Do you have a question? Please contact us.

• I heard that OHIP will pay for Ontario patients to have laparoscopic gastric bypass at your facility. How do I get approval to come to your center?
  The Ministry of Health and Long Term Care of Ontario (through OHIP) will pay for gastric bypass surgery for Ontario patients at our private facility in Montreal. Once approved, Ontario patients can have their surgery within 4-6 weeks, the time required to properly prepare them for safe surgery.  To get this approval you need to contact your physician and ask to be referred to the Regional Assessment Center (RAC) closest to you. These are:
  

  1. Humber River Regional Hospital Bariatric Clinic: –  416-747-3720  or 416-744-2500 (ext. 3720)
  2. St. Joseph’s Health Care Hamilton Bariatric Clinic: - 905-522-1155 ext. 33240
  3. Guelph General Hospital Bariatric Clinic: – 519-763-8442
  4. The Ottawa Hospital Weight Management Clinic: – 613-761-5101

  Tell them you want to be assessed for eligibility for bariatric surgery and that you would like to be referred to Dr. Christou at Weight Loss Surgery (WLS). All these centers have been made aware of the contract between OHIP and WLS to provide timely surgery to Ontario patients. When OHIP approves your application for bariatric surgery, a decision letter will be sent to the RAC and a copy sent to you. Once you have it call us at 514-843-1531 for instructions as to how to set up a consultation with Dr. Christou.
• Why should I have Surgery?
  There are several reasons you should have the surgery if you are morbidly obese:

  
  

  1. Weight loss surgery may save your life. Your risk of death can be reduced by as much as 89% if you lose weight through weight loss surgery compared to staying morbidly obese.
  2. Weight loss will help improve most of the associated co-morbidities. Patients who are morbidly obese have much higher rates of diabetes, high blood pressure and heart disease than non-obese patients. These improve or are eliminated with successful weight loss in 90% of patients.
  3. Diets don't work - Only about 3-5% of all people who attempt weight loss through diet and exercise programs are successful long term.
  4. Medical experts have sanctioned surgery as the only permanent solution to weight loss. The National Institutes of Health (NIH) of the United States of America convened a consensus panel of experts on obesity and medical management of obese patients in 1991 and 1996. Their conclusion was that weight loss surgery in patients who have failed diet and exercise programs is the most effective and ONLY method which results in significant weight loss long term. This premise has been proven over and over again since then.
• Are these procedures covered by Medicare?

  Most provinces consider the surgical treatment of morbid obesity an insured service under the publicly funded Medicare Act. There are variations within each Province  so you should check with your provincial health authority.

  Unfortunately, even with Medicare paying for bariatric surgery, finding a public hospital/surgeon to do it in a timely fashion is nearly imposible for most patients.  A wait of 5-7 years for weight loss surgery in publically funded hospitals across Canada is the norm.

  For patients who are concerned that the long wait in the publicly funded system may compromise their health and life expectancy there is an "alternate access route" to this surgery within our program. Patiens must be prepared to finance their surgery out of pocket or through their insurace (as of now a small component of the overall cost).

• What does the surgery cost?

  Laparoscopic weight loss surgery can cost from $17,500 to 22,000 depending of the type of surgery, the patient characteristics (sex, sive, body habitus) and whether this is first time surgery or revision from previous surgery. The true cost can only be determined at the office consult with the bariatric surgeon.
   

• What if my current weight loss surgery is not working?

  We have the largest experience with revisional bariatric surgery in Canada for patients who have failed other weight loss surgeries. Examples are laparoscopic band intolerance, band leakage, band erosion into the stomach or failure to lose weight after laparoscopic banding. Most patients are referred to us from other programs across Canada and some are from our own program. We have also revised obstructed vertical banded gastroplasty patients. We perform all these revisions laparoscopically (even those patients who had their gastroplasty the old fashioned was with a cut down the middle)with a completion rate of better than 95%.

