From consultation to gastric sleeve surgery: the steps in order

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From consultation to gastric sleeve surgery: the steps in order

Between a first consultation and a gastric sleeve there is usually a set of steps: a medical work-up, nutrition and psychological evaluations, insurance approval if you are using insurance, a period of preparation, and then a surgery date. The order is similar for most people. How long it takes varies, mostly with your health and your insurance plan, so ask the office for an estimate.

The sequence at a glance

Consultation. You and Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, discuss whether a sleeve is worth pursuing. See your first sleeve consultation.
Medical work-up. Blood tests and any heart, lung, sleep or stomach tests your health calls for.
Nutrition and psychological evaluations.
Insurance authorization, or, if you are paying yourself, a written estimate you ask for in advance.
Preparation. Stopping tobacco, adjusting medicines, and often a short pre-surgery diet.
Scheduling and final instructions.
Surgery at a hospital where Dr. Davtyan has surgical privileges. Ask the office which one.

Steps 2 to 4 often overlap instead of running one after another.

The medical work-up

The purpose is to find anything that should be treated or planned for before an operation. A 2019 clinical practice guideline cosponsored by five American societies, including the American Society for Metabolic and Bariatric Surgery (ASMBS), sets out a pre-procedure checklist. In plain terms it includes:

A full history and physical examination.
Routine blood tests: blood sugar, cholesterol, kidney and liver function, blood count, clotting and blood type.
Nutrient levels: iron, vitamin B12, folic acid and vitamin D.
Heart and lung evaluation with screening for sleep apnea (pauses in breathing during sleep), and an electrocardiogram.
Stomach and gallbladder evaluation, with an upper endoscopy (a camera examination of the stomach) when clinically indicated.
Diabetes and thyroid tests where relevant.
Counseling about pregnancy and about stopping smoking.

That is a guideline list, not a list of what any one practice requires, and not everyone needs every test. Ask which ones apply to you and where they are done. Our page on tests before sleeve surgery explains each one.

Nutrition and psychological evaluations

The same checklist calls for a clinical nutrition evaluation by a registered dietitian and a psychosocial-behavioral evaluation. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes what these visits are for: the dietitian explains what and how much you will be able to eat and drink after surgery, and a psychiatrist or psychologist may assess whether you are ready to manage the challenges of weight-loss surgery.

Practices and insurers differ on how these are arranged, so ask who you would see and whether your plan needs them from a particular provider. The aim of the nutrition visit is to prepare you for the eating pattern you will follow after surgery. The psychological visit looks at things that can affect results, such as mood, eating habits, alcohol use and the support you have at home.

Insurance authorization

If you are using insurance, your plan usually needs a request showing that you meet its criteria. Ask the office how that is handled. Plans differ. Some follow the 2022 guidelines from ASMBS and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), which recommend surgery at a body mass index (BMI) of 35 or more and say it should be considered at 30 to 34.9 with metabolic disease. Others still apply older thresholds, and some require months of documented, supervised weight management first. This step can make one person's timeline longer than another's.

The practice works with PPO and HMO plans that allow care with Dr. Davtyan. For general information on plan types, see insurance requirements for a sleeve, IEHP, Medi-Cal and bariatric surgery, and Medicare rules. If you have Medi-Cal or Medicare, ask us whether we can see patients on your plan.

Getting your body ready

Tobacco

The 2019 guideline says people who smoke should stop as soon as possible, preferably a year and at the very least six weeks before a bariatric procedure, and should stay off tobacco afterward because of poor wound healing and ulcers. The 2021 Enhanced Recovery After Surgery (ERAS) Society guideline sets its minimum at four weeks. Ask your surgeon what is required in your case, and ask for help quitting.

Medicines

Bring a full list. Blood thinners, diabetes medicines and anti-inflammatory pain relievers often need a plan around surgery. If you take a GLP-1 medication such as Wegovy, Zepbound, Ozempic or Mounjaro, tell both the surgeon and the anesthesia team, and ask them whether and when to pause it. Do not stop a prescribed medicine on your own.

The pre-surgery diet

The ERAS Society guideline recommends weight loss with a low-calorie or very-low-calorie diet before bariatric surgery, usually for two to four weeks. Follow your own surgeon's instructions on this. The purpose of such a diet and what it can involve are covered in our page on the pre-surgery liver diet.

Scheduling and the last days

A date generally follows once the work-up is complete and coverage is settled. Make sure you know the instructions on eating and drinking, which medicines to take that morning, and when to arrive, and ask if any of this is unclear. Use the waiting time to arrange a driver, help at home for the first week, time off work, and the liquids and protein supplements you will need afterward. Our pages on surgery day and the hospital stay and returning to work and driving cover what follows, and the Rancho Cucamonga gastric sleeve guide has the wider picture.

Frequently asked questions

How long does it take to get from consultation to surgery?

There is no single answer. A healthy person paying privately has fewer steps than someone whose plan requires several months of supervised weight management or who needs a heart or sleep problem treated first. Ask the office for an estimate based on your plan and your test list, and ask what you can do early to avoid delays.

What most often delays a surgery date?

Common causes are missing records, an insurance requirement that has not been documented, a test result that needs follow-up such as untreated sleep apnea or poorly controlled blood sugar, continued tobacco use, and evaluations that were booked late. Booking required visits promptly and sending records as soon as they are requested can reduce avoidable delay.

Who decides that I am ready for surgery?

Several people may contribute, such as a dietitian, a psychologist, your primary care doctor, and any specialists who cleared you. The 2022 ASMBS and IFSO guidelines say a team can help manage risk factors you can change, and that the final decision about surgical readiness should be determined by the surgeon. Your insurer separately decides whether it will pay.

Can I change my mind after insurance approves the surgery?

Yes. An approval is permission, not an obligation, and a sleeve is not reversible, so you should only proceed if you are sure. Tell the office as early as you can. Approvals often carry an expiry date, so ask your plan how long yours lasts if you want more time, and ask about non-surgical options in the meantime.

Can I keep working during the preparation period?

Usually, yes. The appointments are generally outpatient visits and tests, and most of the preparation is done at home. The part to plan around is any pre-surgery diet, when you may feel hungrier or more tired than usual for the first few days. If your schedule is tight, ask whether appointments can be grouped.

Start with a consultation in Rancho Cucamonga

The first consultation is complimentary, and Spanish is spoken. Davtyan Medical Weight Loss & Wellness is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. Call 909-355-2525 or 877-9-BE-SLIM (877-923-7546), or write through the contact page.

From consultation to gastric sleeve surgery: the steps in order

From consultation to gastric sleeve surgery: the steps in order

The sequence at a glance

The medical work-up

Nutrition and psychological evaluations

Insurance authorization

Getting your body ready

Tobacco

Medicines

The pre-surgery diet

Scheduling and the last days

Frequently asked questions

How long does it take to get from consultation to surgery?

What most often delays a surgery date?

Who decides that I am ready for surgery?

Can I change my mind after insurance approves the surgery?

Can I keep working during the preparation period?

Start with a consultation in Rancho Cucamonga

Sources

More in the Gastric Sleeve in Rancho Cucamonga guide

Understanding the sleeve

Weighing your options

Getting care in Rancho Cucamonga

Adult BMI Calculator

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Glendale

Rancho Cucamonga

South Coast Lap-Band

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