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Metabolic & Bariatric Surgery Consultation Guide

  • Criteria for Metabolic & Bariatric Surgery

    • Bariatric Surgery (Patient’s Share: 20%)
      • Indications
      • BMI ≥ 35.0kg/m² or BMI ≥ 30.0kg/m² with comorbidities

      • Revisional surgery due to complications or excessive weight loss after bariatric surgery
      • Corrective surgery for complications after bariatric surgery
      • Corrective surgery if indications persist after 18 months of active management

      • Comorbidities

        Type 2 diabetes, hypertension, hypoventilation, sleep apnea, joint disease, non-alcoholic fatty liver disease, asthma, hyperlipidemia, GERD, cardiomyopathy, coronary artery disease, polycystic ovary syndrome, pseudotumor cerebri
    • Metabolic Surgery [Diabetes Surgery]
      - Proven to be more effective than conventional treatments for diabetes remission
      • Indications
      • BMI ≥ 27.5kg/m² with uncontrolled Type 2 diabetes

  • Initial Consultation

    • Blood tests may be conducted if necessary (Fasting not required)
    • Additional specialist consultation may be required based on comorbidities and degree of obesity
    • Required Documents
      • Referral or doctor’s note for comorbid conditions
      • Health check-up or blood test results within the past 6 months
      • List of current medications or prescription
      • For medical benefit recipients: Referral from primary medical institution

  • Preoperative Tests

    • Tests scheduled 3-4 weeks before surgery

      • Test Items

        · Blood test
        · Chest X-ray
        · Electrocardiogram
        · Pulmonary function test, for BMI ≥ 40 or asthma
        · Abdominal CT scan with contrast or ultrasound
        · Body composition analysis
        · Bone density test
        · BMI ≥ 35: Non-sedated endoscopy
        · Continuous glucose monitoring for diabetes patients
    • Preoperative Test Preparation:

      • Fasting including water from midnight on the day of examination

        Medication Instructions
          * Hypertension/thyroid medications: Take with a small amount of water
          * Diabetes medications (Metformin): Stop 48 hours before the test

      • BMI ≥ 35: Our hospital does not offer endoscopy under sedation for patients with a BMI of 35 and higher. Other options may be discussed during your consultation.

  • Nutrition Education

    • ✔ Pre- and post-operative nutritional education (Additional sessions as needed)
    • ✔ Education Schedule
    • 1st 2nd Nutrition Education 3rd Nutrition Education 4th Nutrition Education 5th Nutrition Education
      Preoperative Nutrition Education Post-op Day 1-2 1 Month After Surgery 3 Months After Surgery 6 Months After Surgery

  • Hospitalization Guide

    • ✔ Hospital Stay: 5 days (4 nights), extendable if needed
    • ✔ Admission usually one day before surgery

      • Items to Bring

        Current medications
        Toiletries, slippers, wet tissues, towel
        CPAP machine, if applicable
    • ✔ Preoperative Preparation
      • Diabetes medications: Stop one day before surgery

      • Smoking cessation 4 weeks before surgery

      • Remove nail polish, piercings, and jewelry

  • Types of Bariatric & Metabolic Surgery

    • Pre-operative stomach Sleeve Gastrectomy Roux-en-Y Gastric Bypass Sleeve gastrectomy with Intestinal Bypass Gastric Balloon Insertion

  • Postoperative Outpatient Follow-Up

    • 1 Week Post-op Follow-up + Nutrition Education / Suture removal
      2-3 Months Post-op Blood test + Consultation + Nutrition Education
      6 Months Post-op Blood test + Consultation
      1 Year Post-op & Annually Blood test, Endoscopy, Abdominal CT

  • Postoperative Nutritional Management

    • 1) Nutritional Management After Bariatric and Metabolic Surgery: Goals

        1. To provide adequate calories and nutrients necessary for wound healing and muscle preservation
           during rapid weight loss after surgery.
        2. To minimize diet-related discomforts such as dumping syndrome, dehydration, nausea,
           reflux, indigestion, and diarrhea resulting from changes in gastrointestinal structure and function.

    • 2) Basic Dietary Principles After Surgery

        ① Stay well-hydrated daily. (Target: 1.5L or more per day)
           * Drink water in small, frequent sips.
           * Avoid drinking during meals and within 30 minutes before or after eating.
           * Avoid using a straw.

        ② Limit high-calorie foods, sugary drinks, and sweet snacks.
           * These can trigger 'dumping syndrome' and slow down weight loss.

        ③ Diligently take prescribed medications, vitamins, and mineral supplements as directed by your doctor.

        ④ Eat slowly. Swallowing without proper chewing can lead to indigestion.

        ⑤ Initially, consume 50-100ml or less per meal.
           Signs of overeating (consuming more than the appropriate amount)
           include: a) Pain in the pit of your stomach b) Nausea c) Pain in the shoulder or upper chest
           * If these symptoms persist or worsen, contact your doctor.

        ⑥ To maximize protein intake, eat protein first during meals.
           * As your stomach gradually stretches over time, aim for three meals a day with 1-2 protein shakes.

        ⑦ Advance your diet gradually based on your adaptation.
           Step 1 Liquid Diet ➔ Step 2 High-Protein Liquid Diet ➔ Step 3 High-Protein Soft Diet ➔
           Step 4 High-Protein Solid Diet ➔ Step 5 Regular Diet


      Adequate hydration
      (At least 1.5L per day)      		 Avoid high-calorie and sugary foods Eat slowly & prioritize protein intake Gradual diet progression
      (Liquid → Soft → Regular diet)
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