Frequently Asked Questions

Can Roux-en-Y gastric bypass surgery be reversed?

The Gastric Bypass is not reversible.
The LAP-BAND® can be reversed if necessary.

Is weight loss surgery a guarantee for permanent weight loss?

No. Some patients may regain a substantial portion of the weight that is lost. This is especially true if the patient does not follow the dietary and exercise guidelines in the months and years following the procedure.

Must I be in good health to qualify for the surgery?

No. Many patients are in poor health because of diseases caused by their obesity. These diseases include diabetes, high blood pressure, heart problems, lung problems, and kidney difficulties. However, before surgery we would want these conditions to be under control with the use of medications to reduce surgical risks.

Are there different ways weight loss surgery can be performed?

Yes. The preferred method by many surgeons and patients is the laparoscopic approach in which the operation is performed through four to six very small incisions. The benefits of this method include less pain and faster recovery time. It is an appropriate method for most, but not all, patients. There is also the traditional, open approach, in which a large incision is made. The benefits of laparoscopy are typically less discomfort, shorter medical center stay, earlier return to work and reduced scarring. The open approach is generally more painful, a little longer hospital stay, longer healing time, increased risk for infection, and hernias.

How long does it take to perform the weight loss surgeries?

The Roux-en-Y gastric bypass can take anywhere from one and a half to two hours in most cases, occasionally longer if procedures are performed such as gallbladder removal or hernia repairs. The LAP-BAND® surgery will take 45 minutes to one hour.

How long has Dr. Fath been practicing?

Dr. Fath has been in private practice for seven years. He is a compassionate and skilled board-certified surgeon highly specialized in laparoscopic general surgery. He and the Bariatric staff are members of the American Society for Bariatric Surgery (ASBS).

How long has Dr. Fath performed weight loss surgeries?

Over the past four years, Dr. Fath performed over 180 Roux-en-Y gastric bypasses, 98% of them being laparoscopic. Dr. Fath began performing the LAP-BAND® in August of 2006.

How long can I expect to stay in the Medical Center after weight loss surgery?

Most patients can expect a stay of two to three days for a laparoscopic Roux-en-Y Gastric Bypass procedure and three to five days for an open Roux-en-Y Gastric Bypass procedure. The LAP-BAND® procedure is generally performed on an "outpatient" basis, allowing the patient to return home the same day as the surgery.

When can I expect to return to work and resume a normal lifestyle?

Most patients return to work and all levels of pre-surgery activity within two to six weeks. This depends on the type of work you perform and whether you have the open or laparoscopic procedure. Patients having the LAP-BAND® procedure can return to full activity in one to two weeks following surgery.

What are the routine medical tests prior to weight loss surgery?

Complete Blood Count (CBC)
Urinalysis
Thyroid
Chemistry Panel, which gives a readout of about 20 blood chemistry values
Chest X-ray
Electrocardiogram (EKG)
Gallbladder ultrasound to look for gallstones
Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, and/or cardiology evaluation, may be requested when indicated

Why do I have to have a Sleep Study prior to weight loss surgery?

If you have symptoms or risk factors for sleep apnea, a sleep study will be performed. A sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the airway muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.

If I want to undergo a weight loss surgery at Guadalupe Regional Medical Center, how long do I have to wait?

Currently from the time you attend a seminar to your surgery date is approximately 2-3 months. The major factor in this time frame is the insurance approval.

What can I do before the appointment 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. Work with your physician 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. Make a list of all the diets you have tried (a diet history) and your results of dieting, and bring it to your doctor.
Call your insurance company and check for coverage for morbid obesity. If it is covered, ask specifically if there is certain criteria that need to be met prior to approval for the procedure. In most instances, insurance companies want proof of a physician monitored diet and exercise attempt (at least 6 months). This includes monthly weigh-ins and check-ups with the doctor who is monitoring the attempt.
Bring any copies of pertinent medical data to the seminar – this would include reports of special tests (echocardiogram, sleep study, etc.) or inpatient discharge summary if you have been hospitalized recently.
Bring a list of your medications with dose and schedule.
Begin exercising NOW!

If I continue to smoke, what happens?

Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues. Your surgery will be rescheduled if you do not stop smoking one month prior to your surgery date.

Why does it take so long to get insurance approval?

After you have been selected and attend a seminar, a letter of medical necessity is written by our insurance specialist. This process generally takes 1-2 weeks. The time it takes to get an answer from your insurance company can vary from about 3-4 weeks. It may take even longer if you are not persistent in your follow-up with the insurance company. It may be helpful for you to contact your insurance company about two weeks after your letter is submitted and ask about the status of your request.

What can I do to help the process?

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.

How soon will I be able to walk?

Almost immediately after surgery medical staff will require you to get up and move about. Patients are asked to walk or stand at the bedside on the afternoon of surgery, take several walks the next day and thereafter. On leaving the Medical Center, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

How soon can I drive?

For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 7-14 days after surgery.

What do I need to do to be successful after surgery?

