Frequently Asked Questions
You are a candidate for bariatric surgery if your BMI is more than 30 and above with co-morbidities like type 2 diabetes, hypertension, arthritis, high cholesterol, sleep apnoea, etc or BMI 35 and above without any co-morbidities.
As a general rule all bariatric procedures will require general anaesthesia for a safer outcome.
Surgery on obese people may take slightly longer to perform than normal individuals. Depending on the nature of surgery, your operation may take between 60 minutes to few hours.
If the surgery is uneventful, feeding can be started on the same day for sleeve gastrectomy once the patient has recovered completely from the effects of anaesthesia. Patients undergoing Gastric bypass and other malabsorptive procedures will be started on liquid diet 24 hours after surgery
For most operations, 4 – 6 hours after surgery you will be able to return to your normal activities such as getting in and out of the bed, walking, going to the bathroom, etc. However some can take up to 24 hours depending on their age and co-morbidities.
Post operative tests may no be necessary for sleeve gastrectomy or other restrictive procedures. In case of Gastric bypass & other malabsoprtive procedures, you may undergo Gastrograffin study 24 hours after surgery. If there is no demonstrable leak in the bowel, patient will be fed orally.
Depending on the type of surgery you
may most likely be discharged home on the day after surgery or two days later. After a complex or revision surgery. Sometimes patients will spend a long time (with severe comorbidities like sleep apnoea) to be fully functional without support before discharge. In general, hospital stay for Bariatric surgery is significantly like any other laparoscopic surgery.
No. Because of anesthetic and pain medications, you will not be able to drive immediately after surgery due to poor refluxes and discomfort.
Patients can be able to do routine house hold works like cooking, climbing stairs, etc in a span of three to five days. Within one week many patients are able to return to work. For the first 4 weeks after surgery, patients are advised to avoid strenuous activities or lifting very heavy weights. After that you can resume more strenuous activities.
You need to keep the surgical sites clean and dry (that means no showering or bathing except sponge baths) for the first two days after surgery. After that you may remove the bandages, shower, and expose the sites to water and soap.
Yes. After 48 hours, you should remove you bandages but leave the area clean and dry. You should take atmost care not to disturb the wound area until your next office visit.
No. We will be using absorbable subcuticular sutures that are buried inside the skin and don’t need to remove them. Sometimes, we will be using interrupted sutures over the skin, but still they need not be removed and will dissolve by themselves in 2 weeks.
Minilaparoscopy, or pinhole surgery, uses much smaller surgical instruments (about 1/4 the of an inch in diameter) almost half the size of laparoscopic techniques (about 1/2 of an inch in diameter). The main advantage will be a reduction in the size of the scar and less pain after surgery.
Since this laparoscopic technique involves, one small naval incision for laparoscopy, and not three holes like in conventional laparoscopy, theoretically speaking pain is less and recovery is faster. However, cosmesis is the most important advantage due to its literally invisible scars immediately after surgery.
If your Body Mass Index is not very high ( > 45), you are not suffering from life-threatening complications, large abdominal apron displacing the navel way below the regular position, or any previous abdominal surgeries with long midline scars, then you can be a candidate for SILS surgery.
Robotic surgery is the latest trend in bariatric surgery which gives the advantage of surgical safety with technical precision, least complications and blood loss coupled with patients comfort like less pain and faster recovery.
Laparoscopic bariatric surgery at times becomes more complex and difficult on super obese patient (BMI > 50) which adds to the risk of post-operative complications. Hence a 2 stage procedure or a less effective surgical option may be suggested for treatment. Robotics will help avoid this confusion and can be useful to perform the more complex procedures on patients with any BMI as a single stage procedure.
Advantages of SILS bariatric surgery come at no significant additional cost. Robotic surgery will cost you 30% more than laparoscopic option, however the advantages of safety, precision & recovery outPLAYS this increase.
There are few endoluminal Bariatrics available for people interested in excess weight loss of 20 – 30 % and better control of diabetes along with medicines. However you need to be evaluated before making a decision on the eligibility criteria.
Our institute performed Asia’s first Endoscopic Bariatric Surgery way back in 2012. We perform all forms of endoscopic weight loss surgeries including endoscopiesfor revisions and complications in our center on a regular basis.
You should consult us. Thorough evaluation of nutrition intake, energy expenditure, and other reasons for weight gain / poor weight loss have to be evaluated. Our nutritionist will modify you diet pattern to aid with more weight loss.
