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Our Programs

Our program follows a systematic approach with safe outcomes always a priority. Below is an overview of the steps you will go through as you prepare for bariatric surgery and achieve long-term benefits:

Step 1 – Attend an Obesity Information Seminar
Dr. Thodiyil conducts free public seminars on obesity at the New York Methodist Hospital. These seminars help people struggling with obesity to be better informed when making decisions about their treatment. Visit our Seminar Registration page for more information.

Step 2 – Initial Office Visit
You will meet with Dr. Thodiyil for an initial evaluation for bariatric surgery. He will perform a detailed history and examination and discuss the bariatric surgical options. He will be able to tell you if you are a candidate for bariatric surgery and how you are likely to benefit. He will also outline the tests you would need to have prior to surgery.

Step 3 – Medical Evaluation in Preparation for Surgery
Persons suffering from severe obesity frequently also have many medical conditions that are caused or aggravated by obesity. Many are even unaware of their medical conditions. It is far safer to identify and treat these well before the day of surgery.

Medical evaluation is individualized, but would typically include some tests for your heart, your lungs, a sleep study, an upper endoscopy and a number of blood tests. All prospective patients are screened by a psychiatrist to determine that they are psychologically well prepared to undergo what is essentially a life changing experience.

Step 4 – Final Preoperative Visit; Start of Low Calorie Diet
Once testing is complete and required paperwork is in order, Dr. Thodiyil will see you to review test results with you and to set a date for your surgery. You may have more questions. He will start you on a low (800 kcal) diet for the two weeks prior to your surgery. This is designed to help you loose 10 to 15 lb so as to reduce the size of your liver and hence make surgery safer and smoother. If you are diabetic, you will need to work closely with your primary care doctor at this point to adjust your diabetic medications to avoid low blood sugar.

Step 5 – Insurance Precertification
Once the medical evaluation is complete, Dr. Thodiyil’s office will write to your insurance company with all supporting test results seeking authorization for the bariatric surgery. In most circumstances this proceeds without difficulty.

Step 6 – Anesthesia Pre-testing
This will be your final visit to the hospital prior to your surgery. During pre-testing, the anesthesia staff will evaluate your fitness for anesthesia. They will utilize most of the tests you would have undergone up to that point, but will often also include some more up-to-date blood tests.

Step 7 – The Day Before Surgery
It is normal to feel nervous. You could carry on with your normal activities. Continue with the low calorie diet. The Operating Room Office will call you, usually in the evening, to confirm the time of your surgery and will advice you about where and when to report. You should be fasted for 8 hours prior to surgery. As a general rule you should continue taking your medications as usual up to the morning of surgery, with the exception of diabetic medications. You should consult with your primary care doctor or endocrinologist about adjusting your diabetic medications. As a rule oral diabetic medications should NOT be taken on the morning of surgery while long acting insulin may have to be stopped a day before. Some long acting agents such as (e.g. chlorpropamide, Diabinese) are stopped 2 to3 days prior to surgery.

Step 8 – Surgery
On the evening of surgery, your nurse will help get you out of bed and walk about on the ward. This will reduce the chance of getting a blood clot. You will have a drip and have nothing to eat or drink except for ice chips. Whether you have had a lap band or a gastric bypass, you will undergo a swallow test the day after surgery. If the results are good, you will be started on a liquid diet. If this is well tolerated, lap band patients are sent home on the day after surgery, while those who have had the gastric bypass stay an extra day.

Step 9 – Follow-up
The first follow-up visit is at one week after surgery. Patients who have had the lap band would then be seen on a monthly basis for the first six months for adjustments and subsequently for two to three visits per year. Patients who have undergone a gastric bypass will be seen at one week and then at 3, 6, 9, 12 and 18 months and then on an annual basis.

Step 10 – Support Group Meetings
Patients who have undergone bariatric surgery are encouraged to attend one of our monthly support group meetings. These meetings are designed to bring together people who are adjusting to their new life styles after bariatric surgery. This would be a place where tips are exchanged and where one hears the ups and downs of those who have gone through it all before.