FAQs for Referring Physicians
Which patients are candidates for weight loss surgery at Southeast Bariatrics?
Patients with:
- A Body Mass Index (BMI) of ≥ 40kg/m2 or ≥ 35kg/m2 with obesity-related co-morbidities including diabetes mellitus, hypertension, coronary artery disease, dyslipidemia, obstructive sleep apnea and gastroesophageal reflux disease
- Ages 18-65. Patients over 65 will be evaluated on an individual basis and must have their primary care physician’s approval. Patients under 18 may be evaluated only under an investigational trial with institutional review board permission
- Ability to undergo general anesthesia
- History of attempting diet, exercise, behavior modification and/or weight loss medications in the past, particularly within the last 5 years.
- No smoking for a minimum of three months prior to surgery.
- ≥ 5 years after treatment for major cancer
- No psychological illness or addiction
- Ability to understand the risks, benefits and alternatives of weight loss surgery
- Willingness to participate in our pre-operative evaluation and post-operative follow-up programs
- Must have a good support system
- Must have a primary care physician
What is the pre-operative evaluation process at Southeast Bariatrics?
Our goal during the pre-operative process is not only to determine if a patient is a candidate for weight loss surgery, but also educate the patient about how their surgery works, what they need to do to maximize the benefits and minimize the risks of their surgery, and set up a lifelong support system for the patient.
We do this by conducting:
- Educational Seminar
- Initial office consultation which includes surgical evaluation, discussion with our bariatric coordinator and financial/insurance planning
- Nutritional evaluation
- Psychological evaluation
- Exercise evaluation
- Gastrointestinal evaluation with either an UGI with H. Pylori breath test or Upper endoscopy with H. Pylori biopsy
- Pulmonary evaluation with a mandatory CXR with sleep study and pulmonary consultation as needed
- Cardiac evaluation with a mandatory EKG with echo and cardiology consultation as needed
- Laboratory work to evaluate for operative considerations, as well as rule out endocrine causes for their obesity
- Mandatory attendance to at least one support group
- Pre-operative visit to explain the OR/hospital process and address any additional questions or concerns
What are the surgical options offered by Southeast Bariatrics?
We offer the widest variety of surgical options in the region. Just as there is not one diet that fits every patient, we believe that there is not one surgery for every patient. Each has is own risks and benefits and should be tailored to meet each patient’s needs.
Our surgical options are:
- LAP-BAND
- Roux-en-Y Gastric Bypass
- Biliopancreatic Diversion with Duedenal Switch
- Vertical Sleeve Gastrectomy
Each of these operations can, and usually are, performed laparoscopically using minimally-invasive techniques. Please see review Surgical Options for more information on the specific procedures.
What pre-operative changes should be made to the patient’s medical regimen?
Patients will be placed on a high protein, low carbohydrate liquid diet two weeks prior to surgery to reduce body fat, decrease liver size and help patient adjustment to their post-operative diet. Diabetic patients may need medication adjustments.
Patients will be asked to stop oral contraceptives and hormone replacement therapy two weeks prior to surgery to reduce the risk of venous thromboembolism.
Patients will be asked to stop any anti-coagulants such as aspirin, NSAIDs, plavix or coumadin one week prior to surgery. If the patient must stay on anti-coagulants, we can use Lovenox in the pre-operative period. Patients at very high risk for DVT may need a pre-operative vena caval filter.
Patients will not be allowed to take pills for three weeks after surgery to minimize obstruction, stenosis and ulceration. All medicines must be crushable, chewable or in liquid form. Sustained-release medications should be converted to their standard form during this period.
What short-term issues should be considered in the post-operative patient?
Signs and symptoms of post-operative complications, such as pulmonary embolism, anastomotic leaks, anastomotic stenosis, bowel obstruction, pneumonia, gastrointestinal bleeding and wound infection, include:
- Fever
- Tachycardia
- Excessive abdominal pain
- Dyspnea
- Chest pain
- Excessive nausea/vomiting
- Abdominal distention
- Inability to tolerate liquids for 24 hours
- Excessive fatigue/weakness
- Very pale complexion
- Melena or hematochezia
- Wound erythema
- Purulent or bilious wound drainage
- Anastomotic leaks occur within the first 10 days in 95% of cases.
- Gastrojejunostomy stenosis usually occurs during weeks 4-8 post-op.
Sustained release medications may be started after 3-6 weeks, but need to be monitored closely as their absorption may be changed.
What long-term issues should be considered?
Long-term complications to be on the lookout for include: anastomotic ulcer, bowel obstruction, micronutrient deficiency, wound hernia and cholelithiasis. In addition, the following should be noted or followed post-surgery:
- NSAIDs should be avoided completely because of the risk of pouch irritation, ulceration and stenosis. If they must be taken, Celebrex would be the first choice, if tolerated, and they must be taken with a proton pump inhibitor.
- Vitamin and mineral supplementation is mandatory. Common micronutrient deficiencies include: iron, calcium, thiamine, B12, vitamin D, selenium and zinc. Gastric bypass patients will be placed on MVI, calcium, iron and B-complex. Duodenal switch patients will receive all of the above plus ADEK and 80grams of protein daily. Lap band and sleeve gastrectomy patients will be placed on a MVI. We will monitor nutritional labs every three months the first year and yearly thereafter. Our lab panel consists of: CBC, CMP, iron panel, ferritin, pre-albumin, iPTH, thiamine, folate, B12, zinc, selenium, vitamin A and 25-OH vitamin D. Yearly DEXA scans in postmenopausal women should be considered.
- Patients are placed on Actigall for six months to decrease the risk of developing cholelithiasis.
- Patients who regain weight should be referred back to Southeast Bariatrics for evaluation of potential causes. The most common causes are: noncompliance, psychological issues or mechanical issues.
- Excess skin occurs in most patients. It is generally a cosmetic issue for the plastic surgeons, but may cause skin necrosis, panniculitis and pain.
- Pregnancy is strongly discouraged until weight loss is plateaued, usually after 18-24 months. Two forms of birth control are recommended. Should a patient become pregnant during her period of weight loss, her nutritional status will need to be closely monitored and supplemented. Once the weight loss period is complete, pregnant patients need only add their pre-natal vitamins to their LAP-BAND patients may need to have their bands deflated.
How can I refer my patients to Southeast Bariatrics?
Please call us at 704-347-4144 or email us at info@southeastbariatrics.com for referrals or more information about our program.
