List of Questions for the Surgeon

First topic message reminder :

Hi everyone,
I have my initial appointment with Dr Thomas on wednesday 23rd july.

I was hoping you could help me out with the questions I should ask him.

The ones I have so far are;

1. How many surgeries have you done?

2. What's your complication rate and what were the complications??

3. How many deaths from this surgery or the related complications have you had?

4. How long does the operation take and how long will I have to stay in hospital?

5. Will I need blood, if I do should I start donating some before the operation?

6. Will I have to take vitamins supplements?

7. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food? If it does what do you have to do to fix the problem or do you just have to live with?

8. What will I be able to and not be able to eat?? Will I be able to eat normally but smaller amounts?

9. How long does it take for the stomach to recover, repair and completely heal?

10. How long will I need to be off work? I'm a school teacher and have to go up a couple of flights of stairs to get to some of my classroom and the toilets.

11. Will I have any problems with constipation and diahorrea??

12. How will I know if I have a leak or an infection on the staple line?

13 Is there any chance of the staple line bursting - say in a month, year, 10 years??

14 How will the staple affect the neighbouring organs when and if I get pregnant?

15 Will this surgery affect the method of delivery I choose - natural or C setion?

16 Will I be able to carry to the full 40 weeks with a sleeve?

17 What affect will this have on my diabetes?

18 How much weight can I expect to lose? Give me kilo number not percentages.

19 How much is this going to cost me?

20 What hospital will I have to go to?

21 What is the pre-op procedure and when does it start?

22 What is the post-op regime??

23 Give me the details of someone who has had this surgery about 2-3 years ago and what is thier quality of life like??

24 Why a sleeve as opposed to a sac or a pouch what is the difference and how is it going to affect me?

25 What's your success rate? Meaning how many people have to go one and have a full gastric bypass or some other method of surgery?

These are my questions if there is anything I've missed that I should ask the doctor could you please let me know

Hi there. I am a newbie and I am getting my list of questions together, having stolen a heap from this list and added some of my own. I know it is really *long* but I would still like to see if you guys think I have missed anything? Thanks!

Tam

Doctor Qualifications and Experience
1. How many tubes have been done?
2. How many have you done?

Partnerships, Waiting Times and Cost Questions
1. What is it going to cost me?
2. What are your waiting times?
3. Who is anaesthetist?
4. Pre and Post op referrals etc? Do you have partnerships, if so, with who? Are these things included in the cost or extra?
5. Do you charge for cancellations if I change my mind?

Pre-Op Questions
1. Can I have a last supper at some point before op and when?
2. I have heard of using Optifast pre-op in order to shrink the liver – how does this work? What is it necessary to shrink the liver? Will this damage the liver? How long do I have to do this?
3. What are the Pre op referrals, tests, diet etc?

Questions about the Surgery
1. Obviously the surgery is best used in conjunction with a good diet etc. once past all the surgery recovery, but how do specific weaknesses impact which surgery is best? For example my issue is chocolate, but my husband’s is Coke.
2. How do eating types affect which surgery is most suitable? For example I tend to binge eat related to depression and stress, where my husband tends not to binge but rather to simply eat too much for the amount of activity he does.
3. How is the sleeve different to the ‘stomach stapling’ that happened years ago?
4. How many incisions will you make? How big will they be? How much scarring can I expect?
5. Will I need blood, if I do should I start donating some before the operation?
6. Are the staples used permanent or are they dissolved, and can they fail down the track? If they remain in place, why is this so? Is the stomach not able to reheal after the surgery?

Questions about Surgical Complications
1. What is the complication rate and what are the main complications? I have heard a statistic of 1 in 50 sleeves leaking. What exactly is a leak, what damage can it do and do you agree with the statistic?
2. I’ve also heard reflux can be an issue – how big an issue is this?
3. What percentage of sleeves kink or fold and why?
4. What's your personal complication rate and what were the complications??
5. Have you personally had any deaths or serious disabilities?
6. When were the first sleeves done? What is known about the long-term effects?

