Evaluating a Surgeon

A Second Chance for a Long & Healthy Life: A Mr. Mom's Gastric Bypass Story

Evaluating a Surgeon

I understand that there may be some surgeons who perform gastric bypass operations who might not share the same commitment to patient care to which I was entreated, or who may attempt to coerce patients to accept open operations rather than laparoscopic procedures. So, if you are going to consider having the surgery, you should know the questions to ask your potential surgeon to find out her level of experience and her dedication to your short-term and long-term care.

Appreciate that laparoscopic procedures entail a small number of very short incisions through which the equipment is inserted and through which your surgeon works (with the help of a television monitor). Because you do not have a lengthy incision down your chest, your recovery time is greatly reduced and you're able to get up and move around in the hours after surgery (which is critical in your recovery and in limiting the risks of embolisms). Also, because the surgeon does not have to cut through layers of muscle and then stitch everything back up, the laparoscopic patient is on the table for a shorter period of time (it only makes sense, right?). And, with a shorter incision and no external staples or stitches, the laparoscopic patient should have a greatly reduced risk for wound infections. Notwithstanding the unambiguous logic of these points, I have heard many pre-operative and post-operative patients tell me that they were told by their surgeons that the laparoscopic procedure could take over five hours, that laparoscopy could not be performed on very heavy patients and that the laparoscopic bypass is a more dangerous operation than the open one. However, my experience, and the experience of many other patients at the Norwalk Hospital support group I attend (but which has no connection to this website) tells an entirely different story; Dr. Crum performed my gastric bypass in about 95 minutes, I was up walking around less than 20 hours after I left the OR (and many other patients have gotten out of bed less than 12 hours after surgery), I did not have a single stitch or staple closing my wounds (steri-strips were used), Dr. Crum tested for leaks before I left the OR so I didn't leave with a drain in and my procedure was performed laparoscopically even though I weighed over 500 pounds and had a BMI of more than 61.

So, when you hear a surgeon tell you that you are too big for a laparoscopic gastric bypass or that the operation is more dangerous than an open procedure, know that he might not have the experience you deserve.

Questions to ask your prospective surgeon:

General experience:

1. What types of bariatric operations do you perform? (My preference is for a surgeon who has had broad experience in operating on the stomach and intestines with some experience in critical care.)

2. What is your preference for open versus laparoscopic gastric bypass? (I think doctors should all prefer to perform the operation laparoscopically because it is safer for the patients and entails a greatly reduced recovery time.)

3. How many open gastric bypasses and laparoscopic gastric bypasses have you performed? (I dont know how many is enough--- at least 20, maybe.)

Pre-surgical considerations:

1. Does your office write to the insurance company to arrange for pre-approval and will your office appeal any initial denial?

2. What specialists must evaluate me prior to surgery and do you use the same team of specialists for all of your patients?

3. What are the dietary limitations for the weeks and days before surgery? (A low-fat diet is critical as it reduces the size of your liver which tends to be in the way when you are operated on; but, I dont know if its fair for doctors to insist that you lose a set amount of weight before theyll operate--- after all, if you could stick to a diet, why would you be trying to have gastric bypass surgery?)

4. What are your criteria for performing the surgery laparoscopically?

Surgery and hospitalization:

1. Will the anesthesiologist and OR staff have had significant experience working with you on gastric bypass patients?

2. What training will the floor nurses have had in dealing with gastric bypass patients?

3. Are all of your patients sent to the same ward while in-patients?

4. What arrangements are made with the hospital dieticians for post-operative nutrition?

5. What steps are undertaken to minimize the need for leaving the OR with a drain? (This is one of my big gripes with the way the procedure is done by some-- the surgeon can test your connections before you leave the OR to test for leaks, so there is no need for a drain. Also, if leaks are checked for in the OR, you can start sipping water ASAP and truly commence a speedy recovery, rather than waiting 24 hours to have x-rays taken of the field. I left the OR leak-free and drain-free.)

6. What is the rate of incisional infection that your patients have experienced?

7. How soon after surgery do you require your patients to get out of bed?

Follow-up:

1. What, if any, support group do you recommend to patients?

2. Do you attend these support group meetings?

3. What is the schedule for follow-up visits?

4. How closely do you monitor your patients' future pharmacological and nutritional needs? How involved do you become with your patients' primary care physicians? Do you routinely administer B-12 injections?