WELCOME!

Thank you for your interest in Physicians East Bariatrics. We feel very honored that you are considering becoming a partner with us in your weight loss journey. Our goal is to assist you in being successful in overcoming your disease of obesity.

Our mission is to use a team of skilled health care professionals to meet the challenge of delivering quality, cost-efficient, comprehensive health care to our patients. We are committed to helping individuals improve and maintain their health by providing compassionate, state-of-the-art care. We hold sacred the physician-patient relationship and will endeavor to preserve and protect this mutual trust.

This Education Book has been designed to assist you in learning more about our Bariatric program. It provides you with the needed information to help you to determine if having Bariatric surgery is the right option for you.

It is very important that you read this book and understand the information that it contains. We encourage you to share this information with your family and support persons that will be a part of your weight loss journey.

If you have any questions or concerns that arise during your journey with Physicians East Bariatrics, please feel free to contact us. Our contact information is listed below. We are looking forward to working with you.

Contact Information:Physicians East Bariatrics1850 West Arlington Blvd.Greenville, NC 27834

Phone: 252-413-6398

Website: www.physicianseast.com

Surgeons: Dr. Kenneth G. MacDonald Dr. Tim McGuire

Bariatric Program Coordinator: Bobbie Lou Price, RN, BSN, CBN

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Your Bariatric Multi-Disciplinary Team

At Physicians East Bariatrics, our program brings together dedicated professionals that are committed to your care through every step of your weight loss journey, both before and after your surgery. All of our team is dedicated to assure that you are successful in using your tool of bariatric surgery.

Our Multi-Disciplinary Team includes:-Surgeon-Certified Bariatric Nurse-Surgical Technician-Cardiologist-Pulmonologists-Nutritionists-Psychologists-Radiologists-Laboratory Technicians-Endoscopy Center Staff-Anesthesiologist-Hospital Staff-Office Staff

Special Features of Physicians East Bariatrics:-Board Certified Surgeons who has specialized in the field of Bariatric surgery for over 25 years with experience in both open and laparoscopic procedures.-A Certified Bariatric Nurse who has practiced in the field of Bariatric Surgery for over 15 years.-Education Classes that are offered weekly.-Support Groups that are offered once a month.-A facility that offers the services of Pulmonary, Endoscopy, Laboratory, Radiology and Nutrition in one area for more time efficient care. Cardiology and Psychology serves are offered in near by medical offices.-Medical Park Pharmacy that offers easily assessable bariatric supplies such as protein supplements, vitamins and other resources adjacent to the Physicians East Bariatrics building.

Physicians East Bariatrics is affiliated with Pitt County Memorial Hospital and the SurgiCenter, which are parts of University Health Systems in Greenville. You may have your surgery at either facility depending on the type of surgery and insurance requirements. Pitt County Memorial Hospital has served as pioneers in the world of bariatrics for nearly 30 years. Both facilities have received their Centers of Excellence certification for bariatrics with the Surgical Review Corporation.

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Information Regarding Obesity

Obesity is a serious and rising health epidemic in our country. You are not alone in this fight. It is estimated that nearly 93 million Americans are obese and that number is predicted to climb to 120 million within the next five years.

A person is classified as morbidly obese when their Body Mass (BMI) is greater than 40, or they are more than 100 pounds over their ideal body weight. Additionally, individuals who have a BMI of 35 or greater with an existing co-morbidity (i.e. diabetes, hypertension, etc.) are also classified as morbidly obese.

Morbid obesity is most commonly calculated using BMI. BMI is a measurement used to indicate obesity and morbid obesity in adults. BMI is calculated by dividing a person's weight in kilograms by his or her height in meters squared. An adult with a BMI of 40 or greater is considered obese. Additionally, an individual is considered morbidly obese with a BMI of 35 or greater, with an existing co-morbidity.

