Frequently Asked Questions
Welcome to our Frequently Asked Questions and Answers. Below you can see some of the questions others have asked and how we most typically have answered. We also have a number of video answers as well if you want to learn even more about how we’re different:
Do I qualify for Bariatric Surgery?
What is Laparoscopic Surgery?
How does the Adjustable Gastric Band work?
How do the “fills” work for Gastric Bands?
How does the Sleeve Gastrectomy work?
How does the Gastric Bypass work?
How long is the hospital stay?
Does it hurt?
How long is the process from my initial consultation to surgery?
How will Bariatric Surgery change my life?
What are the age limits for Bariatric Surgery?
What can I eat following Bariatric Surgery?
Can I get pregnant following Bariatric Surgery?
Do you accept patients who have had surgery elsewhere?
Do I need to take vitamins following Bariatric Surgery?
Can I drink alcohol, caffeine, or carbonated beverages after Bariatric Surgery?
Now that I don’t need to, or can’t eat as much, what do I do at restaurants?
Video Answers
Do I qualify for Bariatric Surgery?
One of the questions I’m asked most commonly is, “Do I qualify for Bariatric Surgery?” Well, I use the criteria set forth by the National Institute of Health. That criteria is:
- Established attempts at non-surgical weight loss.
- A Body Mass Index, or BMI, of 40 or higher.
- A BMI of 35 to 40 associated with a medical condition, or a comorbidity, such as diabetes, high blood pressure, or sleep apnea.
Bariatric surgery has been around since the 1950’s, yet has become popularized recently because of laparoscopy. Laparoscopic surgery is a way by which I can do major surgery through minor incisions. Laparoscopic surgeons, make very small incisions on the abdominal wall, usually 5-12mm in length, and insert thin hollow tubes, or trocars, through these thin incisions. A camera is inserted to one of those tubes and carbon dioxide is used to sort of blow up the belly from the inside. The camera projects a picture from the inside of the abdomen to a television monitor that is being watched while operating from outside the body.
Laparoscopic surgery is less invasive to patients, smaller incisions mean less pain, earlier return to work and normal activities, fewer lung complications, better looking scars, and overall a better operative experience.
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How does the Adjustable Gastric Band work?
The Adjustable Gastric Band is placed along the top part of the stomach, and it creates a small pouch that fills quickly and sends a hormonal signal to the brain that you’re feeling full, and as you can imagine, with much less food than it would’ve taken to stretch the entire stomach. The stomach, being a brilliant organ, recognizes both the band and the compression it creates. The stomach will actually thin its own wall out, and by thinning its wall, it creates a larger circumference on the inside, which means a larger hole for food and liquid to pass through. When that happens, the band can be adjusted, or filled, at the bedside making the band tighter, and recreating the restriction you need to fill the pouch.
At the time of a band fill or adjustment, a very fine needle will be placed into the port of the band. After placing a small amount of saline, I recreate the restriction you need to feel full sooner and have that feeling of satisfaction last longer. With each subsequent fill, that sensation of restriction will last longer and longer, so the vast majority of fills are performed within the first few months following surgery.
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How do the “fills” work for Gastric Bands?
As mentioned in the previous video, the stomach will accommodate the band. It will actually thin its own wall to allow food and liquid to pass easier. That’s why the bands are adjustable. Many patients wonder, “Well, how do the fills work?”
Fortunately, they are very simple and almost painless procedures performed at the bedside in my office over just a few seconds. At the time of a band fill or adjustment, I will take a very fine needle and place it into your band port, or reservoir. After placing a small amount of saline, I will recreate the restriction that you need to feel full sooner and have that feeling of satisfaction last longer.
With each subsequent fill, that sensation of restriction will last longer and longer, so the vast majority of fills are performed within the first few months following surgery.
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How does the Sleeve Gastrectomy work?
The Sleeve Gastrectomy was actually born from prior Bariatric surgeries, and it’s an operation where the stomach is “tubularized”, meaning it is reshapen from the size and shape of a small football to the size and shape of a banana. It’s an operation where part of the stomach is removed. By “tubularizing”, or refashioning the shape of the stomach into a thin narrow tube, it accomplishes 2 different ways to lose weight.
First, the narrow tube is restrictive, meaning it holds far less than the stomach did prior to surgery, with that you eat less during each meal and of course take in less calories.
The second way by which the Sleeve Gastrectomy helps to induce and maintain weight loss is by removing the source of a hormone called Ghrelin. That portion of the stomach which is removed has the cells that produce this hormone, and Ghrelin is the one hormone that we know causes hunger.
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How does the Gastric Bypass work?
