Bariatric Surgery Overview

Do you have a Body Mass Index of greater than 35-40?

Do you have obesity-related health problems such as diabetes, high blood pressure, or sleep apnea?

Have you been unsuccessful with dieting, exercising, or a medically supervised weight loss program?

If you answered “Yes” to any of these questions, you could be a candidate for weight loss surgery. Dr. Harish Kakkilaya performs Bariatric Surgery including Laparoscopic Sleeve Gastrectomy and Gastric Bypass at SMC. For a consultation, call 856-823-4288 or request an appointment through SMC’s Patient Portal.

What is Bariatric Surgery?

During a bariatric procedure — weight loss surgery — the surgeon alters the size and shape of the stomach which helps the patient shed excess weight.

With more than 20 years of experience, Dr. Harish Kakkilaya has performed more than 1,000 weight loss surgeries and has had better results and less complications than the national average.

Dr. Kakkilaya is currently accepting new patients at 66 East Ave., Woodstown. For more information or a consultation, call 856-823-4288.

What is Laparoscopic Sleeve Gastrectomy?

Laparoscopic Sleeve Gastrectomy, often called The Sleeve, is performed by removing approximately 80 percent of the stomach using a stapling device. The remaining stomach is a tubular pouch that resembles a banana.

This procedure helps patients lose weight and improves overall health in several ways. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food that can be consumed.

The greater impact seems to be the effect the surgery has on gut hormones which influence hunger, satiety, and blood sugar control.

Short term studies show that the sleeve is as effective as Gastric Bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests The Sleeve helps improve Type 2 Diabetes independent of the weight loss. Also, the complication rates of The Sleeve are much lower than with the gastric bypass.

FAQs

How long will I be out of work after having the surgery?

A patient with a desk job should consider taking off work for two to three weeks after bariatric surgery. Someone with a more physically demanding job that requires heavy lifting or physical activity may require more time off.

When can I start exercising again after surgery?

Walking is encouraged during the early post-surgery period and thereafter to increase the physical activity level. Aerobic activities such as brisk walking, stationary biking, and elliptical machines can be engaged shortly after surgery and are limited to the degree of discomfort these activities cause an individual. Swimming is allowed once the surgeon has determined that the wounds have healed sufficiently. This usually takes approximately four weeks. More strenuous activities such as lifting weights are generally discouraged for at least six weeks after surgery.

Can I have bariatric surgery if I’ve had other abdominal surgeries in the past?

Yes. Most common abdominal operations such as C-section, gall bladder surgery, appendectomy, tubal ligation, hysterectomy, and minor hernia repair rarely impact the ability to have bariatric surgery. However, hiatal hernia or reflux surgery, intestinal surgery that involves removing a portion of the small intestine or colon, or a major hernia repair with a large mesh could impact the ability to do bariatric surgery laparoscopically through small incisions. It is important to tell your surgeon or nurse about all prior surgeries during the evaluation process.

Can I have bariatric surgery if I have Type 2 Diabetes?

Yes. Bariatric surgery such as The Sleeve has been shown to improve or cause remission of Type 2 Diabetes by working with gut hormones as well as through weight loss. Studies find that more than 95 percent of patients show improvement in Type 2 Diabetes with bariatric procedures, and up to 85 percent experience diabetes remission. Some studies have reported improvement of Type 1 Diabetes Mellitus following bariatric procedures.

Can I have metabolic and bariatric surgery if I have heart disease?

Yes. Weight loss surgery leads to significant improvement in conditions associated with or contributing to heart disease including lipid abnormalities, an enlarged heart, vascular and coronary disease, and hypertension. However, if you have heart disease, you will need medical clearance from your cardiologist for bariatric surgery.

Will I have to go on a diet before I have surgery?

Yes. You will be on a pre-operative diet for two to three weeks prior to surgery in order to shrink the liver and reduce fat in the abdomen. This helps the surgery go smoother and makes it safer. Additionally, some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement.

Will I have to diet or exercise after the procedure?

Yes. Surgery is just a tool that will enable you to lose weight. Although surgery does produce changes in the body that help with the initial weight loss and maintenance of weight loss, it is ultimately up to the patient to make life-long changes to be successful. This includes making the right food choices, controlling portions, taking vitamin and mineral supplements, drinking plenty of fluid, getting plenty of rest, and exercising regularly. Without a commitment to these and other lifelong changes, weight regain is likely to occur.