Many obesity-related conditions accompany morbid obesity. Once an individual is considered morbidly obese, these conditions become serious health risks. These obesity-related conditions also negatively impact the quality of life for individuals and their family members affected by morbid obesity. The most common morbid obesity-related diseases include:

-High Blood Pressure -High cholesterol -Diabetes -Heart disease -Stroke -Gallbladder disease -Osteoarthritis -Sleep apnea and respiratory problems -Some cancers (endometrial, breast, and colon)

Reference:Obesity Action Coalition, www.obesityaction.org

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Calculating your Ideal Body Weight and Body Mass Index (BMI)

If you are 100 pounds or more above your ideal weight for your height then you are considered as morbidly obese. In order to calculate your ideal body weight, we use the middle of the medium frame size noted in the Metropolitan Life Insurance Company tables. They are provided for you below.

WOMEN (Weight in Pounds)(In Indoor Clothing)*

HEIGHT SMALL MEDIUM LARGE(In Shoes)+ FRAME FRAME FRAMEFeet Inches      

4 10 102-111 109-121 118-1314 11 103-113 111-123 120-1345 0 104-115 113-126 122-1375 1 106-118 115-129 125-1405 2 108-121 118-132 128-1435 3 111-124 121-135 131-1475 4 114-127 124-138 134-1515 5 117-130 127-141 137-1555 6 120-133 130-144 140-1595 7 123-136 133-147 143-1635 8 126-139 136-150 146-1675 9 129-142 139-153 149-1705 10 132-145 142-156 152-1735 11 135-148 145-159 155-1766 0 138-151 148-162 158-179

Indoor clothing weighing 5 pounds for men and 3 pounds for women.

MEN(Weight in Pounds) (In Indoor Clothing)*

HEIGHT SMALL MEDIUM LARGE(In Shoes)+ FRAME FRAME FRAMEFeet Inches      

5 2 128-134 131-141 138-1505 3 130-136 133-143 140-1535 4 132-138 135-145 142-1565 5 134-140 137-148 144-1605 6 136-142 139-151 146-1645 7 138-145 142-154 149-1685 8 140-148 145-157 152-1725 9 142-151 148-160 155-1765 10 144-154 151-163 158-1805 11 146-157 154-166 161-1846 0 149-160 157-170 164-1886 1 152-164 160-174 168-1926 2 155-168 164-178 172-1976 3 158-172 167-182 176-2026 4 162-176 171-187 181-207

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 Indoor clothing weighing 5 pounds for men and 3 pounds for women.Reference: www.halls.md/ideal-weight/met.htm

For example, if a patient is female and is 5’3” tall, we would say that her normal weight as the midpoint of 121-135 pounds. This would be 128 pounds. This person would have to weigh about 228 pounds to be considered morbidly obese.

Determining Your Body Mass Index (BMI): The table below has already done the math and metric conversions. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.

BMI (kg/m2) 19 20 21 22 23 24 25 26 27 28 29 30 35 40Height

(in.) Weight (lb.)      58 91 96 100 105 110 115 119 124 129 134 138 143 167 19159 94 99 104 109 114 119 124 128 133 138 143 148 173 19860 97 102 107 112 118 123 128 133 138 143 148 153 179 20461 100 106 111 116 122 127 132 137 143 148 153 158 185 21162 104 109 115 120 126 131 136 142 147 153 158 164 191 21863 107 113 118 124 130 135 141 146 152 158 163 169 197 22564 110 116 122 128 134 140 145 151 157 163 169 174 204 23265 114 120 126 132 138 144 150 156 162 168 174 180 210 24066 118 124 130 136 142 148 155 161 167 173 179 186 216 24767 121 127 134 140 146 153 159 166 172 178 185 191 223 25568 125 131 138 144 151 158 164 171 177 184 190 197 230 26269 128 135 142 149 155 162 169 176 182 189 196 203 236 27070 132 139 146 153 160 167 174 181 188 195 202 207 243 27871 136 143 150 157 165 172 179 186 193 200 208 215 250 28672 140 147 154 162 169 177 184 191 199 206 213 221 258 29473 144 151 159 166 174 182 189 197 204 212 219 227 265 30274 148 155 163 171 179 186 194 202 210 218 225 233 272 31175 152 160 168 176 184 192 200 208 216 224 232 240 279 31976 156 164 172 180 189 197 205 213 221 230 238 246 287 328

Category BMI range - kg/m2

Starvation less than 14.9Underweight from 15 to 18.4Normal from 18.5 to 22.9Overweight from 23 to 27.5Obese from 27.6 to 40Morbidly greater than 40

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ObeseReference: www.nhibi.nih.gov/guidelines/obesity/bmitbl.htm

Types of Bariatric Procedures Offered

Physicians East Bariatrics offers three different types of bariatric procedures for our patients. Your surgeon will assist you in choosing which surgery type would be best for you.

