Bariatric surgery

Interdisciplinary bariatric clinic (IBC)

A word from the surgeons

We are pleased to give you some information in order to help you navigate through the bariatric surgery process. In this section, you will find answers to your questions, to help you make the right decisions. Several therapeutic aspects may be considered to address obesity and its complications.

Bariatric surgery is one of these tools, but it cannot work alone. We will stay with you through your lifestyle changes, in order to maximize your chances of achieving your weight-loss goals and improving your quality of life.

We will always be available to support you, and the entire team at the interdisciplinary bariatric clinic will collaborate with you in this health project.

We look forward to meeting you,

Dr. Dan Gitlan
Dr. Olivier Mailloux
Dr. Hélène Milot
and the team at the interdisciplinary bariatric clinic

Available surgery

There are different types of surgery based on the following principles:

Restricting the amount of food the stomach can hold;
Causing malabsorption of nutrients, thus reducing the amount of food digested and absorbed in the intestine;
The combination of both restriction and malabsorption. This is the case for the gastric bypass and the biliopancreatic diversion with duodenal switch (BPD/DS).

The types of bariatric surgeries are briefly explained below. However, the only surgery available at the Hôpital Le Royer is the sleeve gastrectomy. The other types are presented for information purposes only.

Should a surgery other than the sleeve gastrectomy better suit you, you will be met and a reference to the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) will be made for you.

Sleeve gastrectomy

The sleeve gastrectomy is performed by removing three quarters of the stomach. It is usually performed laparoscopically. Five to seven small incisions are made in the abdomen to insert a camera and surgical clips. The remaining stomach is about the shape of a banana.

In fact, this is a restrictive surgery. This means that it reduces the capacity to eat, because the stomach is reduced by three quarters. This surgery considerably reduces appetite by decreasing the secretion of hormones controlling hunger. With this type of surgery, you lose about 15 to 25% of your initial weight within two to five years. Weight regain is variable, but more frequent after two years.

Biliopancreatic diversion

The biliopancreatic diversion reduces both the capacity to eat and the absorption of food. Your stomach is reduced in the same proportions as with a sleeve gastrectomy and a large portion of the small intestine is bypassed.

The path of your small intestine is modified in order to direct food through the food segment of the intestine. Secretions from the liver and pancreas go through a new section, the biliopancreatic segment, which carries the bile and pancreatic enzymes where there is no food. The absorption of fat and certain minerals and vitamins is done in the common segment (the only part of the intestine in which food and biliopancreatic fluids come in contact). It usually measures 100 cm, which reduces the absorption of nutrients.

Roux-en-Y bypass

The Roux-en-Y gastric bypass creates a small stomach pouch of about 30 to 50 ml in volume. The remaining part of your stomach is not removed, but completely separated from the new stomach pouch. This surgery reduces the capacity to eat (restriction) and reduces the absorption of nutrients (malabsorption).

Eligibility criteria

In order to be eligible for bariatric surgery at the Hôpital Le Royer, the person must:

1. Have a BMI of 35 kg/m2 or more and obesity-related health problems such as diabetes, hypertension, sleep apnea, arthrosis, dyslipidemia or arteriosclerotic cardiovascular disease (ASCD), OR a BMI of 40 kg/m2 or more with or without obesity-related health problems.

2. Have already used weight loss strategies.

3. Be ready to commit to a life-long follow-up with the team of the interdisciplinary bariatric clinic in addition to the regular follow-up with their family physician.

4. Be ready to change their lifestyle:

Include high-protein foods in their diet;
Reduce their consumption of high-fat and high-sugar foods;
Avoid over-eating;
Take life-long vitamin supplements, according to the recommendations of the team;
Avoid drinking soft drinks;
Stop smoking (preoperative cessation for a minimum of 3 months) and undergo preoperative screening.

5. No alcohol or drug addiction (preoperative cessation for a minimum of 6 months with preoperative screening tests).

6. Be evaluated to eliminate sleep apnea. In the presence of a positive diagnosis requiring a CPAP, provide a compliance report when requested by the team.

7. Be able to take a three-month sick leave following the surgery.

Steps of the interdisciplinary bariatric clinical pathway

Registration for the waiting list

Your reference for a consultation at the interdisciplinary bariatric clinic is exclusively accepted by fax at the appointment centre at 418 295-3604 (references submitted directly to the IBC will be returned to the sender).

In order for your request to be accepted by the interdisciplinary bariatric clinic, your reference must be made by your family physician.

Required questionnaires to classify your file

A decision-making support guide, a food journal, a commitment form, a questionnaire regarding your eating habits and a questionnaire regarding your overall health status are mailed to you to help us study your file. In order for you to be eligible, you must return the documents (except the decision-making support guide) within six weeks of the mailing date. If the deadline is not respected, your reference will be cancelled without further notice.

Each file is studied by a multidisciplinary team, which will classify it to determine the clinical pathway.

Investigations

Then, a nurse will call each registered person in the next few months for a first telephone appointment. They may also give instructions to the user or ask them to complete other evaluations to further document the request. A nutritionist will also make a first intervention to evaluate and properly direct the user in the clinical process. Finally, the surgeon will meet the user to acknowledge the consultation request and the investigations carried out. This will give them all the information they need to decide whether to operate or not.

PLEASE NOTE THAT FOR PUBLIC HEALTH REASONS, THE PREPARATORY AND INVESTIGATIVE DEADLINES MENTIONED HERE CAN BE SUBJECT TO CHANGE WITHOUT PRIOR NOTICE AND ARE BEYOND OUR CONTROL.

Clinical pathway and therapeutic assistance

The purpose of this step is to ensure that the user is well prepared once the surgery is authorized. It can be spread over several weeks or a few months, depending on the recommendations of the professional team. There may be meetings with professionals, telephone follow-ups, information sessions, etc.

Preoperative meeting

The nurse will contact the user and give them the last instructions to complete their preparation, take the required samples and complete user education. The nutritionist and the surgeon may also call for a meeting with the user.

THE USER IS RESPONSIBLE FOR THEIR ACCOMMODATION DURING THE PREPARATION FOR THE SURGERY

Hospitalization

The user will be admitted on the day of the surgery. The hospital stay lasts two to four days in average, depending on the postoperative progress.

Postoperative follow-up

Once you leave the hospital, you must:

Follow a soft diet for the first three weeks;
Have your medication adjusted by your family physician and schedule an appointment to see your physician in the first month after surgery;
Ensure you do a blood test within the required timeframe in order to meet your surgeon for your postoperative follow-up.

The nurse from the bariatric clinic or the appointment centre will notify you of the date and time of your next appointment with your surgeon.

For life, you will have to:

Take supplements (minerals and vitamins);
Get blood samples on a regular basis;
Follow the instructions of the medical team on the adjustment of the prescribed supplements;
Attend medical follow-up appointments;
Keep your new lifestyle habits.

Reference documents

When the nurse at the interdisciplinary bariatric clinic calls you to ask that you fill in the documents, you have a maximum of 6 weeks to return them to:

Clinique interdisciplinaire bariatrique
Hôpital Le Royer
635, boulevard Jolliet, local 507
Baie-Comeau (Québec) G5C 1P1
Fax : 418 294-1002
E-mail : 09.usagers.bariatrique@ssss.gouv.qc.ca

The forms that must be returned are the health evaluation form, the participant's commitment form and the food journal. You must wait for the nurse's call before sending the documents.

Decision-making guide
Health evaluation form
Food diary
Participant's commitment
Questionnaire - Binge Eating Scale