Comprehensive Support through Your Weight Loss Journey

When struggling with weight issues, it’s easy to feel overwhelmed by your diet and weight loss options and discouraged by your setbacks. At Surgical Associates, we empathize with the challenges of your disease and will always treat you with the dignity you deserve. We are dedicated to successful weight-loss outcomes in a caring and compassionate environment.

Weight loss surgery, also known as bariatric surgery, is offering new hope to many who suffer from the medical complications of severe obesity.  Procedures performed by Surgical Associates reduce the size of the stomach or reroute the intestine to limit the absorption of calories. Our bariatric surgeons will work with you to develop a personalized weight loss plan and determine which weight loss surgery or procedure is best for you:

  • Roux-en-Y Gastric Bypass
  • Sleeve Gastrectomy

Following thorough screening and preparation, procedures are completed at Aspirus Wausau Hospital.  

Bariatric surgery is the start of a lifelong commitment to wellness—and we promise to be with you every step of the way! Surgical Associates’ Bariatric Center for Excellence is a comprehensive program designed to support the long-term success of your weight loss journey. We offer follow-up visits and patient support in the form of dietary recommendations, activity, support groups, and physical therapy—everything you need for successful weight loss before and long after your surgery. (And whenever possible, we coordinate appointments with all of your weight loss team members to save you from making extra trips!)

The lifestyle changes that come with bariatric surgery require a serious commitment on your part. But also know your hard work will be matched by Surgical Associates’ commitment to do everything we can to help you succeed!

What does that mean for you?

In 2004, the American Society for Bariatric Surgery and the Surgical Review Corporation created the nationally-accredited Center of Excellence program to develop a rigorous level of standards and outcomes for patients undergoing bariatric surgery.

To maintain a Center of Excellence designation, our bariatric surgery team meets stringent standards while integrating dietary counseling, physical therapy, support groups, advanced surgical technology, and long-term follow-up care.

Besides receiving the best care possible, patients can rest assured that Centers of Excellence often come with insurance advantages.  Several major providers, including Medicare and Blue Cross – Blue Shield, will cover bariatric surgery only when it is performed at a facility with this esteemed designation.

Obesity is an unhealthy, expensive and rapidly growing problem in the United States.  The Centers for Disease Control and Prevention report more than one third of American adults (36.5%) can be considered obese.  Wisconsin is one of 21 states where obesity prevalence is considered to be between 30% – 35% of all adults.

Obesity-related conditions are among the leading causes of preventable death, including heart disease, stroke, type 2 diabetes and some types of cancer.  Obesity costs people in the U.S. about $150 billion every year.  On average, medical costs for an obese person are nearly $1,500 higher than someone considered to be a normal weight.

Bariatric surgery has become a much safer alternative than it was in the past.  In fact, 30-day mortality rates have improved from 0.5% in 2004 to now 0.22% in 2016.  Compare this to other well-known procedures:  Gall Bladder 0.15%, Hip replacement 0.29%, C-section 0.40%.

Our surgeons at Surgical Associates have been fortunate to demonstrate a 0.0% mortality rate with our bariatric procedures.

In recent years, the medical community has developed several surgical operations to give severely obese people a safe, effective, and often permanent way to lose weight and improve their health.

Surgical Associates’ surgeons have selected the Roux-en-Y gastric bypass and sleeve gastrectomy procedures as their operations of choice. These procedures can be performed using a laparoscopic approach which uses several tiny incisions.

The strict criteria needed to be considered a bariatric surgery candidate differs from one insurance company to another. Below is a list of some of the most common criteria, and in addition to that, there is often a specific order in which you are required to see the specialized medical professionals. At Surgical Associates, we will guide you through the appropriate criteria which are tailored to you specifically.

  • 18-70 years old
  • At least 100 pounds overweight or 100 percent above ideal weight (body Mass Index [BMI] greater than 35).
  • Weight-related health problems such as diabetes mellitus, heart disease, sleep apnea, reflux disease (GERD), hypertension (high blood pressure), hypercholesterolemia (high cholesterol or lipids), or degenerative joint disease of a weight bearing joint (spine, hips, knees or ankles)
  • A history of non-surgical weight loss attempts
  • Dietitian visits
  • Physical therapy visits
  • Non-smoker
  • A psychological evaluation & counseling

How Am I Screened? What Are The Risks?

