List of Questions for the Surgeon

Hi all, I have my first appointment with the surgeon tomorrow and reading through all these questions and answers has helped. I feel really informed and can't wait to get closer to a surgery date.

Thanks

Daini

Denise1971 wrote:

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?

The sleeve is a much simpler procedure, it doesn't cut or change the entrance or exit to/from the stomach.  When you cut the stomach down to a pouch, you have to dettach and then re-attach one of these connections.  That adds a complication to the procedure.

Hi Bea Jaye, i live in Albany and travelled to Bunbury and had my sleeve done by Dr W on the 13 th Dec 2012,all i paid out of pocket was $1600 which is what they call a booking fee,i had HBF cover for what i needed and i could have had a private room at sjog but i had a double which was good,gives you someone to chat to. Make sure you get a knock out guy who is BBF allocated,i had Dr Lim from Gelorup,he was great. I did not have to pay any more than the $1600. I know HBF monthy memebr fees are going up at the beginning of April and i think that is all that it was. Dr W did a great job and i had no problems at all,op on a Thursday and went back home to Albany on the Sunday,fantastic team at sjog. Good luck

Hi Bea, just curious as to why you have to wait until August for your appointment with Dr W.
I phoned HBF to confirm if I will still be covered to have my sleeve item no 30518 with any changes that come into effect in April, I was told that the only difference between top and intermediate cover is your accommodation , so I will still be covered, however it will also depend upon which provider number the surgeon uses , if he uses 243740bb then there should be no other out of pocket but if the surgeon uses provider number 2437407h then there will be out of pocket expense to pay, maybe this could be the booking charge.
I will quiz Dr W tomorrow.
Btgirl

Hi Bea, I have a follow up appointment tomorrow to have my stitches out from having my band removed and to get a date to be sleeved. I also have HBF cover on the intermediate scale which fully covers me except for the " booking fee" which I think is the amount he charges over the prescribed fee.
I rang HBF the other day to make sure I was covered for Mr W for this op and they said yes. However another member of this site has mentioned that HBF as of April will only cover you if you are on top cover, I will have to ring them to confirm this as Dr W office does not know of this change.
I will post here what I find out but I won't be able to do that until Sunday as we are going away for a couple of days straight after my appointment and will not have any Internet.
Btgirl

Thanks for all the great info on pre and post operative expectations for the Gastric Sleeve. I have my first appointment with Dr Werapitiya in Bunbury in August. Trying to do research to know as much about the procedure and expectations as I possibly can before going ahead with this.

Went on Optifast for 3 months and lost 12kg but as soon as I introduced normal food I gained all that I had lost and probably a bit more as well.

Has anyone had an operation with Dr Werapitiya? What was the out of pocket expense. I have the paperwork and he is charging me a Booking Fee of $2300. Is this a normal procedure. I have private health.

Thanks All,

xxx

AHA the post I have been searching for! Thanks!

Great list of questions. I have my appointment on Monday and have just made my list using a combination of the below. Thanks guys. This forum is a godsend!!!

xx

I have a sick sense of humor,

My questions were:
have you had anyone die? (the answer was no!)
do you like your job?
do you ever get disgrunteled?
as his wife is his assistant I asked:
Do you guys fight?
If your having an argument on whoever forgot to take out the chicken, dont worry either book me in on a new date, or Ill send my hubby out to buy some for you.
Do you faint at the site of blood?
Do you enjoy slicing and dicing?

he passed all of my questions :)

I would ask the surgeon about golf, I know people can be rather addicted, the walking bit wouldnt be a problem after a couple of weeks, I doubt the putting would either. So if you are a true addict I would run the golf past him and if he says no run past him having a gentle putt he might pass you on that one weeks before the full round :)

applesauce

As a general rule no heavy lifting, shoving or twisting for a minimum of 6 weeks.
I would check with your surgeon.

When can I return to golf. Walking 18 holes twice a week??

Hi, Tam

Thanks, good luck to you, too.

Hi Missty,

I spoke briefly to my surgeon (Michael France in Adelaide) about the lap band and he said he won't even do them anymore because there are so many maintenance issues and he sees so many people for reversals and they can do so much damage to the stomach. That's where I originally started looking too and the main reason was the reversibility.

You said that both have similar Post op as far as eating, but that is not my understanding at all...my research has shown a lot more restrictions in the post-op diet for the band, and some people (not all of course) can never have bread or steak after the band.

