 |
|
|
Patients must discontinue smoking prior to surgery. Weight Loss Surgery is a life-style change towards better health, so it is suggested that health be improved in all aspects of your life, not just weight loss. Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, and can interfere with blood supply to the healing tissues. Back to top.
All patients will be required to take a multi-vitamin with minerals for the rest of your life. In addition, supplemental B12 and Calcium are recommended. Our dietician will review all the vitamin requirements and make suggestions regarding appropriate dosages and frequency. Dr. Koura and your primary care physician will periodically perform blood tests to evaluate the need for further supplementation. Back to top.
A psychological evaluation is performed on every patient going through the Weight Loss Surgery program. It is important that each patient be evaluated for any underlying mental health condition as well as to ensure that each patient has realistic goals for surgery and is able to make an informed consent regarding the procedure. In addition, clearance by a patient's psychiatrist must be obtained if the patient is currently on prescription medications for a diagnosed mental health condition. The Bariatric Coordinator will work with each patient to obtain this evaluation, trying to work within your health insurance plan. Please be advised that if this is not a covered benefit under your insurance plan, this will be an out-of-pocket expense. Back to top.
Because the procedure is elective, you ultimately make the decision, but you will do so in consultation with Dr. Koura. You are encouraged by Dr. Koura to learn about the procedures, and ask questions, so that you make an informed decision. Back to top.
If you have significant disease, our medical review team will do a preliminary evaluation. If needed, you may need to obtain independent evaluation and testing by your personal care physician or an appropriate specialist. The benefits and risks of the surgery will need to be weighed carefully as to whether you are a candidate for surgery. Dr. Koura can discuss your case with your personal care physician and specialist, so they are aware what will be involved. Weight loss surgery procedures may not be contraindicated even with significant disease, and may even improve your prognosis. However, this must be evaluated on a case by case basis. Back to top.
Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. Initially, a Patient Controlled Analgesia (PCA) is used while you are in the hospital, which allows you to give yourself a dose of pain medicine on demand. Many times, patients will use an oral, liquid pain medication in the early post-op days and find that it lasts longer. If your pain is uncontrolled, be sure to inform your nurse.
Upon your discharge from the hospital, Dr. Koura will prescribe a liquid pain medication for your use at home. Back to top.
Yes. There will be a scar on your upper abdomen from the surgery. The open procedure results in a scar from the bottom of the breastbone, approximately 4-6 inches in length. The laparoscopic operations leave multiple small scars on both sides and in the middle of your abdomen. Back to top.
When you agree to have Weight Loss Surgery, you need to commit yourself to life-long contact with our program. Each patient will be expected to attend all scheduled post-op appointments with Dr. Koura at the prescribed intervals. In addition, we encourage all patients to establish an ongoing relationship with our program dietician, as well as attend regular support group meetings. Patients from out of the Sacramento area must take this into consideration as all follow-up appointments are mandatory. Back to top.
Eating foods high in sugar may cause dumping syndrome in patients who have had a gastric bypass surgery. Your body handles sugar molecules by diluting them with water, which reduces blood volume and causes a shock-like state in your body. Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling: you may become hot or cold, clammy, perspire, turn pale, and have a pounding pulse. Cramps and diarrhea usually 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. Back to top.
Because of the rapid weight loss that occurs with surgery, pregnancy within the first 1-2 years following surgery is not suggested. A pregnancy is safest when your weight loss is stable and you are medically stable. Discuss this with Dr. Koura, your primary care physician and your obstetrician/gynecologist. Back to top.
Each patient should inform the physician about every medication he/she is taking, whether it is prescribed or over-the-counter. Generally, most medications such as hormone replacements can be taken without change in dosage or route. Some medications can cause problems. For example, nonsteroidal anti-inflammatory medications (e.g., ibuprofen, naproxen, aspirin, etc.) may cause gastrointestinal irritation, ulcers or other side effects. Another example is diuretics, which some patients may be taking as anti-hypertensive or cardiac medications. Diuretics affect the kidney and can cause loss of potassium or other electrolyte balance. Post-weight loss surgery, a patient's food and fluid intake is diminished and altered; this can cause complications, including electrolyte imbalance and cardiac arrhythmias, even to the point of causing death. Consult with your physician before resuming medications, post-operatively. Back to top.
Each patient responds to surgery differently, and you should ask specific information from Dr. Koura. However, generally, how quickly you return to work depends on the type of job you have. Those who have rather sedentary jobs find that they are able to return to work as soon as two weeks post-op, while those with jobs requiring physical exertion typically require up to six weeks to fully recover. Having just had major surgery, it is important to listen to your body and take your time in recovering. Back to top.
