Q: What is Laparoscopic surgery?
Laparoscopic surgery is the same as Minimally Invasive surgery. It entails making very small keyhole wounds (incisions) through which a camera (laparoscope) and certain instruments facilitate the procedure planned. It also involves inflating the abdomen with CO2 gas to increase the working space. This gas is completely safe, is almost entirely removed at the end of the procedure, and what is left is absorbed by the body completely within hours. As for what can be done laparoscopically, almost all traditional procedures can now be safely done with laparoscopy.
Q: Does laparoscopic surgery have added benefits to open traditional surgery?
Laparoscopy nowadays has evolved to the point it is taking over traditional surgery all over the world. It carries multiple benefits to the patient: less pain, earlier and faster recovery, less hospital stay, earlier return to work and normal activities, and above all, less wound complications such as infection and hernia. As for the surgeon, the image is magnified. The surgeon will be able to see better thus do a better job compared to open surgery. It involves less trauma to the organs, thus decreases the risk of adhesions (organs getting stuck together) like in open surgery, hence decreasing the incidence of adhesive bowel obstruction to patients, and making redo surgery for all surgeons much easier.
Q: I previously underwent open surgery; can I still have my procedure done laparoscopically?
Yes you can. With previous open surgery, adhesions are a high possibility, altering the normal anatomy the surgeon is usually used to. But with great experience especially in GBMC, redo surgery even after open surgery can be done laparoscopically. It just takes more time to cut through adhesions and restore the normal anatomy, and then proceed later with the desired procedure. There is however, the possibility the surgeon might not be able to proceed laparoscopically, and open surgery is needed then.
Q: What insurance companies does GBMC accept?
Jordanian local insurance companies are: MedNet, Gulf Insurance Group (GIG), and Islamic Insurance Company.
International insurance companies are those that accept admissions to Jordan Hospital.
Usually prior to any procedure or admission to the hospital, an authorization from the insurance companies has to be obtained.
Q: Where are the procedures done?
All procedures are currently only done at the best hospitals in Amman, Jordan which are Jordan Hospital, Khalidi Hospital & Farah Hospital.
Q: How soon can I travel after surgery?
Depending on what the surgery entails. It is safe to travel in one to two weeks after most procedures, but for specific case recommendations, you should ask your doctor.
Q: Is bariatric surgery covered through national Jordanian insurance companies?
No, bariatric surgery and whatever it entails are not covered by the insurance companies. Any procedure related to a previous bariatric procedure, is also not covered by the insurance companies.
Q: Does laparoscopic surgery decrease the risk?
It decreases the wound complications only compared to open surgery, but other surgical risks are the same. However, in bariatric surgery, multiple studies have showed a tremendous advantage to laparoscopic surgery with an actual difference in mortality rate, especially in experienced surgeons hands.
Q: Will I have a lot of pain?
Generally laparoscopic surgery has less pain. Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds up recovery. Various methods of pain control, depending on your type of surgical procedure are available.
Q: Will the doctor leave a drain in after surgery?
Dr. Ahmad Bashir almost always leaves drains after surgery. Patients will have small tubes that will allow the drainage of fluid that accumulates after surgery. It is a safety measure for all patients that generally produces only minor discomfort, and is usually removed after a few days.
Q: How soon will I be able to walk?
As soon as you wake up from anesthesia. You will be asked to walk initially with the help of the nurses or physical therapists. At time of discharge, you will be able to carry on with personal needs, but you will need help with transportation and lifting heavier objects.
Q: How soon can I drive?
Generally, as soon as you are off the pain medication, which is generally five to seven days after surgery.
Q: What is so important about exercise?
With most bariatric procedures, you will lose weight initially spontaneously. With spontaneous weight loss, all unused muscles will also be lost. Exercising all your muscles will help you maintain your muscle mass and lose instead the excess fat mass that you have. But certain procedures like gastric banding, and gastric plication depend on the patient to exercise to lose weight. Spontaneous weight loss occurs less frequently with these procedures.
