The decision to have weight loss surgery cannot be made lightly. All patients must go through our process, which is designed to ensure that surgery is the correct course of action for you, as well as prepare you for surgery and give you all the information you need to be successful after surgery. Below is a description of each of the steps in the process. Step 1: Register for our free patient informational seminar, “Surgical Weight Loss, Is it Right for Me?” The first step in the process of evaluation for weight loss surgery is to call Roller Weight Loss & Advanced Surgery at 877.445.6460, provide some basic information and register for the free patient information seminar, “Surgical Weight Loss, Is it Right for Me?” Reading this website is a good way to prepare for the seminar. Call early to reserve your spot, as seating is limited. Step 2: Attend our free seminar, “Surgical Weight Loss, Is it Right for Me?” All prospective patients are required to attend our free one-hour informational seminar, “Surgical Weight Loss, Is it Right for Me?” presented by fellowship-trained bariatric surgeons Drs. Roller, Kwon and Mourot. Seminars are usually held at Roller Weight Loss & Advanced Surgery at 1695 E. Rainforest Road in Fayetteville, AR 72703, with occasional seminars in Joplin, Missouri, Ft. Smith, Arkansas and other cities in Arkansas, Missouri and now in Tulsa,Oklahoma — our newest office. Patients are encouraged to bring a support person with them. Patients may apply for an evaluation after they have attended the seminar. Applications for weight loss surgery will be available, and you will be able to ask questions. Step 3: Apply for weight loss surgery We have two registration options for our patients. At the seminar, all patients will be given a quick application that can be filled out and turned in at the seminar. Also, patients will be given instructions on how to register with our program online. Our online registration is fast, simple and saves time by allowing you to complete most of the necessary paperwork online at your convenience. After either application is received, our office will call your insurance company to verify benefits and the specific requirements your plan requires prior to approval for surgery. Step 4: Verification of insurance coverage for weight loss surgery After you have made the decision to proceed with weight loss surgery, you should call your insurance company to determine whether your plan has an exclusion for weight loss surgery (whether it is a covered benefit). If your insurance policy does not cover weight loss surgery, we offer several self-pay options and have financing arrangements with several different institutions. We understand that this surgery is medically necessary and is life-saving, and will work for you to help make this happen. For more information, see our Insurance & Financing page. If your insurance plan does cover weight loss surgery, you should also ask them what the requirements are prior to insurance approval. For example, some insurance companies require patients to perform six months of physician-supervised diet and exercise prior to approval for surgery. For more on insurance, see our insurance and financing page. Step 5: Schedule Your First Appointment for Weight Loss Surgery Once your application is received and your insurance benefits have been verified, our office will call you to schedule your initial appointment. At this appointment, you will need to bring with you documentation of your weight for the last five years (if required by insurance) as well as a supporting letter from a primary care physician (Family Practice, Internal Medicine, OB/GYN) stating that you suffer from obesity and that you would benefit from losing a substantial amount of weight. These forms are available on the patient forms section of this website and should be completed prior to the first appointment. Your initial appointment will be with Dr. Kristin Roller and a thorough medical evaluation will be performed. Step 6: First appointment: medical consultation evaluation At your initial consultation, you will be evaluated by one of our bariatric medical specialists, Dr. Kristin Roller and one of our bariatric dieticians. A thorough medical evaluation will be performed and all the appropriate tests and consultations will be ordered. Our program is unique in that a bariatric medical specialist performs all the medical evaluations prior to surgery. We find that this step is extremely important in helping optimize patients prior to surgery as well as helping reduce and prevent complications after surgery. All patients will have the following tests:
- Chest X-ray
- Upper GI series with esophagogram or EGD
- Laboratory evaluation: CBC, complete chemistry profile, TSH, HgA1C, lipid panel, liver function tests, coagulation profile-PT/NR, PTT, H. pylori serum antibody, thiamine, B12 and iron levels.
The following tests and consultations will be ordered if indicated:
- Cardiology consultation
- Pulmonary consultation
- Hematology/oncology consultation
- Gastroenterology consultation
- Endocrinology consultation
- Sleep apnea study with CPAP titration
- Esophageal manometry if patient has history of dysphagia or if abnormal EGD or UGI series
Every patient will be given our Patient Education and Resource Manual at the initial appointment. This manual will be your resource guide for both before and after surgery and also contains our nutritional program. You will be given the contact information to schedule your psychological evaluation. After all laboratory data has been obtained, we will review your test results and determine whether you are a candidate for weight loss surgery. To progress to the next appointment, each patient must:
- Pass the psychological review.
- Have all medical problems fully evaluated and optimally treated.
- Reduce his or her weight, if necessary, to a maximum of 400 pounds.
- Receive insurance company approval for surgery or establish an ability to self-pay.