Three main criteria on which revision bariatric surgery are performed are:
- Intractable complications after bariatric surgery
- Excess weight loss of less than 50 % at 18 months
- Weight regain of > 30 % in one year after nadir (after achieving expected weight loss)
Revision Bariatric surgery is a more complex procedure and is performed only in very few tertiary centers like us across the world. A malabsorptive component is added if restriction alone was done in primary surgery or stronger malabsorption is added on previous primary malabsorption to achieve expected weight loss.
Complication rates are between 1 and 6% in Bariatric surgery. They can be presenting early or late after surgery. Few of the signs of complications include fever, vomiting, severe abdominal pain, and distension, giddiness and fainting episodes, sudden breathlessness, etc. Our center has the distinction of having one of the least complication rates (1.2% overall) reported in the world.
For any emergencies, please attend the nearest emergency service hospital to get your vitals checked. You need to inform the attending doctor about the surgery you underwent. It’s better you or the treating physical get in touch with us before attempting any intervention on you. If you can access us, it’s always better to contact and visit us for better management of emergencies. You can reach u 24 x 7 either through our Bariatric helpline +91 9944099440 or Apollo helpline +91 44 33133333
Bariatric surgery is like other major surgeries. You can best prepare by knowing the benefits and risks of surgery and by closely following your doctor’s instructions. To mentally prepare yourself:
- Understand the surgical process and what to expect afterward.
- Keep in mind that you’ll never be able to eat the way you did before, and that you’ll have to watch the way you eat for the rest of your life.
- Talk to people who have had bariatric surgery.
- Write down your reasons for having bariatric surgery, outlining your plans to maintain your weight loss after surgery.
- Get the support of your family. It helps to know you have people behind you, waiting to help.
To prepare yourself physically, follow the guidelines that we will give you. The guidelines will be based upon your procedure, your personal profile, and other factors. They will lay out the need for weight loss before surgery, and the diet, supplement, exercise, and behavioral requirements after surgery. You want to ensure your best outcome, and the guidelines will help you accomplish that.
We will often require our patients to lose a small amount of weight before surgery. This is primarily done to decrease the size of the liver and increase your chances of undergoing a safe laparoscopic procedure. Studies have shown significant shrinkage of the left lobe of the liver with weight loss prior to surgery. We will provide you with an easy-to-follow plan between 3 – 14 days based on individual requirements to help you reach the target weight.
Certain basic tests are done before surgery: Complete Blood Count (CBC), nutritional and hormone analysis. Often, a blood glucose test is done for diabetes, which is very common in people suffering from obesity. Except for the very young, all patients receive an electrocardiogram. You may receive a gallbladder ultrasound to look for gallstones. Other tests include pulmonary function testing, echocardiogram, sleep studies, endoscopy, cardiology evaluation, and psychiatric evaluation.
Patients who have gastrointestinal symptoms, such as upper abdominal pain, heartburn, belching sour fluid, etc. may have problems such as a hiatal hernia, gastroesophageal reflux, or peptic ulcer. For example, many patients have symptoms of reflux. Some of these patients may show early changes in the lining of the esophagus, which could be an early sign of esophageal cancer. It is important to identify these changes so that a treatment program can be planned.
If you snore at night, and feel excessively tired and fall asleep frequently during the day, you may be suffering from Obstructive Sleep Apnea. To test for that, the sleep study looks for abnormal stopping of breathing because of the airway being blocked when the muscles relax during sleep, which is linked to a high mortality rate. After surgery, you will be given pain-killing drugs, which affect normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of whether you have Obstructive Sleep Apnea and start treatment with CPAP (Continuous Positive Airway Pressure) ahead of surgery.
Time of admission depends on your obesity grading, the severity of comorbidities and anesthetic grading. A normal risk patient will be admitted the night before surgery, and their bowel is prepared for surgery. You will be given a liquid to drink at 8 pm which cleanses your digestive system. Any additional or repeat tests required will be performed. Patients requiring optimization of their complications may have to be admitted 24 – 48 hours earlier.
For many bariatric surgery patients, the long-anticipated day of surgery is an exciting end to a long wait. It’s often referred by patients who have gone through surgery as their “birthday,” because of the life-changing transformation of health they’ve achieved.
Preparing for the day of bariatric surgery is like preparing for many other surgeries: We will give you specific instructions for you to follow. A few of the more frequently given instructions include:
- Do not drink or eat anything prior to surgery, beginning the midnight before the day of surgery.