Patient screening is important and rigorous. Potential patients must complete a history of a weight loss program as well as nutritional, fitness and psychological screenings before undergoing bariatric surgery.

Once you pass screening, our team will give you instructions on how to prepare for your surgery. There may be additional lab tests or exams, you may need to alter your diet, and if you currently take any medications, you may need to alter them as well.

It is also recommended that you start a physical activity regimen and stop any tobacco use. The better your physical health at the time of any surgery, the better your chances are of optimal recovery following your procedure.

Other steps you may consider include arranging for a ride home after your surgery, and any help at home, including running errands, collecting mail, preparing meals, and caring for pets and loved ones.

10 important steps to improve your chances for a successful bariatric surgery

  1. Educate yourself about all angles of bariatric treatment. Be mentally prepared by knowing exactly what to expect before, during and after surgery.
  2. Educate your family and close friends with a summary of your research. If they are uneducated, they are more likely to steer you off-course before or after surgery (i.e. eating tempting foods around you, not encouraging you when you need it, etc.) which can lead to complications.
    If you find that anyone is vehemently opposed to your decision, it is best to discuss this with your surgeon.
  3. Lose as much weight as possible prior to surgery. The lower your body mass index before surgery, the lower your risks.
  4. Eat a healthy bariatric diet both after surgery and in the months prior to surgery.
  5. Choose good bariatric doctors and a good bariatric weight loss clinic. This is the most important step by far. In fact, there is evidence that a surgeon’s reoperation and rate of conversions to an open (and more dangerous) procedure drops as his total number of surgeries performed increases…
  6. Stick to your bariatric surgery center and surgeons follow-up plan. Successful bariatric surgery patients complete follow-up every 3 months the first year, every 6 months the second year and annually thereafter.
  7. Exercise before AND after gastric bypass surgery. Start walking as soon as possible and as your fitness level improves, work your way towards a more robust program that incorporates strength, flexibility and endurance routines.
  8. Use tools and/or medication to keep the blood flowing in your legs. Following surgery your surgeon will give you blood thinners in the hospital, and devices on your feet to help with circulation and keep from getting blood clots.
  9. Follow your doctor, dietitian’s, and exercise therapist’s advice to the letter.
  10. Have and use an effective support system before and after surgery.  In addition to friends and family, working with a good in-person weight loss surgery support group and online weight loss support that is recommended from your center is essential.

Retrieved from Bariatric Surgery Source

The Roux-en-Y Procedure

The Roux-en-Y is a procedure that both restricts the amount of food that can be taken in at a single sitting and also reduces the body’s ability to absorb calories.

 

 

 

 


Sleeve Gastrectomy

Sleeve Gastrectomy is a procedure that restricts the amount of food that can be taken in at a single sitting by reducing the volume of the stomach.

 

 

 

 


Both surgeries also affect GI hormones that can also impact weight loss.


Your Hospital Stay

Most people are hospitalized around 4 to 5 days following an open procedure and one to two days after a laparoscopic procedure. Depending on your medical condition, there is the possibility of staying in the ICU to monitor your heart and lungs.

While you are in the hospital, you will speak with a registered dietitian, physical therapists, and your surgeon to plan your discharge from the hospital and your road to recovery and continued good health.


Role of Physical Therapy

During the surgery hospital stay, the nursing staff works with you to increase your activity level.

When you return home, you will continue to increase your activity level with the goal of achieving your pre-operative level of activity. Ideally, you should achieve a level of activity that allows you to lose weight until you have achieved your weight loss goal. Going forward, maintaining that activity level, combined with new, healthy eating choices and habits should help you keep your weight under control.


Role of Clinical Nutrition

During your hospitalization, you will see a registered dietitian who will remind you of the products you should have available when you get home. They will help you plan your diet plan for when you first get home and help with recommendations to help guide you to healthier decisions for life. Your dietitian will meet with you to review:

  • The types and amounts of liquids you should drink
  • The meal pattern recommended after surgery
  • The importance of taking chewable multivitamin, mineral and calcium supplements
  • Eating techniques and behaviors to help you achieve success

Following surgery, you begin a diet of clear liquids, with the diet being advanced to full liquids after a few days. Your diet will then be advanced to soft foods in small amounts, and finally, to a general diet. The registered dietitian works with you to advance your diet appropriately.


