Is Bariatric Surgery covered by Medicare?

“Medicare” is actually composed of 14 systems – one delivered by each of the provinces, territories and federal government. Most provide coverage for certain bariatric surgical procedures. Then there is the problem of access. Bariatric surgery wait lists are inhumanely long across Canada.  Certainly more than 1 year, the legally defined maximum wait for any surgery. Check with your Provincial/Territorial Health Care Plan.

What is the wait time for bariatric surgery under Medicare?

Dr. Christou’s study published in the Canadian Journal of Surgery in 2009 found an average wait time of 5.2 years in 2007-2008. This may be somewhat decreased today to perhaps 1-3 years but we do not really know. Check with your Provincial Health Authority.

How soon can I have my surgery in your private hospital facility?

If you are ready to self finance your surgery you can have this done in 4-6 weeks the time required to prepare you for safe surgery (e.g. 2-4 weeks of special high protein diet to shrink your liver, and medical testing).

What if my current weight loss surgery is not working?

Dr. Christou has Canada’s largest experience with correcting failed bariatric surgeries. Examples are laparoscopic band intolerance, band leakage, band erosion into the stomach or failure to lose weight after laparoscopic banding. Other examples are obstructed or bleeding vertical banded gastroplasties. Most patients are referred to us from other programs across Canada or from medical tourism sites in Mexico or India. Some are from our own McGill University Health Center Bariatric Surgery program. We perform all these revisions laparoscopically (even those patients who had their gastroplasty the old fashioned open or cut down the middle surgery) with a completion rate of better than 95%.

How many of each procedure has Dr. Christou performed?

Dr. Christou has performed over 2,000 laparoscopic gastric bypasses over 300 laparoscopic gastric bands and over 100 laparoscopic sleeve gastrectomies. He performs all weight loss surgery laparoscopically (no big cut down the middle).

How long will I be in surgery?

The total time in the surgical theater is ~2 hours. This includes 45-80 minutes of actual surgery time (what surgeon’s call “skin to skin”) and the rest of the time is nursing preparation and anesthesia (going to sleep and waking up) time. An additional 2 hours may be spent in the post anesthesia recovery are before patients return to the ward.

How long do I stay in Hospital?

Laparoscopic adjustable gastric band patients go home the next day (around 10 am). Laparoscopic gastric bypass or vertical sleeve gastrectomy patients leave on the morning of the second day after operation (around 10 am). Rarely, a patient may have a serious complication and be in the hospital for a month or more.

How do I take care of my wounds?

If not already done by the nurse before you go, remove the small plastic covering and sponge and let the wounds dry. You can take showers and let soap and water run over the wounds gently. Pat dry with a clean towel and leave it exposed to the air to dry before covering with clean, loose, clothing.

Can I take baths or showers?

You can take showers starting the day after the surgery. Let soap and water run over the wounds gently. Pat dry with a clean towel and leave it exposed to the air to dry before covering with clean, loose, clothing.

What will I eat when I leave the hospital?

Follow the 35-day menu plan given to you in your Patient Information Folder.

What is regurgitation and will I have it?

Regurgitation occurs because of the small size of your new stomach. This can cause heartburn and indigestion. It is normal that you may experience mild symptoms for up to 6 months. Avoiding certain foods may help. If it persist or get worse, call the nurse-clinician or ask to see Dr. Christou.

When will I see Dr. Christou again?

10-14 days after the operation. You will be given an appointment before you leave the hospital. Otherwise call us for an appointment.

Can I drive my car?

Yes, as soon as you feel strong enough. Usually this is two weeks after leaving the hospital.

Can I wear my seat belt?

Yes you can.

How long before I can return to work?

This ranges anywhere from 1 to 6 weeks and depends on the type of work. Most patients can return to work that does not involve manual labor (e.g. construction) within a week of surgery. We recommend at least 2-4 weeks off for a smoother recovery. Even if you are doing well, you may feel quite fatigued from the low caloric intake for the first 4 weeks after surgery so it is advisable to avoid work until this resolves.

