Surgical Preparation

Important steps we take before surgery.

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It Starts with Patient Education

Bariatric surgery is one of the few surgical interventions where the process of education and lifestyle change may be more important than physical preparation and risk mitigation. The education process begins with a free seminar presentation, given by the surgeon, at which patients receive information about all aspects of an informed decision about surgery, including:

• Impact of obesity and its commonly associated diseases
• Non-surgical management of obesity
• Surgical options for treatment of obesity, with detailed description of the gastric bypass, gastric sleeve, and gastric band
• Key features of the surgical options, to facilitate informed patient choice among the procedures
• Surgical outcomes, including health impact and realistic prospects for weight loss
• Detailed outline of risks associated with each surgical procedure
• Overview of lifestyle changes required to achieve optimal health with surgery, including activity increase, diet management, supplement intake, psychological issues, and lifetime follow up
• Overview of the physical aspects of preparation for surgery

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Personalized Evaluations

After attending the educational seminar, patients who are interested in pursuing surgery are assigned a patient advocate who walks them thorough the pre-surgery evaluations and pre-op checklist. The advocate sets up a multidisciplinary evaluation throughout the practice, which usually lasts for several hours and includes the following visits:

Surgeon evaluation: During this visit, the surgeon evaluates the patient’s current medical state with attention to the impact of obesity (metabolic syndrome, sleep apnea, etc.) and the ability of surgery to mitigate risk factors related to the existing diseases. If the surgeon and patient agree that it is appropriate to pursue surgery, the procedures are discussed and one is chosen. This allows the doctor and patient to begin the pre-surgery checklist of general health maintenance and risk mitigation necessary to prepare the patient for the chosen surgery

Dietician teaching and evaluation: Based on the selected procedure, the dietician staff conducts extensive education about the peri-operative and long-term dietary changes required for the procedure. The patient will likely have several visits with the dietician preceding surgery to check his or her understanding and compliance.

Behavioral health evaluation and coaching
Experienced therapists interview each patient to proactively identify any pitfalls or problems that may interfere with the patient’s long-term success. Some patients are required to have a set of counseling visits before surgery to clear up issues that are identified.

RN and physician assistants
Multiple staff members participate in the process of gathering information, providing education and coaching. Relationships are established that will enhance therapeutic impact of coaching and teaching in the post-operative phase.

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Pre-Surgery Checklist

Some of the most common pre-operative tasks include:

Labs and EKG – A baseline is taken on every patient. It is essential to check for diseases that might cause obesity and make surgery inappropriate (such as Cushing’s disease or hypothyroidism).

Sleep study – 85% of candidates for bariatric surgery have some degree of sleep apnea, and the nightly hypoxia associated with untreated OSA causes some degree of right heart failure. If interview suggests OSA in a patient who is not already under therapy, we will help get that tested.

Cardiac clearance – This is requested selectively, depending on risk assessment.

Hematology – A few patients are at extremely high risk of DVT/PE around surgery.  These patients are usually still candidates for surgery, but hematology evaluation and assistance is engaged for peri-operative prophylaxis.

Upper endoscopy, or upper GI X-ray – For patients who desire a gastric band, a barium swallow is arranged to ensure normal esophageal motility, which is important for successful Band function. Other patients may need to be studied if they have a history of gastric or esophageal problems in the past.

Colonoscopy – We believe it is important for each patient to be up-to-date on screening for colon abnormalities prior to undergoing abdominal surgery.

Pre-operative weight loss – This may seem strange at first glance, since we are choosing surgery only for a set of patients who have been unable to achieve sustained weight loss on multiple previous diets. However, the fact is that almost every patient can lose weight temporarily with a certain goal in mind, and we have found that pre-operative weight loss leads to much less fatty infiltration of the liver and hepatomegaly. Since the liver rests on the proximal stomach, this “liver shrinkage” can be the key factor in allowing the surgical procedure to be technically feasible.