• What is the current wait for bariatric surgery in the public system?
  Because of the limited resources (operating room time and hospital beds) we hope to perform 150 bariatric surgeries at the publicly funded McGill University Health Center (MUHC) this year. With a total of  1782 patients waiting on our various wait lists (Office, Contact, Case History Form sent, Case History Form received, Approved for Surgery, , Surgery Date Given) we estimate the average wait from the time a patient contacts our office to having their surgery to be 1782/150 = 11.8 years. Actually the real wait is 5-7 years because some patients give up, have adverse events, or manage to get operated in the 2-3 other Quebec centers that offer weight loss surgery.
• How many of each procedure have you performed?
  We have performed over 4,400 weight-loss surgeries. These include jejunoilial bypasses in the late 70's, vertical banded gastroploasties, and since 1989, Isolated Roux-en-Y gastric bypass. Dr. Christou has performed over 1,300 gastric bypasses and 200 gastric bands. Since 2002 all weight loss surgery is performed laparoscopically or by minimally invasive surgery. This includes the gastric bypass as well as the duodenal switch now performed by Dr. Court.
• Can this surgery be performed using minimally invasive techniques?
  Yes. Our center is the largest one in Canada that offers laparoscopic RY Gastric bypass, laparoscopic adjustable gastric banding and most recently laparoscopic biliopancreatic diversion with duodenal switch.
• Can I be considered a candidate for surgery even though I have one or more associated health conditions related to my obesity?
  Yes, because we have a very efficient pre-admission process that ensures you can tolerate your surgery. We occasionally ask patients to make special efforts to reduce their risk for surgery including losing 10% of your weight, using a CPAP machine, stopping smoking, or taking a new medication to help your heart. In most cases the risks of not doing the surgery override those risks of having it.
• Which procedure is best for me?
  The ideal procedure for a patient depends on many factors. In general, the Adjustable Gastric Banding device is the safest procedure but, requires a very motivated and compliant patient for success. The Roux-en-Y gastric bypass is a very safe for most patients and produces better weight loss.. The Duodenal Switch procedure has the highest risk but tends to produce a greater long-term weight loss (this statement is based on limited data). For more details click the "Which one is Right for Me" tag.
• How long will I be in surgery?
  The total time in the surgical theater is ~2 hours. This includes 45-70 minutes of surgery (depending on the type) and the rest of the time is preparation and anesthesia time. An additional 2 hours may be spent in the post anesthesia recovery are before patients return to the ward.
• What is the length of my hospital stay?

  Laparoscopic adjustable gastric band patients go home the evening of surgery or the next day (12-24h).
  Laparoscopic RY gastric bypass patients usually ask to leave on the morning of the second day after operation (36-48h). We do not force any patients out of the hospital and most request to leave. Occasionally, a patient may have a serious complication and be in the hospital for a month or more.

