Frequently Asked Questions

Do I qualify for Bariatric Surgery?

One of the questions I'm asked most commonly is, "Do I qualify for Bariatric Surgery?" Well, I use the criteria set forth by the National Institute of Health. That criteria is:

1. Established attempts at non-surgical weight loss.
2. A Body Mass Index, or BMI, of 40 or higher.
3. A BMI of 35 to 40 associated with a medical condition, or a comorbidity, such as diabetes, high blood pressure, or sleep apnea.

What is Laparoscopic Surgery?

Bariatric surgery has been around since the 1950's, yet has become popularized recently because of laparoscopy. Patients often wonder "What is laparoscopy, or laparoscopic surgery?" Well, laparoscopic surgery is a way by which I can do major surgery through minor incisions. We, as laparoscopic surgeons, make very small incisions on the abdominal wall, usually 5-12mm in length, and inset thin hallow tubes, or trocars, through these thin incisions. A camera is inserted to one of those tubes and carbon dioxide is used to sort of blow up the belly from the inside. The camera projects a picture from the inside of the abdomen to a television monitor, and we, as laparoscopic surgeons, watch the monitor while operating from outside the body. The first laparoscopic procedure was performed by Dr. George Kelling in 1901. He actually used a cystoscpe, or an elongated looking-glass for the bladder, to look inside the abdominal cavity in dogs. He later applied the technique to humans to try and stop bleeding in the belly. The first non-diagnostic, or therapeutic, laparoscopies were performed in the 1930's, and it was the Gynecologists that led the way through the 1970's. Dr. Phillipe Mouret was the first to perform a laparoscopic cholecystectomy (or gall bladder removal) in 1987, and since then we've been able to apply this technique to just about any abdominal and now even chest, or thoracic, operation. My training is in advanced laparoscopic surgery; not just Bariatric, but G.I., transplant, and cancer surgery as well. I chose laparoscopy because it's less invasive to patients; smaller incisions means less pain, early return to work, early return to daily activities, less wound complications, less lung complications, better looking scars, and overall a better operative experience.

How does the Adjustable Gastric Band work?

One of the questions I think is vitally important to answer for my patients is, "How do the Adjustable Gastric Band systems actually work?" Well, I place the Adjustable Gastric Band along the top part of the stomach, and it creates a pouch, a small pouch that fills quickly, stretches quickly, and sends a hormonal signal to the brain that you're feeling full, and as you can imagine, with much less food than it would've taken to stretch the entire stomach. The stomach, however, is a brilliant organ. It will recognize the band, and will recognize the compression. Over thousands of years of evolution the stomach has learned to adapt to the compression, or accommodate, the restriction of the food caused by the band. The stomach will actually thin its own wall out, and by thinning its wall, it creates a larger circumference on the inside, which means a larger whole for food and liquid to pass through. When that happens, I can adjust, or fill, the band at the bedside, which makes the band tighter, recreates the restriction that you need to fill and stretch that pouch sooner, and it allows you to again feel full sooner, have better feeling of fullness during a meal and throughout the day.

How do the Adjustable Gastric Band Fills work?

As I mentioned in the previous video, the stomach will accommodate the band. It will actually thin its own wall to allow food and liquid to pass easier. That's why the bands are adjustable. Many patients wonder, "Well, how do the fills work?" Fortunately, they are very simple and almost painless procedures performed at the bedside in my office over just a few seconds. At the time of a band fill or adjustment, I will take a very fine needle and place it into your band port, or reservoir. After placing a small amount of saline, I will recreate the restriction that you need to feel full sooner and have that feeling of satisfaction last longer. With each subsequent fill, that sensation of restriction will last longer and longer, so the vast majority of fills are performed within the first few months following surgery.

How does the Sleeve Gastrectomy work?