When do I start taking the Vitamin-Mineral Supplements you prescribed, and for how long?

You can start taking the vitamin-mineral supplements prescribed to you every day after 10 days from your surgery. IT IS IMPORTANT THAT YOU TAKE VITAMIN-MINERAL SUPPLEMENTS EVERY DAY FOR THE REST OF YOUR LIFE TO PREVENT VITAMIN DEFICIENCY.

Are there any activities that I shouldn’t do?

Avoid contact sports for 4 weeks. You can do long walks for the first 4 weeks, then you can do any activity as long as it does not hurt. Patients are strongly encourage to do regular physical activities to achieve and to maintain good weight loss.

When can I have intercourse?

As soon as you feel like it and there is no pain. Women must take precautions not to become pregnant for the first 2 years after surgery.

Can I go swimming?

Yes, as soon as your clips come out at 10-14 days after the surgery.

How much exercise can I do?

Walk as much as you can without becoming tired. The first four weeks, go easy! Eventually, you might try to set a goal for yourself to walk one or two miles per day. Climb stairs, as you need to. All patients are strongly advised to start a regular training program in order to maximize their weight loss. Walk, join a gym, higher a trainer, whatever you can do helps. Wear a podometer and try to log in at least 10,000 steps per day.

When will I lose weight? Can I regain it back?

By eating only at the suggested times and until you feel full, your daily food intake will be decreased enough to provide a gradual weight loss. The rate at which you lose weight will vary from month to month. It will take between 1 1/2 to 2 years for you to reach your goal weight. After this time you must work VERY HARD to maintain it. As the time passes you will slowly start to eat more frequently and innapropriate type of foods (“junk food”). You must maintain discipline and use the tool you were given (the bariatric surgery you chose) to help you stay on track.

What are the ways I can regain weight after weight-loss surgery?

The following “bad habits” have been observed in patients who report weight gain after weight-loss surgery. This is true in patients who do not have failure of their surgery such as a gastro-gastric fistula (a reconnection between the pouch and the old stomach).
  • Eating a diet rich in high carbohydrates with a high glycemic index– such as donuts, cookies, cakes, ice cream.
  • Not starting or maintaining the suggested exercise program, and spending more time watching television and increased time in front of the computer.
  • Eating food rapidly so that patients don’t get that full feeling. Remember, feeling full — or satiety — takes a while to register, so if you eat rapidly you can stuff a lot more in than if you eat a bit slower and feel full with less.
  • After feeling full, eating just a bit more (this stretches the pouch out to a normal sized stomach).
  • Grazing throughout the day (eating a little bit all the time will cause any weight-loss operation, even a duodenal switch, to fail and patients will regain weight).
  • Drinking alcohol regularly.
  • Gulping down liquids, not sipping (this forces the food out of a pouch and patients can eat more).

What type of long-term, after-care services (such as support groups and counseling) can you provide for me?

We have regular support groups. We have dedicated nurse practitioners who work with us and can answer questions or refer you to Dr. Christou. We also have a psychologist and registered dietician who work closely with us to help you achieve the very best weight loss possible.

Do you have patients who are willing to share their experiences, both positive and negative?

Yes, you can come to the support group and ask other patients questions, or we can provide you with some names and phone numbers of patients who would be willing to talk to you. We will continue to post information on this web site about our support group meetings. You can also join our discussion forum.

Can I expect to live a normal life after this operation without constantly worrying about secondary problems?

Most patients report a remarkable improvement in the quality of life after they lose most of their excess weight. Certain associated medical conditions like type II diabetes, high blood pressure, sleep apnea, and stress incontinence improve or disappear after this weight loss. On the other hand women usually develop chronic anemia due to insufficient iron after this operation. This can be avoided by taking the recommended supplements and post-operative follow-up.