Weight Loss Surgery Timeline

Deciding to undergo weight loss surgery is a major decision that will have a dramatic effect on your lifestyle and eating habits. It is important that you are well motivated and informed before you are even evaluated by your surgeon and the multidisciplinary team at the Columbia St. Mary’s Bariatric Center.

This Weight Loss Surgery Timeline has been created to guide you through the process of undergoing bariatric surgery - the preoperative work-up and consultations, the operation and hospital stay, and the postoperative course and follow-up. Bariatric surgery is a process that involves much more than just an operation. Therefore, it is critical that you understand this process and what is necessary to create a healthier you.

Information about weight loss surgery is readily available, and it is important to learn as much as possible before meeting your surgeon. Magazines and newspapers, as well as the Internet, are excellent sources of information about bariatric surgery. Talking or meeting with other patients who have undergone a procedure or are considering surgery is also a good way to learn about the process of weight loss surgery. The Columbia St. Mary’s Bariatric Center offers preoperative seminars and support groups that can also be helpful. Finally, it is important to discuss the possibility of surgery with your primary care physician. Your doctor knows your medical history best, and may have important information regarding your qualifications for surgery.

After you have learned about weight loss surgery, you may call the Columbia St. Mary’s Bariatric Center to find out if you are a candidate for surgery. The phone number for the Center is (414) 962-2274. A bariatric nurse specialist is available at that number to perform an intake of basic health information to determine if you are a candidate, and to schedule an appointment with our multidisciplinary team.

The bariatric nurse specialist will help you calculate your body mass index (BMI) based on your weight and height. If your BMI is greater than 40, or greater than 35 with significant obesity-related health problems, you may be a candidate for weight loss surgery. You may use the BMI calculator located on this website to determine your own body mass index. Your surgeon will make the final decision regarding whether you are a candidate for undergoing a bariatric procedure.

Your appointment at the Columbia St. Mary’s Bariatric Center will begin with meeting a nurse specialist to obtain more medical history. You will meet with your surgeon to review this information and answer any questions you may have. You will discuss the risks and benefits of undergoing bariatric surgery to help determine if surgery is the right choice for you. Together with your surgeon you will decide if you are a potential candidate for surgery, and if you should begin the preoperative work-up. Most likely, you will also meet with a bariatric dietitian at this appointment to further evaluate you for surgery, and to discuss the significant dietary changes that occur after weight loss surgery.

The preoperative work-up depends on your individual health status and history. Everyone undergoing weight loss surgery at Columbia St. Mary’s must meet with their surgeon, a bariatric dietitian, as well as a psychologist or psychiatrist. All patients will then see their primary care doctor for a history and physical exam, as well as routine blood and urine tests. In addition, patients may have an EKG and chest X-ray performed. Further testing, such as a sleep study to test for sleep apnea or a stress test to check for heart problems, may be necessary depending on your individual health status. This work-up can be arranged through the Columbia St. Mary’s system, or may be done closer to home if you are traveling a significant distance.

Most insurance plans will cover weight loss surgery as long as the National Institutes of Health guidelines for body mass index are used as qualifying criteria. However, some plans do have a weight loss surgery exclusion clause and some plans may require a period of monitored dieting prior to approval. Should you want to check your coverage, a list of commonly used insurance companies and their links are listed below.

Aetna Healthcare BlueCross BlueShield BlueCross BlueShield Federal Cigna Empire BlueCross BlueShield

Humana Medicaid Medicare UnitedHealthcare WPS Health Insurance

Approval must be obtained for your preoperative visit with your surgeon, as well as the surgery itself. The approval process for surgery may take as little as a few weeks, but most likely will take a few months once the process has started. The bariatric nurse specialist at Columbia St. Mary’s will assist you with obtaining authorization. Your surgeon will also send a letter to your insurance company to document why the procedure is medically necessary. In some cases appealing an initial insurance denial or even changing insurance companies may become necessary.

Columbia St. Mary’s Bariatric Center now participates in the BLIS program. Designated BLIS Centers have demonstrated that they meet or exceed standards for patient safety and long term follow-up. The BLIS program allows for competitive package pricing for patients considering cash payments, as well as coverage for complications or additional care required after surgery. Please contact Columbia St. Mary's Bariatric Center at (414) 962-2274 for additional information. To learn more about BLIS, visit www.bliscompany.com.

You are strongly encouraged to lose some weight prior to your procedure. It may be difficult to lose weight, but even a few pounds of lost weight prior to the surgery can make for a technically easier and safer operation. Binge eating and weight gain can cause your liver to become engorged with fat, which can make the operation more difficult and injury to the liver more likely.

