Surgeon Questions

One of the things to think about as you start your journey is what questions you want to ask potential surgeons. I had some questions that I used during email interactions (with surgeons in Mexico, for example), and some that I reserved for more exploratory in-person discussions. I've split up the questions into those categories below. If you have anything to add, please leave a comment!

Before we get into questions, there are a few terms you might want to get familiar with and do some reading about (if you find that sort of thing helpful):

• Complication rate: Most gastric sleeve complications relate to one of the following: bleeding (1.2% of patients), leaks (2.2% of patients), and stenosis/strictures (0.6% of patients). Overall complication results, dependent on the study, can range from 0% to 24%. There's an interesting compilation of study results at Bariatric Surgery Source. I was primarily interested to compare amongst doctors I was investigating.
• Mortality rate: measure of rate of deaths
• Leak rate: This seems to be one of the most common complications. A gastric sleeve leak occurs when one or more of the staples in the stomach do not hold and stomach acids begin to leak through the stomach, resulting in infections and damage to other organs. You're at your highest risk of leaks around the first seven weeks after surgery, when your stomach is still healing and is most rigid. Check out more on some interesting facts on leak rates and bougie size below.
• JCI Accreditation: Joint Commission International (JCI) was established in 1997. International hospitals may seek accreditation to demonstrate quality, and JCI accreditation may be considered a seal of approval by medical travelers from the U.S. That being said, I didn't find too many hospitals in Mexico that were accredited. You can search the JCI website.
• Bougie: This is an interesting one, and you'll see discussions about it on some of the message boards. Bougie (boo-ghee) is a guide that the surgeon uses to butt the stapler against when forming your new stomach size. Read more on ObesityHelp. Sizes for gastric sleeves seem to range between 32-Fr and 46-Fr (Fr = French) or so. Now, one might wonder if there is a correlation between smaller size and more weight less (due to smaller stomach size). However, there may also a correlation between smaller size and higher leak rates. One surgeon I spoke to said he went to only using a size 40-Fr or greater after reading an article which indicated that, based on a review of medical literature, the use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Most surgeons I exchanged emails with in Mexico used smaller sizes (under 40-Fr). That being said, there may be some correlation to greater weight loss? Food for thought. My Dr. (Dr. Aceves) uses a 36 bougie and then sutures over the staple line making the sleeve smaller. You can read a little more about bougie size on NCBI. You can also check out this video on bougie size from Dr. Alvarez (not my surgeon):

Now, on to the questions I asked...

Email Questions

1. Is gastric band performed open or lapriscopically?
2. Who would be my surgeon?
3. Will someone assist the surgeon? Who? What are their qualifications?
4. How many bariatric procedures of each type does your practice AND the surgeon perform per year?
5. What are the surgeon’s complication and mortality rates? For complications, what's the leak rate?
6. Are the professionals on the surgeon’s pre- and post-care team well-qualified? What are their qualifications?
7. Will another doctor be assisting the surgeon during surgery? If so, what are the assistant’s qualifications and how involved will he/she be in my treatment?
8. Are you JCI accredited?
9. Do you have any partnerships with US hospitals (for out-of-country surgeons)?
10. What size bougie does the surgeon use?
11. What type of support and follow-up do you offer and/or require after surgery?
12. What is the cost? Does this cover any potential complications? Is there anything that's not included?

Interview Questions

1. How many surgeries have you done on people with a BMI similar to mine? What types of results do they see?
2. What percentage of your patients are losing 50% of more of their excess wait (a typical measure of success)?
3. What are the biggest reasons you see your patients "fail" at long-term weight loss?
4. What specifically does my insurance cover? What will my out of pocket costs look like?
5. What will my life look like 2 days, 2 weeks, 2 months, and 2 years after surgery?
6. What will my incisions look like?
7. Do you think gastric sleeve is my best option?
8. Do you have patients that I could speak to?
9. How many years out from surgery is your first patient? What have their results been?
10. Why do you use the size bougie you do?