Can I go off some of my medications after surgery?

With weight loss, you may be able to discontinue or reduce the dosage of medications being taken for obesity-related comorbidities such as high blood pressure, heart disease, arthritis, lipid abnormalities, and Type 2 Diabetes. You may even be able to discontinue using or reduce diabetes medications in the early period following surgery.

When can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?

Bariatric surgeons generally recommend that patients wait approximately 18 months after surgery to become pregnant due to the possibility of nutrient deficiencies during the weight-loss period.

However, obesity is a major cause of infertility. With weight loss, your fertility levels may increase. Therefore, it is important to practice effective contraception in addition to taking birth control pills during this period to avoid pregnancy.

With appropriate nutrition and vitamin/mineral supplementation, bariatric surgery does not cause growth or developmental problems for offspring. Studies show that women who have had bariatric surgery prior to pregnancy have less complications than those who are severely obese. Some benefits include a reduced rate of preeclampsia, gestational diabetes, stillbirths and miscarriages.

Will my skin sag after bariatric surgery? Will I need plastic surgery?

Whether your skin will sag after surgery or not depends on several factors: how much weight is lost, age, genetics, and exercise regimen. Loose skin can be hidden by clothing. However, some patients may choose to have plastic surgery to remove the excess skin. Most surgeons recommend waiting at least 18 months before having plastic surgery.

Does insurance cover plastic surgery to remove excess skin?

Insurance companies rarely cover plastic surgery to remove excess skin after weight loss surgery because it is generally considered a cosmetic procedure. However, in some cases, removing the excess skin is necessary for medical reasons such as skin irritation, ulceration or infection, pain, sexual function problems or hygiene issues. Insurance may cover the procedure in these cases, but it is still unlikely. Many post-operative patients utilize compression garments to help with the appearance of excess skin.

Will I lose my hair after bariatric surgery?

Some hair loss is common following surgery and typically occurs between three and six months after surgery. This can result from physiological stress, emotional stress and nutritional stress. The hair loss is temporary, and adequate intake of protein, vitamins and minerals will help to ensure hair re-growth.

Will I have to take vitamin and mineral supplements after surgery? Will insurance pay for these?

Vitamin and mineral supplements are necessary during the weight loss period. Certain vitamin and mineral supplements require prolonged use, depending on the type of surgery that was performed.

Insurance typically does not pay for vitamin and mineral supplements. However, you can pay for vitamins and minerals out of a flex medical account.

If my insurance company will not pay for surgery, are payment plans available?

SMC offers self-pay options as well as the MDSave Program. There are loan programs available to cover the cost of health expenses, including loans for metabolic and bariatric surgery. Furthermore, metabolic and bariatric surgery is a health expense that you can deduct from your income tax.

If I am self-pay, but have health insurance, will my insurance company pay the cost of postoperative complications?

Often the complication is reported under a separate code and the insurance company will pay. However, this may not always be the case.

Bariatric Surgeon
Dr. Harish Kakkilaya

Dr. Harish Kakkilaya is Board Certified in General Surgery and fellowship- trained in Laparoscopic and Bariatric Surgery. He has more than 20 years of experience in general surgery and 10-plus years as a bariatric surgeon. He attained distinction as a Fellow of the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery.

Dr. Kakkilaya received his Master of Surgery degree from the University of Bombay, India, a Fellowship of the Royal Colleges of Surgeons (FRCS) from the Royal College of Physicians and Surgeons in Glasgow, UK, and a Fellowship in Minimally Invasive and Bariatric Surgery from the Sinai Hospital and Northwest Hospital, in Baltimore, MD.

He has performed more than 1,000 weight-loss surgeries with excellent outcomes. He is a fellow of the American College of Surgeons and a fellow of the American Society of Metabolic and Bariatric Surgery.

In 2008, Dr. Kakkilaya was honored with the Outstanding Laparoscopic Surgeon Award by the Society of Laparoscopic Surgeons, recognized as a “Best Doctor” from 2012 to 2018 by South Jersey Magazine, and in 2017 and 2018 as a “Top Doc” by SJ Magazine.

Dr. Kakkilaya is currently taking new patients. Call 856-823-4288 to make an appointment.

Effectively all insurance contracts prior to the transition to Salem Medical Center on February 1, 2019, are currently active and in full force.
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