So, how does the Sleeve Gastrectomy work? It sounds as if something is actually placed around the stomach, but that's not the case at all. The Sleeve Gastrectomy was actually born from prior Bariatric surgeries, and it's an operation where the stomach is "tubularized", meaning it is reshapen from the size and shape of a small football to the size and shape of a banana. It's an operation where part of the stomach is removed. By "tubularizing", or refashioning the shape of the stomach into a thin narrow tube, it accomplishes 2 different ways to lose weight. First, the narrow tube is restrictive, meaning it holds far less than the stomach did prior to surgery, with that you eat less during each meal and of course take in less calories. The second way by which the Sleeve Gastrectomy helps to induce and maintain weight loss is by removing the source of a hormone called Ghrelin. That portion of the stomach which is removed has the cells that produce this hormone, and Ghrelin is the one hormone that we know causes hunger. So by removing this portion of the stomach, you will feel full during and after each meal, but also by removing Ghrelin, you will feel less hunger between meals as well.

How does the Gastric Bypass work?

If you are considering the Laparoscopic Roux-en-Y Gastric Bypass, it's important to understand just how the operation works to induce and maintain weight loss. First is by "restriction." Restriction means it literally restricts how much food you can eat at each meal. I reshape the stomach into a 1 ounce pouch. I don't remove anything, but by doing so I limit how much food fits into the stomach and how much you can eat at one sitting. The second way by which the Gastric Bypass maintains weight loss is through "malabsorption." Malabsorption means simply that not all the food that you eat is digested. The best way to think about the Gastric Bypass is to simply envision the letter Y. Down one limb comes the food, down the other limb the enzymes for digestion. Digestion, or absorption, begins in the stem. As food bypasses a large portion of the intestinal tract, it's not absorbed, and if the food is not absorbed, the calories aren't either.

How long is the hospital stay?

A common question asked by patients is, "How long is the hospital stay?" Well, the vast majority undergoing Adjustable Gastric Band Surgery will qualify for outpatient surgery, meaning you will not need to spend a night in the hospital. A small percentage of patients undergoing Laparoscopic Sleeve Gastrectomy will also qualify for outpatient surgery. Most patients undergoing Sleeve Gastrectomy or Gastric Bypass will spend one night in the hospital.

Does it hurt?

A common question that I hear in the office is, "Will Bariatric Surgery hurt?" Well, fortunately, it's performed laparoscopically. As such, a large percentage of patients never even fill the narcotic prescription that I provide. Of those who do fill the script, I would say they use it for an average of about three or four days, and most patients feel ready to return to work within one week.

What can I eat following Bariatric surgery?

Many patients wonder, "What can I eat following Bariatric Surgery?" Well, before your operation, we will have a visit in my office to go over the Patient Guide. I will provide you with a detailed Dietary Guide, in writing, that will help to advance you from a sugar-free clear liquid diet to a regular diet over about one month. Following that month, you can eat whatever you want. The restrictive nature of Bariatric Surgery is intended to limit how much you can eat with each meal, but not what you can eat as much. I encourage a wide menu, especially foods rich in protein, and I also want you to experiment and still enjoy eating meals.

How long is the process from my initial consultation to surgery?

One of the first questions patients ask is, "How long will it take from my initial consultation until surgery?" Well, we will submit your paperwork for you, and fortunately, in my office, you have Laurie Burns on your side. She is my practice manager and a tireless patient advocate. She works very closely with just about every major insurance company in Tucson, and with her working for you we can usually get patients to surgery within 3 to 12 weeks.

How will Bariatric Surgery change my life?

So you're considering Bariatric Surgery and you're wondering, "How will it change my life?" Well, Bariatric Surgery will not only help you to lose weight, but to become a healthier human being. I prescribe to the motto "Live Healthier, Live Happier, Live Longer," and Bariatric Surgery is a tool by which you can not only lose weight but lose medications, which are worth much more than weight in my eyes. I can talk about how Bariatric Surgery will change your life and give you a new lease on life, but the truth is if you really want to know how Bariatric Surgery will change your life, please take a look at the Patient Testimonials section on my website to get a much better idea.

What are the age limits for Bariatric Surgery?

A common question that I hear in the office is, "What are the age limits for Bariatric Surgery?" Well, general guidelines state the patient should be between the ages of 18 and 65 years of age. I generally follow those guidelines and I don't operate on patients less than 18. For those at the younger end of the spectrum, I look mostly at maturity, home life, and support. Do they understand the operation, the implications of surgery and how it's going to change their life? Are Mom, Dad, Brother or Sister supportive of these changes, of the lifestyle that will needed to be adopted for surgical success; for weight loss success. For those at the other end of the spectrum, I look at physiologic age; not purely chronologic. Can they understand what the surgery will mean at this point in their life? Are they able to undergo the surgery? Will they be able to benefit from weight loss? Can they participate in an exercise program? These are the questions we we'll have to answer individually, because that's the only way that we can really look at you as a potential patient, as an individual, and as a safe candidate for Bariatric surgery.

