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Summa’s Weight Loss Surgery Information & FAQs

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About Our Program

How do I contact Summa's Bariatric Care Center?
If you are not yet a patient of the Summa Bariatric Care Center, you can further research our weight loss surgery program through the "Contact" form or by calling the Center at (888) 680-1341. We stand behind our program and all of its components. Please thoroughly research all of your options, but we are confident you will come back to Summa for all of your healthcare needs, including minimally invasive weight loss surgery.
 

What is the next step?
After researching weight loss surgery information online, the next step would be to contact us here at the office. After contacting our staff, we will take all of your personal information, including insurance information, so that our financial counselor may verify your benefits and be able to better assist you in knowing what your obligations will be for your specific program plan. We will also get you scheduled at that time for one of our free monthly Weight Loss Surgery seminar (the seminar may also be viewed on Wednesday mornings or as a video on our website). Concurrent to you attending the free information seminar, we will schedule your appointment to meet our dedicated office staff as well as your laparoscopic surgeon.
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What are the basic program components?
All of our patients are assessed in a multidisciplinary fashion and will have a physician/surgeon visit followed by a visit with the financial counselor. Our patients are required to attend an informational weight loss surgery seminar prior to meeting with the team, in order to better prepare themselves for the office visit. As patients get closer to their surgery date, patients will have completed a preoperative nutritional assessment, and a preoperative psychological evaluation, in addition to a rigorous medical work-up clearance. After surgery, our program provides postoperative nutritional counseling as well as ongoing psychological counseling if indicated. Because lifelong exercise is so important after surgery, as part of the program we have designed both a preoperative exercise evaluation, and two postoperative assessments led by an exercise physiologist. The goal of our program exercise component is to help you plan for ongoing and lifelong postoperative exercise.
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Does the hospital support the program?
The hospital overwhelmingly supports the Bariatric Care Center at Summa Health System. Hospital administration is key to the success of any multidisciplinary program. We have been provided with state of the art operating rooms, and in fact, there is no better available technology for laparoscopic surgery in the country. Furthermore, we have several patient rooms that have been refurbished specifically for the care of the post-operative weight loss surgery patient, including floor mounted toilets, oversized furniture, and other general amenities to make the stay for the bariatric patient more comfortable.
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What does it mean to be "fellowship trained"?
After completing a traditional five-year general surgery residency, Drs. Zografakis, Dan and Pozsgay completed an additional year of surgical training focused solely on advanced laparoscopic (minimally invasive) general and bariatric surgery.
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Why choose the Bariatric Care Center at Summa Health System for your weight loss surgery needs?
We are proud to offer the most comprehensive weight loss surgery program in Akron, led by three surgeons, fellowship trained in laparoscopic bariatric surgery. Combined, Dr. Zografakis, Dr. Dan, and Dr. Pozsgay performed over 2,000 laparoscopic weight loss surgeries. In addition, we have dedicated staff to care for all of your needs, including a dedicated nurse case manager, a full time program dietitian and a financial counselor available to help you navigate your insurance company’s requirements. A full compliment of medical consultants is available to help you make your journey through weight loss surgery. We are in compliance of, and our program is modeled after the standards of the American Society for Metabolic and Bariatric Surgery (ASMBS) and Surgical Review Corporation (SRC) program for Centers of Excellence.
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 Insurance 