Step 7: Acquire insurance approval After the initial consultation, all documentation of weight history, attempts to lose weight through diet and exercise, lab results, and other records will be compiled. Roller Weight Loss & Advanced Surgery will submit your file to your insurance carrier requesting approval for the surgical weight loss procedure. We will also include your medical records. The insurance company will let Roller Weight Loss & Advanced Surgery know whether additional information is needed to approve or deny coverage for surgery. The amount of time an insurance carrier will take to decide varies greatly. You will be contacted when we receive your carrier’s decision. You may contact your insurance company to check on the status of the insurance approval. Step 8: Second appointment: surgical evaluation with surgeon Once all the testing results are collected from the bariatric medical specialists, bariatric dieticians and clinical psychologist, your chart will be reviewed by our team. Areas of concerns are addressed and referred back to the appropriate medical or psychological group for resolution, if necessary. If there are no concerns, you will then have an appointment with Drs. Roller, Kwon or Mourot for your surgical evaluation. At this appointment, you will discuss all the benefits and risks of the procedure you have chosen as well as what to expect in the hospital. All laboratory and testing results will be reviewed, surgical risks and benefits and expected hospital course and outcomes will be discussed, and any questions you may have will be answered. You are encouraged to bring a support person with you to this appointment. If you and your doctor elect to proceed with surgery, a surgical consent form will be reviewed in depth and signed by both parties. You will be given an operation date and an appointment with the anesthesiology pre-op nurse, who will obtain final laboratory studies and give instructions for what to do the day of surgery. Step 9: The surgery Typically, you will be admitted to the hospital the morning of surgery. Pre-operative instructions will be given prior to surgery. Your arrival time will not be known until the day before surgery. After you check in, you will put on a gown, and a nurse will assign a bed and start an IV. We recommend you arrange to have a friend or family member stay at the hospital before, during and after your procedure. The operation can take anywhere from 45 minutes to two hours. Once surgery is complete, patients begin the post-op recovery period in the bariatric surgery specialty unit, located in tower one on the fifth floor (2500) or the surgical intensive care unit (SICU) if the patient has sleep apnea. Patients sent to SICU generally are transferred to the bariatric surgery unit the next day. The rooms in our bariatric surgery specialty unit all are over-sized and private. Approximately four hours after surgery, a nurse will help you walk in the hallways and sit up in a chair. The next day you will be encouraged to walk as much as possible. Typically, laparoscopic gastric bypass and sleeve gastrectomy patients will be in the hospital for two days, and Lap Band patients will stay less than 24 hours. All patients will be discharged home on a high protein liquid diet for two weeks after surgery. Step 10: Follow-up Visits Roller Weight Loss & Advanced Surgery looks forward to working with you, following your progress and guiding you into your new life. Complying with your follow-up schedule is critical to a successful outcome. The required follow-up after surgery is as follows: Two-Week Return Visit You will return two weeks after surgery so that your doctor can monitor your recovery and ensure you are doing well. You will also meet with one of our bariatric dietitians to advance your diet from liquids to soft foods and also answer any questions you might have about nutrition. You are encouraged to bring a support person. Medications will be adjusted as necessary. Three-Month Return Visit All patients return for a clinic visit three months after surgery to evaluate progress. If possible, it is helpful for your support person to accompany you. At this appointment, you will meet with one of our medical specialists, who will evaluate how you are doing and how your medical problems are improving. Medications will be adjusted as necessary.
- You will see the dietician to continue to advance and transition back to regular food.
- You will have a separate appointment with our clinical psychologist to monitor psychological adjustment.
Six-Month Return Visit All patients return for a six-month post-operative clinic visit. If possible, you are encouraged to bring your support person. To evaluate your progress, we will review results from certain tests that will need to be conducted several days in advance. Medications are adjusted as necessary.
- You will see the dietician for adjustments to your diet.
One-Year Return Visit All patients return for a 12-month post-operative clinic visit. Recovery is monitored and medications are adjusted as necessary. To evaluate your progress, we will review results from certain tests that will need to be conducted several days in advance.
- You will see the dietician for adjustments to your diet.
Yearly Visits Thereafter It is our goal to see all patients at least once a year so that we can monitor your progress, adjust medications and complete any other necessary follow-up, and evaluate for any long-term issues that can arise after weight loss surgery. Remember, potential problems can be minimized or even prevented with regular long-term follow-up. Adjustable Gastric Banding Patients Gastric banding patients will need more frequent follow-up to ensure that the band is properly filled. Your first fill we be six weeks after surgery. It is not uncommon to feel hungry or not lose any weight until the first fill is completed. We will then see you back every month for the first year for band adjustment evaluations and to monitor your progress. Frequent follow-up is necessary for the gastric band to achieve optimal weight loss.