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How should I prepare for bariatric surgery?

Deciding to have surgery is not a spur of the moment decision, you do not take it lightly, and you should prepare carefully for surgery. We take the preparation for surgery very seriously, too. When we send you a quotation we will explain everything you need to do to prepare for your procedure and to play your part in trying to ensure you have safe and successful surgery.

No surgery performed under a General Anaesthetic is without risk, and it is vitally important that you do your best to ensure you come for your surgery in as good a medical condition as possible, to help reduce those risks. These preparations will help in making sure the pre-operative tests at the hospital all go smoothly for you. Generally, we expect you to:

Strictly follow the pre-operative diet we send you, and follow any individual instructions we send
Make sure your weight is recorded accurately
Make sure you follow our instructions on taking Milk Thistle when preparing for your operation
Avoid alcohol and quit smoking in the run up to your surgery. Alcohol affects some liver enzyme levels which can prevent surgery and smoking can cause respiratory problems during and after surgery.
Get your GP to give you a thorough health check before surgery. We will suggest which tests should be carried out.

What factors other than my BMI and co-morbidities will determine whether I am a suitable candidate for Weight Loss Surgery?

You will obviously need to be in sufficiently good health to allow you to safely undergo the surgical procedure. Weight Loss Surgery, whilst carried out for good medical reasons, is an elective surgery, not an emergency surgery, and the surgical team will agree to operate only when satisfied the operation will not put you at undue risk. The team is familiar with the health problems associated with obesity, and will take all precautions to enable your surgery to be safely completed
You should be able to show that you have been unable to lose weight by the more usual methods, over a period of years, and that you have made the decision to seek surgery after full consideration of the facts and an understanding of what is involved, not just in the surgery itself but also for your life after the surgery.
You should be in a position, mentally, to be able to succeed in your weight loss after surgery, and have no psychiatric incapacity which would make your success with weight loss after surgery impossible. We and the surgical team want to make sure you can succeed in your attempts at weight loss, and we will not accept a patient for surgery if we believe he or she is not capable of benefitting from it.

What pre operative tests will I have?

On the day of your admission to the hospital the following preoperative exams are on the schedule:

laboratory test of your blood and urine - all patients
abdominal ultrasound examination (sonography),- all patients
lung and heart X-ray (RTG),-all patients
electrocardiography (ECG) possibly with ergometry - all patients
spirometry possibly with complete pulmonary examination - all sleeve patients and band patients with a history of asthma or other breathing problems
endoscopic examination of the stomach (gastroscopy) - all sleeve patients and possibly band patients
evaluation of your general health status by the internal medicine specialist and by the anaesthesiologist. - all patients
evaluation by the psychologist - all patients
final preoperative consultation by Dr Cierny, the bariatric surgeon - all patients

What risks are involved in Bariatric Surgery?

All forms of surgery performed under a general anaesthetic carry a degree of risk, but in evaluating you for suitability for Bariatric surgery it is part of the job of Dr Cierny and his team to assess the risk and take all steps necessary to ensure your surgery can be safely performed. When looking at candidates for obesity surgery Dr Cierny, the anaesthetist and other physicians will assess the risks and perform surgery if they consider the risks to a patient's health in remaining obese are far greater than the risks involved in the surgery.

Even though surgery is performed with great skill and care there is always a small possibility of a complication during the operation or postoperatively. These complications are rare, and part of the reason Dr Cierny insists on your staying in the hospital for four days after your surgery is to be able to monitor you closely and ensure your complete recovery.

High Risk Patients

The risks involved in surgery for some patients are greater than for others. Statistically "higher risk" patients fall into one or more of the following categories:

Age over 50 - As with most operative procedures, people older than 50 are known to be at higher risk during surgery
BMI over 50 - those patients whose Body Mass Index is over 50 tend to be more at risk of peri-operative and post-operative complications
Male Patients - Men are more likely than women to suffer from certain conditions that can increase surgical risk. These include diabetes, hypertension and metabolic syndrome (also known as syndrome X or insulin resistance syndrome), a condition characterized by a group of risk factors including hypertension, high triglyceride levels, low HDL levels and high blood sugar levels after fasting.
High Blood Pressure (Hypertension) - People with high blood pressure (hypertension) often suffer from heart disease and/or chronic blood vessel inflammation, both of which increase the odds of serious surgery-related complications.
Heart or circulatory problems or a history of ischemic heart disease, or disease of the heart valves
History of Pulmonary embolism (blood clots in the lungs) - People who have previously had a blood clot in their lungs (pulmonary embolism) or legs, or who are genetically at risk for developing blood clots are at elevated surgical risk. All patients, regardless of their risk for clotting, are prescribed blood-thinning medications during the course of their stay in the clinic.
A history of breathing problems, pulmonary and bronchial disease, asthma or chronic bronchopulmonal obstructive syndrome. People who have suffered from these problems are more likely to encounter difficulties during or after surgery and present a higher risk for anaesthesia
A history of hiatal hernia, gastro-oesophagal reflux disease, stomach ulcers or a history of chronic diseases of the digestive tract (e.g.Chron's disease, Barrett's oesophagus)
A previous open major abdominal surgery in the upper abdomen might also signal a higher probability of adhesions which would prolong the proceedure and make the operation technically more difficult.

If you fall into one or more of the higher risk groups Dr Cierny may well ask for additional medical reports/tests to be made available to him prior to making his decision on your approval for surgery.

Patients who are in High Risk categories usually require additional tests, treatments and medication at the hospital, either before or after their surgery to ensure maximum care and safety. This will generate additional costs for the hospital. If you are regarded as a high risk patient because you can be placed into one or more of the categories listed above, your medical questionnaire will be carefully evaluated by the team at the hospital (together with any further medical information you are asked to provide) and we will let you know into which Risk Band Dr Cierny and the team have placed you when providing your quotation. Extra charges for High Risk patients will either be £200.00 (Risk Band I), £390 (Risk Band II) or £760 (Risk Band III - the most vulnerable patients)

Further information on any complications and risks associated with Bariatric surgery can be found in the FAQ's section of the website.

Will the surgery be successful?

Weight loss Surgery is the only statistically proven effective treatment for Morbid Obesity. We believe that the less invasive, more straightforward surgical treatments such as Sleeve Gastrectomy and Gastric Banding can achieve results that can transform and prolong the lives of our patients. As we state above, NO surgery in itself will work as a magic wand - you still have to put the effort in and work with it, accept the limitations it makes to your eating habits, and maintain a healthy diet, exercise and eating regime after your operation: Having said that, surgery gives you a wonderful tool to allow you to lose weight quickly, effectively and permanently with only a little self discipline and effort. It will transform your life.

Please feel free to look through the comments and chat on our Forums, and to check out our Facebook page, where many of our patients chat. Also look at some of our patient Testimonials and photos, and read through all the other pages of the website concerning Weight Loss Surgery. You can search for comments about us in the other Weight Loss Surgery forums on the internet - we have an excellent reputation, which we work hard to maintain. It's really good to get as much information as you possibly can before making a decision as important as this.