The basic rules are simple and easy to follow:

Before your surgery your Bariatric Surgery Team will provide you with special dietary guidelines. You will need to follow these guidelines closely. The post-surgical diet begins with liquid diets, moving to semi-solid foods and later, sometimes weeks or months later, solid foods can be tolerated without risk to the surgical procedure performed. Allowing time for proper healing of your new stomach pouch is necessary and important.
When able to eat solids, eat 2-3 meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
Never eat between meals. Do not drink carbonated beverages; even diet soda, between meals.
Drink 2-3 quarts or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added 3-4 days per week, as instructed by your doctor.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women wait at least 18 months after the surgery before a pregnancy. Approximately one year post-operatively (depending on how much weight you needed to lose), your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a healthy fetus to term. You should consult your surgeon and your OB/GYN as you plan for a pregnancy. In addition, it is important to use a reliable contraceptive in the first 18 months following surgery.

What if I have had a previous weight loss surgical procedure and I'm now having problems?

Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure.

What happens to the lower part of the stomach that is bypassed in the Gastric Bypass Procedure?

With the Roux-en-Y gastric bypass, the stomach is left in place with intact blood supply. It may shrink a bit and its lining (the mucosa) may atrophy (become smaller), but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor and gastric juices, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.

How big will my stomach pouch be after the Gastric Bypass Procedure?

This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 4-8 ounces.

What will the staples do inside my abdomen after the Gastric Bypass Procedure? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means MRI will not affect them. The staples will not set off airport metal detectors.

Is there any difficulty in taking medications after weight loss surgery?

Most pills or capsules are small enough to pass through the new stomach pouch. Initially, we suggest that medications/pills larger than a regular M&M should be taken in liquid form or crushed.

Is sexual activity restricted after weight loss surgery?

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a temporary drop in desire for about 6 weeks after weight loss surgery.

Is there a difference in the outcome of surgery between men and women?

Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.

How can I know that I won't just keep losing weight until I waste away to nothing after weight loss surgery?

Patients may begin to wonder about this early after the surgery when they are losing 20-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a rare surgical complication, patients are very unlikely to lose weight to the point of malnutrition.

What can I do to prevent lots of excess hanging skin after I have lost the weight?

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds.

Will exercise help with excess hanging skin?

Exercise is good to strengthen muscles and maintain muscle mass and tone. Unfortunately, most patients may still be left with large flaps of loose skin.

Will I be miserably hungry after weight loss surgery since I'm not eating much?

Most patients say no. In fact, for the first 4-6 weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger. Frequent hunger is typical and is often caused by the types of food consumed, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since it may wash food out of the pouch.

Will I have to change my medications?

Dr. Fath and your primary care physician will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Two classes of medications that should be used only with your surgeon's permission are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to serious heart problems.

What is a hernia and what is the probability of an abdominal hernia after surgery?

A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Generally patients that undergo the open procedure have higher incidence of hernia development. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.

How long will I be off of solid foods after weight loss surgery?

We recommend a period of four weeks without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred.

Why drink so much water?

When you are losing weight, there are many waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss. Water also fills your stomach and helps to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.

What is Dumping Syndrome?

Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass or BPD where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a shock-like state. Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling: you break out in a cold clammy sweat, turn pale, feel "butterflies" in your stomach, and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable - you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal.

Does Dumping Syndrome occur after having the LAP-BAND® Procedure

The Dumping Syndrome does not occur after having the LAP-BAND® Procedure because it does not involve bypassing part of the small intestine.

Is there a problem with consuming milk products following the Gastric Bypass?

Milk contains lactose (milk sugar), which is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea.

Why can't I snack between meals?

Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake, defeating the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to regain of weight.

How many grams of protein should I consume per day?

You should consume at least 50 grams of protein a day with a goal of 60-70 grams per day.

Will I be able to eat "spicy" foods or seasoned foods?

Most patients are able to enjoy spices after the initial 6 months following surgery.

Will I be allowed to drink alcohol following weight loss surgery?

After having the Gastric Bypass, you will find that even small amounts of alcohol will affect you quickly due to the bypass. It is suggested that you do not drink alcohol for eight months to one year after having any weight loss surgery. Alcohol slows the metabolism and is a source of sugar and extra calories, therefore it may slow the weight loss process.

Will I need supplemental vitamins?

Yes, for the rest of your life. A good adult multi-vitamin with iron, calcium and B12 is the recommended vitamin regimen.

Can Weight Loss Surgery prolong my life?

There is good evidence from scientific research that if you have Type 2 diabetes (or other serious obesity-related health conditions), are at least 100 lbs. over ideal body weight, and are able to comply with lifestyle changes (daily exercise and low-fat diet), weight loss surgery may significantly prolong your life.

Can weight loss surgery help other physical conditions?

According to current research, weight loss surgery can improve or resolve associated health conditions.

Is There A Chance To Regain Weight?

Some patients may feel frustrated and discouraged after weight levels off but is yet too high, or when slow weight regain occurs. This cannot go uncorrected. While responsibility to continue making progress and to avoid regression remains with the patient, help will be available. It is important to constantly realize that the pouch is there only as a tool and must be used properly. If this leveling off or regression happens, support may be necessary, and it is important to come back to see us so we may evaluate.