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This document is one of the most important lists you will read. If you are having surgery or are seriously considering surgery for weight loss, please read over the whole document so you will be well informed. We may have spoken about the different aspects of having surgery, but most of us only retain 20% of the new information we've been exposed to--we retain another 20% when we read it--so ideally, if you read this document 5 times you would be able to remember and retain 100% of what is written here! It's a great resource to have at hand and will help answer many of the questions and concerns that arise with having this type of procedure. If there is any way we can assist you on your weight loss journey please don't hesitate to ask. We are happy to help. 

Gastric By-Pass Pre-Operative Education Guide

Lap-Band Pre-Operative Education Guide

Pre-Operative Diet (By-Pass & Lap-Band)

The lap band is a form of restrictive weight loss surgery. The term “lap band” refers to a combination of terms: laparoscopic surgery and gastric banding. Laparoscopic surgery is a minimally invasive surgery involving very small incisions in the abdomen. The gastric band is an inflatable silicone prosthetic device that is place around the top of the stomach creating a small pouch. This pouch allows the person to feel full more quickly, and it slows the passage of food from the top of the stomach to the bottom of the stomach. This controls food portions and facilitates weight loss over time. The band is adjusted (filled) via a port, which is placed under the skin. Saline is introduced into the band through the port, giving the person flexibility in restriction, depending on their weight loss needs. 

Roux-en-Y gastric bypass surgery is the most commonly practiced obesity surgery worldwide. Dr. Rumbaut performs Roux-en-Y gastric bypass surgery at the San José Hospital in Monterrey, Mexico laparoscopically. This means that instead of a large incision, he makes a series of very small incisions through which he passes the laparoscope, or optical telescope, to guide him as he resections and separates a small stomach pouch directly below the esophagus. In the next step of the R-n-Y, the small intestine is incised approximately 20 inches after its origin. It is then attached directly to the new stomach pouch. The end still attached to the now-detached stomach is connected to the small intestine about 40 to 60 inches down the intestinal tract. After Roux-en-Y gastric bypass ingested food passes only through the limb of intestine attached to the small stomach pouch, also known as the Roux limb. Food does not pass through the bypassed limb of intestine. Nutrients and calories are not absorbed in the Roux limb because of the absence of digestive juices there. However, those digestive juices continue to pass through the bypassed limb, meeting up with food much farther down the small intestine where the bypassed limb reconnects with the Roux limb. The longer the Roux limb, the less absorption of calories and nutrients to the body, the greater the weight loss.

As with anything that is worth the effort, there are some challenges or side effects with the lap band. Most of these side effects are associated with recovery after surgery. Many patients experience nausea and upset stomach after surgery. Most patients also experience referred shoulder pain—which is actually caused by adjustments your diaphragm is going through. You may feel this is your shoulders, lower back, or middle back. Although this may provide you with discomfort after the surgery, it will pass. Most patients also experience some discomfort around their port site. Swelling and discomfort around the port site can last 4 – 6 weeks. While uncomfortable, this is totally normal, and will also pass. You may also feel uncomfortable as you begin eating solid foods again, especially if you’ve swallowed a bite that is too big and has not been chewed well enough. 

With gastric bypass, chewed food, which is undigested, goes right from your mouth to the esophagus into your stomach pouch and directly into the small intestine. The difference from the normal anatomy is that food enters the intestine very rapidly in gastric bypass and into a portion of the intestine that is not accustomed to having undigested food. If you eat or drink something high in sugar or fat, this cause excess fluid to rush to that area of the small intestines, and it makes you feel awful, this is called dumping. Dumping varies from patient to patient; you may feel one or more of the following or a combination of these:  Diarrhea, Cramp or abdominal pain, Nausea, Cold sweat, Fast heart rate or palpitations, Fatigue, Weakness. The unpleasant sensation will go away.

As your body heals and you become more comfortable with the band, you should begin preparing for your first ‘fill’ or adjustment. You may choose to return to Mexico and do your fills with Dr. Rumbaut. If so, Dr. Rumbaut will not charge you for the fill, and you will only be responsible for the hospital fee. Many patients have also found doctors in the United States who are willing to do fills/adjustments for other patients. Some of these programs are affordable, and some of them are quite costly. Depending on the doctor you can pay anywhere from $150.00 to $2,500.00 for your first adjustment. We encourage you to research your options. After you’ve had your first fill, pay close attention to how much restriction you feel when you eat and to your weight loss. Everybody is different; some people feel like they’ve hit their “sweet spot” after one fill, and some people need six adjustments before they reach that point. Make sure you ask your fill doctor how long he is going to make you wait before you come in for another adjustment. Some doctors will see you again after two weeks, and some may make you wait two months. 