What insurance does the Bariatric Care Center accept? 
Our Bariatric Care Center is included in the Summa Health System list of accepted insurance plans based on individual member benefit coverage. Check with your provider to determine what bariatric options are covered in your plan.
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Will my insurance company cover all of the costs?
The surgical workup, hospitalization/surgery, and professional fees of the physicians will be covered. There are components of our program that are not covered by ANY insurance company. These fees and charges are what make up our program fee at $275.
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Do you take Medicare and Medicaid products?
Yes, Summa is contracted with both Medicare and Medicaid. In addition, patients with the Buckeye Health Plan Medicaid HMO and Caresource Medicaid HMO can receive care at Summa.
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What are the insurance company requirements?
Most insurance companies adhere to national guidelines regarding requirements for weight loss surgery. However, many also do require a physician-directed weight loss program focused on diet and exercise. Many insurance companies such as Aetna (3 months), SummaCare (3 months), Cigna (6 months), Blue Cross/Blue Shield (6 months to 12 months) require a physician-directed weight loss program in order to maximize your outcome. The goal of these programs is not to have you lose weight, so as not to quality for surgery; but rather to begin making the lifelong dietary changes and behavioral modification changes necessary prior to surgery.
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Are my requirements different if I am a Summa Health System Hospital employee?
Yes. While your preoperative medical requirements are the same, there are financial obligations that are specific to Summa Health System Hospital employees. Depending on your individual policy, there are inpatient co-pay out-of-pocket expenses that range from $2,137.50 for laparoscopic adjustable gastric banding and $2,850 for laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. While these are in addition to the program fee (which must be paid prior to surgery), we can work with you for your inpatient co-payment in a payroll deduct manner, in order to facilitate money being taken out of your paycheck on every pay for the first year after surgery.
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Do you have self-pay rates?
For those patients that are uninsured or do not have weight loss surgery benefits on their current insurance plan, we do offer self-pay rates for laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. More information regarding our self-pay program will be given to you upon your request.
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What are the fees?
There are several out-of-pocket fees, components of our program that are not reimbursed by ANY insurance company. These will be explained to you in detail during your office visit. The main role of the financial counselor is to provide you with exactly what your out-of-pocket expense may be. Initially, there is a program fee of $275. In addition to this is a $120 nutrition assessment. You will also be subject to physician co-pays on your visits, as per your insurance policy. Many of our patients will be required to take Optifast preoperatively as part of the presurgical requirement. This will also be explained to you in more detail at the time of your office visit. However, the financial counselor will work with you to identify your pay requirements, as well as common insurance requirements and limitations.
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What are the insurance preoperative requirements necessary before weight loss surgery?
There are many preoperative insurance requirements prior to weight loss surgery, many specific to each individual plan. Each candidate must meet basic medical requirements as outlined by the NIH. In addition, there may be further dietary and exercise requirements necessary prior to surgical intervention. Many insurance companies require a period of a physician-supervised weight loss. Depending on your insurance plan, this will be explained to you individually.
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Weight Loss Surgery Information: Roux-en-Y Gastric Bypass

What is Gastric Bypass Surgery?
Gastric bypass surgery provides an effective tool to limit the amount of food eaten and to change how food calories are absorbed. It must be understood that the surgery is not magic: it works with you, not for you. By working consistently to make appropriate food choices and behavioral changes, a successful, long-term health impact is possible.
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Why should I consider Gastric Bypass Surgery?
Despite the billions of dollars spent yearly by consumers on weight loss programs and dietary supplements, no medical treatment has been demonstrated to sustain a long term weight loss in a significant number of men or women. In fact, the 1992 NIH consensus statement concerning obesity asserts that medical treatment is considered ineffective in 95% of patients. While many patients can lose weight with diet and exercise, there are very few who can maintain that weight loss for longer than 1-2 years. The conclusion of this statement is that surgery is the only way to obtain consistent, permanent weight loss for patients with morbid obesity. Surgery is indicated for patients with documented, supervised, failed dietary attempts and (1) have a BMI of 40 or over or (2) a BMI of 35-40 with significant additional obesity-related diseases.
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What are the successes and Benefits of Gastric Bypass Surgery?
Although complications may occur, the benefits of surgery outweigh the risk in carefully selected patients. Recent studies have demonstrated that up to 80% of excess body weight can be lost, and that 40-70% of excess body weight lost can be maintained for as long as 5 years. 95% of diseases related to obesity can be improved or cured. As weight loss occurs, patients regain their ability to lead an active lifestyle, which may include returning to work, increasing productivity at work and participating in activities with family and children that were previously not possible. Most important, the results of this surgery have a tremendous positive impact on each patient's overall state of health.
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How does Gastric Bypass Surgery work?
Gastric Bypass Surgery will change:

  1. The volume of food you can comfortably eat at one time.
  2. Your ability to tolerate different types of food.
  3. The absorption and digestion of fat calories.
  4. The absorption and digestion of proteins.
  5. The absorption and digestion of the calories from sugars, starches and alcohols.

Diet and exercise are key components for ensuring success following Bariatric surgery. Compliance with dietary changed, combined with the right exercise program, will help you lose weight in the post-surgical period, as well as maintain that weight loss over time. These principles, along with many others, are discussed at each Summa Bariatric support group meeting to help keep you on track.
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Who qualifies for Gastric Bypass Surgery?
To qualify for gastric bypass surgery, you will need to meet the following requirements:

  • You have failed repeated, medically-supervised attempts at losing weight and controlling your obesity
  • You are 100 pounds over your ideal body weight and have a Body Mass Index (BMI) greater than or equal to 40, or a BMI of 35 (approximately 80 pounds over ideal body weight) if you have a serious associated medical complication or other obesity-related disease(s)
  • You have had a consultation with one of our Bariatric Surgeons and have been determined to be a surgical candidate.