I haven't had it done yet but i have chosen the sleeve due to the post op simplicity and lower risks. Also you can't cheat on the sleeve so easily as you can on the band, and I know I would!

Good luck!

To everyone, thank you for all of your comments. I have a surgery date of June 1st for the Lap Band, but have since started to research the Sleeve. It seems that both have a similar Post Op as far as eating, but there seems to be a lot more maintainence and possible problems with the Lap Band. After reading as many letters as I could these last few days, I'm seriously considering changing to the Sleeve. The things that worried me the most about the surgery and quality of life have been addressed here and I feel that the Sleeve would be the better choice for me.

So, thank you, again.

Having now had my appointment I thought that I would add my answers here for others who may be looking for a one-stop shop. My surgeon (9 June 2010) will be Michael France in Adelaide. These questions were answered by him and his surgical assistant, Fiona Nancarrow.

Hope its helpful!

Doctor Qualifications and Experience
1. How many tubes have been done?
didn't ask
2. How many have you done?
about 500

Partnerships, Waiting Times and Cost Questions
1. What is it going to cost me?
2000 pacakge includes everything from surgeon, anaesthetist if extra.
2. What are your waiting times?
it was 6 months for the initial appt and then the surgery wait could be as short as 3 weeks (my husband)
3. Who is anaesthetist?
several, depending on the day of surgery.
4. Pre and Post op referrals etc? Do you have partnerships, if so, with who? Are these things included in the cost or extra?
Pre-op - 1. barium swallow to check for hiatus hernia 2. blood test. He also does an endoscopy but that is immediately b4 the surgery, while you are under anaesthetic.
Post-op - they have a dietician starting on the team March 2010 and 1 or 2 visits with her will be included in the package...you can continue with her at a cost after that.
Partnerships - not as such, but there is a team of psychologists that specialise in weight management they recommend...use a mental health care plan from GP to minimise cost.
5. Do you charge for cancellations if I change my mind?
didn't ask

Pre-Op Questions
1. Can I have a last supper at some point before op and when?
didn't ask
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?
The liver sits over the stomach and they have to move it aside to get to the stomach for surgery. The liver holds fat, and is often surrounded by fat too. When you lose weight (through any means) the first place the fat comes off is the liver and around the organs. Removing fat from in and around the liver is returning it to its normal state and will not damage it, but help it. A smaller, helathier liver (and surrounds) will make access to the stomach easier and safer in surgery. Generally recommend 2 weeks of optifast but can be longer or shorter depending on where you hold your weight, and how much you have to lose.
3. What are the Pre op referrals, tests, diet etc?
barium swallow. blood test. optifast. appt with anaesthetist.

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.
Didn't ask specifically. We talked mainly about the band vs the sleeve. They prefer not to do bands and will only do them very very occassionally. Problem with the band is that while the operative risks are lower, the post-operative risks are much higher, and they see too many people for revision and removal. The sleev is the least invasive, physiologically...you don't actually change the way anything works, just the size of an organ. The band creates a pouch with a small hole into an otherwise unchanged stomach...so if you have something like coke of ice-cream that can get through that small opening, it will not work for you at all because you are not actually reducing the overall size of the stomach. With the sleeve you are reducing the size of the whole stomach so even if all you have is water, you can't have much of it at a time...but the key words are 'at a time' if you snack all day in small amounts then the sleev won't help as much. The sleeve removes part of the stomach though, and the part that it removes is the part that produces the hunger hormone ghrelin...after the surgery you produce much less ghrelin and therefore your hunger levels are much much lower. New 5 year data just out shows that the lowered ghrelin levels are sustained.
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.
See above
3. How is the sleeve different to the ‘stomach stapling’ that happened years ago?
This was a very big question for me. the old stomach stapling was actually very similar to the current band. So look at a picture of a banded stomach but think of the band being replaced by staples. All the issues of the band where there, but also it was quite common for the stomach to stretch to open the small opening left by the staples and render the surgery useless.
4. How many incisions will you make? How big will they be? How much scarring can I expect?
five incisions, each about an inch long. scraring takes a long time to establish...will be worse at first then settle into a small red line and then clear up a bit and then over several years develop into a scar. Different people scar differently - look to your own scars to see how your are likely to look in several years time.
5. Will I need blood, if I do should I start donating some before the operation?
Only if they nick something they shouldn't - thats why they take blood from you a few days prior to the surgery.
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?
Yes they are permanent, they are titanium. Staples are apparently better than sutures, and they use a little stapler that actually does six rows of staples and then cuts with three on each side. this minimises bleeding and is the best way to ensure no leakage of stomach contents into the abdominal cavity. The stomach does heal around them, and they become unnecessary but to remove the staples would require another surgery, so they are left there.

