Preparation for Surgery

What are the routine tests before surgery?
All patients will have a psychological evaluation. Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), a Chemistry Panel (which gives a readout of about 20 blood chemistry values), thyroid function tests, and a test for the bacteria that causes ulcers. All patients but the very young get a chest X-ray and an electrocardiogram. Most patients will have a study of the leg veins to make sure that there are no blood clots and a sleep study. Other tests, such as pulmonary function testing, echocardiogram, GI evaluation, or cardiology evaluation, may be requested when indicated.

What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.

Why do I have to have a Psychological Evaluation?
The most common reason a psychological evaluation is ordered is that your insurance company may require it. Most psychologists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

Why do I have to have a Sleep Study?
The sleep study detects a tendency for abnormal stopping of breathing (sleep apnea), usually associated with airway blockage when the muscles relax during sleep. Many patients have sleep apnea and do not know it. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.

What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average. A individuals medical condition will be evaluated at the time of the consultation with the surgeon.

If I want to undergo a gastric bypass, how long do I have to wait?
New evaluation appointments may be booked at the time of the Seminar. Once a patient is seen, if the surgeon and patient agree it is appropriate, the operation may take place within 8 weeks. Why so long? The surgeon will provide a letter of medical necessity to the insurance company. The insurance company decision may take up to 3 weeks. Once insurance approval is obtained a date can be scheduled for surgery.

What can I do before the appointment to speed up the process of getting ready for surgery?

• Select a primary care physician if you don't already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
• Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
• Bring any pertinent medical data to your appointment with the surgeon - this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
• Bring a list of your medications with dose and schedule.
• Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.