How to Choose an Obesity Surgery Practice
If you are thinking about having obesity surgery, there are three very important considerations in choosing the surgical clinic providing your care and follow up.
1. Experience with obesity operations
2. Length of time they have been doing obesity surgery
3. Quality of the follow-up care they provide after surgery
Experience counts!
There is a slow learning curve in becoming an accomplished obesity surgeon. Many very competent general surgeons take years to learn to do obesity surgery properly. This is because obesity surgery has significant differences from general surgery. Occasionally, these important differences can be subtle, but can make a big difference in the outcome of your surgery. An inexperienced surgeon may not recognize or know how to deal with these differences. An experienced general surgeon does not automatically become a competent bariatric (obesity) surgeon. It takes the experience of doing many obesity operations. Otherwise, the surgeon may be “learning” on you.
Long-term follow up is important in several ways; the first is that obesity surgery is not like other operations. It requires that you be carefully coached on how to use the tool (the obesity operation) the surgeon has given you. If you are not taught what you must do to use the tool properly, the success is predictably less than is you had you been adequately coached. It takes at least five years of follow up to know whether an obesity operation is successful in any patient. Early weight loss occurs with every obesity operation. But long-term success is the real issue. This can only be determined by getting and evaluating published results from the clinic’s successes (outcomes) after five years of patient follow-up. Surgeons can have impressive results for the first 18 to 24 months, but then their patients can experience weight regain, and are disappointed with their results.
You cannot determine how successful a surgeon’s patients are long-term without seeing something in print. You may not always be able to depend on the surgeon to verbally give you valid information because often he/she doesn’t have long-term results, hasn’t been doing obesity surgery that long, doesn’t have enough patients for a study, or does not have the experience and/or a good follow-up program and therefore doesn’t publish his less-than-ideal results.
Without statistics (research) specific to that surgeon’s practice, the information is only anecdotal (not based on fact). Some surgeons may be inclined to fudge a little bit on their outcomes. If a surgeon can only give you 18-24 months of follow up (even 36 months), the information is meaningless in terms of long-term weight loss outcomes. If you are going to take the risk of surgery, you need the assurance that you will be successful at five, and even ten years. You won’t know that if you are quoted statistics on 18 to 36 month outcome data.
Most experienced obesity surgeons have published their results in medical journals or presented their outcomes at scientific meetings and have copies of the papers they have presented. They should be happy to share them with you. Your purposes are best served by going to a clinic that does primarily obesity surgery, and has seasoned obesity surgeons. The surgeon and operation you choose determines your success as much as your willingness to properly use the “tool” (the weight loss operation), so be thoughtful in making your choice.
In choosing an obesity surgeon, call his/her office and ask for four things in writing: (1) the number of cases he/she has done, (2) how long ago he/she started doing obesity surgery, (3) what is the follow up program, and, (4) what are his/her 5 year outcomes for weight loss and complications by procedure (i.e., Gastric Bypass or Adjustable Gastric Band). Knowing these things will help you make an informed decision and markedly improve your chances of successful long-term weight loss while reducing your risk for complications.
Even if the surgeon is technically competent and has done the surgery properly, if the follow up and coaching is inadequate, your weight loss and healthiness is predictably much less than if the proper instruction and monitoring had been carried out.
If you decide to be a guinea pig; do it by choice, not by accident.
Weight loss is important, but equally important is the return to a more healthy body. Changes in your co-morbid conditions (those you had prior to surgery, like diabetes, high blood pressure, etc.), must be watched and adjustments made. If your post operative visits, lab work, and nutritional status are not properly and routinely monitored for the rest of your life, you may experience serious nutritional and metabolic deficiencies. These can be life-threatening if not properly diagnosed and treated. In our practice, we often take care of patients who were done by surgeons who do not have a good follow-up component to their practice.
Another aspect of long-term follow up is the change in your quality of life. It’s important that the surgeon and his staff be familiar with the many changes that occur in your life as a result of your surgery. For some, these changes are all positive and not much support is needed. For others, these changes are new, sometimes frightening or bewildering. A sophisticated surgeon and staff will be able to help you adjust to these new situations because many of them are common to others who have had surgery, or, they will be able to guide you in getting the support you need in making these transitions.
If you do these things, you markedly improve your chances of successful long-term weight loss and improved health, along with reducing the risk for complications or problems.
So, in summary, obesity surgery is technically difficult even for a competent general surgeon until he/she has done at least 500 cases. The first few hundred patients an obesity surgeon does, he/she is learning how to do the surgery properly. An inexperienced surgeon should have an experienced surgeon in the operating room with him until he is comfortable with obesity surgery techniques.
Obesity surgery is a life-changing event. Our clinic staff & doctors are dedicated to helping you be successful with your weight loss, your improved health and quality of life. We want you to live life well.