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How is the surgery done?
The surgery is performed either through six small, half-inch incisions in your abdomen (laparoscopic surgery) or through an incision that runs from your breastbone to your navel (called a laparotomy, referring to the opening gastric bypass procedure). During the laparoscopic procedure highly specialized surgical instruments, including a small camera, are placed through these incisions via tubes called ports. The abdominal wall is lifted off the intestines by putting air into the abdomen, a process called insufflation. The air allows the surgeon to see the stomach and small intestines clearly through the tiny camera. Both types of gastric bypass surgery change the internal structure of the digestive system in exactly the same way, and are equally effective.
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Why is it called a Roux-en-Y?
The term "Roux-en-Y" refers to the "Y" shape of the small bowel connection that is created during surgery. The small bowel is transected (divided) and then reattached at one end to the newly created pouch (the new stomach) where it will now receive food that has been chewed and swallowed. The other end is reconnected farther down on the small intestine, creating the "Y" shape. None of the bowel is removed during surgery.

The new connection between the stomach pouch and the small bowel is called the gastro-enterostomal anastomosis, and is sized into an exact, narrow opening to help restrict the passage of food moving from the pouch into this piece of small bowel. This section of small intestine is called the "Roux limb" (after the French surgeon, Roux, who pioneered this approach.) The Roux limb is also called the "Alimentary Limb." Alimentation refers to food intake, so you can think of this as your personal 'food channel.' The Roux limb is the right arm of the "Y". The left arm of the "Y" is the part of the bowel still connected to the remaining part of the stomach. It is called the "Bileopancreatic Limb." It carries the acid produced in the distal (excluded, or remaining) stomach, the digestive juices produced by the liver and pancreas (including insulin), and some juices produced by the small bowel itself to the area where the two arms of the "Y" connect again. Foods and digestive juices now meet each other for the first time, later than in the normal digestive process, in what is known as the 'common channel.'
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Can my surgery be done laparoscopically if I have had a previous open abdominal surgery?
Your surgeon will evaluate you on an individual basis. It is possible to have a laparoscopic gastric bypass after having open abdominal surgery or other laparoscopic abdominal procedures.
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I have a high Body Mass Index (BMI). Can I still have laparoscopic gastric bypass?
We exclude no one as a laparoscopic surgical candidate based on BMI alone. High BMI and extreme physical parameters might mean that the laparoscopic approach is not right for you. Our goal is for every patient to have the best possible outcomes, thus you surgeon will evaluate you on an individual basis, and will make a professional recommendation as to which procedure will work best for your case.
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Is it possible for me to become pregnant after surgery?
In fact, it is very possible for you to become pregnant after surgery, as the ovulatory cycle for women is one of the first systems to correct after weight loss surgery. However, it is IMPERATIVE that you do not become pregnant for 12-18 months after surgery. While you are in your period of dramatic weight loss, your body will essentially be "melting." It is not a safe environment for which to sustain a fetus. That is not to say that you will not have a safe pregnancy; however, you will be referred to a high-risk obstetrician for the majority of your pregnancy and it will be difficult for you to gain weight and nutritionally support your fetus. We recommend contraception of your choice or abstinence in order to prevent becoming pregnant for 12-18 months after surgery. After 18 months, there have been numerous studies to document the safety of pregnancy after gastric bypass surgery.
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What are the postoperative protein requirements?
Postoperatively, you will be required to consume between 65-75 grams of protein on a daily basis. For the first several weeks to months this will be in the form of "shakes" that will be mixed with low fat milk or water. These can provide significant amounts of protein in a low calorie fashion. Ultimately, however, you will be able to transition to "bars" that are chewable and will have high protein as well. It is important that we give your body the necessary building blocks after surgery in order to facilitate healthy weight loss.
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What are the postoperative vitamin requirements?
Postoperatively, patients will be required to take an assortment of vitamins in order to compensate for the malabsorption experienced from the gastric bypass. A daily multivitamin fortified with iron, daily calcium supplementation, as well as weekly vitamin B12 supplementation will be necessary. Depending on your preoperative vitamin stores, additional supplementation with zinc and/or vitamin D may also be necessary.
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What is the postoperative dietary routine?
Postoperatively after laparoscopic Roux-en-Y gastric bypass, the patients will be discharged home on a clear liquid diet for approximately 7-10 days. After this, they will be advanced to a "full liquid" diet and ultimately be advanced to a soft and pureed diet by approximately 1 month after surgery.
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Weight Loss Surgery Information: Adjustable Gastric Band