Risks and Complications

There are risks and complications associated with gastric bypass surgery. The surgery has almost an eight percent complication rate in the peri-operative period. Fortunately, life-threatening complications are rare. The national death rate for bariatric surgery is about 0.5 percent, or one out of every 200 patients.

Complications vary on whether the open, or traditional, incision is used or laparoscopic surgery is done. Talk with your surgeon about the percentage of patients who experience these complications. Complications include but are not limited to:

  • An intestinal leak
    • This is serious and usually requires another surgery to fix the problem.
  • Serious bleeding that requires a blood transfusion or further surgery
  • Infection of the surgical wound
    • These complications can be difficult to treat and might require antibiotics and special wound care.
  • A pulmonary embolism, or blood clot that lodges in the lung
    • This is a serious complication. Blood thinners and special stockings are used after surgery to lessen the chance of blood clots forming.
  • An abscess in the abdomen
    • This is a very rare infection inside your abdomen. Sometimes these abscesses can be drained, and other times, they require surgery.
  • Incisional hernias
    • Corrective hernia surgery can be performed after the patient has lost most of his/her weight.
  • Narrowing of the stomach and small intestine connection
    • This might become evident around four to eight weeks after surgery and can usually be corrected with a procedure.
  • Blockage of your intestines because of scarring
    • This is rare but can occur. Some patients might develop an ulcer which can be painful and cause bleeding.
  • Hair loss
    • This is often noticed three to six months after surgery. It is rarely noticeable to others and usually stops after several weeks. The lost hair does grow back.
  • Nutritional deficiencies like anemia, osteoporosis, and metabolic bone disease
    • Continually monitoring nutritional health and taking supplements is important in averting these deficiencies. Patients may also develop a lactose deficiency after surgery, even if they did not have one before.
  • Gallstones
  • Many patients choose to have the excess skin resulting from extreme, rapid weight loss removed by a plastic surgeon. Additional surgeries like this result in additional costs, which may or may not be covered by insurance.

After your surgery, you will stay in the hospital 1-2 nights. You will need a ride home when discharged. As you recover, you will need to take the following steps to achieve optimal results:

  • Visit with surgeon, dietitian and exercise therapist two weeks, three months, six and 12 months after your procedure.
  • Get laboratory work at 6, 12, 18 & 24 months after surgery to check for any vitamin deficiencies.
    • You will then see the surgeon twice the second year with laboratory work and then yearly after that.
  • Time off of work is 10-14 days.
    • However, you are walking and moving at home – we don’t want you to lie around to “recover.” This is your critical weight loss time. Some people elect to go back to work and get into the swing of things within a few days after surgery.
  • You are on a liquid diet immediately after surgery.
    • However, the dietitian will work closely with you after surgery to get you back to solid food quickly.
  • We encourage you to attend the support group meetings after surgery.
    • The extra support makes a world of difference.
  • Most importantly: Keep a challenging exercise program going.
    •  Simple math: You need to burn more calories than what you are taking in to keep losing the weight.

Panniculectomy

The purpose of a panniculectomy is to remove hanging fat and skin, as one would have after losing a massive amount of weight. This procedure can be done by itself or as part of a tummy tuck, depending on the patient’s condition. Panniculectomy is different from abdominoplasty, in that abdominoplasty tightens the muscle as well as removes excess skin and fat, but a panniculectomy is performed only to remove excess skin and fat. It may also be done with another abdominal surgery, such as a hysterectomy, abdominal wall repair or hernia of the belly button.

People suffering from obesity or those who recently experienced a massive weight loss are the best candidates for panniculectomy. It may also be an option to correct post-pregnancy issues. Some candidates may have fat extending as low as the knees, over hips and around the back. This condition can cause the candidate for this procedure to have lots of health issues, including back problems, skin breakdown, rashes, ulcers and skin disorders. Even walking or standing may be very difficult.

