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1 question to ask your surgeon before your bariatric weight loss surgery

Not all weight loss surgeries are right for every patient

Maintaining a healthy weight is a struggle for many Americans. For some, the challenge begins in youth. For others, it happens with aging, as the natural loss of muscle mass results in burning fewer calories.

Excess weight or obesity contributes to an increased risk for a host of serious medical conditions, including high blood pressure (hypertension), high cholesterol (hyperlipidemia), Type 2 diabetes, heart disease, stroke, joint disorders, and even death.

Dieting and exercise aren’t enough to achieve a healthy weight for everyone, and some of them look to weight loss surgery as a solution. The field of surgery devoted to weight loss is called bariatric surgery. According to the most recent data available from the American Society for Metabolic and Bariatric Surgery, over 250,000 patients have some type of bariatric surgery in the United States each year.

There are several different options for bariatric weight loss surgery. The popularity of different procedures has waxed and waned over the years. Here are the currently most common surgeries:

• Gastric sleeve (61.4%)

• Roux-en-Y gastric bypass (17%)

• Revision (15.4%)

• Balloons (2%)

• Gastric band (1.1%)

• Biliopancreatic diversion with duodenal switch (BPD/DS) (0.8%)

Some bariatric surgeries, such as gastric sleeve and gastric band, help with weight loss by restricting the volume that the stomach can accommodate. The idea is that with less volume of food, there will be reduced intake of calories.

Other weight loss surgeries, such as Roux-en-Y gastric bypass and BPS/DS, also create a surgical diversion that skips large segments of the intestinal tract, deliberately causing malabsorption. Each segment of the intestinal tract has a digestive role, including receiving bile and enzymes to aid in digestion or absorbing certain nutrients for metabolic use or storage. For these procedures, the idea is that whatever volume of food reaches the intestines, very few calories will be absorbed.

The right procedure for the right patient

The weight loss surgeries available to patients largely depend on what Medicare will pay for. This is true even for non-Medicare patients, because many private health insurance companies have reimbursement guidelines that mirror those of Medicare.

Currently, Medicare will pay for the following procedures under “specified conditions for the treatment of complications of morbid obesity,” which vary by each procedure:

• Roux-en-Y gastric bypass 

• Biliopancreatic diversion with duodenal switch (BPD/DS) or gastric reduction duodenal switch (BPD/GRDS)

• Gastric band 

• Gastric sleeve 

Bariatric surgeons make more money for bypass surgeries than gastric sleeves or bands. For example, in 2021, the national average Medicare payment to bariatric weight loss surgeons for a Roux-en-Y gastric bypass was 56% higher than the payment for a gastric sleeve.

In several bariatric surgery medical malpractice cases, we have had clients tell us that their weight loss surgeons have asked them to gain weight so they would qualify for a weight loss procedure. This makes absolutely no sense (unless you consider the potential financial motivation)!

One client, a woman in her 30s, went to see a bariatric surgeon for help because she had a hard time controlling her weight despite working out five times a week and eating a special low-carb diet. She did some research and inquired about a gastric sleeve surgery, but the surgeon recommended a more extreme, higher-risk procedure, the duodenal switch (BPD/DS).

There was a problem, though: She didn’t weigh enough for this procedure per Medicare and private insurance guidelines. The surgeon told her that she would need to put on an extra 30 pounds to qualify for the procedure.

This patient who is looking for a healthy lifestyle took her surgeon’s advice, gained some weight over a four-month period, and had the BPD/DS surgery at a hospital in the Dallas/Fort Worth metroplex. 

Immediately after the surgery, the patient had unending nausea and vomiting. Initially, the surgeon told her it would get better, but when it didn’t he started her on total parenteral nutrition (TPN). TPN involves placement of a permanent line through a vein, to allow nutrition from a pump that bypasses the gastrointestinal tract.

Even with this supplemental nutrition and another surgery to try and un-do part of the original bariatric procedure, the woman’s condition didn’t improve. Her nausea, vomiting, and uncontrollable diarrhea continued and she developed severe swelling from malabsorption. 

Instead of achieving her goal of a healthy weight of lifestyle, this woman had to quit her job because of unrelenting nausea, vomiting, and diarrhea, and even requires help from her family members to care for her infant child.

The 1 question to ask your surgeon before surgery

Before agreeing to any bariatric weight loss surgery recommended by a surgeon, ask this one question: Is there a less risky alternative?

It’s important to understand what you’re getting into before you undergo any surgery. Bariatric weight loss surgeons often only give one recommendation and leave out or gloss over discussing the risks and benefits of alternative procedures, or having no surgery at all.

Do some surgeons recommend riskier procedures because they get paid more? Some bariatric surgery experts who have reviewed cases for us believe so, and I agree with them. 

If you’ve been seriously injured because of poor bariatric surgical care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for free consultation about your potential case. While no amount of money can restore your health, a medical malpractice attorney can let you know if you may be eligible to receive funds to pay for medical bills, replace lost wages or earnings, and reimburse you for pain, suffering, and mental anguish.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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