Preparation for Surgery

Our Frequently Asked Questions section references accepted standard of practice and guidelines from regulatory and professional organizations including the National Institutes of Health (NIH), American College of Surgery (ACS), American Society for Metabolic and Bariatric Surgery (ASMBS) As always, please check with your healthcare provider to determine their individual practices, guidelines and what they recommend for you.

 
What are the routine tests before surgery?
 
After your initial consultation with the bariatric team you will be given physician orders for specific preoperative consultations the may include the following:
  • Cardiology
  • Pulmonary (to include Pulmonary Function Studies, Arterial blood gases and possible Sleep Study)
  • GastroIntestinal (GI) Evaluation(to include a upper endoscopy test)
  • Psychiatric Evaluation
  • Letter of medical necessity from your primary care provider (also documenting history of at least 5 years morbid obesity)
  • Laboratory Blood Studies (To establish baseline values for chemistries, vitamins, thyroid function etc)
What is the purpose of all these tests?
 
An accurate assessment of your health is needed before surgery. These tests (and others) will assist us in learning more about you and your current health conditions. As you know weight loss surgery has known risks and complications and by knowing all we can pre operatively allows us the chance to decrease you risks. However with that said remember not all risks and complications can be avoided.
   
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 they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not discourage the surgeon from recommending weight loss surgery (bypass or banding)if it is otherwise appropriate, but these conditions will make a patient's risk for complications higher.
   
Why do I have to have a Gastroenterology (GI) Evaluation?
 
Many patients who are morbidly obese have gastrointestinal symptoms and or conditions which they may or may not be receiving appropriate treatment. These symptoms may include heartburn, increased belching or passing gas, or pain. Sometimes the pain may be caused by a hernia in your esophagus or irritation of the lining of your stomach known as an ulcer. An upper endoscopy will allow the physician to see, diagnose and treat any of the above. The treatment plan and monitoring of these conditions allows you to preparing the inner lining of your stomach and intestines for the weight loss procedure you are seeking.
   
Why do I have to have a Pulmonary Evaluation?
 
This type of evaluation gives you a better understanding of the status of your respiratory system which is important with respect to general anesthesia and your pain management. The pulmonary function study and arterial blood gases allow the anesthesiologist to plan for your anesthesia care the day of your surgery. The sleep study also allows for this but provides you with the opportunity to better care your respiratory disease (if detected). Conditions such as sleep apnea are very common in the morbidly obese and if undetected is associated with a high mortality rate for anesthesia and weight loss surgery. Your pulmonary doctor will explain in detail the disease of sleep apnea and discuss with you the options for treatment.
   
Why do I have to have a Psychiatric Evaluation?
 
A psychiatric evaluation is ordered most commonly because your insurance company may require it and our team would like confirmation that if there is a pre existing condition such as depression or bipolar; that you are currently being treated appropriately. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the the required lifestyle changes after surgery.
   
If I want to undergo a weight loss procedure (gastric bypass or gastric banding), how long do I have to wait?
 
After attending the mandatory informational session, your first consultation with the bariatric team can be scheduled within 3-4 weeks. The amount of time between the first consultation and the date of surgery depends on several factors which include appointments for necessary pre operative medical consultations and meeting the required insurance criteria for surgical authorization.
   
What can I do before my initial appointment with the bariatric team to speed up the process of getting ready for surgery?
 
  • Select a primary care physician if you don't already have one, and establish a relationship with him or her. Remember most insurance companies are asking primary care providers to document in their letter of medical necessity that you have been under their care for at least 5 years for morbid obesity. Work with your primary care provider to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
  • Verify with your current insurance plan that weight loss surgery is a covered benefit and if possible obtain any of the required criteria for surgical authorization. You are not authorizing the surgery (the surgeon must do this) you are simply making sure it is a covered benefit with your plan. You will also be given information related to your responsibilities for co insurance and co pay amounts. The following are procedure codes sometimes asked when you are verifying benefits:
    • Laparoscopic Roux en Y Gastric Bypass (43644)
    • Laparoscopic Adjustable Gastric Banding ( 43659 )
  • Call the office (if you have not already) for an initial patient screening and directions on how to register your personal health information on line and upcoming dates for the required informational session attendance.
  • Make a list of all the diets you have tried (a diet history), giving dates of when started, How long you stayed on a diet and how much you lost or gained. (Honest approximation is acceptable)
  • Stop Smoking if you smoke. You must be at least 3 months smoke free prior to scheduling surgery.
  • Gather any pertinent medical data such as reports of special tests (echocardiogram, sleep study, etc.) or surgical reports for past surgeries you may have received..
  • Gather list of your current medications with dose and schedule. Also include any over the counter medications you take routinely such as vitamins, pain relievers.
  • Insurance Issues

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