What are the risks and complications associated with Laparoscopic Adjustable Gastric Banding?
There are several complications and risks associated with banding. While the hospital stay is significantly shorter and there are less intraoperative and postoperative risks, there are some that are specific to laparoscopic adjustable gastric banding. These include band erosion, pouch dilation, band slippage, as well as mechanical problems associated with the band. These are generally not life threatening, however, some may require further surgical intervention in order to correct these problems.
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What is the expected weight loss after Laparoscopic Adjustable Gastric Banding?
You can expect to lose 50% of your excess body weight after a laparoscopic adjustable gastric banding. It is certainly possible to reach 100% of your expected weight loss goals, however, dietary changes, portion control, and exercise are paramount in order for this to happen.
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Is there a need for exercise or dietary changes after Laparoscopic Adjustable Gastric Banding?
In fact, yes, exercise is paramount to your success. The restrictive nature of the band is simple math. You will eat less, however, it is important for you to exercise in order to burn off those calories, plus some, in order to lose weight. An individual commitment for daily exercise is essential for the best possible outcome.
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What is a band “adjustment” and how is it performed?
In addition to placing a ring around the top of the stomach (restriction), there is a buried “port” placed at the time of the operation (under the skin) for the gastric band that allows access and addition of saline or saltwater to the band. This allows us to adjust your level of satiety and prevent you from being hungry and allow you to eat less. Band adjustments are performed in the office or under x-ray guidance using a small needle that is passed through the skin and into the port. It takes just a few minutes and is not any more painful than having blood drawn.
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Are there any vitamin or protein supplementation requirements?
The vitamin and protein supplementation after LapBand is similar to the laparoscopic Roux-en-Y gastric bypass.
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What is the follow-up after gastric banding?
Follow-up is different than the laparoscopic gastric bypass. Band patients need to be seen in the office on a monthly basis to be evaluated for adjustments. If there are adjustments that are necessary, these will be performed either in the hospital under x-ray guidance or in the office.
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What is Laparoscopic Adjustable Gastric Banding?
Laparoscopic Adjustable Gastric Banding is a purely restrictive procedure by which a small plastic ring is placed at the top of the stomach to limit the amount of food intake of the patient. This is a much safer procedure than the gastric bypass in that there are no connections or division of the bowel. LapBand patients are discharged home after an overnight hospital stay.
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About Your Surgery

What are the main surgical complications noted after surgery?
There are many complications or individual procedure risks associated with laparoscopic Roux-en-Y gastric bypass. In general, after any surgical procedure requiring general anesthesia a myriad of complications can arise including bleeding, deep vein thrombosis or pulmonary embolism, pneumonia, hospital acquired or intraabdominal infection, bleeding, wound infections, or hernias.

Specific to gastric bypass surgery, however, is the concept of a "leak." Leaks occur at any of the anastomoses (connections) that have been created between the bowel; the national average for this is approximately 3%. If there is a leak, this will require further surgical intervention and likely a prolonged hospitalization and possibly death. One of the main risk factors for leaks is smoking and tobacco abuse. It is essential that you stop smoking before surgery and, in fact, we will not proceed towards surgery unless you have passed a blood test that is negative for nicotine.

Other complications specific to gastric bypass include an anastomotic stricture (narrowing) of the connection. This likely will require an upper GI endoscopy and a "balloon dilation" of the stricture that can be performed on an outpatient basis and without surgery. Vitamin deficiency is also very common after surgery; however, the main reason for this is noncompliance and not due to any anatomic abnormalities.
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What is the postoperative follow-up?
After laparoscopic gastric bypass surgery and your hospitalization, you will be seen in the office at 1 week, 1 month, 3 months, 6 months, and 1 year, and then every year after surgery. In addition to being seen by the surgeon, it is important that we check your vitamin levels at these visits. Demonstrating compliance with postoperative vitamin requirements is essential to excellent long-term weight loss results.
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Will I have any tubes, catheters, or drains after surgery?
Generally, patients awake with a Foley catheter in place to drain their bladder. We also place a buried pain catheter system in order to deliver a local anesthetic or "numbing medicine" directly to the surgical sites. These catheters will be removed on your second postoperative day. Depending on your individual body shape and size, and/or previous surgical history, it may be necessary for drains to be left in place; however, this is not part of the surgical routine.
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How long is the hospital stay?
You will be in the hospital for 2 nights after laparoscopic Roux-en-Y gastric bypass surgery. For example, if your surgery was on a Monday, you would have surgery on Monday, be in the hospital on Tuesday, and be discharged home Wednesday in the mid-afternoon, if there are no complications in your postoperative course.
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What is my recovery after surgery and when will I return to work?
Your recovery will be approximately 2-3 weeks. Most patients can return to work during the third week depending on the profession of the patient. If you are mostly a desk worker and are not required to perform manual labor or heavy lifting, it is possible that you will be able to return to work at approximately 3 weeks. If you do have a manual labor job however, you will be kept out for 1 month after surgery. It is essential that you inform your employer that you will likely be out for 1 month. It is much easier for us to return you to work earlier, as opposed to trying to delay your return to work. We will be happy to fill out your FMLA or any appropriate work-related paperwork necessary to keep you off your required work routine after surgery.
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