Gastric Bypass

This procedure, the Roux-En-Y gastric bypass, involves placing three rows of staples near the top part of the stomach. This forms a small pouch that will hold less than 30cc of food or liquid (about 1 ounce). The remainder of the stomach is not removed, but excluded from the pouch. A portion of the small intestines is attached to the pouch with a small opening. This is called an anastomosis. This opening is the size of the eraser on a pencil. By doing this, food is unable to pass through the larger part of the stomach. It is also unable to pass through the first part of the small intestine. This operation helps with weight loss because it decreases the amount of food that is eaten. A person feels full when eating a small amount of food. It also makes a person feel full longer after a meal. This is because the small hole created prevents food from leaving the pouch too fast. This type of procedure helps you to lose weight by malabsorption of your foods and calories and by restriction, allowing you to only eat small amounts of foods at one time.

The Dumping Syndrome can occur when you attempt to eat foods or liquids with glucose or sugar in them. These include foods like breads, pasta and sweets. Your body is trying to get rid of the high sugar load that has rapidly passed through your small stomach pouch. Sweets and refined sugars should be avoided in your daily diet and breads and pasta should be eaten in moderation. The symptoms that you may have are:

Rapid Heart Beat SweatingDizziness LightheadednessSleepiness HeadacheNausea DiarrheaStomach Cramping

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These symptoms may occur in any combination. They many be severe, but should go away on their own. The Dumping Syndrome will only occur after with the gastric bypass.

Sleeve Gastrectomy

The Sleeve Gastrectomy is a restrictive procedure, which limits the amount of food you can eat by reducing the size of your stomach. During this procedure, a thin vertical sleeve of stomach is created using a stapling device. This sleeve will typically hold between 50 to 150 ML, or is about the size of a banana. The excised portion of the stomach is removed. The nerves to the stomach and the outlet valve remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume without bypassing the intestines or causing any malabsorption.

Gastric Band

The Gastric Band is a silicone ring designed to be place around the upper part of the stomach and filled with saline on the inner surface. This creates a new small stomach pouch and leaves the larger part of the stomach below the band so the food storage area in the stomach is reduced and the pouch above the band can hold only a small amount of food. The band also controls the stomach outlet between the two parts of the stomach. The size of the stoma regulates the flow of the food from the upper to the lower part of the stomach. When the stoma is smaller, you feel full sooner. This type of procedure helps you to lose weight by restricting the amounts of foods and liquids that you can consume at one meal.

The band is connected by tubing to an access port that is placed beneath the skin during surgery. Later, the surgeon can change the stoma size by adding or subtracting saline inside the inner balloon through the access port. This process helps the rate of weight loss. This surgery can be done through the open or laparoscopic approach. This will be determined by your surgeon

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The Gastric Band can be removed if there is a problem with the band, or if you cannot lose enough weight or adjust to the new eating habits. This decision will come after your surgeon has consulted with you. Please keep in mind that when the band is removed, your weight will likely increase.

Our programs offers placement of the Realize® Band that is produced by Ethicon EndoSurgery and the LAP BAND® that is produced by Allergan. For more information about the two band products on the market, please visit their website at:

www.lapband.com OR www.REALIZEband.com

Revisions

If you have had any other type of bariatric surgery and you are seeing us for a consultation, please bring a copy of your operative note, discharge summary and any other reports with you to your appointment.

Complications Related to Bariatric Surgery

All Bariatric procedures, whether open or laparoscopic should be considered as a major operation. Every precaution is taken during surgery to prevent any complications. However, the chance of these happening cannot be taken away. The following is a list of complications that may occur following surgery. This list is a review of the common things that may occur following surgery, it is not an inclusive listing. Please discuss this list with your surgeon for a more detailed explanation.

