Pre-op: To diet or not to diet

[NewLife2011 13]

When I was scheduled to have my surgery in Dallas, the doctor required a 2 week clear liquid diet. I was totally unable to stay on it as I was hungry all the time. I have now switched to Dr Aceves (not because of the diet requirements) and he does not require a pre-op diet for lower BMIs. His pre-op diet for higher BMIs allows full liquids and lean Protein and veggies, which in my mind seems a lot more reasonable.

I also cannot stand artificial sweeteners, so i was struggling to drink 2 glasses of the BariEssentials drinks a day, he wanted me to have 4.

When I canceled the surgery in Dallas, they told me that all doctors require the pre-op diet which I know is not the case - why is there such a difference of opinion about this??

[former_vbg 198]

I'm just going to give you my opinion on this, but the medical reason Dr.'s tend to require the pre-op diet is because it helps to shrink the liver prior to surgery which helps reduce complications during surgery like nicking the liver and also giving them just a little more room to work. I think I have also heard that it makes the liver less "slimy", but I don't know for sure on that one.

My Dr. was from Dallas and he did NOT have a pre-op diet, except to stop eating the night before.

As for why some docs require it and others do not, personally I think it comes down to experience/ skill with working with the conditions I mentioned above. I never asked my doc why he didn't require it, but knowing him, he would probably have said it doesn't really make much difference.

I think another reason some docs like their patients to do it is because they believe it will help prepare them for life after surgery and to get them mentally and physically prepared for what is to come.

I am glad I didn't have to do the pre-op diet, although I know others were glad they did have to- so it comes down to a personal choice/ preferences.

When I was scheduled to have my surgery in Dallas, the doctor required a 2 week clear liquid diet. I was totally unable to stay on it as I was hungry all the time. I have now switched to Dr Aceves (not because of the diet requirements) and he does not require a pre-op diet for lower BMIs. His pre-op diet for higher BMIs allows full liquids and lean Protein and veggies, which in my mind seems a lot more reasonable.

I also cannot stand artificial sweeteners, so i was struggling to drink 2 glasses of the BariEssentials drinks a day, he wanted me to have 4.

When I canceled the surgery in Dallas, they told me that all doctors require the pre-op diet which I know is not the case - why is there such a difference of opinion about this??

[M2G 1,836]

I did not have to pre-op (except for clears 1 day before, and no eating/drinking after 9pm) and I sooooooo wish that I had done some type of pre-op. I didn't have a food funeral, ate my last restaurant meal on a Sun. and my surgery was on a Fri. (and I had 2 crab cakes, a salad and a cheesy biscuit from Red Lobster) so it's not like I went all crazy, but I can tell you right now that every single pound you lose BEFORE surgery is one less that you have to lose after. You will be just that much farther ahead. I am currently close to 10 months post-op and have been stalled at the SAME weight for the last 2 months. So yeah, it would have benefitted me (or I think it would have) to lose a few extra lbs before surgery.

Also my BMI was a 44, so I don't know WHY some surgeons require and some don't. I agree with former_vbg that it comes down to surgeon's experience and just their overall way of doing things that they are comfortable with. It's possible that my surgeon requires higher BMI's to pre-op but I never asked if that was the case. I felt like my BMI was pretty dang high, since I had the label of Morbidly Obese...pretty grim sounding, huh.

Anyway, IF I could go back and do it all over again, I would pre-op. Just my 2 cents!

[iegal 460]

Hello NewLife - I agree the preop diet was torture. But, if you can not handle a two week liquid diet how are you going to handle eating after surgery?

Yes, there is a reason behind the preop diet...a medical reason. You are reducing the fatty liver which then makes it easier for surgeon to navigate around your liver. If you take a look at anatomy of where stomach is located, it is partially hidden behind liver. Fatty liver is slippery and lapriscopically surgery is easier when not working with a sliding. A nick of the liver is nasty.

Suggest consider doing your own modified preop diet, I would not want a surgeon who takes ANY risks although I hear your surgeon is good. Better safe than sorry is the best you can do. I think the comment about experience is out of context or mistated. Those surgeons who are even more experienced than yours have different methods. At the risk of sounding defensive here - especially to those on this site who respectfully have chosen to go outside US to get surgery. Currently. are more updated accepted procedures than your surgeon of choice uses. Many experienced surgeons (mine included) no longer use a drain, the # of entry points are much less now with smaller entry points, no hospital stay is requred, no pain meds needed, no catheder and so much more (or less). Experience proves - preop diet is needed.

Glad you are getting VSG - best wishes. No regrets.

[Guest Rosalind]

I don't think it has anything to do with experience. My doc has over 1200 surgeries and requires 2 weeks with no exceptions.

[Bakomom 0]

I agree with you Rosalind. My doctor has a ton of experience, however all three surgeons in his office require a pre op diet. They have to use a tool to actually hold your liver up so that they can actually get to your stomach. A fatty liver will bleed super easy. Just touching it with the tool to hold it up can sometimes make them bleed. Also, a fatty liver is much more rigid which can cause bleeding. By doing the pre op diet and losing a decent amount quickly, it helps the liver to become more pliable and therefore less likely to bleed.

I haven't gotten to that point yet and when I do I am sure it won't be easy, but I am glad my doctor wants the pre op diet. I think for me personally (and everyone is different) it will help get my mind in the right place for post surgery. I think it will be a huge challenge, but it is one I am ready to tackle!

[NewLife2011 13]

Hello NewLife - I agree the preop diet was torture. But, if you can not handle a two week liquid diet how are you going to handle eating after surgery?

Well, I kinda thought without most of my stomach I would be able to handle eating less food. That's the idea of the surgery, right??