Recovery Questions
1. Recovery diet? How long on liquids, mush, lumps etc until I get back to a normal diet?
2. Time in Hospital?
3. Recovery time? When can I pick up the children? Resume normal housework? Driving? Personal Care?
Post-Op Questions
1. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food (in efficiency, type or rate)?
2. Does the surgery affect nutrient absorption? Are any nutritional or Vitamin supplements are needed after
3. Is Constipation or Diarrhoea an issue?
4. Post op diet is normal foods?
5. What is the effect of the stomach surgery on the surrounding organs?
6. Exactly how ‘unnatural’ is the post-op stomach?
7. Will the stomach stretch after the operation? How far can it stretch now and post-operatively?
8. What tube size French Bougie is usually used? Why do you use this size? Can we discuss the size of the post-op stomach or is it ‘one size fits all’? (Not that I want to eat a huge amount, but in terms of eating a sufficient amount I would like to eat at least as much as my kids do…hard to tell them to eat their food if you’re only eating half what they are!)
9. My expected weight loss after 1 & 2 years? Is it reasonable to expect to achieve and maintain a weight of around 65-70kg?

Breastfeeding Questions
1. Can the surgery be done while breastfeeding?
2. Will the detoxing of my body release toxins into my milk? If so how long will this last? (Can I express enough milk to get through this detox period and continue feeding again afterwards?)

Pregnancy Questions
1. Will the changes to the stomach and the addition of staples affect future pregnancies?
2. Will this surgery affect birthing? Will normal birthing place excessive strain on the stomach?
3. I have had liver issues (choleostasis) in my previous pregnancies – is this surgery likely to affect my liver in future pregnancies?

Hi MissKax, The requirement for a pre-op diet varies considerably with each surgeon. Even people with similar BMI's are told different things by different surgeons. Some do not require a diet at all, where others are 1,2,3,4 weeks or more. The pre-op diet is beneficial for a number of reasons:

1. It shrinks the Liver which makes the surgery easier for the surgeon and also minimises the risk of a tear or other damage to the liver it self.
2. Any reduction of weight before surgery makes the operation and anaesthetic safer for you
3. It helps gets you prepared for the post-op diet when you usually have liquids for 2 weeks followed by soft foods.

Personally after doing it for 2 weeks, I think it made the next two weeks much easier.

Hi Molly, The term XX French Bougie refers to the diameter of the flexible rod (dilator) that the surgeon puts down the throat into the stomach used as a guide to staple against. One French equals 0.3302 millimetres, so a 40 French bougie is 13.208mm, or about the size of a male index finger. So in reality when Dr's here use 34-42 French Bougie here there is only a maximum of around 2.6mm difference smallest to largest diameter. There is a thread on the subject here.

Peter.

Hi All,

Peter what is a "40 French bougie"??

[quote]Regarding his choice of a 40 French Bougie, he says that it is not only the size of the bougie that matters, but also how it is used. He uses a tight method, which means he pulls the stomach while using the insert. Some surgeon do not do this. So his 40 may be similar to another doctors 36-38.

Quote :

sounds like i should know what that is but i've not heard that term before..

Cheers,
Molly

Hi all. Peter, does everyone have to do the optifast before surgery or only your BMI is a certain number? TIA

Yes it is scary to talk about a possible death, but reality is that with any operation there is a least a small percentage chance that it will result in death. And it is best if the information given to people who come here includes both the negatives as well as the positives.

So, I just thought I would update some of the Answers given earlier as I have asked Dr Cohen for some more details.

The single death at the Mercy Bariatric unit occurred about 3-4 years ago following a reversal (band to sleeve) operation. There was a leak which caused a fungal infection. I do not have the full details but the patient died about 6 months later because the fungus was resistant to all three lines of treatment.

Band to Sleeve operations have a much higher chance of a leak. 8 in the 60 Dr Cohen has done so far (13%). I assume this is beacuse often there is damage from the band weakening the stomach, but this is just a person opinion. Of Dr Cohens Sleeve only operations there have been 11 leaks in 490 operations (2%).

Regarding his choice of a 40 French Bougie, he says that it is not only the size of the bougie that matters, but also how it is used. He uses a tight method, which means he pulls the stomach while using the insert. Some surgeon do not do this. So his 40 may be similar to another doctors 36-38.

Dr Cohen does not do any leak testing while in hopspital. He believes if there is a leak while in hospital you will become ill straight away. He is not aware of any doctor who has found a leak because they performed a leak test prior to discharge.

