So you have decided to undergo gastric bypass surgery. You also have decided what the best surgery for you is going to be. The next step, probably the last in the premeditation process, is choosing a bariatric surgeon, and a good one at that.
Bariatric surgery, open or laparoscopic, is a serious and risky operation. There are a number of possible complications:
- GI tract leak
- Bowel obstruction
- Bleeding and infection
- Pulmonary embolism
- Kidney problems
- Complications from anesthesia
- Scar tissue formation
- Nerve problems
…among others. It is not likely for you to experience all these complications all at once, but one, two, or three of these mishaps may occur during or after the surgery. I’m not trying to scare you, but considering all possible disasters that can happen, even in the hands of the best surgeons around, you can never be so sure.
Let me help you by offering some guidelines in choosing a surgeon.
Basically, you will be choosing not just one surgeon, but actually a team of medical experts – dietitian, anesthetist, endocrinologists, gastroenterologists, nurse, psychologist… So why the lengthy list of hospital personnel?
First of all, weight loss surgery procedures don’t start and end at the operating table. It starts at the doctor’s office, where you get your diagnosis and pre-operative assessment. This assessment consists of a series of physical and psychological tests to ensure that you are in the right body and mind.
- You want a surgeon that has already performed a number of bariatric operations. How many successful operation has the surgeon performed? This is actually a trick question. For one thing, if you choose the duodenal switch (DS) procedure, which is a relatively new procedure, it has only been performed by a few surgeons in the country. So, if one of these surgeons say they have performed 50, then that would be a high number. Whereas a gastric bypass surgeon might have performed well over 1000. Or gastric banding, the preferred procedure next to RNY, is much less complicated and therefore some surgeons have done over 10,000 of these. So before you ask the surgeon how many of your chosen procedures they have performed, make sure you know how many makes them one of the more experienced in the country.
- The surgeon’s training credentials are also necessary. A surgeon who has served as a resident to a practicing surgeon is probably more valuable than the degree in medicine itself. Surgeons who have only attended a conference or seminar on bariatric surgery may not be your best choice, unless they have already performed a high number of successful surgeries. For your peace of mind, it is okay to ask your surgeons how many surgeries have they performed in the last five years.
- It is worth knowing the surgeon’s personal mortality rate. Don’t settle for general statistics. You can find that information on the Internet or the surgeon might tell you the standard 1 out of 200 mortality rate, but this is not the information that is going to protect you. Ask for their personal success rate and mortality rate. You can also search the surgeon’s name on Google, or ask for a list of references to make sure. If you are in the US, the Obesity Help forum is a great place to get surgeon references and information.
- A surgeon with experience and success will be happy to provide you with any information needed to make you comfortable with your chosen procedure. Since we are not surgeons, we don’t understand most of the specifics or numbers related to our procedure, but here are a few clues to help us out. Among the most common mistake a surgeon might commit is to create a too large pouch. Ideally, the target pouch size is 15 cc or 15ml. This is definitely a small pouch size to aim for, which is why inexperienced surgeons tend to create pouches larger than your optimal size. Therefore, it might be a good idea to ask the surgeon what size he is shooting for and what tools he uses to measure the success of this.
- Follow-up appointments after operation are very important. Gastric bypass surgery entails an almost intricate lifetime process, which may require a life-long follow-up by a doctor. Determine your doctors’ commitment to their work by asking how long do they do follow-up appointments and what kind of appointments are we talking – a regular appointment with their physician? With their nurses? Or a follow-up appointment with the surgeons themselves? Make sure that your program won’t turn its back on you a couple of weeks after surgery. Your health is your responsibility. Most of the work is done by your team, but making sure they provide you aftercare is your duty.
As with everything, efficient communication is used to measure one’s dedication and sincerity. This is very important during the pre-operative phase, on the operation day, and after the operation. It is not a good sign if your doctor fails to return your calls in the early stages, puts you on hold, or lets the secretary deal with your questions.
Other Concerns to Consider
Proximity. After surgery, you want your doctor to be available for follow-up appointments. You also want him to attend to your concerns personally if anything were to go wrong or a complication would arise. In cases like these, a telephone call won’t suffice. Some people who choose to undergo gastric bypass surgery decide to have this operation performed abroad due to lower costs in other countries. A popular place to have this procedure performed at a deep discount is in Mexico.
Private or self-paying patients are big on low-cost procedures, but are the savings worth it when your life is put on the line? Personally, I think no. If the availability of your surgeon is also a top priority, look for a surgeon that operates in a hospital or medical center close to where you live.
Price. Again, price is a big issue and tends to complicate your decision-making process. Should you go to a cheap surgeon in Tin-buk-tu or choose a higher priced within 30 minutes of where you live? If you don’t have insurance and are on a tight budget, there are ways to have an affordable operation without sacrificing the quality and your safety.
Here’s a great article I found regarding the cost of bariatric surgery with annual maintenance rate.
There are also several questions to ask yourself about:
- Confidence in your prospective team. Am I certain that these doctors will provide me care that I need before, during, and after surgery?
- Doctor’s attention. Is this doctor willing to extend support even in wee hours?
- Doctor’s reputation. Are these doctors’ reputation good enough to leave my life in their hands? Call the head of the hospital or ask his colleagues if possible. If they say with certainty, “He’s a top notch surgeon,” your life may well be in good hands after all.
Remember that it’s okay to be meticulous and demanding. We are talking about your life here.