Almost immediately after surgery the nursing staff will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation. Back to top.
Anytime one loses a lot of weight, hair loss is a problem. Usually hair loss begins around the 3rd or 4th month post-op. It is usually temporary and the hair eventually comes back. There is a lot of controversy as to what can be done to prevent hair loss. Use caution when purchasing special shampoos or products promoted for this purpose, as there is no proven effective way to avoid post-op hair loss. Back to top.
For an open procedure the Gastric Bypass takes about 1 ½ -2 ½ hours. However, the prep time and time getting the patient to the recovery room make the entire time from the waiting area to the recovery room approximately 2-4 hours. If the gallbladder is removed at the same time, additional time is required. Laparoscopic surgery can vary from 1 ½ - 4 hours. Following surgery, the patient stays in the recovery room for at least 1 hour before going to their room. Back to top.
The Lap Band surgery is the least invasive and a relatively safe procedure. It is safer to have this surgery than it is to have many other operations considered to be routine. The Roux-en-Y gastric bypass is more risky and has some nutritional problems. There are risks with all major surgeries including blood clots, lung problems, infections, bleeding, and even death. During your consultation with Dr. Koura he will discuss with you, at length, the risks involved both generally and based on your individual case. Back to top.
Dr. Koura performs surgery on patients 18 years and older. This is the generally accepted guideline from the American Society for Bariatric Surgery and the National Institutes of Health, although surgery has been performed on patients 16 and younger. There is a real concern that young patients may not have reached full emotional maturity to make this type of decision. It is important that young surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success. Back to top.
Dr. Koura performs two different types of weight loss surgery. The Roux-en-Y Gastric Bypass, or RNY, is offered either "open" or "laparoscopically", depending on the situation. He also offers the Lap Band®, which is performed laparoscopically. During your initial consultation, you and Dr. Koura can discuss which option is better for you. Back to top.
With the Roux-En-Y gastric bypass, the surgery is both restrictive and malabsorptive. It is designed to reduce the size of the stomach, which reduces the amount of food intake. With this smaller stomach, you should feel full with much less food. Making smaller amounts of food possible results in an easier weight loss and makes it easier to maintain that weight. It also bypasses a part of the small intestine which results in fewer calories being absorbed.
The Lap Band® restricts the size of the stomach so that only a small amount of food can be ingested at a time. This process makes you feel full on much less food, which results in weight loss. Back to top.
Diet and exercise are essential in losing and keeping your weight off. Weight loss results from decreased quantity of food, increased quality of food, and increased activity. Your surgery is not magic, but a tool that can greatly assist you to lose excess weight if used correctly. Exercise plays an important role in toning and strengthening your body as you lose weight. In addition, nutritious food choices are critical to your success. Back to top.
First, the stapling and cutting away of the old stomach create a small stomach pouch, which causes restriction in food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum (the first segment of the small intestine) as well as the first portion of the jejunum (the second segment of the small intestine). This causes reduced calorie and nutrient absorption. Back to top.
The Lap Band is the least invasive surgical weight loss procedure. It is performed laparoscopically. It is a restrictive procedure and works by placing a silicone ring around the upper part of the stomach, creating a small pouch. With the Lap Band®, there is no cutting or stapling of the stomach, or bypassing of the intestines. A small balloon is attached which can be inflated or deflated depending on weight loss. If for any reason the band needs to be removed, the stomach generally returns to its original form. Back to top.
Each patient will meet with the dietician to review the progressive diet recommended after surgery. The food must be high in protein and consumed in much smaller quantities. While in the hospital, patients will be given ice-chips, and then advanced to clear liquids. At weekly intervals, or as directed by the physician, patients will be slowly advanced to a full liquid, pureed, soft, and eventually a regular diet. Back to top.
The surgery is simply a tool to help you lose weight. The success depends upon your commitment to yourself and to the overall program (diet and exercise). Most RNY patients lose between 50-70% of their excess body weight by 12-18 months, while patients using the Lap Band may require a longer time for weight loss. Long-term studies show that Roux-en-Y patients and Lap Band patients usually have the same outcomes at 5 years post-op. Not all patients will reach their ideal weight, but if comorbidities are gone of significantly decreased, the surgery is considered successful. Back to top.
|
"Life is good. For the first time in my life, I actually feel like I'm living life, instead of standing on the sidelines and watching it pass by. I'm happy."
Delene Evans, Elk Grove, CA
|
|
 |
 |
Dr. Koura