- Most medicines can be taken the day of surgery, just with small sips of water (however, your doctor will have instructions regarding specific medications).
- Bring all of your medications with you to the hospital.
- Bring your CPAP machine, if you have one, for use in the hospital.
You will undergo a few preoperative steps. You will see your nurses, and you will see your bariatric surgeon as well as your anesthesiologist. An IV line will be started to keep you hydrated and to administer medications such as antibiotics. The preoperative experience is often a short one, after which you will be taken to the operating room.
If you are not already under anesthesia before you get to the operating room, you will be once there. Then, you will be intubated and your surgeon will perform the operation. Bariatric procedures, usually last between 70-180 minutes.
After surgery, your healthcare team will make sure your vital signs are acceptable and arrange for you to be taken to a recovery room.
Soon after surgery, within 2-3 hours, we will require you to get up and move around. Patients are asked to walk at the bedside the evening of surgery and take several walks the next day and soon after. Upon leaving the hospital, you may be able to care for all your personal needs, but you will need help with shopping and lifting, and with transportation.
Your ability to resume your normal levels of activity depends on your physical condition, the nature of the activity, and the type of bariatric surgery you had. Many patients return to normal levels of activity within 2 – 4 weeks of surgery.
It is extremely important that women of childbearing age use the most effective forms of birth control during the first 12 to 18 months after bariatric surgery. The goal is to avoid getting pregnant during the most rapid phase of weight loss. Please discuss with your OB/Gyn doctor about your options. Mechanical forms of contraception are preferred, because oral contraceptives may not be fully absorbed after bariatric surgery.
Bariatric surgery is meant to help you keep off excess body weight for life. It does not guarantee the weight loss. Maintaining weight loss means a dedicated lifestyle-finding new ways to deal with food, get exercise, and even relate to other people.
To ensure success, we require that you make 4 visits within the first year and then a yearly visit. Frequent follow up visits have been shown in many studies to improve surgical outcomes after bariatric surgery. During your visits, you will have physicals, twice during the first year and yearly thereafter or as a nd when necessary, you will have blood tests to look for anemia (low red blood cell count) and to check levels of various vitamins and essential nutrients.
Personal dietary counseling after surgery is extremely important as you toy with your new diet and lifestyle. At our practice, we have made available to you registered dietitians with experience and expertise. They will be able to meet with you and guide you through the process. Our office will make the necessary appointments for you.
With restrictive surgeries like sleeve gastrectomy, co-morbidities resolve with weight loss and so might take few months. Resolution of comorbidities after malabsorptive procedures like gastric bypass, are independent of weight loss and may start resolving immediately after surgery until 2-3 months.
Though Diabetes & Hypertensions resolve well after bariatric surgery, you cannot take things for granted. However, with better control of co-morbidities, you can occasionally fool around with sweets and salty food to treat your palate.
Contrary to popular concern, with the right diet pattern, long term nutritional deficiencies are not common after Bariatric surgery. Nutritionist play an important role in helping you tailor make your diet to avoid deficiencies and we recommend to stay in constant touch with her.
You will be subjected to nutrition assessment at various intervals depending on your pre-operative values and post-operative signs & symptoms. Since there are possibilities of deficiencies in short term, our nutritionist will design the food guide and supplements / medications to set right your deficiencies. For patients with long term nutritional deficiencies, intermittent continuation of replacement supplement / medications will be recommended by our nutritionist.
An average weight loss of 70 – 80% can be expected after surgery. This will take up to a period of one year to achieve this goal. Though the weight loss pattern may differ in each individual, the final percentage goal should be reachable if the bariatric surgical team’s recommendations are followed. The time period when the weight loss plateaus is called as NADIR.
Yes, you can as early as two weeks after surgery. However, we recommend you to have a check on your drinking habits, as people are prone for addiction after surgery.
You are advised to meet our medical cosmetologist one month after surgery. There will be a set of skin & muscle toning workouts you need to follow along with a right nutritional intake recommended by the nutritionist. You might be suggested some creams and gels as well to elasticity the elasticity & moisture of your skin.
Very few ( less than 10%) of patients, especially if there were very huge and lost weight might need cosmetic surgery. You will be reviewed after a year/ once the NADIR is achieved to evaluate on your skin. Depending on the level of your comfort with your body, cosmetic surgery consultation will be adviced.