An adequate discussion of the various types of WLS and what is realistically expected of you afterward is never a five-minute conversation. Addressing these issues frequently takes an entire informational seminar. Most patients understand that it would be difficult to have an individual discussion for two hours with over 100 patients each month, but this is what the job requires. Be very wary of programs that spend little time discussing your options or describing their post-op program. If they are not willing to give you ample time pre-op, how much time do you think will be devoted to you post-operatively?

Be Flexible

I believe it is important to consult with a surgeon who performs more than one type of operation. This is the only sure way to obtain an unbiased opinion as to which surgical option best fits your needs and your risk stratification. You do not need to have your surgery with this same surgeon; I simply feel that you will get a more balanced presentation from someone who does not have a vested interest in which operation you choose. If you attend a seminar by a surgeon who is only capable of performing laparoscopic adjustable gastric banding procedures, you will leave there believing that the band is the greatest invention since the wheel, but you may miss out on other options that might be a better fit for you.

Additionally, be wary of anyone who does not perform a certain operation because it is “too dangerous.” In general, this statement is made by physicians who are not qualified to perform that particular operation.

Strength in Numbers

Though many do not like to admit it, some surgeons are simply better than others at certain operations. The general public may find this disturbing, but that does not make it untrue. Numerous studies have shown that complication rates from WLS are highly dependent on the surgeon’s prior experience. In the case of laparoscopic gastric bypass, a surgeon must perform 50 to 100 operations before the complication rates drop. (Fortunately, it is difficult for an inept surgeon to achieve such numbers today; the peer review process at most hospitals would ferret out incompetence well before 50 cases.) Previous experience is tantamount to success, so ask your surgeon how many of each proposed operation he or she has performed.

Chemistry Matters

In many general surgical cases, the patient’s interaction with the surgeon is fairly limited. This is not the case with weight loss surgery. Depending upon the type of operation, WLS patients may see the surgeon at least four or five times in the first year alone. Be sure that the surgeon’s support staff and program directors are people you feel comfortable with. It is a very reasonable expectation to have these people display genuine concern for you and your progress. If you do not feel that concern from the staff, consider a different program. You should feel that your personality is a good fit with the personality of the program you choose.

Support

Your success following WLS is a function of several things: surgeon experience, as discussed above; your willingness to make permanent lifestyle changes; and post-op support to achieve those lifestyle changes.

All too frequently, WLS is referred to as “the easy way out.” This could not be further from the truth. While WLS itself may be very straightforward, it requires hard work to succeed. I frequently tell our patients that 90 percent of their long-term success is in their hands, not mine. Any weight loss operation can be defeated; the only way to avoid this is by making a conscious choice to change your lifestyle permanently.

Be sure to ask what each program can do to help you make these lifestyle changes. Do they offer support groups, psychological support, exercise or physical therapy, and dietician support? Do they have physicians in other specialties who are familiar with weight loss surgery? Are they prepared to deal with any potential complications?

Regardless of the answers to the above questions, the most important question is one you should ask yourself: “Am I comfortable with this facility, surgeon, or program?” Intuition always counts. If you have a bad feeling about a program, there is no harm in looking at another program.

Summary

Not all programs are created equal. I have always felt it is sound advice to attend more than one seminar and look into more than one program.
There is something to be said for a program’s “drive-up” appeal—both literally and figuratively. If you have misgivings about having your surgery in a strip mall next door to a fast-food restaurant, chances are your intuition is trying to tell you something.

Do not make the common mistake of wanting instant gratification. After all, you have probably been overweight for many years and considered WLS for several years. Remember, WLS is not an emergency; you have the luxury of time to make a good, informed decision regarding the program that you are trusting with your care.

In summary, be patient. Make the right choice, not the one that is simply the most convenient. Don’t bargain-shop for one of the most important medical decisions you will make in your life. The rewards for making a good decision are immeasurable; the consequences of a bad one are exponentially worse.

Nick Nicholson, MD, FACS, of the Nicholson Clinic for Obesity Surgery in Plano, Texas, is a board-certified bariatric surgeon with over seven years of experience. 

June 2008