This initial surgical consultation, whether face to face or virtual (telephone or video call), will, in principle, be a long one.

A meeting report will be prepared and sent to your Doctolib account, with a copy sent to your GP/Family doctor, as well as to all the members of the multidisciplinary team.

Example of the programme for such an initial consultation :

Administrative Information

– Last Name, First Name and Date of Birth

– Mobile Phone Number

– E-mail Address

– Social Security card with your Social Security Number (NIR)

– Private Health Insurance

– Current private health insurance cover certificate

Case History

– Number of children

– Profession

– Physical activity linked to your profession

– Physical Activity: sport/leisure

Estimation of the impact of obesity on your quality of life:

1/ personal esteem

2/ physical activity

3/ social life

4/ professional life

5/ sex life

Health lifestyle: Do you smoke? Do you drink alcohol, or soft drinks?

Eating habits:

Hyperphagia – excessive eating / Tachyphagia – eating too quickly.

Snacking – savoury

Snacking – sweet, sweet eaters, the notion of consuming large quantities of sodas and soft drinks

Taking emotional refuge in food (the Notion of emotional Kilos).  

Medical history of real cases of anorexia/bulimia

History of weight gain (puberty, adolescence, pregnancy, stopping physical activity, depression)

Dietary trials and failures.

Verification of knowledge about foodstuffs.

Detailed analysis of allergies, previous surgical and medical history

Controlling the eventual presence of comorbidities linked to obesity or aggravated by obesity (cause-and-effect relationship):

Sleep apnoea syndrome, dyslipidaemia, diabetes, steatohepatitis – Nash syndrome, high blood pressure, discopathy or where multiple joints are affected, disabling osteoarthritis: all require weight loss before orthopaedic surgery can be carried out.

 

We will register your details:

Maximum and actual weight (Kg)  and waist measurement (m)

Ideal weight; excess weight to be lost.

Body Mass Index (BMI) (Kg/m²)

The excess of BMI to be lost to achieve a normal BMI of 24 Kg /m2

Finally, we will decide if a more complete multidisciplinary evaluation is justified, prior to bariatric/weight-loss surgery being carried out.

Multidisciplinary Team: the specialists at the IGEA SOS Obesity Centre

Endocrinologist

Endocrine/hormonal and metabolic assessment

Cortisol, thyroid hormones, fasting insulin.

Fasting blood sugar, HbA1c: glycated haemoglobin

Cholesterol: total, HDL, LDL; Triglycerides

Uric acid

Liver function test

Nutritional assessment

Hb , Fe, ferritin transferrin, proteins, albumin, TP

Vitamin D, parathormone, calcium

Vitamins B1, B6, B9 and B12

Mg, Zn, Selenium

Monitoring of any eventual deficiencies

Nutritional assessment after 3, 6, and 12 months

 

Dietician

Study of the patient’s eating habits.

Check: quantities, mealtimes, hunger and craving for food.

Identify sources of liquid calorie intake: alcohol and soft drinks.

Analysis and correction of mistakes made.

Detecting compulsive overeating, snacking – sweet, sweet eaters, binge eating disorder.

Preoperative nutrition and dietary advice

Post-operative psychotherapeutic follow-up: repeat the dietary advice, adapt nutrition and detect any deficiencies.

 

Psychologist

Evaluate the motivation of the patient, their capacity to adopt any necessary behavioural changes, and participate in a long term post-operative follow-up programme.

Evaluate the knowledge of the patient (in terms of obesity and surgery).

The patient must have the mental capacity and sufficient information to give their consent freely.

Identify absolute psychiatric contraindications.

Severe mental disorders.

Alcohol and/or drug dependence.

Identify relative psychiatric contraindications.

Latent depression.

Thinking that weight-loss surgery is a magic bullet.

Equilibrium of fragile couples, absence of socio-family support.

Treat eating behaviour problems.

Hyperphagia – Binge eating disorder.

Snacking.

Adapted preoperative psychotherapeutic treatment.

Post-operative psychotherapeutic follow-up.

Support the patient in their changes in mental health linked to bariatric surgery and weight-loss.

 

Gastroenterologist

GDF = gastro-duodenal fibroscopy

Check the integrity of the oesophagus and the stomach.

Check for a hiatus hernia, GORD – Gastro-oesophageal reflux disease, Barrett’s Oesophagus.

Search for and treat an oesophagitis, gastritis, or even an ulcer.

