Surgical Associates of Ithaca Guide to Weight-loss Surgery

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1 Surgical Associates of Ithaca Guide to Weight-loss Surgery Please read through this entire guide. Weight loss surgeons Dr. John Mecenas and Dr. Brian Bollo are bariatric trained surgeons affiliated with Cayuga Medical Center. They see patients in their office at Surgical Associates of Ithaca and perform surgery at Cayuga Medical Center. Are you a candidate for Weight Loss Surgery, or Bariatric Surgery? You are 18 to 65 years old and have: - Body Mass Index (BMI, easily calculated on many online websites) of greater than 40, or greater than 30 PLUS major obesity related co-morbities such as diabetes, hypertension, sleep apnea, etc. - Been suffering from obesity (BMI greater than 30) for at least 5 years. - Tried and failed attempts at weight loss - No untreated mental illness - Obesity not related to treatable glandular diseases such as thyroid and adrenal. - No significant liver, kidney, or gastrointestinal disease - Willingness to be followed by surgeon over a long period of time

2 What Next? If you would like more information, you can attend a free information seminar by registering online or calling , or you can start the process by scheduling an appointment with us by calling Initial appointments will occur at Surgical Associates of Ithaca. At this appointment, additional testing and appointments with other providers will often be ordered depending on your medical history and on the weight loss procedure planned. Prior to initial appointment, we request that you fill out 2 forms (a medical history form and insurance form), and fax or bring them to our office. You can find these forms online at our website All patients are requested to see a clinical psychologist and nutritionist after their initial appointment. Your insurance company may require up to six months of medically supervised weight loss prior to approval. We will help you through this process. Risks of Weight Loss Surgery There are risks with any surgery. You will be under general anesthesia. Some of the risks are: Death Blood clots Excessive bleeding Slippage (Band Only) Respiratory problems Leaks or blockage at site where tissue is sewn or stapled together Nutritional (vitamin/mineral) deficiency Infections Scarring Incisional hernia

3 Stricture( Narrowing at site where tissue is sewn or stapled together) Gallstones Depression Excess skin Weight loss failure or weight regain Before Surgery You and the bariatric surgical team in conjunction with Cayuga Center for Healthy Living (CCHL) will work on preparing your body for surgery. These preparations will include: Exercise: It is just as important before surgery as it is after. You want your body to be in good physical condition so that your surgery goes as smoothly as possible. Dieting You may be asked to lose weight before surgery (always a good idea). The purpose of this is to decrease to size of your liver and make your surgery easier and safer to perform. Some insurance companies require pre-operative weight loss. Anyone with a BMI of 50 or above should be prepared to lose weight before surgery due to the risks involved in operating on a patient this size. Your surgery will not be scheduled until you meet your weight loss goal set by the surgeon. Everyone will be referred to the nutritionist at the Cayuga Center for Healthy Living (CCHL) before surgery for a two-week liquid diet. Smoking If you are a smoker you will need to quit. Your surgery will not be scheduled until you have. One month before surgery: If you are taking oral contraceptives you must stop taking them due to an increased risk for blood clots in the legs.

4 One week before surgery: You will be scheduled for an office visit with our physician assistant or nurse practitioner for a brief history and physical. Prepare your post-op diet: You should start to prepare yourself for after surgery by shopping ahead of time for things such as protein shakes. Review your handout from the nutritionist to make sure you know what you can and can t have. You should also shop for vitamins and minerals that are liquid or can be crushed. Medications: It is important that you speak with your primary care physician before surgery about having your medications changed to a liquid or crushable form. You should pick up these prescriptions at the pharmacy before surgery so that you will have them when you get home. The Day of Surgery Remember to pack things such as slippers and comfortable clothes to wear home. You can expect to be in the hospital from one to three nights, depending on your surgery. Some patients spend the first night in the Intensive Care Unit. After Surgery Group Meetings: After surgery you should be attending support sessions. These meetings will help you get through the tough times. You may be having trouble with the diet; others can offer advice as to what worked for them. Appointments: You can call us at Surgical Associates any time you have questions or concerns. Gastric Bypass: you will be seeing your surgeon every three months for the first year. You will need blood work before your visits at six months, nine months, and twelve months, and yearly thereafter. If abnormalities are discovered, additional tests may be ordered.

5 Adjustable Gastric Banding: you will be seeing the surgeon about once a month initially, but less frequent as time goes by. Sleeve Gastrectomy: you will be seeing the surgeon every three months for the first year. Mental Health: Depression can occur after surgery. If your depression is severe you may need medication or psychological counseling. Resources Books Weight Loss Surgery; Finding the Thin Person Inside You! By Barbara Thompson Laparoscopic Adjustable Gastric Banding; Achieving Permanent Weight Loss with Minimally Invasive Surgery by Jessie H. Ahroni, Ph.D., A.R.N.P. Websites