MOST FREQUENT QUESTIONS ABOUT OBESITY SURGERY

1. A surgery that will change your life.
2. What are the preoperational arrangements?
3. Is the anesthesia dangerous?
4. Will I be in pain when waking up from the anesthesia? What about after a few hours or days?
5. Will I need monitoring in the ICU after the surgery?
6. Does the surgery require a long hospital stay?
7. When will I recover from the surgery? When will I go back to my active life?
8. When will I be able to start physical exercise after the surgery?
9. What and how will I be able to eat after the surgery?
10. Will I need to take any vitamins after the surgery?
11. What is the expected weight loss? In what timeframe?
12. Is the weight loss permanent? What is the risk of regaining the lost weight?
13. How does the surgery impact my lifestyle and my personal and social life?
14. Will I need plastic surgery after the weight loss?
15. Procedure selection and expected results?

• Surgical treatment is the only proven method of achieving long term weight control for the obese.
  
  
• Obesity is a complex multi-factorial disease with an important genetic factor.
  
  
• YOUR OBESITY (BMI > 35) CANNOT BE CONTROLLED WITH A LIFETIME DIET. Patient’s friends and family are always reinforcing the need for discipline, thus the patient blames him/herself for not being able to keep the discipline overtime. These factors create a loss in self esteem that can impact the patient’s social, work and family life.
  
  
• YOU SHOULD NOT BLAME YOURSELF FOR BEING OBESE.
  
  
• In your case, surgery is the only proven method of achieving long term weight control.
  
  
• After going through obesity surgery you will be able to control your food intake and still feel full.
  
  
• Usually you will lose weight quickly and easily.
  
  
• You will not feel like the weight lost can be regained.
  
  
• Your self-esteem will increase
  
  
• You will change all aspects of your life: personal, family, work…

From the first consultation with the surgeon, there are simple steps to follow:

• Consultation with the Nutritionist-Dietitian:

• Evaluates the patient’s dietary habits.
• Presents the preoperational diet to the patient (more details to follow)
• Presents the post operational diet for the next 6 weeks (hard copies available)
  
  
• Consultation with the Psychologist:
• Evaluates the patient’s psychological profile.
• The patient takes obesity-related psychometric tests.
  
  
• Preoperational evaluation:
• The items analyzed vary according to the procedure to be performed and to the patient’s current condition.
• Except for the bypass gastroscopy (for which the patient can request anesthetic sedation), the procedures performed do not have bothersome symptoms or side effects.
  
  
•  Preoperational diet:
• The patient will start a simple diet between 5 and 15 days long prior to the operation.
• The diet includes 3 pouches of Optifast / day (containing the necessary amounts of proteins, vitamins), herbal teas, sugar-free juice and one or two pieces of fruit. Additionally the patient must take an hour long walk every day.
• The goal is to attain a small weight loss in order to reduce the size of the liver and loosen up the abdomen.  This is essential to establish optimal conditions prior to the procedure.
  
  
• Evaluation by the anesthesiologist.
  
  
• Last evaluation by Dr. Jose Vte. Ferrer.

• With all the necessary expert resources, the anesthesia of the obese patient is very safe. Anesthetic complications are very rare and in most cases they can be corrected.
  
  
• The team of anesthesiologists from  Clínica Obésitas has:
• An extensive accumulated experience in morbid obesity without any major complications.
• A detailed and methodical set of protocols that are reviewed and improved on an ongoing basis.
• Excellent anesthesia machines including fibroscopies, used in complex intubations.

• The patient wakes up from the anesthesia progressively and comfortably, without nausea or significant pain.
  
  
• We take steps to prevent post operational pain and have excellent results.
  
  
• A few hours after the surgery the post operational pain is minimal. We recommend patients stand and take slow steps around the room 3 to 5 hours after the surgery.  Mobility shortly after the procedure is crucial to prevent potential problems such as venous thrombosis.

• Since our anesthesia care carefully considers individual circumstances,  ICU monitoring is not necessary.
  
  
• We use the ICU in cases where the patient’s condition requires it.(giving prior notice to the patient)

• Laparoscopic surgery minimizes postoperative pain and speeds up recovery times.
  
  
• The patient is allowed to have a liquid diet 24 hours after the surgery (after a quick and painless radiology test). The patient can also take a walk around the hospital. In the case of Gastric Banding surgery, the patient has a liquid intake 3 hours after and goes home the very next day).
  
  
• The last night of any hospital stay the patient has no tubes which eases mobility and facilitates a good night sleep
  
  
• During hospital stays the patient wears a drainage which most frequently is removed before the patient goes home.
  
  
• Laparoscopy incisions are very small, painless and HAVE INTERNAL DISSOLVABLE SUTURES THAT DO NOT NEED TO BE REMOVED.

(See table below)

• Recovery time is short. When the patient goes back home he/she must take walks in the morning and afternoon.

Recovery time and hospital stay table:

Surgery type	Average hospital stay	Time to go back to work without intense physical  effort
AGB	Less than 24 hours	4-5 days
Gastric tube	2-3 days	7-8 days
Gastric Bypass	3-4 days	7-8 days

• Intense physical effort (lifting over 20 Kg.) is not recommended until 6 weeks after the procedure.

• After hospital release we recommend physical exercise suitable for every patient, age and obesity degree.
  
  
• After 4 weeks from surgery progressive moderate physical exercise is allowed (including swimming).
  
  
• Competitive exercising should also be postponed for 6 weeks.

