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About Weight Loss Surgery

OverStitch Endoscopic Suturing System

Avera has adopted a new technological feature to improve the outcomes of endoscopic surgical procedures, including those for weight loss. The OverStitch Endoscopic Suturing System has allowed surgeons to move from minimally invasive procedures to surgeries with no scars.

The OverStitch tool’s design enables surgeons to have more control and flexibility over the suturing process. For example, it can sew both running and interrupted sutures at the surgical site through an endoscope. A spiral-shaped attachment on the tool also helps surgeons place sutures correctly and control the depth of the sutures in the tissue.

OverStitch Purposes

At this time, the OverStitch system helps maintain previous weight loss surgeries with minor repairs.

One complication associated with gastric bypass surgery that OverStitch can fix is gastrogastric fistula, where the stomach pouch reconnects to the bypassed stomach. This situation can allow excess food to slip through the bypassed stomach, reversing the purpose of weight loss surgery. Gastrogastric fistula is corrected by a less invasive endoscopic procedure through the mouth.

Eventually after gastric bypass surgery the stomach pouch may stretch, allowing more food to be ingested and, therefore, weight regain. To fix this complication, the OverStitch tool is inserted into the patient’s mouth, through the esophagus, to the site of the stretched pouch. Surgeons then sew the pouch smaller to about the size of the initial gastric bypass surgery.

OverStitch is also used to repair leaks along the staple line of past sleeve gastrectomy weight loss surgery.

Future Applications

Over the next few years, the OverStitch system promises more than just a tool for repairing weight loss surgeries, but as a weight loss surgical procedure itself. Surgeons anticipate that this type of procedure holds many benefits for the patient, including little pain, no scarring and no lost work time.

Surgery & Weight Loss Team

The bariatric program at Avera McKennan includes many different team members: physicians, nurses, dieticians, pharmacists, physical therapists/exercise professionals, psychologists, and the bariatric coordinator. All of these team members work together to assist patients in long-term weight loss success. Avera McKennan is a Level 1B Accredited Bariatric Center, Adult and Pediatric by the American College of Surgeons.


Our expert team of surgeons and staff answer some of the most common questions about weight loss surgery.

What can I expect after surgery?
Weight loss success often depends on the type of procedure, gastric bypass or lap band, with gastric bypass being the most effective. However, you can be successful with either surgery. The Avera Bariatric Institute considers that keeping 50 percent of your excess weight off for more than five years after surgery to be a success.

What is the patient experience and what can I expect?
Most patients who come to the Avera Bariatric Institute are self-referred or physician referred. Before the consultation, check with your insurance company to ensure weight loss surgery is covered, and transfer your medical records to the Avera Bariatric Institute. The initial appointment covers your medical history, expectations required of you after surgery and the types of procedures offered. The length of time between the consultation and the surgery can take four or more weeks.

What is the surgical procedure?
Before the lap band procedure, the patient is given anesthesia to fall sleep. The procedure takes approximately 30 to 45 minutes. After waking up, the patient is observed in the hospital for a few hours before receiving the approval to go home. Patients typically rest three to five days and return to work after a week or two.

Bypass patients stay in the hospital for one to two days after surgery. Patients typically wait one to two weeks before returning to work, especially if their job requires heavy lifting.

What kind of lifestyle changes can I expect?
The post-surgery diet is the most important element for weight loss success, and that’s why the Avera Bariatric Institute offers the guidance of a registered dietitian. Right after surgery, you begin a special diet of mostly liquids, gradually increasing to your normal diet. Weight loss surgery helps you control portions better simply because you can only eat very little at each meal.

Tell me about my follow-up appointment.
After bariatric surgery, you return for follow-up appointments mostly for counseling, often reinforcing those lifestyle changes to maintain weight loss success or discussing challenges that prevent weight loss.

How much can I expect to lose?
Weight loss success varies from patient to patient. For most patients, we aim for about 60 percent loss of excess weight. Typically, bariatric patients lose about 50 percent of their excess weight.

What will my expected lifestyle changes be?
Weight loss surgery is just a tool, and therefore, requires lifestyle changes. Before surgery, we thoroughly explain that you must change your diet to include healthier food choices, portion control and eating in response to hunger cues rather than emotional cues. Appropriate exercise can increase the amount of weight loss as well as prevent weight regain.

What should I know about obesity?
Obesity is extremely dangerous to one’s health. When a person’s BMI exceeds 40, his or her life expectancy can be shortened by 25 or more years. The risk for stroke, heart attack and cancer also increases.

What should I expect at my initial consult?
During the first consultation, basic information about your general medical health is gathered. The physician also wants to know what diets you have tried in the past. Every patient is different, so the risks and pros and cons of surgery are also discussed.