What can I eat following Bariatric Surgery?

Many patients wonder, "What can I eat following Bariatric Surgery?" Well, before your operation, we will have a visit in my office to go over the Patient Guide. I will provide you with a detailed Dietary Guide, in writing, that will help to advance you from a sugar-free clear liquid diet to a regular diet over about one month. Following that month, you can eat whatever you want. The restrictive nature of Bariatric Surgery is intended to limit how much you can eat with each meal, but not what you can eat as much. I encourage a wide menu, especially foods rich in protein, and I also want you to experiment and still enjoy eating meals.

Can I get pregnant following Bariatric Surgery?

One of the questions I'm asked frequently by patients, and parents of patients, in my practice is, "Can I get pregnant following Bariatric Surgery?" Well, the answer is, whole heartedly, yes! As a matter of fact, when you lose weight your fertility will exponentially increase. I have a few patients in my practice right now that were deemed infertile by Maternal-Fetal Medicine specialists, and following the weight loss from Bariatric Surgery they have had healthy pregnancies. If you're at the age of, or considering, pregnancy, please be sure to discuss this with me in detail so that we can be sure to choose the right option for you during this time in your life.

Can I drink alcohol, caffeine, or carbonated beverages after Bariatric Surgery?

A very common question asked by patients in my office is, "Can I drink alcohol, caffeine, or carbonation following Bariatric Surgery?" Well the answer is yes, yes, and yes! It's just a matter of timing and volume. In terms of alcohol, your tolerance will significantly decrease with the weight loss, so be careful. In terms of caffeine, caffeine can have a diuretic effect, so early in the post-operative period it may actually promote dehydration. In terms of carbonation, it will not stretch your pouch out or cause complications, but it may cause bloating, it may cause discomfort, and it may cause excess gas early in the post-operative period.

Do I need to take vitamins following Bariatric Surgery?

For patients who have had a Laparoscopic Adjustable Gastric Band placed, there is no malabsorptive component, meaning everything that you eat, you will digest. For that reason, you do not need to take multivitamins following surgery. For patients who have had a Sleeve Gastrectomy, a small percentage will require vitamin supplementation. I will check your blood work at 1 month, 3 months, 6 months, and at least yearly post-operatively to ensure that your vitamin and mineral levels are appropriate and that anything that needs to be supplemented is done so appropriately and timely. For patients who have had Laparoscopic Roux-en-Y Gastric Bypass, I will ask that you take 2 multivitamins on a daily basis for the rest of your life. About 1/3rd of patients will need to take additional supplementation with Vitamin D, Vitamin A, Iron, or a vitamin or mineral that we will find together with the routine blood work performed at 1 month, 3 months, 6 months, and at least yearly for the rest of your life. I do this to ensure that you will always maintain the appropriate vitamin and mineral levels that your body needs for adequate daily function.

Now that I don't need to, or can't eat as much, what do I do at restaurants?

So, you're wondering, after you've had Bariatric Surgery and you can no longer tolerate the same sized meal you did beforehand, what do you do at restaurants. I will provide you with a card, which is honored by almost all restaurants in Tucson, and the card is from my practice and it states specifically to allow you to choose a half sized portion from the adult menu or a regular portion from the children's menu, since you've had Bariatric Surgery. This will allow you to not waste food and hopefully not waste money either.

Do you accept patients who have had surgery elsewhere?

After moving to Tucson in 2007, I learned quickly that there were no Bariatric Surgeons here in town accepting patients from other surgical practices. Well, I view this as a matter of public health. Without question, the success from Bariatric Surgery often comes from appropriate follow-up, so I do accept patients who have had surgery elsewhere. If you have had Bariatric Surgery elsewhere and are in need of follow-up, please contact my office and see how I can help you maximize your surgical weight loss success.