• The 3 types of obesity treatment procedures we perform require a modified diet after surgery. Starting with a liquid diet, the patient moves to a semi-liquid, soft, semi-soft and finally to a normal diet...
  
  
• During the liquid and semi-liquid diet period the patient needs nutritional supplements available at the pharmacy.
  
  
• We have alternative diets for working patients who are not at home during the semi-liquid and soft diet period.
  
  
• The patient will eat normally roughly 5-6 weeks after surgery.

• It is only necessary to take vitamin supplements periodically in the case of Gastric Bypass surgery.
  
  
• In the case of Gastric Tube and Gastric Banding, vitamin supplements are recommended occasionally.

Approx. weight loss table:

• Frequently, the most significant weight loss happens in the first 6-10 months.
  
  
• In the Gastric Banding procedure, there is a slower and more progressive weight loss that can extend up to 4 years after the surgery.   

• The weight loss is permanent.
  
  
• Nevertheless if the patient has unbalanced dietetic habits (usually due to severe emotional issues) he/she can regain part of the lost weight, even with the Gastric Bypass surgery.
  
  
• With the Gastric banding surgery the weight loss can be partially regained when the patient repeatedly eats sweets and hypo caloric foods. With the Gastric Tube this is also possible but less probable. The type of surgery that most helps the patient keep off the weight is the Gastric Bypass.

• Obesity surgery does not only impact but improve overall quality of life for patients.
  
  
• Surgery improves patient’s mobility and the ability to perform activities that were impossible before.
  
  
• Surgery improves the quality of the patient’s social and partner relations.
  
  
• Surgery improves the patient’s mood and feeling of well being.
  
  
• It improves confidence and self-esteem.
  
  
• With Gastric Banding surgery it is possible that the patient will not be able to eat white bread, red meats or grilled meats (it is OK to eat stew or ground meat ), because the band might temporarily restrict the movement of food. This problem can also occur when swallowing food too fast or without chewing.
  
  
• With the Bypass surgery, patients might have diarrhea when eating excessive or very fatty foods.

• This is unpredictable. Similar to stretch marks during pregnancy and the ability to erase them. The bigger the obesity degree, the more difficult to recover the shape. 
  
  
• The most frequently needed surgeries are:
• ABDOMINOPLASTY OR “TUMMY TUCK": Both in men and women.
• FACE, THIGHS AND ARMS PLASTY: Most frequently in women.
  
• The need for plastic surgery is evaluated after weight loss has stabilized (after 1-2 years)
  
  
• The more diet and physical exercise-conscious the patient is during weight loss, the better the cosmetic results and the less likely the need for plastic surgery.

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Surgery type	RESTRICTIVE + MALABSORPTIVE	RESTRICTIVE + ENDOCRINE	ONLY RESTRICTIVE
Name	GASTRIC BYPASS	GASTRIC TUBE OR “SLEEVE GASTRECTOMY”	ADJUSTABLE GASTRIC BANDING
Anatomic description	A small stomach pouch is created (20-30cc) and connected to the small intestine, dividing food and gastric juices over 100-150cm.	A gastric tube of 60-100cc. is created	The gastric band is an adjustable silicone prosthetic device that is placed around the top portion of the stomach. A small stomach pouch of 15-20cc. is created
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How does it work:	Food intake is reduced. Controlled malabsorption. Small diarrheas if excess of sugars or fats.	Food intake is reduced. NO malabsorption /diarrheas. Natural stomach function is maintained.	Food intake is reduced. Delays stomach emptying Needs permanent prosthetic device for life
Weight loss:	70-80% excess weight. Most proven and tested operation.	65%-70% excess weight. Longest experience is 6 years.	50% excess weight. Requires the most effort by the patient.
Long term dietetic habits modification	Initial intake is about 800 cal/day over 18 months. After a while 1000-1200 calories/day. Most patients must stay away from sweets and fatty foods to avoid  "Dumping” Vitamins are needed, Fe, Ca, to compensate for reduced absorption of essential nutrients.	Initial intake is about 600-800 cal/day over 12 months. After a while 1000-1200 calories/day No dumping, no diarrhea No vitamins or supplements needed for life	Initial intake is about 800 cal/day and after a while 1000-1200 calories/day When eating too fast, certain foods (rice, bread, dried meats, popcorn…) can cause pain and vomiting. If eating habits are not modified, the weight loss can be regained.
Potential Problems	Dumping syndrome Stenosis or anastomotic ulcer Intestinal Obstruction. Nutritional deficiencies :Iron, Vitamin B12, Folic Acid Diarrhea	Reflux and regurgitation/ vomiting. Stenosis Regaining weight loss Additional procedure might be needed	Too little weight loss Band Slippage 3% Stomach erosion 1% Infection 1% Access port problems 2% Band and esophagus malfunctioning
Procedure duration	3-4 hours	2 hours	1.5 hours
Off-work timing	1 week (low physical activity or sedentary work )	1 week (low physical activity or sedentary work )	2-3 days (low physical activity or sedentary work )
Our recommendation	Most efficient treatment for BMI of 45-55, when patient can’t control sweets and snacks. However, this procedure might have more long term complications and nutritional supplements are needed for life.	Very safe. It must be used with extremely obese patients (BMI>55). Appropriate for patients with BMI between 35-45 because of the low operational risk.  Must control sweets and snacks.	Requires more effort by the patient. Appropriate for patients who want to participate in a program to change eating habits, with dietetic restrictions and physical exercise for life!!.

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