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?
Several different complications that we discussed and I can't remember the details of them all. They were quite up front about having made mistakes and continually trying to improve their practices. Their highest compliactions rates were about 5%, but they now have most things down to about 1%.
A leak is when the contents of the stomach escape through the staple line into the abdominal cavity. Obviously this is not supposed to happen and your body fights it by creating a cyst around the escaped bacteria, which then needs to be surgically removed. Their incidence is about 1% (1 in 100). They tell you to call with even the slightest feeling of unwellness and they will put you in for a CT scan to make sure everything is OK..they would prefer to do unecessary CT scans than to have you in pain and miss something taht might be wrong. Call if you get any flu-like symptoms, as these can be signs of something amiss.
2. I’ve also heard reflux can be an issue – how big an issue is this?
didn't ask.
3. What percentage of sleeves kink or fold and why?
she didn't really answer this one...didn't seem to have heard of this issue.
4. What's your personal complication rate and what were the complications??
As above...about 1%. Various.
5. Have you personally had any deaths or serious disabilities?
didn't ask
6. When were the first sleeves done? What is known about the long-term effects?
five year data commonly available now and all is positive. one surgeon in Aust is up to nine years and still has positive data. It is common to lose weight rapidy at first then less rapidly and then stabilise. It's also common a few years down the track to put a little back on and you need to make sure you watch for this and address your lifestyle.

Recovery Questions
1. Recovery diet? How long on liquids, mush, lumps etc until I get back to a normal diet?
the average is 6 weeks in 3 x 2 weeks, liquids, mushies, lumps. It varies.
2. Time in Hospital?
two to three nights.
3. Recovery time? When can I pick up the children? Resume normal housework? Driving? Personal Care?
about 10-14 days. personal care - from day one

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)?
No, the digestion happens with the most muscular part of the stomach, which is right at the base, near the beginning of the intestine...this part of the stomach remains. Only volume is affected
2. Does the surgery affect nutrient absorption? Are any nutritional or Vitamin supplements are needed after.
It doesn't affect nutrient absorbtion at all (this happens in the intestines not the stomach) however they do recommend you stay on a multivitamin due to the reduced volumes of food and therefore reduced volume of nutrients.
3. Is Constipation or Diarrhoea an issue?
Can be in some people
4. Post op diet is normal foods?
yes, but it will take timeto get there. steak and fresh bread can take up to 9-12 months
5. What is the effect of the stomach surgery on the surrounding organs?
the least of all surgeries as nothing is actually moved. the stomach that is being removed is attached to other organs (can't remember which) and this attachment is severed. Other organs are only moved to allow access to the stomach. The stomach attachment naturally fixes itself and attaches back to the smaller stomach. If you went into a sleeved abdomen not knowing that the person had had surgery you would just assume that they had a very small stomch, there is no evidence of surgery internally.
6. Exactly how ‘unnatural’ is the post-op stomach?
not very. basically the pouch part of the stomach was intended for gorging, which we traditionally did as a hunter-gatherer race. When a large animal was killed the tribe needed to get as much of it inside as they could before it went off and so they gorged, and the large stretchy stomach allowed them to do this. Then they would go back to eating small amounts of foods that were gathered until the next kill. We no longer have a need to gorge. We have food available in plenty and refrigeration available to keep food fresh for longer - the pouch is therefore not necessary in our modern society, and the sleeve removes it. In the long term, no other part of the body is affected by this.
7. Will the stomach stretch after the operation? How far can it stretch now and post-operatively?
Yes it will stretch somewhat, and the more you push into it the mor eit will stretch. It could even potentially burst (as could your pre-op stomach)...but you would have to try *really* hard to achieve this.
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!)
Generally they use a standard size (didn't ask what size specifically) but in some special cases they will use something larger - usually for people with lots of comorbidities which are a worry, or for older people. Basically the smaller the stomach the higher pressure system they make. For otherwise healthy(ish) people they go standard, but if they want to put less pressure on the person's body as a whole then ethy will go bigger...obviously bigger means a bigger stomach and less weight loss overall.
Regarding eating less than the kids...probably better to move away from a 'finish everything on your plate' mentality with the kids anyway...present their food but tell them they only need to eat as much as they want to, same as you. Eliminate desserts and there is no need for an 'eat this before you eat that' argument.
9. My expected weight loss after 1 & 2 years? Is it reasonable to expect to achieve and maintain a weight of around 65-70kg?
I actually didn't ask that!

