New Year, New You

The bariatric surgery journey can be a life changing, rewarding experience. What if a year from today you could look and feel like a new person? Sometimes the hardest part of this journey is the first phone call. Stelios Rekkas, MD, FACS, FASMBS, is the physician and director for Manatee Memorial Hospital Surgical Weight Loss Center. His bariatric coordinator, Cate Roskind, shared the process steps to surgery to help patients have a better understanding of this experience.

I would like more information about bariatric surgery. Where should I start?
Patients who are interested in bariatric surgery should call their insurance company to see if they have benefits for bariatric surgery as an initial step. Then, if they would like to learn more about their weight loss options, they should call our office information line. A knowledgeable patient advocate will provide an initial phone screening by asking you a few questions, such as your height and weight, to determine body mass index (BMI), and inquire about any comorbidities you may have, as well as which surgery you are considering. They can then determine if you meet general insurance criteria for bariatric surgery. If the patient meets the general insurance criteria, the patient will then be scheduled for the first initial consultation with Dr. Rekkas. The patient will meet with the experienced bariatric team at the consultation appointment, and they will discuss the individualized process steps to surgery.

What should I expect after the initial consultation appointment?
After your initial consultation appointment with Dr. Rekkas and the bariatric team, you will start your individualized process steps to surgery, which typically include the following:

Remember, insurance criteria vary by provider, but may include:
• A psychological evaluation
• A dietitian supervised diet which is either three or six consecutive months in duration
• One time visit with a physical therapist for exercise evaluation
• Lab work
• An EGD (camera study of the stomach)
• Cardiac or other specialty clearance as deemed necessary by the surgeon
• Other diagnostic testing could be required depending on the patient’s history

Once these items are complete, you will be scheduled for the preoperative consultation appointment with Dr. Rekkas and if weight loss goals are met, a surgery date will be scheduled.

What else happens before surgery?
Patients will attend their hospital pre-testing appointment and pre-op instruction group class, usually one week prior to surgery. The comprehensive pre-op instruction class is one hour long, and we review everything you need to do to prepare for surgery. The bariatric coordinator will spend the entire day with the bariatric patient. From preop, to the moment the patient is taken to the OR, to when they go to the recovery room and finally when they are assigned to an inpatient nursing unit. Patients typically stay overnight, then go home the next day, whether they have a gastric sleeve or gastric bypass surgery.

What are the most common post-operative concerns with these kind of procedures?
Nausea and pain (gas and surgical site) are the two concerns patients are most cautious about. With these surgeries, these can be the most common side effects. Dr. Rekkas and his team follow best practice guidelines to keep patients as comfortable as possible in the post-operative period. Dr. Rekkas utilizes standardized order sets which give nurses medication options for pain and nausea control to better manage patient symptoms.

What are the guidelines for recovery?
The bariatric coordinator will review the discharge instructions with the patients before they leave the hospital. This includes activity restrictions, wound care, signs and symptoms of complications, diet instructions, medications & vitamins, and when to call the office. There is a structured post-op follow-up schedule to ensure we are meeting Center of Excellence (COE) criteria and ensuring our patients are losing weight at a healthy rate.
• 1-week
• 1-month
• 2-months
• 4-months
• 6-months
• 9-months
• 12-months
• 18-months
• Annually to five years post-op

Generally, 4-6 weeks after surgery, patients can advance from their walking plan and start going to the gym, or other activities. The post-procedure diet is done in five stages. Right after surgery, patients start with bariatric clear liquids for four days and they then advance to bariatric full liquids for 10 days. After this, they are on a bariatric pureed diet for 14 days, and then a bariatric soft diet for 14 days. They progress to the bariatric regular diet for life.

What would you say to someone who may still be hesitant?
If anybody is considering, yet hesitant about getting bariatric surgery, I invite them to come to one of the support group meetings. Support groups are held once a month. Guests do not have to participate, but they can sit in and listen, or ask questions if they would like. We have patients attending that are new post-ops right after surgery, and we also have patients attending that are one-month, six-months, one-year, or three-four years out. If someone does not feel comfortable coming into a group setting, they are more than welcome to call me directly, as I am more than happy to discuss bariatric surgery with them.

My goal as bariatric coordinator is to ensure the patient is well educated and prepared for surgery, and never blindsided. An important part of my job on surgery day is to provide emotional support–to put the patient at ease before and after their surgery. It is an honor to spend the bariatric patient’s special day with them.

Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if bariatric surgery is right for you.

Manatee Weigh Loss

232 Manatee Ave. East, Bradenton, FL 34208
941-254-4957 | msaweightloss.com

Physicians are on the medical staff of Manatee Memorial Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. For language assistance, disability accommodations and the nondiscrimination notice, visit the hospital’s website.