You will be required to attend a preoperative class a few weeks prior to your surgery. You will sign your operative consent forms and further discuss the details of your hospitalization and diet changes.

The operation will last from 2-6 hours depending on the operation that is being performed and any prior surgical history. Your family can wait in your room and your surgeon will find them after the procedure to update them.

After surgery you will be taken to the recovery room. The breathing tube that is used during surgery for general anesthesia may be removed in the operating room or once you have been moved to the recovery room. Your anesthesiologist will monitor you closely as you wake up from anesthesia.

Most patients remain in the recovery room for a couple of hours, and then are moved to a room in the Columbia St. Mary’s Bariatric Center. In rare situations it may be necessary to be transferred to the ICU for closer monitoring.

Every patient’s hospital stay is different, but the following is a typical hospital course for a Roux-en-Y gastric bypass procedure. After you arrive in your room the nursing staff will set up a patient controlled analgesia (PCA) pump for pain control. You will also be asked to begin walking the halls the day of your surgery. Early ambulation is an important part of a safe and more rapid recovery. You will also be encouraged to take deep breaths and use a device called an incentive spirometer to help reduce your risk of pneumonia. The day and night of surgery you will be allowed to eat ice chips, but will not be allowed to have anything to drink or eat.

The first day after surgery most patients start the stage I bariatric diet, which includes low calorie and non-carbonated liquids and sugar-free Jell-O. If your surgeon feels it is necessary you may undergo an X-ray study where you drink a small amount of contrast liquid. The catheter in your bladder is usually removed on the first day after surgery. You will also start to take oral pain medications (crushed pills or liquid form), and you will no longer need your PCA pump.

The second day after surgery most patients are advanced to the stage II bariatric diet, which includes pureed foods. Most patients are ready to be discharged home in the afternoon or evening of this second postoperative day (if your surgery is Monday you go home on Wednesday). Your bandages will be removed and you may shower prior to discharge from the hospital.

Prior to discharge you will be given detailed instructions regarding your recovery, medications, and follow-up. Your medications on discharge from the hospital will include pain medication, a chewable multivitamin, and any other essential preoperative medications. It will be important to crush your pills for the first 3 weeks after surgery.

For patients undergoing a Lap-Band^® procedure, oral pain medication and the stage I bariatric diet are started immediately after surgery. Most patients are discharged from the hospital the day after surgery.

Your first postoperative appointment will be three weeks after surgery. Your wounds will be covered with white tape (steri-strips) when you leave the hospital, but these strips will fall off over the first week or so. You may shower during this time, but you should not take baths or go swimming. It is important that you continue to walk during the first three weeks after surgery, but you do not want to lift anything greater than 20 lbs. You may resume driving once you stop taking narcotic pain medications and no longer have significant pain. Most patients take off work for about three weeks, depending on the individual job situation.

At your three week visit your surgeon will discuss your recovery and examine your wounds. You will be started on nutritional supplements, which will include an iron pill (Chromagen Forte prescription), calcium, and a multivitamin. If you still have your gallbladder a medication called Actigall will be prescribed for 6 months to decrease your risk of developing gallstones while you are rapidly losing weight.

Most patients undergo significant weight loss during the first year after surgery. You will be able to resume a more regular diet after the first few weeks. You must also remember to take your supplements every day. The bariatric dietitians are available to answer questions during this time of rapid weight loss and dietary changes. In addition, Columbia St. Mary’s Bariatric Center also offers exercise classes and instruction through the physical therapy department. Appointments for these sessions can be arranged by contacting the Center.

You will have follow-up appointments at six months and yearly after your operation. These appointments allow us to check blood tests and track your weight loss. In addition, many of your obesity-related health problems may improve or even disappear as you lose weight. It is important for your surgeon and primary care physician to follow these changes. Undergoing bariatric surgery is a life-changing event that requires medical care and follow-up for the rest of your life.

Many patients undergo dramatic changes after weight loss surgery. All patients are encouraged to participate in postoperative support groups, which help with answering questions and sharing experiences associated with weight loss surgery. These sessions occur twice a month and appointments can be made by contacting the Columbia St. Mary’s Bariatric Center.

Board certified plastic surgeons are also available through the Columbia St. Mary's system. Evaluation for possible skin removal procedures after weight loss has stabilized after Bariatric Surgery can be arranged through the Bariatric Center.

Patients undergoing a Lap-Band^® procedure will also be seen three weeks after surgery. The first band adjustment occurs six weeks after surgery. Patients are typically seen monthly for the first year after surgery and undergo three to four adjustments during that first year. Patients will start a multivitamin after a Lap-Band^® procedure, but will not be required to take any additional supplements or gallbladder medication.