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Girard Medical Center

Bariatric Services

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Requirements for the Gastrectomy

Requirements for Bariatric Surgery

1. *EGD (esophagogastroduodenoscopy) - this test uses a fiber optic scope placed through the mouth to evaluate the esophagus, stomach, and a portion of small intestine. This procedure is performed under sedation and evaluates evidence of peptic ulcer disease, reflux, esophageal abnormalities, or stomach tumors. This test also evaluates presence of a hiatal hernia. It requires the patient have no food or drink eight hours prior to the procedure. If the patient has had an EGD in the last one to two months then this report can be submitted in lieu of testing.

2. *Gallbladder Ultrasound - this ultrasound evaluates gallbladder anatomy and presence of gallstones. This test is unnecessary if the gallbladder has been removed. In addition, a hepatic-biliary scan may be ordered for those patients with questionable symptoms without evidence of gallstones. The gallbladder can be removed if indicated during gastric bypass procedures but not with the lab band.

3. *Lab Work - lab tests are ordered to evaluate current electrolyte abnormalities, monitor blood glucose, assess nutritional deficiencies, and rule out anemia. This test may be ordered twice, once upon initial evaluation and another within one week of surgery.

4. *Dietitian Evaluation - pre-operatively all surgical candidates will need to attend a nutritional course that specifically describes pre-op and post-op dietary recommendations and restrictions. This will be a one-on-one meeting with our dietitian.


5. *Psych Evaluation - this evaluation is ordered to rule out alcohol or narcotic dependencies, eating disorders, and assist in diagnosing clinical depression or other psychological illnesses. It is also used to assess surgical expectations. This is a hospital requirement.


6. Sleep Apnea Testing - this is an overnight sleep analysis to evaluate possible sleep apnea (a patient’s tendency to stop breathing during deep sleep). Previous sleep study reports are accepted. If sleep apnea is detected then a CPAP titration test will be scheduled and a CPAP/BiPAP machine will be prescribed as indicated.


7. Cardiac Clearance - if the patient has previous history of heart disease or has high risk factors (long term smoker, elevated cholesterol, severe hypertension, long term diabetes, or history of heart attack) then a cardiology consult may be necessary. This would involve scheduling an appointment with a cardiologist and additional cardiac testing if needed.

8. Letter From Primary Care Physician - In order to obtain approval from your insurance company a letter from your primary care physician is required.