[NewLife2011 13]

At the risk of sounding defensive here - especially to those on this site who respectfully have chosen to go outside US to get surgery. Currently. are more updated accepted procedures than your surgeon of choice uses. Many surgeons no longer use a drain, # of entry points are much less now with smaller entry points, no hospital stay is requred, no pain meds needed, no catheder and so much more

Actually a 1 to 2 day hospital stay was required with the Dallas surgeon, I have never heard of any US doctors doing VSG as an outpatient procedure.

Did some research and the drain usage is not based on "modern" methods. Some things I found from current USA bariatric surgery doctor web sites:

feeding tubes. Some surgeons use these as a matter of routine, and some do not. If you need to have a feeding tube, it is easy to put in during the surgery. After surgery it is harder to put in. The same can be said for a drain. Those who don’t use them say the odds of needing them are small, and they can be placed later. There is no right or wrong answer here, so do not ask your surgeon to change his way of doing things.

This is from the Johns Hopkins web site for gastric bypass (they didn't have anything for VSG):

Surgical drain, placed during the operation if you have had an open procedure. The drain will be removed in 48 to 72 hours, or when drainage is minimal

And - no pain meds needed - with "modern" methods?? ROFL!

[former_vbg 198]

A drain is dependent on the patient also. I was having a revision and although it was laproscopic, he placed the drain in to help detect if there was any infection going on.

[Guest Rosalind]

I had a drain when I had neck surgery for bone spurs pressing my spine. The drain was to reduce swelling and chance of infection.

[PeteO 3]

I think the use of a drain can also depend on your doctor's method to check for leaks. My doctor fills the abdominal cavity with Fluid, then pushes air into the stomach, looking for bubles to identify a leak. He uses a drain while you are in the hospital to help eliminate the fluids he pumped into your body.

[HappyFace 5]

I too wondered the same thing! My surgeon doesn't require it & when I inquired with his office I was told that Dr. Marvin found that patients that did the pre-op diet failed miserably during the post-op diet. I'm on the fence if I should just do it on my own or just wait to see what his recommendation will be. All the best to you!

[smkeller 3]

I don't know why there is not more of a standard for pre-op or post op. I chose Dr. Aceves, too, and did not have to diet. In fact I used the last week to eat any and everything I wanted to - knowing that very soon I would not be able to do that. I did not pig out on the night before though, as some suggested. I wanted to have very little going through my digestive tract coming out of surgery. I am just starting week four and am getting into more solids. It's a little tricky I am finding out, but manageable. I actually am feeling better and better, and can see the weight coming off my face and body.

I'm just going to give you my opinion on this, but the medical reason Dr.'s tend to require the pre-op diet is because it helps to shrink the liver prior to surgery which helps reduce complications during surgery like nicking the liver and also giving them just a little more room to work. I think I have also heard that it makes the liver less "slimy", but I don't know for sure on that one.

My Dr. was from Dallas and he did NOT have a pre-op diet, except to stop eating the night before.

As for why some docs require it and others do not, personally I think it comes down to experience/ skill with working with the conditions I mentioned above. I never asked my doc why he didn't require it, but knowing him, he would probably have said it doesn't really make much difference.

I think another reason some docs like their patients to do it is because they believe it will help prepare them for life after surgery and to get them mentally and physically prepared for what is to come.

I am glad I didn't have to do the pre-op diet, although I know others were glad they did have to- so it comes down to a personal choice/ preferences.

[smkeller 3]

'I have never heard of any US doctors doing VSG as an outpatient procedure.'

Oh, yes there is a clinic right there in Texas that does outpatient - in and out the same day for insurance purposes. That makes me shudder, but it works for some people.

[iegal 460]

Actually a 1 to 2 day hospital stay was required with the Dallas surgeon, I have never heard of any US doctors doing VSG as an outpatient procedure.

Did some research and the drain usage is not based on "modern" methods. Some things I found from current USA bariatric surgery doctor web sites:

feeding tubes. Some surgeons use these as a matter of routine, and some do not. This is from the Johns Hopkins web site for gastric bypass (they didn't have anything for VSG): And - no pain meds needed - with "modern" methods?? ROFL!

Hi NewLife;

You are aware VSG surgery can be done with just a little discomfort and not require post op drugs?

Oh - I went home (that same day as surgery) with pain drugs to take if needed. Yep, did VSG as an outpatient almost a year ago. I was home that same night I slept in my own bed and did not endure what most on this site do after sugery. Took no pain meds after sugery and didn't require any...and those who know me are aware my motto is "no pain, no pain", not " no pain, no gain." Total wussy here, I avoid pain at all costs. I gained (or lost as it may be) without pain. I had outpaitient surgery for VSG and so did SEVERAL members on this website. Have read from those who did not just use my surgeon but across the country. This is the new trend.

The most update to date VSG method is a scarless VSG surgery with one entry point where a tool which looks like a three legged spider goes out. Tool is called a SPIDER. The "DR's" TV show aired VSG sugery in November 2010 again this spring 2011 ... guess you missed those episodes about the latest and greatest VSG surgery when doing research. Suggest you go and watch before responding again. Oh and when you watch...that is my surgeon you will be watching who is "the" go to surgeon when medical companies such as Allergan, Transerix and media outlets including 20/20, Newsweek, ABC, plus more for advice and news for WLS. Even Alex, thecreator of VST web site has even posted about these new procedures and my surgeon.

John Hopkins does have information on VSG...I have the diet guide book if you would like me to forward to a copy? No Hopkins surgeons do not use a drain anymore for VSG. Nor does University of CO Weight loss, Dr. Craingle, Cornell University or many other well known institutions or WLS centers I can continue to rattle off.

NewLife - I am not here to mock you, nor to have a newbie mock me. Hurt that you would laugh at modern methods you are not aware of yet. Why the attack? As a newbie you are here to gather information, right?

Again, I wish you the best.