Gastric Bypass FAQ Detroit
Laparoscopic RNY Gastric Bypass
- How many surgeries has Dr. Chengelis performed ?
Dr. Chengelis studied and learned how to do this complex procedure for several months with an experienced surgeon. He has done well over 700 cases to date.
- Where are the surgeries performed?
All surgeries are done at William Beaumont Hospital, Royal Oak, Michigan. The facility has been involved in over 2000 cases and has special equipment, personal and experience to deal with people of size.
- What is the conversion rate to open surgery ?
Any laparoscopic case has the potential to be converted to open surgery for a multitude of reasons. Currently, Dr Chengelis conversion rate is quite low at under 1 %. Even patients who have had previous surgery rarely require conversion to open.
- What is the potential for serious complications ?
Depending upon which study one reads, the death rate nationally is under 0.5 %. The leak rate is also low, somewhere below 3%. The formation of a serious blood clot called deep vein thrombosis (DVT) which can lead to pulmonary embolism also occurs under 1%. Dr. Chengelis’ complication rates are well below the national averages. Nevertheless, patients must realize these and other complications at the time of surgery are always possible. Ideally, consultation with the surgeon allows for time to educate the patient about these and other potential outcomes.
- What pre operative testing needs to be done ?
There are many considerations which need to be addressed.
All patients should obtain consultation with a board certified nutritionist and be very familiar with the diet required both before and after surgery. Since various vitamin and mineral deficiencies can occur, replacement and life long periodic blood tests to monitor are essential. A long term relationship with a nutritionist is very benificial .
All patients will need a psychological evaluation by either a psychologist or psychiatrist in order to obtain approval to have surgery.
Patients over the age of 50 should have medical clearance and often a cardiac stress test.
Patients with suspected sleep apnea should have a sleep test to maximize the treatment of sleep apnea preoperatively. Blood tests such as Iron level to rule out anemia are often done.
In short, there are many considerations and a comprehensive approach is needed to safely manage the patient both before and after the surgery. This requires the cooperation of many professionals, such as the surgeon, an internist familiar with bariatric patients, dieticians, conselors, etc.
Beuamont offers a comprehensive approach via its association with dedicated weight loss programs.
- How long does the surgery take?
Approximately, two hours of actual surgery time.
- How many days are spent in the hospital?
Most people stay two days although some feel well enough to go home the very next day.
- What can I eat after the surgery?
The first two weeks the diet is restricted to liquids. Then gradually advance to pureed foods and eventually to solid foods. Some patients report difficulty with certain foods for several months but after about a year, can eat almost all foods but in smaller portions.
- What else can I expect after surgery?
Fatigue and not pain will be the main issue for the first 3 weeks. Patients need to concentrate on getting enough protein and fluid. Rarely, patients develop a narrowing between the pouch and intestine at about 3-5 weeks after surgery. This can be resolved with an endoscopic procedure and does not require reoperation.
- How soon can I exercise?
As soon as you feel able to do so. Walking is strongly encouraged as soon as the patient feels compable.
- How often do I need to see the doctor after the surgery?
Routine visits are recommended at 2 weeks, 6 weeks, 3 months, 6 months and one year. Yearly visits thereafter with lab tests are important.
- What medications are needed after surgery ?
Pain medication in the form of a liquid, Lortab elixer is frequently used for several days. Over the counter anti ulcer medication is recommended for several weeks. A twice daily multivitamin each day for the rest of the patients life is a requirement. If the patient still has a gall bladder, ursodiol (Actigal) is used the first 6 months to greatly decrease the formation of gallstones. The need for other supplements such as Calcium, Vitamin D, Iron are addressed on an individual basis.
Oral medications for diabetes frequently can be stopped after the surgery. If you need insulin injections before surgery, reduction in dosing is common with eventual freedom from insulin shots often the long term result with proper weight loss. Blood pressure medications will also need adjustment.
- What if I have sleep apnea?
This is a common problem with obesity patients. If you require a CPAP machine, use it for this will reduce the pulmonary complications post operatively. Bring it with you for use during your hospital stay. Know that a vast majority of patients will be rid of sleep apnea and the machines within a few months of the surgery after proper weight loss.
- What are some long term complications ?
Nutritional deficiencies: The incidence of some sort of vitamin, mineral or iron deficiency is not uncommon. Patients must have regular follow up visits and labs drawn to watch closely for such for the rest of their lives. For example, failure to take a multivitamin for several months can result in Thaimine, a B vitamin, depletion which can produce neurologic consequences, including brain damage.
Bowel obstruction from adhesions or internal hernia also can take place. Most studies place the rate at about 2% of patients; sometimes, years later. The symptoms are mid abdominal cramping pain, nasuea without vomiting. The Xray findings can be subtle and radiologists and surgeons not experienced with bariatric patients may not be able to diagnose this early. An experienced laparoscopic bariatric surgeon can often perform prompt laparoscopic evaluation and fix this condition.
Food Intolerance. Initially, certain foods such as red meat may not be tolerated for several months. After a year, most patients can ingest most foods in small amounts of course. Rarely, patients can have frequent nausea, emesis and chronic abdominal pain leading to malnutrition and excessive weight loss.
Weight Regain. Many patients loose approximately 70% of their excessive body weight by 18 months but statistics show at 5 years a substantial number of patients do regain between 10 and 20% of this amount and level at 50% loss of excessive body weight long term. In the vast majority, poor eating habits are the root of this reality; in rare instances, an anatomical cause is present.