Breastfeeding Questions
1. Can the surgery be done while breastfeeding?
The issue is your fluids. You need lots of fluids to create breastmilk, and on a small stomach you may not get enough in and so your milk may dry up. Also issues of anaesthetic going through to milk. My son is 15 months old and doesn't *need* breastmilk so we have decided that we will try to wean before my surgery (which is in 3.5 months)
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?)
didn't ask.

Pregnancy Questions
1. Will the changes to the stomach and the addition of staples affect future pregnancies?
No. They don't recommend falling pregnant within a year of the surgery due to your diet and getting used to your new stomach, and your body recovering. Also, being pregnant squashes everything and puts everything under pressure, and thats not good on your new stomach. Having said that, it has been done and there were no issues.
2. Will this surgery affect birthing? Will normal birthing place excessive strain on the stomach?
No. The muscles for birthing are not near the stomach.
3. I have had liver issues (choleostasis) in my previous pregnancies – is this surgery likely to affect my liver in future pregnancies?
Didn't ask.

It is very true tho the size bougie they use is not that relevant as it is how tight they pull the stomach when stapling that will determine the size you end up with. Your best guide to finding out the size of your new stomach is to talk to patients of your surgeon, but even then it is hard to get the perfect idea because just how tight they pull will not only change with each patient but over time.

But you seriously want to pick a surgeon who has NOT had to do any revision sleeves on his own patients, that would be asking for trouble.

applesauce

Molly wrote:

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.

Sounds like such a male thing to say LOL

This thread is excellent. I've just made an appointment to see a surgeon and have already made my list - woohoo!

Tam,

I've sent you a PM. If your surgeon is Michael France...you're in safe hands and he will answer any question you have but you will need to see his GP Dr Fiona Nancarrow first so she will probably cover most of them off.

Jo

Tam wrote:

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!

A lot of surgeons have a god complex and don't appreciate their methods being questioned. Don't let this stop you from asking questions. It never hurts to be well informed, but in hindsight to avoid being seen as a problem patient it would be worth only asking questions that will affect your choice of surgeon or surgery.

I would much rather have good surgeon with a bad bedside manner than an average surgeon who has a very good bedside manner and is open & friendly (hard to find one that has everything).

I'd suggest you drop
1. How many tubes have been done? (the answers is thousands worldwide)
3. Who is anaesthetist? (this can usually only be answered once a specific hospital is chosen and surgery date is given)

The surgery is not a magic pill, and can still be cheated. It is only a tool to help you, and will be most effective in the first 6-9 months. It still requires willpower to be successful.

The sleeve will stop you eating large portions in one sitting, and will lower your hunger levels for the first 6 months. But it does not stop you from being able to graze the wrong foods all day long.

I agree with bushgirl, unless you really want to know your surgeons opinion all the questions below have either been discussed here with fairly uniform results for most or are just common sense.

Tam wrote:

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.

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?
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!)

Peter.

I am due to be sleeved in October and read with interest Peters questions and answers and the one relating to death did not scare me.At my last appointment with my surgeon i had to sign a consent form stating that complications COULD result in death but i am sure this is very rare,i would rather be told the facts than be kept in the dark.It would not put me off having the op and i think thats the chance you have to take.

Well the doctor definitely will know youv'e spent time thinking about this.

Good luck with your decision making.

xxx

Thanks bushgirl, I will certainly look around and I know that some answers are around, but I would still like to ask them of my surgeon...it's part of how i select a surgeon a sit means a great deal to me to have someone who is willing to talk and explain just as much as how good their technical surgical skills are. I have rejected several surgeons in the past (for different surgeries) based on their attitude.

Having said that, that is one of the reasons I have put them into sections, so that I can make sure I cover the most important ones first.

Tam, A lot of your questions are answered here in various threads if you'd like to read about them before your appointment. The Dr. may not have enough time in your appointment to answer all these in enough detaikl for you, given they are usually booked pretty solidly. Have a read through on the pre and post op sections, and diaries and see :)

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?