First appointment
You might already know some of these things from a pre-op seminar, but if you don't, now's the time to ask!
1. How big will my sleeve be (it seems that 38-40 are on the larger side, but thought to help reduce reflux, and 34 and below have more restriction) -- but people have been successful at all sizes, but you may want to know.
2. Why do you think some patients get reflux and others don't? What do you do to help ensure patients don't get reflux?
3. Leak rate, mortality, complications, education, training how many has he done? If he is a doc at an insurance plan's Center Of Excellence, that's always good because the insurance companies go through their data and select docs/programs who have the best outcomes (not just cost -- the cost is lower because people aren't going back into the hospital with complications!)
4. Inpatient or Outpatient? Most outpatient is 23 hours, so you do spend at least one night. Sometimes the surgery is planned as outpatient (again, still one night), and other is planned for inpatient of one night -- this is sometimes an insurance technicality, and typically the surgeon's office has an insurance person that you ask all of the insurance questions to -- make sure to pay VERY CLOSE attention to what she tells you. If the insurance paperwork isn't done correctly, then there is no surgery!
5. Does he think you are a better candidate for Sleeve vs RNY? Why? If you really want a sleeve, but there are medical reasons why an RNY may be better for you, hear him out. You may still choose the sleeve, but it will be an informed choice -- there are medical conditions, like reflux, where RNY is the gold standard for CURING reflux, whereas the sleeve may help it, or could make it worse. So, make sure you understand the pros and cons of both, so you are making an informed choice.
My two cents! Good luck!
5.
Sorry about the reflux. Here's what my GI doc told me. He ALWAYS recommends RNY to his patients who are considering WLS because that will take care of your reflux. I explained to him why I wanted VSG, and he said that those were valid reasons, but overall, no one absolutely understands why people have such varying levels of reflux. For every possible cause (32 bougie or shape of new stomach), some people with that possible cause don't have reflux. For every possible work-around (larger bougie), some people still get reflux. And for the people who get it 3 years out -- no clue. But what he did tell. In HIS experience, none of his reflux patients got worse. So, I currently take 40 mg of Nexium twice a day -- so hopefully, that will be the worst case!
Also, if you are prone to nausea (my reflux presents as nausea), be sure to tell the surgeon that during your first visit, your final visit, and at the hospital. It is also something you want the anesthesiologist to know!
Good luck!