At the end of the day, to achieve great healthy results and maintain your weight loss, you will need to completely change your lifestyle and exercising is part of that change. Patients who do not exercise have a higher risk of regaining their weight long-term years after surgery.
Q: Can I get pregnant after weight loss surgery?
Yes you can, but it is strongly recommended that you wait at least one year prior to any attempts at getting pregnant. After one year, the weight loss generally stabilizes and you will be able to carry a well-nourished baby.
Q: What if I am not hungry after surgery?
Sleeve gastrectomy and to a lesser extent the gastric bypass, decreases the hunger feeling significantly especially in the first two months. Your appetite will slowly return, but till then, you need to have the habit of eating 3 meals a day, even if the meal is one bite. You will also need to drink at least a liter of fluids in between meals. The first two months are the hardest, but things get usually easier after that.
Q: Is there any difficulty in taking medication?
You may need to crush your medications early on, but usually all of them are small enough to pass through without difficulty.
Q: Will I be able to take oral contraception after surgery?
Yes, you can resume your pills as soon as you are able to drink liquids.
Q: Will I be asked to stop smoking?
Patients are strongly advised to stop smoking (including Hubble bubble) one month prior to surgery to decrease the risk of lung complications from surgery and anesthesia.
Q: If I continue to smoke, what happens?
Smoking increases the risk of lung infection and pneumonia after general anesthesia, interferes with healing, thus increases the risk of abdominal infection after bariatric surgery. After gastric bypass, smoking increases the chances of ulcers, which may cause bleeding or generalized abdominal infection that will require surgery. After Sleeve gastrectomy, smoking increases the acid secretion of the stomach, and increases the chances of having reflux and severe heartburn, which are already increased from the surgery itself.
Q: How can I know that I won’t just keep losing weight and waste away to nothing?
As you continue to lose weight, your body caloric needs will decrease significantly. Your caloric intake increases also with time. These two things usually make your weight loss stop in one and a half to two years’ time. After the two years, you need to be aware of the risk of regaining your weight slowly over time if you do not carefully watch what you eat, and do not exercise.
Q: What if I am still really hungry?
Especially if you are not taking enough protein, and instead eating starches like potatoes, pasta, … etc, you might have that feeling. We advise all our patients to concentrate on protein first and foremost. Also make sure your are not eating and drinking together as this will, during later stages, help flush food down and increase your caloric intake.
Q: Will I have to change my medications?
With weight loss your medical problems associated with your obesity will slowly improve. Your supervising doctors who prescribed the medications for you will determine when these conditions have improved or resolved completely, to either alter or stop the medication completely. Certain medications for joint pain and swelling (arthritis), which are called Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), have to be stopped completely with bypass procedures to prevent marginal ulcers and initially with Sleeve gastrectomy to ensure proper healing. Fluid Pills (Diuretics) have to be reduced or stopped initially to prevent dehydration early on.
Q: How long will I be off of solid foods after surgery?
You will be provided with specific dietary guidelines for each procedure. In general, there will be a gradual transition in your intake from liquids to mashed (Pureed) food, soft food, and lastly solid food with variable timeline, depending on the procedure and your tolerance to each stage.
Q: Will I be able to eat “spicy” foods or seasoned foods?
You will be able to enjoy spices after the initial trial and error phase, which usually takes 3-4 months.
Q: What vitamins will I need to take after surgery?
With any procedure, the amount of food that you eat will not sustain you with all the vitamins that you need. Therefore, daily vitamins are strongly advised. Vitamin levels are monitored annually, and types or doses are altered accordingly.
Q: Will I get a copy of suggested eating patterns and food choices after surgery?
Yes, you will. Every procedure has its own instructions to follow. Every person differs in her/his progress after surgery. Compliance with these instructions however provides the best-predicted outcome possible. Avoiding high calorie-carbs, fried food, fatty food and frequent snacking will help you after all get the weight loss you desire, and sustain it for a long period of time.