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Gastric Bypass

Early complications (may occur within the first 30 days after surgery)Death Spleen injuryPneumonia Bowel ObstructionAbdominal Infection BleedingHeart Attack Anastomotic NarrowingLeak from the bowel Pulmonary Embolus (blood clot)Wound Infection Nausea/Vomiting

Late complications (may occur after the first 30 days after surgery)Incisional Hernia Weight GainBowel Obstruction Ulcers at the AnastomosisNutritional Problems Excessive Weight LossHair Loss DepressionStaple Line Breakdown Gallstones

Sleeve Gastrectomy

Separation of stapled tissue Leak from staple lineGastric leakage UlcersDyspepsia Esophageal dysmotilityDeath BleedingBowel Obstruction Pulmonary Embolus (blood clot)Stomach Stricture Vitamin B12 deficiencyReflux Iron Deficiency

Gastric Band

Band/Stomach or port slippage Ulceration at the BandBand erosion Esophagus dilation or stretchingPort Infection Leakage from the devicePulmonary Embolus (blood clot) Wound InfectionBleeding PneumoniaDeath Stomach/Esophageal InjuryWeight Re-Gain Poor Weight LossReflux

Surgical Techniques Used to Perform Bariatric Surgery

There are two types of surgical techniques used to perform Bariatric surgery. It can either be done through an open or laparoscopic approach.

The open approach is done by making an incision from below the breastbone to several

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inches above the belly button. This gives the surgeon enough room to be able to the surgery safely. It also allows the surgeon to see the areas of the stomach needed to do the operation.

The laparoscopic approach is different because of the type of incision that is used. The surgeon will make six small incisions instead of one long one. Long instruments are inserted into each incision. With the aid of a camera and television screen, the surgery is performed. This surgery may not be ideal for every patient because of his or her size, weight, size of the patient’s liver and past abdominal operations.

General Considerations for Weight Loss Surgery

To be considered a candidate for Gastric Bypass and Sleeve Gastrectomy you need to:

Be 100 pounds above your ideal body weight Have a body mass index of greater than 35 with health complications or 40 or

greater with or without health complications Have been overweight for more than 5 years Be between the ages of 18 and 69 (anyone younger or older will be reviewed on

an individual basis by their surgeon)

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Have documented failed attempts at weight loss in the past Have no psychological contraindications, if you have a diagnosis of

schizophrenia, you will not be considered a candidate. Be able to understand the surgery and its risks Be able to comply with the dietary and exercise requirements Be willing to continue to be monitored by your surgeon Be willing to make necessary lifestyle changes to help your tool work effectively

To be considered for the Gastric Band you need to:

Be at least 18 year old Have a body mass index of greater than 35 with health complications or 40 or

greater with or without health complications Have a body mass index between 30 to 35 with a health complication, only

available for the LAP-BAND®, insurance may not cover BMI must be equal or less than 50 Be 100 pounds above your ideal body weight Have been overweight for more than 5 years Have had failed attempts at weight loss in the past Not be suffering from any other disease that may have caused your obesity Be prepared to make substantial changes in your eating habits and lifestyle Be willing to continue to be monitored by your surgeon Be willing to have your band adjusted

*Please note that your insurance company may have additional requirements as well.

You cannot be considered for Bariatric Surgery if you:

Have an inflammatory disease or condition of the GI tract such as ulcers, severe esophagitis or Crohn’s disease

Have severe heart or lung disease that makes you a poor candidate for surgery Have some other disease that makes you a poor candidate for surgery Have a problem that could cause bleeding in the esophagus or stomach, this may

include esophageal or gastric varices Have portal hypertension Have a congenital or acquired problem with your esophagus, stomach or intestine Have or have had a surgical injury to your stomach where the band will be placed Have cirrhosis Have chronic pancreatitis Are pregnant Might be allergic to materials in the band Are on chronic, long-term steroid treatment Have an autoimmune connective tissue disease such as lupus or scleroderma

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Referral to Physicians East Bariatrics

Referrals can happen in one of two ways:

Self-Referral: You as a patient may call our office at 252-413-6398 and refer yourself to be scheduled for an Education Class.

Doctor Referral: Your doctor may also refer you. This type of referral is most helpful if your insurance carrier requires for you to have an authorization to see a surgeon who specializes in the surgical treatment of obesity.

