- What are the most important things to know about a surgeon and a hospital prior to selecting one to perform my surgery?
- Experience, commitment and collaboration are critical. Because of the many health problems that obesity surgery patients have, most of the procedures are considered high risk. The surgeon’s experience therefore, is crucial. Other important determining factors are your care team’s knowledge about obesity surgery and its collaboration between specialties. Obesity surgery isn’t just about losing weight. We believe that successful outcomes are best achieved when patients are educated by a multidisciplinary team that includes nurses, dietitians and psychologists.
- What are the routine tests before surgery?
- Certain basic tests are done prior to surgery: a complete blood count, urinalysis and a chemistry panel, which gives results of about 20 blood chemistry values. All patients except the very young get a chest X-ray and an electrocardiogram.
- Many surgeons ask for a gallbladder ultrasound to look for gallstones. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation or psychiatric evaluation, may be requested when indicated.
- What is the purpose of all these tests?
- An accurate assessment of your health is needed before surgery. The best way to avoid complications is to understand their potential in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.
- Why is a gastrointestinal evaluation necessary?
- Patients with significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching, sour fluid, etc., may be symptomatic of underlying problems including hiatal hernia, gastroesophageal reflux and/or peptic ulcer. Up to 15 percent of reflux patients may show early damage in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify this so a suitable surveillance or treatment program can be planned. The staff of the UI Weight Management program will assist your surgical evaluation in this regard.
- Why must I complete a sleep study?
- The sleep study detects a tendency for sleep apnea. The abnormal stopping of breathing usually associated with airway blockage when the muscles relax during slumber. This condition is associated with a high mortality rate. After surgery you will be sedated and will receive pain narcotics, which further depress normal breathing and reflexes. Airway blockage also becomes more dangerous at this time. It’s important that your surgeon has clear expectations of the procedure so he can decide how to handle possible irregularities.
- Why do I need a psychiatric evaluation?
- The most common reason a psychiatric evaluation is ordered is to fulfill insurance company requirements. Most evaluations focus on a patient’s understanding and knowledge of the risks and complications associated with weight-loss surgery and their ability and commitment to follow the basic recovery plan.
- What impact do my medical problems have on the decision for surgery, and how do medical problems affect risk?
- Medical problems such as serious heart or lung problems can increase the risk of any surgery. Conversely, if these problems are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
- If I decide to undergo gastric bypass surgery, how long do I have to wait?
- New evaluation appointments are typically scheduled two to three months in advance. Once a patient is seen, if the surgeon and patient agree the operation is appropriate, it is usually scheduled within six weeks.
- 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. And for men, this may include a prostate specific antigen test (PSA).
- Prepare a diet history of all previous weight-loss attempts to show your surgeon.
- Bring all pertinent medical data to your surgical appointment, including reports of special test results (echocardiogram, sleep study, etc.) and or hospital discharge summaries.
- Bring a complete list of medications including dose and schedule.
- Stop smoking. Patients who use tobacco products are a much higher surgical risk.
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University of Iowa Hospitals and Clinics
200 Hawkins Drive, 4604 JCP
Iowa City, IA 52242