If you are considering the Laparoscopic Roux-en-Y Gastric Bypass, it’s important to understand just how the operation works to induce and maintain weight loss. First is by “restriction.” Restriction means it literally restricts how much food you can eat at each meal. The stomach is reshaped into a 1 ounce pouch. Nothing is removed, but by doing so the amount of food that fits into the stomach at one sitting is limited
The second way by which the Gastric Bypass maintains weight loss is through “malabsorption.” Malabsorption means simply that not all the food that you eat is digested. The best way to think about the Gastric Bypass is to simply envision the letter Y. Down one limb comes the food, down the other limb the enzymes for digestion. Digestion, or absorption, begins in the stem. As food bypasses a large portion of the intestinal tract, it’s not absorbed, and if the food is not absorbed, the calories aren’t either.
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How long is the hospital stay?
The vast majority undergoing Adjustable Gastric Band Surgery will qualify for outpatient surgery, meaning you will not need to spend a night in the hospital. A small percentage of patients undergoing Laparoscopic Sleeve Gastrectomy will also qualify for outpatient surgery. Most patients undergoing Sleeve Gastrectomy or Gastric Bypass will spend one night in the hospital.
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Because surgery is done laparoscopically, a large percentage of patients never even fill the narcotic prescription that is provided. Of those who do fill the script, I would say they use it for an average of about three or four days, and most patients feel ready to return to work within one week.
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How long is the process from my initial consultation to surgery?
Luckily for our patients, our practice manager Laurie Burns is a tireless patient advocate. She works very closely with just about every major insurance company in Tucson. We will submit your paperwork and with Laurie on your side, she is usually about to get patients to surgery within 3 to 12 weeks.
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How will Bariatric Surgery change my life?
Bariatric Surgery will not only help you to lose weight, but to become a healthier human being. I can talk about how Bariatric Surgery will change your life and give you a new lease on life, but the truth is if you really want to know how Bariatric Surgery will change your life, you need to talk to previous patients. If you would like to speak to some we can arrange that easily.
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What are the age limits for Bariatric Surgery?
Even for those that are very young on the age spectrum, I look at a combination of maturity, home life and support. Support is the most critical component to weight loss success. Do parents and siblings support the life changes that must be adopted after the procedure? Do they understand the operation, the implications of surgery and how it’s going to change their life?
For those on the other end of the spectrum I look at physiologic age; not purely chronologic. Can they understand what the surgery will mean at this point in their life? Are they able to undergo the surgery? Will they be able to benefit from weight loss? Can they participate in an exercise program? These are the questions we we’ll have to answer individually, because that’s the only way that we can really look at you as a potential patient, as an individual, and as a safe candidate for Bariatric surgery.
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What can I eat following Bariatric Surgery?
Before your operation, we will have a visit in my office to go over the Patient Guide. I will provide you with a detailed Dietary Guide, in writing, that will help to advance you from a sugar-free clear liquid diet to a regular diet. The type of procedure you have will dictate how fast we advance through the diet. At the end of your advancement you can eat whatever you want. The restrictive nature of Bariatric Surgery is intended to limit how much you can eat with each meal, but not what you can eat as much. I encourage a wide menu, especially foods rich in protein, and I also want you to experiment and still enjoy eating meals.
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Can I get pregnant following Bariatric Surgery?
Yes! As a matter of fact, when you lose weight your fertility can exponentially increase. I have a few patients in my practice right now that were deemed infertile by Maternal-Fetal Medicine specialists, and following the weight loss from Bariatric Surgery they have had healthy pregnancies. If you’re at the age of, or considering, pregnancy, please be sure to discuss this with me in detail so that we can be sure to choose the right option for you during this time in your life.
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Do you accept patients who have had surgery elsewhere?
Without question, the success from Bariatric Surgery often comes from appropriate follow-up, so I do accept patients who have had surgery elsewhere. If you have had Bariatric Surgery elsewhere and are in need of follow-up, please contact my office and see how I can help you maximize your surgical weight loss success.
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Do I need to take vitamins following Bariatric Surgery?
For all procedures you will need to take some vitamins. Which vitamins depend on the procedure that you have, before your surgery you will receive and we go through detailed handouts regarding your vitamins so that you will know exactly what to take.
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Can I drink alcohol, caffeine, or carbonated beverages after Bariatric Surgery?
Yes, yes, and yes! It’s just a matter of timing and volume. Your tolerance will alcohol significantly decrease with the weight loss, so be careful. Caffeine can have a diuretic effect, so early in the post-operative period it may actually promote dehydration. Carbonation will not stretch your pouch out or cause complications, but it may cause bloating, it may cause discomfort, and it may cause excess gas early in the post-operative period.
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Now that I don’t need to, or can’t eat as much, what do I do at restaurants?
So, you’re wondering, after you’ve had Bariatric Surgery and you can no longer tolerate the same sized meal you did beforehand, what do you do at restaurants. There are two methods to employ, the first is a card, which is honored by almost all restaurants in Tucson, and the card is from my practice and it states specifically to allow you to choose a half sized portion from the adult menu or a regular portion from the children’s menu, since you’ve had Bariatric Surgery. The second is simply using a measure to make sure you do not overeat by asking for a “to-go” box to come with your meal. Place half of your meal into the box prior to eating and eat the remaining half the following day.
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