The best candidates will have their weight remain relatively stable for about a year before the procedure. The candidate additionally must be participating in proper diet and exercise plans. If the candidate has had a gastric bypass, they need to wait for at least a year before having a panniculectomy.

Panniculetomies are typically done in a hospital, with the surgery taking several hours. The procedure is normally performed under general anesthesia and requires a hospital stay in the range of one day to one week.

As with any plastic surgery, complications are possible. You may experience one of these uncommon complications: infection, bleeding, or excessive scarring.

If you are a smoker, it would be wise to quit at least between one to two weeks prior to surgery. Smoking can increase the risk of potential complications, and it can also delay the healing process significantly. After your surgery, you should not start smoking again for at least two or more weeks (preferably not at all).

It is important to plan ahead for the post-surgery period because for one to two days after your surgery, you will have difficulty moving around and may be in pain. After your surgery, you will not be fit to drive so it is important to arrange ahead of time for a ride home from a family member or friend. You should also arrange to have someone at home to help you at all times for at least a couple of days following your surgery. With your abdominal area in pain, it will be much more difficult to move around.

How do I get started?

First, you see the surgeon for a formal consultation. At that visit, the surgeon will ask questions and do a thorough exam so appropriate documentation can be recorded. The surgeon will be looking for things like Candidiasis infection, yeast infection, Intertrigo, skin breakdown or skin necrosis, and inflammation. They will also ask you what you are doing for “conservative” therapy (e.g., multiple showers a day or towels, creams, lotions, and/or powders between the skin folds, etc.) These things need to be documented for insurance purposes as well. Insurance also requires the submission of specific pictures which the surgeon’s office will obtain at your consultation visit. Once your information is reviewed by the insurance company and authorization is obtained,  your surgeon will answer last minute questions, give you instructions on your prep before surgery, and will work with you to choose a surgery date.

If you have FMLA and/or disability papers, you would need to get those to the surgeon’s office as soon as your surgery date is known.

Today’s options in bariatric surgery offer a wealth of benefits for people who need to lose 50 to 100 pounds or more, but there are several things to consider when choosing a weight loss treatment plan. To get started, you will need to meet with a qualified weight loss surgeon to find out if you are a good candidate for a bariatric surgery procedure. Here are some important questions to ask your weight loss surgeon when you’re considering bariatric surgery.

Do I qualify for a surgical bariatric procedure? 
The best candidates for surgical bariatric procedures are individuals who are severely obese with a body mass index over 40 or a body mass of 35 and up with certain specific medical conditions dictated by insurance companies.

What type of medical tests do I need before surgery?
Patients will undergo a thorough physical evaluation and undergo psychological testing to ensure they are in good health for the procedure. Special lab tests, sleep studies, and/or heart studies may also be required. Patients will also see a dietitian and physical therapist for healthy eating and exercise strategies before and after surgery.

What risks are involved with the procedure?
Bariatric procedures are accompanied by many risks. You will be given a detailed rundown of all risks and complications before you choose to pursue treatment. Our surgeons will explain the specific risks in your one-on-one consultation to ensure you make the most informed decision.

How quickly can I expect to start losing weight?
Most bariatric procedures make it easy to lose weight immediately after the procedure. Your surgeon will work with you to determine realistic expectations for your procedure.

How long is the recovery process?
The length of recovery can vary depending on your state of health and how successful the operation was. Typically, we see patients back to work within a week or two from surgery.

Will weight loss surgery affect my ability to become pregnant?
Extreme weight loss can have an impact on your hormones, and we have seen some patients become pregnant soon after surgery. We highly recommend waiting 12-18 months after weight loss surgery to try getting pregnant.

What are the options for minimally-invasive surgery?
There are several methods and techniques used in bariatric surgery. Our doctors prefer to use minimally-invasive procedures such as laparoscopic surgery to reduce recovery time. With laparoscopic surgery, the surgeon gains access through small incisions in the stomach and inserts a tiny camera into the incisions to perform the procedure.

What dietary changes will I need to make?
Restrictive weight loss surgery, malabsorptive weight loss surgery and combination surgery all require making dietary changes before and after the procedure. Your diet will be limited to liquids for several weeks after the procedure. Patients will find out about the recommended diet plan at their dietitian appointments.