Eradicate any infection caused by Helicobacter pylori (obligatory before a gastric bypass).

Undergo a control gastro-duodenal fibroscopy 1 year after the surgery.

Test for intestinal metaplasia/Barrett’s Oesophagus, after a sleeve gastrectomy.

Diagnose and treat any ulcers or cases of anastomotic stenosis after the bypass.

Even carry out a Coloscopy if necessary.

Detect and treat colic lesions in patients who are over 50 years old.

Obesity is an independent risk factor for the development of digestive cancers.

Liver function test

Look for steatohepatitis or non-alcoholic steatohepatitis (Nash syndrome).

Hepatic ultrasound

Estimate the size of the liver (a factor predictive of technical difficulties during the operation).

Look for stones in the bladder.

 

Pulmonologist

Polysomnography looking for SAS: sleep apnoea syndrome, as 40% of obese people suffer from this condition.

Epworth Score and overnight oximetry (measuring the proportion of oxygenated haemoglobin in the blood).

 

Rheumatologist

Looking for mechanical complications: discopathy, where multiple joints are affected.

 

Cardiologist

Losing weight after bariatric surgery favours fertility.

The use of some form of contraception is recommended as soon as bariatric surgery is programmed, as well as during the 12 to 18 months afterwards.

Anaesthetist

The anaesthetist is the doctor responsible for putting you to sleep.

A consultation is obligatory before the surgery takes place, to check if you have any contraindications in terms of the anaesthetic.

All types of surgery (gastric banding, sleeve gastrectomy, gastric bypass) are made under a general anaesthetic.

You will have two appointments with the Anaesthetist. The first prior to the  gastric fibroscopy, then the second, two weeks prior to any programmed surgery.

Sophrologist

The sophrologist is a ‘well-being’ professional, who helps their patients make progress in terms of personal development, but also to become more aware and conscious of themselves.

Sophrology sessions are used in our programmes to give well-being support when a patient is treated for a chronic pathology.

Madame Alfano will also see you in order to establish with you, the patient, a programme of therapeutic education to be put into practice with the multidisciplinary team prior to your surgery, and to continue during the postoperative period.

The programme is based around the elaboration of an educational diagnosis: analysing patient needs and expectations; defining a personalised programme including the most useful skills to acquire, and learning priorities; planning and implementing individual or collective therapeutic education sessions (or alternately). 

The evaluation of acquired skills and the execution of the programme must take place at least before the surgery takes place.

The Second Consultation with a Surgeon

If the multidisciplinary evaluation proves to be favourable, the surgery can take place.

The aim of this second (and sometimes a third) consultation with a surgeon is in order to:

– Go into the detail of the bariatric/weight-loss surgery;

– Take the time to explain to you clearly the objectives to achieve in terms of weight control and the remission of comorbidities;

– Explain the advantages and inconveniences of the surgical technique chosen in a collegial manner because it is the best adapted to your needs.

– Make sure that you have understood and accepted the risks of the bariatric/weight loss surgery, and the necessity of long term medical and surgical follow-up.

In your presence a letter will be dictated to your GP/Family Doctor communicating the information we have exchanged concerning:

the results of the evaluation, the proposed surgical strategy, the terms and details on the expected benefits, the risks involved in the surgery, the crucial importance of regular follow-up.

The surgeon is available to reply to any of your questions.

You can ask any further questions to your GP/Family Doctor, who is collaborating with us.  Your GP/Family Doctor can check with you that you have sufficient knowledge and  information to give your consent freely for such bariatric/weight-loss surgery.

The use of corrective surgery.

If necessary, it is possible to resort to corrective surgery. However, it must be carried out at the earliest 12 to 18 months after the bariatric/weight-loss surgery, in the absence of undernourishment, and with stabilised weight-loss.

Advice in terms of pregnancy and obesity.

Bariatric/weight-loss surgery is not recommended for pregnant women. After bariatric/weight-loss surgery we recommend:

In the case of pregnancy

Nutritional monitoring by the multidisciplinary team during the pregnancy and after the birth.

Including the following food supplements: iron, folates, vitamin B12, vitamin D and calcium (particularly after a Gastric Bypass: malabsorptive weight-loss surgery).

Loosening the gastric banding for a pregnancy which happens after the band has been put in place.

In case of a planned future pregnancy.

A clinical and biological dietary and nutritional evaluation.

Taking folates as a food supplement, in conformance with international recommendations, should be put in place as soon as a pregnancy is planned.