Dr Cohen usually performs the surgery between your legs, some doctors do it from the side.

Dr Cohen uses a dissolving strip on the staple line for added safety the first week. Some surgeons use glue or stitches, I have read that stitches can cause stictures so are not recommended.

The access ports are closed with staples and may be removed before discharge.

As for the post-op diet I was given more detailed information during the assesments. The Mercy Plan is for 2 weeks Nourishing fluids, then 4 weeks on soft foods (Mushies), then gradually see what you can eat.

I hope that clears up some things.

Peter.

yes it is possible to eat solids as straight after op.but most dr's say to have liquids then mushie etc to give the stomach time to heal without working on solid foods.sounds ok to me,

I am happy to remove the answers if most people request it, but I thought it would actually be useful if others also provided the answers to the questions they asked. It would be nice to see responses from different Surgeons.

I certainly didn't post this as medical advice and it should not preclude anyone from asking any of the same questions from their Surgeon.

While a few of the answers may have been longer, the answers I have listed are a fair representation of what was said.

For example question 9 about the change in tastes, her answer was just simply no to the question. I then said that wasn't the answer I was expecting (not the only one that surprised me) She did then say, as you cannot eat as much after the operation some people choose to eat different foods. But your actual taste does not change. Right or wrong this is what was said.

As for the death, it should frighten you. Any operation is a risk and any operation could result in a death. I chose not to ask about the details as I didn't think it would make any difference to my choice. I assumed this one death was for a Tube patient, and if it was performed by Dr Cohen that would make better than 1 in over 600, so less than 0.167%. This is only counting the operations performed by Dr Cohen and this is less than the percentage given by ssteph2342 in this post. I do not know who the actual Surgeon was during that resulted in death, how long ago or the total number of surgeries performed by the Mercy unit, so it's quite possible the figure as a percentage is even lower.

Steph, the post op diet also surprised me. She was really talking about immediately post-op! See said that there is nothing medically stopping you from eating solids, but most people just do not feel like anything. Again this seems to go against what others have said.

Regarding the size of the bougie used, I told her that I was expecting her to say somewhere between 34-38. She believed anything smaller makes it difficult for the patient. I didn't ask if 40 was used for everyone or if this was just what she recommended for me. This is probably one of the questions I'll bring up at the Pre-Op meeting with Dr Cohen.

Again, what I posted should not be taken as a definitive answers for all doctors. This is just what I was told by my Doctor regarding my Surgery.

Peter

i agree hayley, if i was a newbie and saw about the death it would frighten me....maybe peter could leave the questions on here but edit it and take out the answers. I do beleive they are great questions but we all have different surgeons and they have different answers.

Nicole

Wow I am surprised Cohen uses a 40 as well.

Why would more leaks occur with high risk patients?

Steph I think he means he can eat any type of food once he is healed and over the post op diet requirements, at least I hope so lol.

Hi Peter,

Your list of questions and answers is very interesting. I'm curious about how you are allowed anything to eat post op. So your surgeon doesn't recommend fluids, then mushies before moving onto real foods?

Also Applesauce, I don't think there is any surgeon in Australia doing a 32 bougie. My surgeon does a 34 and is apparantly the smallest in Australia. But he said that in the States there is a surgeon doing a 32 and it is considered too small but that surgeon claims you have to be cruel to be kind and likes to make his patients struggle in the beginning.

steph

Kaili wrote:

Did you ask him how many leaks he'd had? (I think it was the first questions I asked mine!)

I had heard the rumours about many leaks for Dr Cohen, but figured the stats they gave of 1 in 50 puts this at 2%, which I thought was fair considering some of the cases he takes on. Reading the info given to me today, they put the figure at 1-2%.

Kaili wrote:

I met Dr Kurian several times when I worked at Osborne Park Hospital and she's lovely. :)

Thanks, I won't be meeting her until the day of the OP, but she is supposed to call the night before.

Peter

well that is interesting as I thought he was the only one using a 32 for surgery. If I remember correctly he even said that in his video. My brain must be failing hehehehe. Great questions and answers :)

applesauce

Peter:

That's a good list of questions. I know I didn't ask a lot of that stuff!