As you begin planning your trip to Mexico, there are a few more things you’ll want to know. Of course, one of the first things you do will be booking your flights. Keep in mind that you will have your pre-operative examination the day before your surgery. You will need to arrive at least by NOON the day BEFORE your surgery to be there in time for your pre-ops. If you cannot get a flight early enough to make it by noon, you will need to come two days before your surgery. For example, if your surgery is on a Tuesday, you will need to arrive in Monterrey on Monday before noon. If you cannot make it Monday before noon, you will want to fly in on Sunday. When booking your flights home from Monterrey, remember that you have to be at the Monterrey airport 2 ½ hours before your flight. So, if your flight is at 6:00 am, you will need to be at the airport at 3:30 am. You may want to plan to take an afternoon flight for more convenience. 

If you choose to use a taxi for transportation at any point, be sure to bring a business card from the hotel with you. Then when you would like to return to the hotel, you can simply show that to the driver and he or she should be able to get you there. Also, tipping is usually expected with drivers and hotel staff. A few dollars is generally sufficient.    

            When traveling to Mexico, please make sure that you have the proper documentation. You will need your passport. Please plan. 

Before going to surgery, you will be contacted by Dr. Adriana or Dr. Richard from Dr. Rumbaut’s office. This will give you an opportunity to go over any medications you are currently taking and any previous surgeries you have had.

Another thing to be aware of before you go to surgery is your pre-op diet. You will be on a liquid diet before you surgery for 1 – 7 days depending on your BMI. Please refer to the pre-op diet information that we have given you. If you do not have it, please ask us for it. Also, please remember not to eat or drink anything after midnight the day of your surgery. If these guidelines are not followed, it is possible that you will not be able to have surgery on your scheduled day. 

Your pre-op examination will be with Dr. Gonzales. He is the cardiologist and does the pre-op work up for Dr. Rumbaut’s patients. Dr. Rumbaut trusts him and has been using him for some time. He will be doing your blood work, including CBC, PTT, PT, and SMA-28. He will also do an EKG, an abdominal ultra sound, and a chest x-ray. You will meet Dr. Rumbaut later that day (after pre-ops).

Let’s go over an outline of your basic itinerary in Mexico:

Ø      Day 1 – Remember to arrive in Mexico before noon. There will be a driver at the airport to transport you either to the hotel or to pre-ops, depending on your schedule. There should be a driver holding a sign with your name on it. If you don’t see the driver, turn to your right after you come through the double glass doors after picking up your luggage, and you will see the counter for Sub-S-A. (The hotel will also cover all other transports with-in 10 miles, if you give them some notice.)  

Ø      Day 2 (and Day 3, if you are having the bypass) – You will have a driver to take you to the hospital on this morning. You will have surgery and spend the night at the hospital. You will spend two nights in the hospital if you are having a bypass.

Ø      Day 3 (or Day 4 if you are having a bypass) – A doctor will check you out of the hospital mid-day, and you will be able to go back to the hotel. Make sure you move and walk around plenty and get plenty of rest.

Ø      Day 4 (through day 8 if you are having the bypass) – This is a day for you to rest, walk, and sight see, if you’re feeling up to it. You will also have a conference with Dr. Rumbaut. You should get your post-operative report – do not leave without it. You will most likely need it if you choose to get your fills done by another doctor. 

Ø      Day 5 (or Day 9 if you have having the bypass) – You can return home when it is convenient for you. Notify the front desk at the hotel when you need a driver to pick you up and take you to the airport. Remember that you will need to be at the airport 2 ½ hours before your flight. 

• Food for after surgery:

You may want to bring some food with you for after your surgery, when you begin the liquid stage of your ‘post-op’ diet. Please refer to the post-op diet information we have already given you. If you do not have it, please ask us. Some examples of things to take with you are protein drinks, instant cream of wheat (to be made very thin), or your favorite powdered drinks, or any combination. 

• Nearby places to eat (before your surgery or for guests that come with you!)

There are some places close by the hotel where you can get food: HEB (a Texas chain grocery store), Applebee’s, McDonalds, and other small cafés. 

•  Financing information:

If you are concerned about financing your surgery, we have several financing companies that we work with. On the FAQ page there is more information.

If you choose to pay by credit card, we accept Visa and MasterCard. Up to $7,000 can be charged to your card for this procedure. It is set at this amount because of hospital accounting requirements. You will need to call your card company ahead of time to let them know you will be making this transaction in Mexico and find out if they have a limit on the dollar amount charged. Please bring the remainder in a cashier's check. You may use only one credit card. We cannot split the transaction into multiple credit cards. You may possibly incur a transaction fee or other charges from your credit card company for the international transaction – check with your credit card company if you are concerned because it is not something we have control over, nor can we alter it later. 

To download this document click here.

Centro Medico Metropolitano
 Av. Del Hospital No. 110 – 104
 Colonia Sertoma
 Monterrey, NL, Mexico, 64710
 Tel: (52-81) 8347-4481 or
 (52-81) 8333-6891
 Fax: (52-81) 8347-4481