Sleeve Questions??

Hey I'm going back to meet another Doc. in the same practice... I wanted to know is there any certain question I should be asking him?? If so please let me know. I have a small list of questions just want
to make sure Im not leaving anything out!
Thanks Jennifer

Questions for my surgeon


1)      What do I need to do for pre-op (tests and such)

 2)      Do you have a program to help with pre/post surgery follow up (support classes, nutritionist etc)

 3)      Does your office handle the insurance piece or do I need to do all the follow up for pre-op? (making sure docs send in all pre op info)

4)      How small/big do you cut the stomach for your VSG patients? (Can range from 30 french to 40 french bougie, pronounced "boo-she" or he may use an endescope as a guide)

5)      What are the statistics of his WLS practice of complications after surgery?

6)      What is his expectaion of your weight loss after surgery? Some surgeons are really aggressive about their patients losing x lbs by x date. Mine is cool about it, he just wants me losing.  

 7)      Does the hospital, and his practice, have the Bariatric Center of Excellence certification?

8)      Q. What are the side affects of removing the Ghrelin hormone?
A. They do not know the long-term affects, but it will suppress your appetite for 12-18 months.  What they found is that your body will start developing Ghrelin in other areas after about that time so you will get your appetite back.

9)      Q. When is the catheter in?
A. Goes in when you're under anesthesia.  Comes out in the hospital when you're awake but shouldn't hurt.

10)  Q. Will there be a drain?
A. Yes, goes in while you're under.  Comes out in the hospital when you're awake and it feels "weird".

 11)  Q. Do Gas X Strips help and is it okay to use them?
A. It is okay to use them, but there is no real information on if they help.  About 90 percent of the gas is removed from your intestine and stomach after surgery.  Pains often come from the stomach spasms and the intestine not knowing which way to flow.  The flow stops after surgery and takes about 3-5 days to get back to normal.

12)  Q. How large is the sleeve?
A. The actual french number doesn't really say much because a tight 40 could be the same as a loose 32.  So it's really just a number, but he uses a guide that allows for a 38.

13)  Q. Do you use stitches or glue over the staples inside?
A. He uses a reinforcement that dissolves after 4-6 weeks.  You definitely want to use something, but none of the options have been proven to be better then others.

14)  Q. Do you perform a leak test?
A. Yes, he actually performs 3 of them while you're still in the hospital.  The first is done during surgery by submersing the staple area in water while forcing air through and looking for bubbles.  I can't remember the details of the second one, but it is done during surgery through another endoscopy.  The third and last one is done by testing the fluids from your drain for saliva.  If saliva is found, that means there is a leak. 

15)  Q. Is there anything I can take for nausea after surgery?
A. Nausea is typically due to the anesthetic, which generally happens within the first 12 hours after surgery.  So the hospital staff will give you something as needed, but he usually doesn't send you home with anything.

16)  Q. How long do I need to be on pain medicine?
A. As long as you need - liquid Lortab.  He gave me the prescription today so I can get it filled before surgery.

17)  Q. Why do some people have their gallbladder removed and others (like me) don't?
A. If you're not having issues with it, there is no reason to take it out.  Laparoscopic removal is difficult and he puts all WLS patients on Actigal for 6 months after surgery to help prevent stones, etc.

18)  Q. Will I need to crush my medicines or will I be able to swallow with the sleeve?

19)  How many VSG's has he performed in the last year, and how many he averaged a week and month?

20)  What is his percentage of complications during and after surgery?

21)  What size bougie does he use and does it change from patient to patient?

22)  When does he perform the leak test?

23)  Will you be able to give me a laminated card stating I had surgery and need smaller portions/kid portions and/or special accommodations?

Great list !!! I also asked about his mortality rate. but I'm sure many/most do not. I asked how many bariatric surgeries he has done and how many deaths he has had within 8 weeks of surgery, and at 6 months out. I asked about his leak rate.

He had ZERO deaths. One at about a year, but that was due to a heart attack, and could not be ascribed to the surgery itself, nor to any effect there of.

That is a great list, and here are a few more things to ask and consider in your surgeon - if not in specifically qualifiying/disqualifying him but at least to prepare yourself - (so that you don't have to ask later why you are still on a liquid diet after two months while others are having steak.)

What kind of pre-op diet do you require? (Some docs have none at all other than the usual pre-surgical day before thing while others have a week or two of low cal/carb dieting - some liquids only.)

Do you require a specific amount of weight loss pre-op? (Some require a specific amount or percentage loss while others do not.)

What is your post-op dietary regimen? (Some do extensive liquids for weeks/months while others start with mush/puree/soft proteins at tolerated from the outset, and everything in between. Some do an ultra low carb Atkins style diet, others a more classic balanced but high protein diet.)

What is the normally expected hospital stay? (Some do it outpatient and send you home the same day while most have a day or two stay.)

What is the typical supplement regimen for your VSG patients? (This gives you a good clue as to how experienced the doc is with the VSG - many who are still new to it just copy their RNY regimen instead of tailoring it for the specific procedure; same with their pre- and post-op diets.)

How long before I can have some alcohol (if you care)? (Some docs are okay with it after a few weeks while others will have you abstain from it for a year or more while you are losing weight, if not forever.)

Thanks for the list!