Sometimes a patient who is undergoing bariatric surgery has another surgical issue that should be handled at the same time. We refer to additional operations as "accessory procedures." Normally, accessory procedures will be planned and discussed just like the main operation. On rare occasions, the surgeon finds a problem that no one knew about before surgery - we will use our best judgement and take care of the problem in such cases.
We sometimes find gallstones or severe inflammation of the gallbladder in patients who undergo Gastric Bypass surgery, probably due to the many preceding cycles of weight loss/gain. Experience has shown that gallstones can cause significant problems if left alone, so we ask for the patient’s permission to remove the gallbladder at the time of surgery if these findings are present.
On the other hand, if the gallbladder is normal at the time of surgery we believe that removing it would add a small but unnecessary risk to the operation and we leave it alone. When we leave the gallbladder in place, we recommend that patients take Actigall (a bile thinning medicine) for six months following the surgery to reduce the chance of gallstone formation during the most dramatic phase of weight loss.
We find it is best to avoid handling the gallbladder during Band placement, because the gallbladder sometimes contains bacteria that we worry might cause Band infection. Management of Band patients who have gallstones is individualized according to symptoms.
If removal of the gallbladder (cholecystectomy) is appropriate, then it can almost always be done by scope (laparoscopically).
Many patients with morbid obesity have a hernia that results from a prior surgical procedure. Most of the time, a temporary repair of the hernia will be accomplished during the weight loss procedure and a permanent repair will be planned for a later time when the patient has lost substantial weight. Decreased weight allows less abdominal pressure and better long term success for the repair.
A hiatal hernia is potentially important because it is a looseing of the muscle that supports the esophagus and stomach in their proper position. If we know of a Hiatal Hernia (or find one during surgery) we will most likely do a repair (muscle reinforcement) during the surgery.
Tubal ligation to prevent pregnancy can be done during the same anesthesia as a weight loss operation. The tubal ligation needs to be done by a gynecologist - it is not done by New Dimensions surgeons. It is necessary for the gynecologist to come to the OR where the bariatric procedure is planned.
It is possible to do a hysterectomy under the same anesthesia as a weight loss procedure, but our experience has been that this combination is a bad idea for the patient and the surgical teams. If a morbidly obese patient needs a hysterectomy, we believe it is best done separate from the weight loss operation, either several months before or several months after.
Patients commonly ask if a lot of the excess fat can be removed at the same time as the weight loss operation. There are a few surgeons who do add fat reduction procedures on top of the main operation, but we feel this is a bad idea for the following reasons:
Note that if a procedure is done in addition to the main weight loss procedure, such as those listed above, the surgeon and hospital will usually bill for the additional procedure on top of the weight loss procedure. Almost all accessory procedures are clearly medically indicated and there is rarely a problem with having insurance cover the bulk of the cost of the accessory procedure. In some special circumstances such as cash-pay for the weight loss procedure, the insurance payment for the accessory procedure may slightly mitigate the out-of-pocket expense of the weight loss operation.