How many visits before and after surgery are required?

  • Consultation: You will be scheduled to see the surgeon once you have completed the information packet. At your consultation, the surgeon will review your medical history and explain the surgery in detail to you. He or she will also perform a brief physical examination. Please be prepared to spend about an hour at the office that day. He or she will make recommendations for any special tests at this time as well (e.g., a colonoscopy).
  • Support Groups: The support group meets the third Tuesday of each month at 6:30 pm in the Medallion Room at Aspirus Wausau Hospital. Support groups are open to patients, family and friends. You must attend at least one support group prior to surgery. Make sure you sign in to record your attendance for your insurance requirement. We find our most successful patients regularly attend support groups.
  • Dietitian Visits: Our program requires meeting with our dietitian 3-6 visits prior to surgery depending on the insurance company and post-operatively at 2 weeks, 3, 6 and 12 months. Our dietitian is specially trained to work with bariatric patients and will assist in both preoperative and postoperative diet coaching.
  • Psychological Evaluation: Psychological evaluations are required for all patients by an approved psychologist. There are no exceptions. Following this, you will be required to have ongoing therapy prior to surgery. You must abide by the treatment plan to be considered a candidate for surgery.
  • Physical Therapy Evaluation: This is an evaluation of your preoperative fitness and is used to assist in getting you started on an exercise program and preparing you for your future exercise strategy. Our Physical Therapist is specially trained to work with bariatric patients and will follow you both preoperatively and postoperatively. She sees patients 2-3 times preoperatively and at 1, 3, 6 and 12 months postoperatively.
  • Preoperative Evaluation/History and Physical: Once your surgery is scheduled, you will receive an appointment to have a history and physical completed by your primary doctor. Your family doctor will determine whether you are physically ready for surgery.

What is covered in the cost of the operation?
The cost of the operation includes:

  • Hospital fees
  • Surgeon fees
  • Anesthesia fees
  • Lab, x-ray, and pathology fees and a number of miscellaneous fees

Many insurance companies will cover part of the cost of bariatric surgery. They do require that we provide them with documentation that your surgery is medically necessary due to specific health issues related to obesity. Often you will be asked to provide documentation of your attempt and failures at other non-surgical weight loss methods, nutritional counseling, and that you do not have major psychiatric or emotional problems that would make surgery unsafe. Surgical Associate’s staff will be able to help you meet insurance company documentation requirements.

After we have submitted the required documentation to your insurance company, be sure to follow up with them to ensure they have everything they need to approve your surgery.

Will my insurance cover bariatric surgery?
Our bariatric surgeons accept payment from insurance companies or allow the patient to pay out of pocket. Find out what your options are for financing so you can stay within your budget.

If you have an insurance policy that specifically says it excludes payment for bariatric surgery, there are other options. Many patients choose to pay for the operation themselves, and we are happy to help you explore payment options.

Read the “certificate of coverage” your insurance company is required by law to give you. If you do not have one, ask your company’s benefits administrator or ask your insurance company directly.

One month is the usual time for an insurance provider to respond to your request. If you have not heard from your insurance company after one month, you should call them to check on the status of your request. Even if your initial request is denied, there are still options available through an appeal process that insurance companies provide.

Are there support groups for bariatric surgery patients?
Aspirus Wausau Hospital holds monthly support groups to help you cope with the life changes that bariatric surgery might bring. This is an opportunity for socialization, education and sharing ideas with others who have been through the surgery.

The support group meetings are a free service provided by Aspirus Wausau Hospital.

Location: Aspirus Wausau Hospital Dieticians Office, 3rd floor
(Enter the Hospital: At the main entrance off of 28th Avenue.)
Dates: Third Tuesday of every month & second Wednesday of every month
Time: Tues.: 6:30pm to 8:00pm, Wed.: 11:00am to 12:00pm
Contact: Margee Romportl, 847-2819 or 800-283-2881, extension 70024

Please visit the Aspirus Bariatrics – Support After Surgery page for more details.

When can I drive after surgery?
After surgery, you will be sore and have limited mobility. Once you are completely off narcotic pain medications and your braking reaction time isn’t delayed, you can drive. Your surgeon will advise you on what to expect for the timing of this.