• How long will it be before I can return to pre-surgery levels of activity?
  This ranges anywhere from 3 days to 6 weeks and depends on how active you were before the surgery. Most patients can return to work that does not involve manual labor (e.g. construction) within a week of surgery. We recommend at least 2-4 weeks off for a smoother recovery.  Even if you are doing well, you may feel quite fatigued from the low caloric intake for the first 4 weeks after surgery so it is advisable to avoid work until this resolves.
• How will my eating habits change?
  Drastically! You will be severely restricted with all procedures. For specific nutritional guidelines for each procedure, refer to the Life After Surgery section of this website.
• What is the typical excess weight loss for your other patients?
  Typical excess weight loss 2.5 years after the surgery ranges from 50% to 110% depending on the procedure, the compliance of the patient with post-operative instructions and the starting weight of the patient. After 5 years and up to 17 years in some of our patients with the RY gastric bypasses, the excess weight loss averages 70%. Other centers that have followed large numbers of adjustable gastric banding patients report 40-50% excess weight loss at 5 years. No reliable data exists for adjustable gastric banding patients followed for 10-15 years or more.
• Do you have patients who are willing to share their experiences, both positive and negative?
  Yes, you can come to the support group and ask other patients questions, or we can provide you with some names and phone numbers of patients who would be willing to talk to you. We will continue to post information on this web site about our support group meetings. You can also join our discussion forum.
• What information can you give me to help family and friends better understand this surgery?
  This web site contains most of the information you need. We have additional information and a video in the office that we can provide you with at the time of your office appointment. You may invite your friends and family to our support group meetings as well. The minimum information your family and friends need to review is the downloadable "Weight Loss Surgery Brochure" and the comparison chart of the most common procedures.
• What do you expect from me if I decide to choose a surgical solution?
  We expect that you will comply with the entire surgical weight loss program including diet, exercise, and lifelong follow up.
• What type of long-term, after-care services (such as support groups and counseling) can you provide for me?
  We have regular support groups. We have a dedicated nurse practitioner who works with us and can answer questions or refer you to the doctors. We also have a psychologist and registered dieticians who work closely with us to help you achieve the very best weight loss possible.
• Can the RY gastric bypass be done laparoscopically on me?
  Weight loss surgery can be done laparoscopically on almost everyone even with previous surgery. We always start by laparoscopy and if we find that the operation cannot be completed safely for anatomical reasons we convert to the open procedure and complete the operation. Nothing is lost by this approach and there is much to be gained. The operation is the same on the inside.
• Will vitamins truly replace nutrient absorption loss?
  The small gastric pouch created by the RY gastric bypass does not allow intake of sufficient food to provide all essential vitamins and minerals. For this reason vitamin supplements must be taken for life!
• Is there an increase chance of stomach cancer after RY gastric bypass?
  We do not know whether the RY gastric bypass increases or for that matter decreases the chance for stomach cancer. So far, careful patient follow-up has not shown evidence for an increased risk.
• If you could choose the safest ways to do a RY gastric bypass, would it be open or lap? Do you find that with open you can see better?
  Safety is always paramount and is not dependent on the approach. The most common complication of wound infection which occurs 1 in 5 patients is eliminated by the laparoscopic approach. As a matter of fact we can see much better by lap then by open approach. Laparoscopic approach to RY gastric bypass is now becoming a standard of care.
• Will you remove the gallbladder?
  The gall bladder is not removed routinely with lap RY gastric bypass. Evidence based medicine does not absolutely indicate that removal routine removal of the gallbladder is necessary. If symptomatic gallstones develop during followup a laparoscopic cholecystectomy can be done.
• Will you remove the gallbladder with lap?
  The gall bladder is not removed routinely with lap RY gastric bypass.
• Can I expect to live a normal life after this operation without constantly worrying about secondary problems?
  Most patients report a remarkable improvement in the quality of life after they lose most of their excess weight. Certain associated medical conditions like type II diabetes, high blood pressure, sleep apnea, and stress incontinence improve or disappear after this weight loss. On the other hand women usually develop chronic anemia due to insufficient iron after this operation. This can be avoided by taking the recommended supplements and post-operative follow-up.
• Will I still be able to obtain life insurance policies?
  There is no reason why the ability to obtain life insurance should become worse after this type of surgery. It should be easier and more cost-effective to obtain coverage after successful weight loss. Check with your insurance broker.
• What are the ways I can regain weight after weight-loss surgery?

  The following "bad habits" have been observed in patients who report weight gain after weight-loss surgery. This is true in patients who do not have failure of their surgery such as a gastro-gastric fistula (a reconnection between the pouch and the old stomach).

