FAQs about Bariatric Surgery

Surgery is done on patients between the ages of 18 - 65. If you're younger than 18, please refer to our Adolescent Bariatric Surgery Program at Lucile Packard Children's Hospital. If you are older than 65, cases are evaluated on a case by case basis. Please keep in mind your insurance may restrict your options.  

We look at Body Mass Index (BMI), which is the weight over the body surface area squared. Patients who have a BMI of 35-40 and have obesity related co-morbidities are candidates for this surgery. Patients who have a BMI greater than 40, even if they don't have co-morbidities, are also candidates for this operation. 

These include diabetes, hypertension, arthritis, degenerative joint disease, sleep apnea, low pack pain, gastroesophageal reflux disease, stress incontinence, high cholesterol and triglyceride levels and depression. 

The gastric bypass operation allows you to lose upto 82% of your excess body weight, however it's almost 100% effective in reversing obesity related co-morbidities including sleep apnea, hypertension and diabetes. The adjustable gastric banding (lap-band) operation allows you to lose 50% of your excess body weight at two years. It's also effective in reversing obesity related co-morbidities. The sleeve gastrectomy is between the gastric bypass and gastric banding in terms of weight loss with 60% excess weight loss at 1 year. 

1. You must have a stable relationship with a primary care physician who has been treating you continuously for one year prior to consideration for surgery.
2. You must have a dietician evaluation.
   
3. You must have a psychological evaluation. Patients with bipolar disease are generally excluded from consideration for surgery. 
4. If you have a history of heart disease, if you've taken Fen-Phen in the past, if you're over the age of 50, or other cardiac risk factors, you'll require an echocardiogram.
   
5. At some point prior to surgery, you'll have to undergo a chest x-ray, an EKG and blood tests.  

Laparoscopic surgery means that instead of making one large incision in your abdomen, we make five small incisions in the middle and to the left side of your abdomen. These smaller incisions allow you to recover faster. You'll also experience less pain, leave the hospital sooner and will be back to your normal activity sooner. In general, we start all of our cases laparoscopically unless the patient has had previous surgery on their stomach. 

We require patients to begin a diet and exercise program that allows them to lose 10% of their weight pre-operatively for three reasons:

1. Patients who undergo weight loss before surgery have fewer complications during and after
   surgery.
2. This allows patients to truly understand the lifestyle changes that will occur after surgery and therefore make an informed consent about the diet and exercise programs that they will have to be on for the rest of their lives.
3. This allows us to identify the patients who are truly motivated and therefore who will be most successful following surgery. Most important, we'll work with you to develop a weight-loss program to achieve the 10% reduction goal.

Your initial workup/consult will be done by a surgeon who will screen you for medical problems. Once the surgeon has determined that you're a good candidate for this operation and if you've met all of our criteria, you’ll then be given a plan for bariatric surgery. 

We will work with you to quickly get you started on your new life.

Weight loss surgery is major abdominal surgery with significant risks. However, we know experience counts and high-volume centers like Stanford Health Care have an extremely low complications rate.

The following potential complications include, but are not limited to:

• Risk from general anesthesia
• Bleeding
• Infection
• Pneumonia
• Blood clot in the legs or lungs
• Hernias (internally or externally)
• Blockage or obstruction
• Narrowing where surgeons suture the pouch to the intestine, which can require another endoscopy and dilation 
• Leakage from the stomach or the intestines
• Injury to liver and/or spleen
• Pulmonary and/or cardiac and/or renal failure

With the adjustable gastric band (lap-band), there's a risk that the band can either slip or erode. There's a risk that you will not lose weight if you don't follow the diet and exercise program. There's a risk of needing another operation or conversion to an open operation with a long incision. While there's a risk of death with each procedure: 1-in-200 with the gastric bypass, 1-in-500 with sleeve gastrectomy, and 1-in-10,000 with the lap band.  

Conversion to open surgery is required in less than 1% of patients. The risk of conversion is higher in patients who have had previous upper abdominal surgery.  

Deciding which procedure is best for you is largely a personal one best achieved in discussion with your surgeon. 

It's very important that you understand this surgery won't remove your sense of hunger. It won't cause you to lose your desire to eat and it won't remove any of the psychological cravings that you may have for food. If you eat when you're stressed, you'll still feel like eating when you're stressed. Therefore, it'll be very important that you understand the stresses that make you feel like eating and identify other ways of resolving these issues. Part of your Bariatric Surgery team can include a psychologist to help you understand your eating triggers and how to cope with them.  

In general, you'll be in the hospital for two nights. We'll expect you to get up and walk while you're in the hospital – this is your best defense against blood clots. You'll meet with the dietician before going home and while you're here, you'll have a clear liquid diet that will be limited to a medicine cup every 15 minutes.

Once home, you can drink until full. Please walk, drink once every hour, and take in at least 40 - 60 grams of protein daily for women, and 60 - 80 grams of protein daily for men