or medication to increase your heart rate and see how your heart performs.
6. Pulmonary function tests – measures your breathing to evaluate your lung function.

Plus any other test deemed necessary by your surgeon.