  • Eating a diet rich in high carbohydrates with a high glycemic index-- such as donuts, cookies, cakes, ice cream.
  • Not starting or maintaining the suggested exercise program, and spending more time watching television and increased time in front of the computer.
  • Eating food rapidly so that patients don't get that full feeling. Remember, feeling full -- or satiety -- takes a while to register, so if you eat rapidly you can stuff a lot more in than if you eat a bit slower and feel full with less.
  • After feeling full, eating just a bit more (this stretches the pouch out to a normal sized stomach).
  • Grazing throughout the day (eating a little bit all the time will cause any weight-loss operation, even a duodenal switch, to fail and patients will regain weight).
  • Drinking alcohol regularly.
  • Gulping down liquids, not sipping (this forces the food out of a pouch and patients can eat more).
• Now that I'm going home, what can I eat?
  Take liquids, pureed foods and other foods recommended for the first 2 weeks until your first clinic visit. For specific details see the Life After Surgery section. The dietitian will see you in the clinic to review the foods you will be able to add to your food intake.
• How do I take care of my wounds.
  If not already done by the nurse before you go, remove the small plastic covering and sponge and let the wounds dry.  You can take showers and let soap and water run over the wounds gently. Pat dry with a clean towel and leave it exposed to the air to dry before covering with clean, loose, clothing.
• Can I take baths or showers?
  You can take showers and let soap and water run over the wounds gently. Pat dry with a clean towel and leave it exposed to the air to dry before covering with clean, loose, clothing.
• When will I see my surgeon again?
  10-14 days after the operation. You will be given an appointment for the surgeon's office or the Bariatric Surgery Clinic  before you leave the hospital. Otherwise call us for an apointment.
• Should I take a vitamin-mineral Supplement?
  Yes, the one prescribed by your Bariatric Surgery team should be taken daily. CENTRUM Forte or Select chewable 1 tab per day is sufficient. IT IS IMPORTANT THAT YOU TAKE VITAMIN SUPPLEMENTS EVERY DAY FOR THE REST OF YOUR LIFE TO PREVENT VITAMIN DEFICIENCY. Patients are also including Caltrate D (chewable) 500 mg 1 tab twice a day, B12 vitamin 250 mcg twice a day, and for menstruating women we add Palafer 300 mg 1 tab per day.
• When are blood tests done in the post-operative period ?
  The first blood tests are done one year after the gastric bypass, unless otherwise clinically indicated.
• Can I drive my car?
  Yes, as soon as you feel strong enough. Usually this is two weeks after leaving the hospital.
• Can I wear my seat belt?
  Yes, you can.
• Are there any activities that I shouldn't do?
  Avoid contact sports for 4 weeks. You can do long walks for the first 4 weeks, then you can do any activity as long as it does not hurt.  Patients are strongly encourage to do regular physical activities to achieve and to maintain good weight loss.
• When can I have intercourse?
  As soon as you feel like it and there is no pain. Women must take precautions not to become pregnant for the first 2 years after surgery.
• Can I go swimming?
  Yes, in about four weeks after the operation.
• How can I get my insurance forms filled out?
  Bring them to the Surgeon's office (there is a charge for this).
• Should I be afraid to eat?
  You may be afraid to eat because you are concerned about gaining weight. Also, your eating habits will have to change drastically and overeating can cause you discomfort and problems. Don't be discouraged. Following the guidelines for the types and amounts of food to eat will help. Speaking to others who have had the surgery may be helpful.
• What is regurgitation and will I have it?
  Regurgitation occurs because of the small size of your new stomach. This can cause heartburn and indigestion. It is normal that you may experience mild symptoms for up to 6 months. Avoiding certain foods may help. If it persist or get worse, call your surgeon or the nurse-clinician.
• When will I lose weight?
  By eating only at the suggested times and until you feel full, your daily food intake will be decreased enough to provide a gradual weight loss. The rate at which you lose weight will vary from month to month. Your goal weight should have been established with the surgeon and the dietitian in the Pre-Admission clinic. It will take between 1 1/2 to 2 years for you to reach your goal weight.
• How much exercise can I do?
  Walk as much as you can without becoming tired. The first four weeks, go easy! Eventually, you might try to set a goal for yourself to walk one or two miles per day. Climb stairs, as you need to. Don't lift anything heavier than one grocery bag for 3 months if you had the OPEN gastric bypass. Gastric bypass patients are advise to start a regular training program in order to loose maximum of weight. Consult your surgeon or your nurse-clinician to know what you can do.
• When are you going to restart the Telemetric Adjustable Gastric Band Study?

  The acquisition of Endoart Inc. (the previous study sponsor) by Allergan Inc. last March 2007 necessitated we put a "hold" on this exiting study. Allergan has decided to make changes to the EASYBAND device to improve patient safety and outcomes. The study is on indefinite hold until then. We estimate that the study is not likely to start again until 2010 or later.

• What about the Laparoscopic Sleeve Gastrectomy (LSG) or Vertical Sleeve Gastrectomy (VSG)?

  The laparoscopic sleeve gastrectomy (LSG) procedure has been utilized as a first-stage bariatric procedure to reduce surgical risk in very heavy patients (over 200 kg) by induction of weight loss and this may be its most useful application at the present time. The mechanism of weight loss and resultant comorbidity improvement seen following LSG may be related to reducing the capacity to eat or to neurohumoral changes observed following the procedure because most of the stomach is removed or some other unidentified factor(s).