What kinds of surgery do you do?
The Avera Bariatric Institute offers two types of weight loss surgery:

  • Laparoscopic adjustable gastric band – An adjustable band is positioned at the top of the stomach that helps you eat smaller portions of food. Though this restrictive surgery is minimally invasive and low risk, weight loss is typically slower.
  • Laparoscopic and open Roux-en-Y gastric bypass – A more invasive procedure, gastric bypass calls for a surgeon to divide and staple the stomach, making a tiny pouch, and then connecting it to a portion of the small intestine. Not only do you eat less food, but you also absorb fewer calories. Weight loss tends to occur rapidly.

How do I know if I am a candidate for this surgery?
Being 100 pounds overweight is a typical qualification. However, a more accurate tool is the body mass index (BMI) to evaluate a potential candidate. A BMI of 40 or more is a qualification. A BMI of 35 along with an obesity-related problem — such as hypertension, type 2 diabetes or sleep apnea — can also qualify you for weight loss surgery.

How do I get more information about this surgery?
The personal navigator at the Avera Bariatric Institute is an excellent source to get more information on the weight loss procedures, insurance process and what to expect at a consultation. Call 605-322-1320 to speak with the personal navigator.

Are there other options if my insurance company will not cover this procedure?
Some places offer financial loans, such as banks or credit unions. Cash payment plans are also offered at Avera McKennan Hospital & University Health Center. Remember, if paying with cash, you may be eligible for money back on your taxes.

How do I start the process to get weight loss surgery?
First, call your insurance company to ensure weight loss surgery is a covered benefit. From there, call the Avera Bariatric Institute at 605-322-1320 to set up a consultation.

Is there support after I’ve had surgery?
The Avera Bariatric Institute offers a full team of experts ready to guide you for lifelong success. The team includes dietitians, psychologists, nurses, pharmacists, surgeons and physical therapists. After surgery, we also encourage you to attend our support group to maintain weight loss results.

What if I’m anxious about this surgery?
Anxiety is normal, but thoroughly educating yourself about weight loss surgery can ease worries and doubt. Visit trusted websites or contact the personal navigator at 605-322-1320 to get straight answers for your questions.

How long until surgery is scheduled?
After meeting with a physician and a dietitian, you will complete a psychological evaluation with a psychologist. All of this completed information is submitted to the insurance company for approval. After approval, a second consultation takes place that discusses the offered procedures in depth. Then, surgery is scheduled. This entire process could take four or more weeks before surgery is scheduled.

What do I need to bring?
Before your consultation, you must sign a release form so your primary physician can fax three years of your medical history to the Avera Bariatric Institute. After scheduling your initial consultation, you will receive a bariatric packet, which you MUST read, complete and bring to the consultation. Failure to bring the packet delays the process. Remember to bring your insurance card. Contact your insurance company for their faxing information so we can process your information efficiently.

Are there foods I have to avoid after weight loss surgery?
You cannot eat and drink at the same time. Liquids speed up the digestion, pushing food through the pouch quickly, which counters the purpose of weight loss surgery. Avoid gummy foods, such as white bread, white pasta and processed cheese products.

In gastric bypass, eating foods with too much fat or sugar, or drinking alcohol, may lead to dumping syndrome. Undigested food moves from the stomach to the bowels too quickly, causing cramps, nausea and diarrhea.

The lap band allows for more flexibility in your diet. However, concentrating on portion control with these foods ensures weight loss success.

How long will I have to follow these food rules?
Bariatric surgery is just a tool, so your lifestyle changes must be permanent. If you find yourself struggling to maintain your new lifestyle or if you regain some weight, contact the Avera Bariatric Institute immediately for support. Do not allow negative emotions or shame prevent you from reaching out for help.

How much food will I be able to eat at one time? Will that change over time?
Your very first meal after surgery will be clear liquids (broth, jello, juice), sipping on approximately 3 oz. over one hour. You will advance your diet slowly, from clear liquids to full liquids to soft solids to regular food. If you received the lap band, you should be able to eat about a cup of food over 30 minutes after about four to six weeks. For gastric bypass, it will take about 12 weeks to eat a cup of food over 30 minutes.

What do I do when I go out to eat?
Going out to eat can be tricky, so knowing what will be on the menu is helpful. We recommend a protein and a carbohydrate, such as a fruit or vegetable. Restaurant portions are large, so take home at least half of your meal. A card from your surgeon even allows you to order half portions from the menu. Eat slow and take your time. Eating out in the first couple of weeks after surgery should be avoided.

What will I eat the first week?
The type of surgery you have will depend on what types of foods to eat in the first week.

For a lap band surgery, you will eat a full liquid diet. This includes pudding, milk, creamed soups, custards, cooked cereals and any food that turns to liquid at body temperature.

If you have a gastric bypass, you may eat soft solids, such as very moist and tender meat, canned fruits and vegetables, a few crackers or some toast.

Will I feel full or will I still feel hungry?
There are two types of hunger: head hunger, where you see and smell the food, and physical hunger, where there is an actual feeling of hunger. Listen to your body. If you start to feel uncomfortable or full when eating, stop!