Severe obesity over time usually results in many severe medical conditions which can be life threatening, such as diabetes. So there's also a risk of death if a patient does not have surgery and allows their severe medical conditions to worsen over time.

What is the overall risk of death from this operation? Across the country, mortality rates of 1% or less are considered reasonable. How does that compare with other major surgery? Well, heart surgery has a mortality rate of 5%. Colon surgery has a mortality rate of 5%. So there are many other major operations with mortality rates much higher than bariatric surgery.

MODERATOR:
What are recovery types like for these surgeries?

SCHAUER:
If the operations are done with laparoscopic technique, that is with small incisions, most patients have a very rapid recovery.

In our hands at The Cleveland Clinic, gastric bypass surgery means usually a two-day stay in the hospital and then approximately two weeks off of work. With the lap band it's even less. One night in the hospital, and then back to work in seven to 10 days.

MEMBER QUESTION:
I'm not near The Cleveland Clinic. How would I go about finding the right kind of doctor to do this?

SCHAUER:
I highly recommend you find a surgeon and a hospital that has demonstrated a track record with bariatric surgery. It's a highly specialized field and it's clear that the best results are achieved by surgeons in hospitals that have experience in this area.

One way to find that information would be to go to the American Society of Bariatric Surgery web site (www.asbs.org). Listed there are members -- surgeon members -- of the society, according to the state and town they live in.

That's one good way to find that information. Very soon there will be fairly detailed credentialing information available about bariatric centers in your region, probably within the next one to two years, and many hospitals will be required to have accreditation to perform bariatric surgery.

MEMBER QUESTION:
Are costs for the surgery coming down as a result of higher volume of procedures performed?

SCHAUER:
I think so. There is information recently published in the medical literature showing that the high-volume centers tend to have lower costs, in part because the results are better and they have lower complications. So I think it is true, we are seeing some of the costs come down a bit because of this.

We're also seeing, though, very high-risk patients seeking the surgery. These are patients who unfortunately had obesity for many, many years and have already compromised heart and lungs and are severely high risk. These folks obviously will have higher costs because it will require more intensive therapy during their hospital stay.

MODERATOR:
What kind of therapy?

SCHAUER:
For example some patients who already have severe heart disease or severe lung disease as a consequence of obesity may require a stay in an intensive care unit after surgery. That's quite expensive. And if they are in the intensive care unit for several days, that cost goes way up.

Some folks require special tests prior to surgery to determine if they are in good enough health to withstand an operation. Some folks will require treatment of their conditions prior to surgery to optimize their health, to make the operation as safe as possible.

MODERATOR:
We have a question here asking how common is abdominal hernia following gastric bypass surgery?

SCHAUER:
One of the many benefits of the laparoscopic surgery with the small incisions is that the rate of hernia formation is extremely low. Those patients who have open bariatric surgery, that is with a large incision, usually from the breast bone down to near the naval, have a much greater risk of having a hernia.

This is because their large weight pulls on the incision, leading to a hernia in approximately 20% of patients. So two out of ten patients will get a hernia after open surgery. It's fairly common. However, hernia surgery today can be very effective at resolving or curing this hernia.

MEMBER QUESTION:
How long does it take for the insurance company to decide "yes or no" in coverage of bariatric surgery?

SCHAUER:
There are many different insurance companies throughout the country. It's been my understanding that each company has their own policy regarding who they believe is suitable to have bariatric surgery, and they have their own process for approving a surgery.

I have seen some companies respond rapidly -- within a few days of the application. I've also seen some companies take weeks if not months to make that decision.

SCHAUER:
How much excess skin a patient has after weight loss is entirely dependent upon how large they are before surgery. For example, a person that needs to lose 100 pounds after surgery may have only minimal loose skin and may not desire or need to have any plastic surgery.