Did you ask him how many leaks he'd had? (I think it was the first questions I asked mine!)

And I met Dr Kurian several times when I worked at Osborne Park Hospital and she's lovely. :)

Kaili.

I had my first appointment at Mercy Bariatrics with Dr Deborah Jenner and Dr Leon Cohen today.

Thought I'd post the questions I asked and the answers I got while there.

Some of the answers are different to what people have reported on some of the forums.

Peter.

1.Is there any difference between Vertical Sleeve & Tube Gastrectomy operations
No

2. My expected weight loss after 1 & 2 years in KG.
30kg, ??kg (can't remember)

3.Is Mercy Hospital the only hospital Dr Cohen operates at
No, and we do not use Mercy for Tube operations as there is no Emergency Dept. We use The Mount or St John of God

4.How many tubes have been done by Leon
600+

5.What is the complication rate and what are the main complications
1 in 50, leaks

6.Have you had any deaths or serious disabilities
The mercy team has had 1 death, no serious disability

7.Is it possible to talk to a couple of Previous tube only Patients 2-3 years out
Yes we usually have a couple of past patients at our seminars

8.Have you heard of Lactose intolerance from Op
No

9.Have you heard about peoples taste changing
No

10. Does Ghrelin production increase to pre op levels over time
Not really

11. Does the removal of most of the stomach interfere with the rate of digestion
No, as most digestion is actualy done in the intestine

12. Is it likely to stop my Diabetes
Yes, but may take 20-30kg of weight loss Edit 18/11/8: My diabetes has resolved immediately after the operation

13. What tube size French Bougie is usually used
Current operations are done with a 40. Used to be 50.

14. Is stomach stretching still an issue
Not since moving to a size 40, yes with 50

15. Are the staples used permanent or are they dissolved, and can they fail down the track
Staples are titanium and remain in the body. Little chance of failure after the 1st week

16. Is it possible to reduce the tube size further after a few years
Yes, and has been done with size 50 patients

17. How is Leak testing done, and how will I know if I have a leak
Leak testing is not done, but if there is a leak you feel very sick quickly, usually while still in hospital.

18. Time in Hospital
3 days

19. Recovery time, when can I shower, drive, work
Can shower right away, drive 1 week, work 2 weeks

20. Usually how long until healing of the stomach tube can be considered complete
1 week

21. Currently using CPAP how long till I can use after surgery
Right away, may even be used in recovery

22. What are the Pre op referrals etc
Blood & Urine tests, GP, Dietician, Exercise Physiologist, Hospital Admin Nurse, Pre-Op Surgeon Appointment, Maybe also Anaesthetist (not for mine)

23. Pre op diet. Optifast is disgusting, any other method of shrinking liver
Optifast recommended for 2 weeks.

24. Can I have a last supper at some point before op and when
Yes, but please have it before you start on Optifast. “At least your honest :), most people do it during Optifast which effects the Liver and reduces the effectiveness of the whole Optifast period"

25. Post op diet
You will not feel like much, but can eat anything. Edit 18/11/8: This is untrue as you are on nurishing fluids for 2 weeks, then soft foods for another 4 weeks

26. Is Constipation or Diarrhoea an issue
Not with a good diet

27. What foods cannot be eaten
None

28. What nutritional or Vitamin supplements are needed after
Multivitamin

29. Post op referrals etc
Depend on your needs, but maybe GP, Dietition, & Exercise Pyhsiologist Edit 18/11/8: there is a post op appointment at 2 weeks out with both Leon and the Dietitian, then another with at least Leon 6 weeks, 3 months, & 6 months out

30. Will HIF GoldStar cover all costs
No

31. Can I be treated as a HIF Access Gap patient
No

32. What is it going to cost me.
$200 1st appointment (some medicare refund)
$1000 for facility fee. Incl fees for pre-op assessments (small refund)
$??? Pre-op appointment with surgeon
Up to $4800 for Surgeon & Assistant ($3900 out of pocket)
Up to $1300 for Anaesthetists fee ($180 out of pocket)

33. Who is Anaesthetist
Dr. Sarah Kurian

34. Operation date
31/10/2008 7AM at the Mount Hospital

35. Can I have a video of the operation
Yes if you like. Edit 18/11/8: Turns out they would not give me a copy of the video. They have said that it is only used by the surgical team when there is a problem

