Our Program
|  Preparing for Surgery  |  The Operation  |  Recovery  |
| Support Group |  Revision Surgery  |

Preparing for Surgery

What do I need to do to Prepare for Surgery?
If you think you may be a candidate for the surgery and wish to consult with a surgeon at Valley Surgical Specialists, the following outlines the steps to take. Only after a thorough consultation and only if we are satisfied that you are aware of the implications and alternatives of this type of surgery will we offer you the procedure.

We encourage you to discuss your options with your primary care physician. Your primary care physician will continue to play an important role in maintaining good health.

To find out if your insurance will cover the Roux-en-Y gastric bypass procedure, call your insurance company's customer service line. You may have to inquire in writing.

Contact our office to reserve a seat at our educational seminar for new patients. You must attend a seminar before you can be seen in consultation. Information about our program and what to expect are presented at this meeting. You will also have a chance to meet the surgery team here. You will need to bring your insurance information to the meeting. You will receive a packet to complete and bring to our office with a consultation fee. If you have had prior weight reduction surgery, you will need to have a copy of the original surgeon's operative report sent to our office before your consultation.

When the above are complete, you will be scheduled to meet with one of our surgeons. It will be determined at your initial consultation whether or not you are a candidate for the surgery. Additional consultations may be requested at that time. Cardiology, pulmonary, endocrinology or even psychiatric consultations may be required by your particular insurance plan. Depending on your age and medical condition, certain blood tests and X-rays will be requested. Before surgery, your surgeon will perform a complete physical examination. Our office has a strict cancellation policy.

Once the surgeon and you have determined to proceed with the surgery, we will request authorization from your insurance company for the surgery. It may take many weeks for your insurance company to authorize your procedure. It is common to be denied on the first request. You may need to write several letters of appeal to your insurance company. Don't be discouraged. The insurance companies ultimately deny very few patients who we select as good candidates for this surgery. Take this time to prepare yourself. The best preparation for surgery is through education. We advise you to talk to as many of our patients and ask about their experience. They have been instructed to be as honest as possible and not to "sugar coat" their responses.

When your insurance has approved the surgery, you will need a preoperative visit at which final physical examination is done, questions are answered, and surgery is scheduled

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The Operation:

You will meet your anesthesiologist just before your surgery. He/she may have a few questions for you and this is a time for you to ask about possible anesthetic complications. Only qualified anesthesiologists have been selected as part of our surgical team. You will also meet a variety of nurses and assistants. An IV line will be started so that we can give you fluids and antibiotics and perhaps something to calm your nerves. Special pneumatic devices will be applied to your feet to help prevent blood clots from forming. A medication that also helps prevent blood clots will be given at this time. The preoperative experience usually lasts only 30 minutes, then you will be taken to the operating room. You will go to sleep and at this time a tube will be placed in your bladder to drain urine and will be removed the following day

The operation takes 75 to 90 minutes. The "open" incision varies in size from three to six inches long in the upper part of your abdomen. "Laparoscopic" procedures require five 1/2" incisions. Your gallbladder will remain unless it shows signs of disease. If there are any unusual problems or findings we will use our best surgical judgement to take care of you. Whenever possible we consult with your family and try to keep them informed as to what is happening. Although bleeding is very unusual, our philosophy is to use blood products only when absolutely necessary and there is no substitute available.

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Recovery

After surgery, you will be asked to cough and deep breathe and to ambulate sooner than you would like to. This is important to prevent pneumonia. You will be connected to a machine (PCA) that will dispense pain medication under your control. You cannot overdose with this machine. If you experience nausea, the nurses will give you additional medication. When you have recovered from the anesthesia, you may begin clear liquids. Only take what is comfortable. As you progress, your medications will be switched to pills.

Most patients are discharged from the hospital the next or following day of surgery. You will be discharged only when your surgeon feels that it is safe for you to go home.

At home we expect you to begin to take short walks for exercise.You may take short showers- no baths. There may be some oozing from your incision and bruising of the skin that develops over time.

If you have an "open" procedure, sometimes a collection of pink fluid develops under the skin. This may suddenly "squirt" from between your stitches. This is not dangerous. When convenient, please notify your surgeon if this should happen.

If you are on routine medications, discuss with your surgeon which ones to take prior to discharge from the hospital. We may need to coordinate with your primary physician with respect to certain medications. Also, as you lose weight, the dosages of certain medications will need to be adjusted.

Absolutely no driving or operating mechanical equipment until authorized by your surgeon. We expect to see you in the office within a week of discharge. You are expected to call if you have any questions or problems.

Return to work will depend on many factors. Many of our patients are able to return to work within five to seven days from surgery if their occupation does not require strenuous activities. Stamina may be the main issue.

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Support Group

Our support group was formed in order to help with some of the problems patients face as they lose weight. Some of the problems will be dietary, others will be social and some will be cosmetic (loose skin, etc.). Although not intentional, change is inevitable. The way in which others perceive you will change. Jealousy from friends and colleagues is not uncommon. Your co-workers may see you as more of a threat in competition for promotions, etc. These meetings are a way in which one can meet and discuss solutions to problems with other patients who may have insight into your situation.

Some meetings begin with a didactic lecture such as nutrition, exercise, what's new in Plastic Surgery, etc. Other meetings are designed to promote discussion among the members. Topics will vary as the needs of the group vary and as speakers become available.

The support group is open to all pre and post op patients, including
those who are just interested in getting more information about our
program. A Valley Surgical Specialists employee normally attends in
case there are questions. For our schedule and directions, please view
the following document.

2005 Schedule

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Revision Surgery

Our experience in the area of Bariatric Surgery and our reputation for taking care of complicated problems has lead to our interest in the conversion of other procedures to the Roux-en-Y Gastric Bypass. We have found that the malabsorbtive complications of protein loss, diarrhea, malodorous intestinal gas, general lack of energy and malnutrition can be eliminated while optimizing weight loss. Although the laparoscopic approach is not applicable to this type of procedure, we have not found an increased incidence of complications as opposed to our traditional Roux-en-Y Gastric Bypass.

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