  There are currently 15 published scientific reports describing short-term outcomes in 775 patients after sleeve gastrectomy. The reports describe surgical treatment of patients with preoperative body mass index ranging from 35 to 69 kg/m²and excess weight loss ranging from 33% to 83%. Comorbidity resolution 12 to 24 months after sleeve gastrectomy has been reported in 345 patients demonstrating resolution/improvement of diabetes, hypertension, hyperlipidemia, and sleep apnea. Published complication rates range from zero to 24% with an overall reported mortality rate of 0.39%.

   

  Only a single study compared (in a random fashion) LSG to laparoscopic gastric banding. This scientific study found that  sleeve gastrectomy was at least as effective and durable as gastric banding with better weight loss at one and three years following surgery. Long-term (> 5 yr) weight loss and comorbidity resolution data for sleeve gastrectomy have not been reported at this time. Weight regain or a desire for further weight loss in a super-super-obese patient may require the procedure to be revised to a gastric bypass or biliopancreatic diversion with duodenal switch.

   

  We have used the LSG in 68 patients to date and have been impressed with the results. We would be happy to discuss the current and future developments with the LSG with you, if you feel you may be a candidate for this procedure. Click on “Where do I Start” and follow the links.

   

  For more information click: http://www.obesityhelp.com/forums/vsg/a,messageboard/board_id,5463/action,recentPosts/
• How do I join your e-mailing list? Why should I join?

  How to Join:

  To join our e-mail list please register by clicking the link on the Quick Access Bar always displayed on the right of the page at the bottom, or click here.

  Why Join:

  All patients  You can receive important communiques about our program. You can always remove yourself in the future if you wish.

  Post-op patients: It is extremely important for ALL our post-op patients to be registered with our site so we can communicate with you. Patients often move and their contact details change frequently but their e-mail remains the same. We will be able to send you recalls to the Bariatric Clinic, Support group Information, and any developments that impact on your health and quality of life.

• What is nesidioblastosis?

  Patients who had gastric bypass may experience, a rapid heart rate, sweating, nausea, fatigue and diarrhoea 1-3 hours after a meal, especially if this consists of carbohydrates like spaghetti accompanied by drinking water at the same time. This is a common occurrence with inappropriate eating behaviour after gastric bypass surgery called “dumping syndrome” and the surgery is intended to cause dumping to remind patients that they are not eating right. This cannot occur after gastric banding or gastroplasty surgery.

   

  In some patients the above symptoms become severe and are accompanied by neuroglycopenia which is the medical term to describe a condition where the brain is deprived of glucose (the basic fuel it needs to function properly) and patients feel faint and at times go into a coma (pass out). If patients present with severe dumping syndrome symptoms and especially if they faint (loose consciousness) then their glucose must be measured at the time this occurs. If it is less then 3 mmol/liter (or 55 mg/dl) and is repeated for at least 3 times, than patients should seek immediate help from the primary care physician or bariatric surgeon who should refer them to an endocrinologist who can do the additional testing required to prove the condition called hyperinsulinemic hypoglycaemia with nesidioblastosis after gastric bypass surgery. In some patients a confirmed diagnosis may require removing most of the pancreas to treat the condition. Unfortunately this does not resolve the problem in all patients and may require removal of the entire pancreas which itself presents with potential life threatening complications. Therefore, the diagnosis must be certain and the treatment carried out in centers with expertise in the field.

   

  Fortunately this is an extremely rare condition. The Mayo clinic which is a major referral center for this has seen less than 10-15 cases (with over 300,000+ gastric bypasses done in North America) and as Dr. Cummings in a key editorial in the New England Journal of Medicine in 2005, “this is hardly represents a public health crisis”. Actually some of the potential mechanisms that may cause this condition may actually benefit the great majority of morbidly obese patients with diabetes.

   

  So what do you need to know if you had a gastric bypass or a duodenal switch operation for morbid obesity? Follow the diet and life style modifications as prescribed by your bariatric team. Memorize the 10-Golden rules for weight loss surgery patients (download them form the home page of our web site – down at the bottom) and follow them. If you get true losses of consciousness after meals along with low glucose levels of less then 3 mmol/liter see your bariatric surgery aftercare team.