28. What percentage of sleeve kink or fold and why?

Denise I am so not putting you off asking all those questions I think they are awsome, I will tho be surprised if you get answers to all of them hehehehe

You also need to know how to interpret the answers. My surgeon Mr Epari had not done a lot of sleeves yet, BUT had extensive surgical experence dealing with bariatric cancer. Which when you way them up actually made him as good a bet as somebody with more sleeves under their belt. Another good way to tell about a surgeon is what the threatre staff think of surgeon, and everybody who had worked with my surgeon had nothing but praise for him. Another funny thing to judge a surgeon on is also how rough they are. I had 1 tiny tiny tiny bruise on my for the main incision site and not a single other one on me. Comapre that to any other surgery I have ever had and I have been a mass of bruises. Just shows a hell of a lot of care was taken. Somthing I like.

I also think you will have a tough time working out who say has the most leaks. I can pretty much tell you that from what I hear the guy who actually does the most sleeves here in Perth has the most leaks. So it is more the odds are stacked against him if that makes sense. Tho there is one Perth surgeon, the one old fart is seeing who has done over 800 sleeves withe NO leaks at all. Now that is damn amazing, and should be something to be considered highely. So what I am trying to say is great questions but be prepared to have to interpret them at more than face value to get the facts you will want :)

applesauce

No the previous questions were 25 and 26

This is 27

27. I got a video of my knee reconstruction operation, do I get a video of this one?? As a safety precaution if there needs to be any repairs, adjustments, complications.

Another one or two :?:

23 (i think) Why a sleeve as opposed to a sac or a pouch what is the difference and how is it going to affect me?

24 What's your success rate? Meaning how many people have to go one and have a full gastric bypass or some other method of surgery?

Oh yeah I'm going to this appointment with my Dad ( :cheers: good old Dad) so he will probably have questions for the doctor as well

Hi Hayley,
No worries.

This is the sort of info I want to get from the Doctor because it's a life changing MAJOR operation. I want to be sure the the Doc knows what he is doing and so I can make an informed decision about what I should do - if he is the doctor for me.

Wow that is a thorough list, I might have to nab it for my first appointment. :) I'll have to take out the pregnancy questions though although I hope you come back and let us know what he says as I'm sure this is of great interest to many on this thread.

good luck for the 23rd.

Cinni :)

Hi everyone,
I have my initial appointment with Dr Thomas on wednesday 23rd july.

I was hoping you could help me out with the questions I should ask him.

The ones I have so far are;

1. How many surgeries have you done?

2. What's your complication rate and what were the complications??

3. How many deaths from this surgery or the related complications have you had?

4. How long does the operation take and how long will I have to stay in hospital?

5. Will I need blood, if I do should I start donating some before the operation?

6. Will I have to take vitamins supplements?

7. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food? If it does what do you have to do to fix the problem or do you just have to live with?

8. What will I be able to and not be able to eat?? Will I be able to eat normally but smaller amounts?

9. How long does it take for the stomach to recover, repair and completely heal?

10. How long will I need to be off work? I'm a school teacher and have to go up a couple of flights of stairs to get to some of my classroom and the toilets.

11. Will I have any problems with constipation and diahorrea??

12. How will I know if I have a leak or an infection on the staple line?

13 Is there any chance of the staple line bursting - say in a month, year, 10 years??

14 How will the staple affect the neighbouring organs when and if I get pregnant?

15 Will this surgery affect the method of delivery I choose - natural or C setion?

16 Will I be able to carry to the full 40 weeks with a sleeve?

17 What affect will this have on my diabetes?

18 How much weight can I expect to lose? Give me kilo number not percentages.

19 How much is this going to cost me?

20 What hospital will I have to go to?

21 What is the pre-op procedure and when does it start?

22 What is the post-op regime??

23 Give me the details of someone who has had this surgery about 2-3 years ago and what is thier quality of life like??

24 Why a sleeve as opposed to a sac or a pouch what is the difference and how is it going to affect me?

25 What's your success rate? Meaning how many people have to go one and have a full gastric bypass or some other method of surgery?

These are my questions if there is anything I've missed that I should ask the doctor could you please let me know