Once your have been referred to our office you will be given an appointment to attend a Patient Education Class. You will be mailed a questionnaire and other paperwork to fill out and bring with you completed to the class. Once completing the Education Class, the pre-operative evaluation appointments that you will need will be scheduled.

You will need to contact your insurance company to make sure that bariatric surgery is a covered benefit under your policy and that there is not an exclusion. When calling your insurance company you may ask “I am considering having an surgical procedure weight loss (state name of procedure) whose CPT code (is state code). Is this procedure an exclusion of my group policy?”Gastric Bypass (Roux-en-Y) 43644Adjustable Gastric Banding 43770Sleeve Gastrectomy 43775

If there is an exclusion, then surgery for obesity is not, nor can it become a covered benefit. It will also not pay for any tests or clinic visits pertaining to the surgery. Your only option at this point would be to self-pay for the surgery.

It is very important that you bring your insurance card with you to the Patient Education Class. A copy will be made and put into your chart for future reference during your care with our practice. If your insurance information changes at any point during your care, please let our office staff know immediately.

You will need to stop smoking for 3 months prior to your surgery and remain smoke free following surgery. This is a lifetime commitment. It is best to try and stop smoking now during your pre-operative evaluation work up. This helps your lungs to function at the best level that they can and it also aides in the healing process following surgery.

Evaluation Testing

These are tests that will be needed for the insurance approval process and to better prepare you for surgery. Your surgeon will decide which of these tests you will need. The amount of tests that are ordered will vary depending on the type of insurance and health condition of each patient.

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The tests may include, but are not limited to:Lab Work Anesthesia ConsultUltrasound of the Gallbladder Vascular ConsultNutrition Evaluation Any other tests deemed necessary by your

surgeonPsychological Consult 5 year weight historyEndoscopy 3 or 6 month diet and exercise programPulmonary ConsultCardiology Consult

*Some of our patients will need to be seen by the anesthesia department before their surgery. This will be done if you weigh more than 350 pounds or if your insurance company requires that this be done as part of your evaluation testing. During this visit, an anesthesiologist will talk with you about the risks of being put to sleep during your surgery.

History and Physical/Pre-Operative Appointment (Meeting with the Surgeon)

After receiving all of the results from your evaluation tests in our office, they will be reviewed by your surgeon. If you are a candidate for surgery, our office will contact the insurance company to obtain approval. We will send them the information needed to get prior approval for your surgery. This can take 2 to 4 weeks to receive this. Once your approval for surgery has been received, our office will call you with an appointment date for your History and Physical. You will also get a date for your surgery. If your insurance carrier denies you, there are two options:

Self pay for the surgery Appeal the decision

Although you may be an ideal candidate medically, you still may not get insurance approval. The Obesity Action Coalition has provided patients with a guide that can assist you in working with your insurance provider. You can obtain access to this by going to their website at www.obesityaction.org/educationaltools/brochuresand guides.phpThis guide is titled OAC Insurance Guide and is located at the bottom of the webpage.

Your appointment will be made once all of your pre-operative evaluation appointments have been completed and you have met all of your insurance requirements for surgery. You will meet with your surgeon. A physical exam will be performed and you will also be asked questions about your family, medical and surgical history. Please bring all of the medications that you are currently taking with you to this appointment. Your surgeon will also talk with you about your surgery and answer any questions that you may have.

You will have to sign 3 consent forms. One gives your surgeon permission to operate on you. The second one gives permission to use blood or blood products during your operation if necessary. The third one verifies that you understand all of the information that has been reviewed and given to you during your pre-operative workup.

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One important thing to remember is that you MUST bring your spouse if you are married and if not the support person that will be with you after surgery to this appointment. This is so the surgeon can talk with them about your surgery. If this is not done then your surgery will be canceled. This is a requirement of the program.

After your clinic visit is complete, you will be given a packet of information. You will need to take this to the Patient Testing Center. The Surgery Scheduler will give you directions. At the Center, you will be checked in and a nurse will review your paperwork. All necessary tests will be performed such as lab work, EKG and chest x-ray. You will be given a phone number to call the day prior to surgery to see what time you will need to arrive at the hospital the morning of surgery.

