What are the steps before surgery?

The process from inquiring about Bariatric surgery to having surgery performed involves a number of steps.  It takes time to undergo the proper evaluations and testing necessary before surgery.   Insurance approval for the procedure can also take time and require documentation, which must be collected.  Also, due to the overwhelming demand for the laparoscopic approach to this type of surgery and the relatively few surgeons who perform the surgeries in this manner, there can be a delay caused by the sheer numbers of patients requesting surgery.  It is not unusual for a period of 6-9 months to pass between the initial evaluation and surgery date.  Some centers have waiting periods longer than one year just for the initial visit.  Our clinic understands and empathizes with our patients’ desire to move forward as soon as possible after deciding to undergo Bariatric surgery.  Please understand that we will move you through the process as quickly as possible under the above constraints.

Our staff will contact you throughout the pre-surgical process.  Although you are anxious
about getting surgery, calling the office repeatedly for updates prevents the staff from being able to process patients and may cause delays in surgery.  We ask that you be patient so that everyone may benefit.

Initial Evaluation

Prior to you initial evaluation, you will meet with a staff member for an informational session.  During this visit you will receive a packet, which includes this material as well as a patient questionnaire and other forms.  This information is used to help determine if you are an appropriate candidate for Bariatric surgery.  Insurance requirements will also be discussed
with you.  It is very important to complete this information prior to your visit.  Failure of completing the forms demonstrates a lack of commitment needed to succeed with this type
of surgery.  You will be required to return this completed information before an appointment can be scheduled.

During the initial evaluation, you will meet with the medical director of the clinic.
The evaluation will consist of reviewing the collected information.  The doctor may request further information or testing if needed.  Surgical options will be discussed including risks, complications and weight loss expectations.   If you are deemed an appropriate candidate and decide that you would like to proceed with surgery, you begin the process for surgery.
This process involves many steps.  The time from your initial evaluation to surgery can be
6-9 months.

Consultation with Surgeon

Insurance Approval Process

It is usually necessary to obtain approval from your health insurance carrier in order to have
the surgery covered by the insurance company.  Bariatric surgery is an area where there is a great deal of variability in regards to insurance coverage and requirements.  Some policies
may exclude weight loss surgery totally. Most companies require that you meet their list of criteria to consider approval.  Our staff will advise you about the requirements your particular insurance carrier may have.

We understand that once you have decided to proceed with surgery you are anxious to begin this new phase of your life.  However, getting insurance approval for weight loss surgery is different than approval for other procedures and can take as long as a month.  Also, most insurance companies request that we only submit forms within a certain time frame before surgery.  This may mean waiting until closer to the anticipated surgical date before seeking approval.

Pre-operative Testing

Certain tests are required before surgery to lower the risks of complications.  This allows
the opportunity to correct problems that may affect your surgical outcome, or to discover problems that might place you at too great of a risk to undergo surgery.

Esophagogastroduodenoscopy (EGD)

Patients who are undergoing gastric bypass surgery have their stomachs evaluated
by endoscopies.  This is an outpatient procedure performed at the hospital or surgical center.  After patients are given I.V. sedation, the physician evaluates the stomach with a flexible scope. Biopsies may be obtained if there is significant inflammation.  The doctor may
prescribe medication to heal any abnormalities found from the EGD.

Gallbladder Ultrasound

Patients who are undergoing gastric bypass surgery also have their gallbladder evaluated by
an ultrasound exam to determine if gallstones are already present.
If gallstones are present, the surgeon will discuss the possibility of removing your gallbladder
at the time of the gastric bypass surgery.

Medical Clearance

Every operation places a patient at a certain level of risk of complications.  Morbidly obese patients are considered to be at a higher risk for any surgery.  Patients must
be evaluated and medically cleared for surgery.  Sometimes, your primary care physician may do this.  In some cases, you may need to be cleared by a specialist, such as a cardiologist.

Psychological Evaluation

Some insurance companies require that patients undergo a psychological evaluation as part of the approval process.  You will undergo psychological screening tests as part of the initial evaluation process.  We do not generally refer patients for formal psychological testing unless the patient’s insurance company requires it or there are reasons a patient might benefit from this type of evaluation.  Research has demonstrated that currently used psychological tests do not predict which patients are successful with Bariatric surgery.

Nutritional Evaluation

An evaluation of your dietary habits is performed during your initial evaluation.  However, some insurance companies require patients to undergo formal evaluations as part of the approval process.

Maintaining Current Weight

As mentioned many times earlier, Bariatric surgery is a tool used to aid weight loss.  It is not a cure.  Successful results require a commitment to healthy eating habits
and activity.  If patients are unable to maintain their weight throughout the pre-operative process, they may have difficulty adhering to post-operative recommendations.  Patients who gain a significant amount of weight during this process may be deemed poor candidates for surgery.

Nutritional Counseling

Hopefully at this point you have had all of the pre-operative testing completed and been approved for surgery by your insurance company.  Before having surgery, patients are seen at the clinic for a pre-operative visit.  During this visit, the
physician will review any medication changes needed before surgery and any instructions for the day of surgery.  You will also receive counseling about the post-operative period after surgery.  This includes a comprehensive nutritional program
to get the most benefit from your surgery.

Support Group

The American Society of Bariatric Surgeons states that every weight loss surgery program should include a support group.  Our clinic has an active support group that usually meets once monthly on the second Monday evening of every month.  We also offer a newsletter for circulation.
We strongly encourage patients to attend support group meetings both before and after surgery.