Once you have been given a surgery date, these are some things that you will need to consider:

Two weeks prior to your surgery stop taking all Aspirin, Motrin, Ibuprofen, Naproxen, Advil, Vitamin E, and other arthritis/pain medications other than Tylenol. These medications can increase your risk of bleeding, inhibit the clotting mechanism and increase your chances of unnecessary bleeding during your surgery. You should also avoid these medications following surgery.

If you have any significant facial hair, you must shave prior to surgery. Please remove all finger nail and toenail polish, as well as false fingernails prior to surgery. All of these things help the anesthesiologist to better care for your respiratory needs during and after surgery by being able to securely place a facemask on your face and to be able to see your nail beds for any discoloration.

You will be expected to lose some weight two weeks prior to your surgery. You and your surgeon will determine the amount of weight loss that is right for you. We will provide you with the diet that you will need to use during this time.

Be sure any medications you are taking have been converted to a liquid, crushable or chewable form by the doctor that prescribed them for you.

If you have sleep apnea, please bring your CPAP/BiPap machine with you to the hospital on your day of surgery.

Day of Surgery

You will come in to the hospital or outpatient facility the morning of your surgery. You should not have eaten or drank anything after midnight on the day of your surgery. Do not eat any heavy meals on the day prior to your surgery.

After you have checked in, the nurse will place you in a bed and have you put on a hospital gown. An IV will be inserted into a vein in your arm. This is needed for fluids and medications to be given prior to, during and after surgery.

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After the nurse has prepared you for surgery, you will then be taken to the holding area. This is where you will stay until it is time for your surgery. The person who will be giving you the anesthesia to make you sleep during surgery will stop by to see you. They will explain the procedure and ask if you have any additional questions.

Recovery

After your surgery, you will spend several hours in the recovery room. You will stay there until you are fully awake. When you wake up you will have several tubes and machines attached to you. These may include, an IV, a catheter in your bladder, drainage tubes inserted into your stomach, a pulse oximeter that will be on your finger, EKG monitor pads on your chest and oxygen tubing in your nose. Several hours after your surgery you will be assisted to sit up on the side of the bed. If you had the Gastric Band surgery, if no complications arise you will be discharged the same day as or the morning after your surgery. If you had the open gastric bypass or sleeve gastrectomy your hospital stay will last for 3 to 4 days and laparoscopically for 2 to 3 days. With the gastric bypass and sleeve gastrectomy on the first day following surgery you will be assisted to sit in a chair and walk as much as possible while in the hospital. Gastric Band patients will continue to do this at home with assistance. You may be out of work with the Gastric Band and laparoscopic gastric bypass and sleeve gastrectomy for 2 to 4 weeks following surgery and the open gastric bypass and sleeve gastrectomy for 4 to 6 weeks. You will not be able to drive for 2 weeks following surgery. Do not lift anything over 10 pounds for 4 weeks following surgery.

General Requirements Following Surgery

Follow up appointments:

Having proper follow-up after your surgery is very important. For the first month after your surgery, you will be seen every two weeks. You will be seen every three months for the first year. You will then be seen every six months or yearly for a lifetime. During these visits your doctor or nurse will see you. Lab work will be drawn to make sure that you are as healthy as possible starting at your 1-month post-operative visit. You will also need to continue to see a family doctor for any health problems not associated with your operation.

You will be required to see our Nutritionist and Psychologist during the first month following your surgery. These appointments are important in helping you to adjust to your lifestyle following surgery.

Vitamins/Medications:

Vitamins and minerals perform specific and individual functions in your body, as well as helping to maintain the function of cells. Problems can occur if you do not get the proper amount daily.

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Once you are discharged from the hospital you will start taking multivitamins, vitamin B12, Iron and Calcium if you had the Gastric Bypass or Gastric Sleeve. Gastric Band patients will only need to take multivitamins and Calcium. You will have to take these for a lifetime.

All of your medications following surgery should be crushed, chewable or in a liquid form. This rule will need to be followed for the first 6 month to a year, after which time you can cut your pills into small portions (no larger than a pencil eraser). Please be sure to contact your prescribing physician regarding all of the medications you are taking to make sure they can be converted into one of these appropriate forms.

Medications to avoid after surgery: Ibuprofen Advil Motrin Aleve BC Powders Goody Powders Aspirin Non-Steroidal Anti-Inflammatory

If you must take these medications, please do so for a very short period of time and ask the prescribing physician to prescribe a proton pump inhibitor to accompany one of the medications above.

Diet

While you are in the hospital your diet will consist of 2 ounces (60cc) of a protein supplement for each meal (three times a day) and 1 to 2 ounces (30 to 60cc) of water every hour in between meals.

When it is time for you to go home, your diet will advance in stages. With the Gastric Bypass and Sleeve Gastrectomy you will begin with liquids only, then advance to pureed foods and liquids, then to soft foods and meats. With the Gastric Band, you will begin with pureed foods and liquids, then advance to soft foods and meats. You must sip water slowly throughout the day to help prevent dehydration. You will be required to obtain 60 to 80 grams of protein within your daily diet. You will be given instructions on how to advance your diet from your surgeon and the office staff. When you have your nutrition consult, you will be given your post-operative diet along with additional teaching.

Gastric Band Adjustments

The first time that your band will be adjusted is usually 4 to 6 weeks after your surgery. You and your surgeon will decide when the right time is for you.

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To adjust your band, the clinician injects saline into the port that is located just under your skin. The band can also be adjusted by removing saline from the port. This is done with a special fine needle. You may feel a pricking sensation when this is done.

Adjustments are done either in radiology or in the surgeon’s office. The surgeon may need x-ray to help him in locating the port. You may need more than one adjustment. During each adjustment, only a very small amount of saline will be added to or removed from the band. The exact amount of fluid required to make the stoma the right size varies from person to person.

Some insurance companies will not cover adjustments, so you will need to check with your company in regards to coverage.

Support Group

This group gives you an opportunity to learn more about our program and more about bariatric surgery before and after surgery. It gives you an opportunity to talk with other patients who are awaiting surgery or who have already had surgery. This group is open to you and to your family and support system. While attending is not mandatory, it is highly recommended, as it will aid you in your journey both before and after surgery.

Exercise

A good exercise program is vital in order for you to have adequate weight loss. You will have to start exercising slowly. Increase the amount that you do each day. Good forms of exercise are bike riding, walking, swimming, jogging, aerobics and weight lifting or training. You should set a goal to exercise 5 to 7 days a week for 30 to 45 minutes daily. After your surgery, you will be given a free 3-month trial membership with ViQuest.

Pregnancy

We believe that becoming pregnant is safe, after a stable post-operative weight has been reached. This is usually 12 to 18 months after your surgery. Some patients have become pregnant within this time frame. Although they have had healthy children, we STRONGLY advise AGAINST getting pregnant during this period. There could be nutritional problems and negative effects on the baby as it develops. We STRONGLY recommend the use of birth control during this 12 to 18 months period.

Plastic Surgery

If you feel the need to have any plastic surgery after your weight loss surgery, we recommend that you wait at least 2 years after your surgery before having any plastic surgery. You want to be sure you have maintained your stable postoperative weight.

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Weight Loss Following Bariatric Surgery

Gastric BypassMost patients who have the gastric bypass will lose around 62% of their excess body weight. Generally, weight loss will level off around the 2-year period after your surgery.

Sleeve GastrectomyMost patients who have the sleeve gastrectomy will lose around 55% of their excess body weight.

Gastric BandMost patients who have had the gastric band will lose around 48% of their excess body weight. With the Gastric Band, you should lose weight gradually.

The amount of weight loss varies from patient to patient. You may not reach your ideal body weight, but your weight loss will be enough to make you see a difference.

Your best chance for weight loss with both surgeries is to follow the diet and exercise programs recommended to you by your surgeon.

Conclusion

Bariatric surgery is a major step for people suffering from morbid obesity. It is a right choice for some people, but not right for others. The only way to be sure that this decision is right for you is to completely understand what the surgery involves. You should also know the risks and benefits of this surgery.

This guide was designed to help you understand more about the choices of bariatric surgery that is offered through Physicians East Bariatrics. Now that you have read all of the information you should discuss this with your surgeon and the staff. Please share any questions or concerns that you may have. Our goal is to help you make the right decision for your weight loss journey.

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