I'm about to get banded but am concerned that my surgeon does the procedure in his office. He's Board Certified and trained at a very prestigious hospital, has impeccable references, etc., but I've not heard of other surgeons doing this procedure in their office. Anyone have experience with this?

I have never heard of this either. Many Dr.'s use a surgical center as opposed to a hospital, but an office, I would be questioning it too!

Is there an anesthesiologist there as well, and surgical attendants (whatever they are called) as well as nurses? I was in a full hospital operating room, and they had people all over the place, an assistant surgeon, a couple of nurses, the anesthesiologist....and TONS of big equipment, used to do the surgery laproscopically.

Does his office have the means to sterilize all the surgical equipment?

Have you ask how many he has done this way? Or ask to speak with former patients? I ask to do both, and knew I was going to the hospital. I would be asking some serious questions of him--and the safety of this.

As obese people we have a higher risk of complications in surgery---what happens in that case? How far is this office from a hospital? Does he have the ability to practice in a local hospital or has he lost privileges?

By board certified---what exactly does that mean?

I think you are wise to question things at this point, and would insist on more info before agreeing to what seems a risky way to do the surgery. Is there another Dr. you can use?

Welcome to LBT---I look forward to seeing how this turns out!

Kat

Hi Kat:

Thanks for your response -- you raise some VERY important issues; I will definitely be asking these questions next time I talk to him. As it is, I'm nervous enough about the procedure so this "detail" just stresses me out even more!

By "Board Certified" I mean he has been certified by the California Board of Medicine, which is the highest accreditation for a physician, and is required to legally practice medicine. In his case, he's certified in both plastic surgery and general surgery, plus he did a fellowship in bariatric gastric surgery. I haven't found a single negative report on him, which is good, but on the other hand, I don't want to be the first one either, lol! I think I'll also ask to see his operating room and the equipment he'll be using just to be sure. This medical practice has been featured in the Dr. 90210 TV show (not that that means absolutely anything with regard to surgical competency!) and they have a number of centers around the SoCal area. They seem to have a "choice" clientele and people flying in from other places to be treated here, but again, that doesn't necessarily attest to anything more than good PR...

I'll keep you posted re: his responses to the questions you pose. Thanks again for your valuable input and the warm welcome!

It could be that he has a full operating theater on site---but I am picturing in the exam room---and wigging out!!

I still think as you do, lots of questions need answers---then if his credentials check out, and the questions you ask are answered satisfactorilly---I would still ask to speak with former patients, and ask about their recovery experience, if they were rushed since it is in that type of setting.

I know that lots of PS have that type of set up for privacy issues---and this may be the reason the Dr, does his this way.

If you like the Dr----just ask LOTS of questions, and make sure you are safe...that is #1!

Let me know---ok?

Kat

If he has the means to have an operating room in his practice with all the surgical participants (anesthesiologist, etc.) then I'm sure it's fine. He wouldn't be allowed to perform this kind of surgery at his office if he didn't have the proper provisions there in the event of an emergency. He can't operate and do anesthesia at the same time. So if he has been doing this for a while I'm sure he's fine. I had my surgery done in a surgical center and the entire center took up the 2nd floor of a very small office building. The actual surgery side was only half of that. So you don't need a big hospital to do this sort of thing. Just the right equipment, space, personnel and licensing. If your doctor is board certified I'm pretty certain you are fine, but always ask about anything that concerns you.

Here's some additional details so you can help me think: His office is located in a medical enclave (ie, where there are a number of medical office buildings surrounding the hospital) and they occupy two suites (one for consultations, the other one for the nutritionist and psychiatrist). I haven't seen the nutritionist side yet, but the consultation suite is rather small, with 3 exam rooms and a receiving area. Funny thing is, I can't imagine where in the office it is that they do the surgery if it's not the patient rooms because I didn't see any other suitable spaces. I may have missed it of course, but I wonder; will definitely ask to see the facilities next time!

Another thing is, I looked up the doctors credentials again and, while he is associated with a number of prestigious hospitals in the LA area, he is not affiliated with the hospital within the medical enclave where the office is located. I have to check on the protocol in such cases because his affiliated hospitals would be way to far in LA traffic to be of any use in an emergency. It could be that other doctors in the practice have hospital privileges at that particular location even if my surgeon personally doesn't, but I'm not sure how that would work. They also did not mention during the presentation how anesthesia would be handled (or by whom), but it might just be that they couldn't cover all the details during a general presentation (and none of the attendees asked either), but it's a great question.

What do you think?

I think you have begun digging, and are now armed with at least enough questions to warrant a phone call to the office to find out if you can tour the facilities used for the surgery. It would open the communication about it....and you might get to go see---before you commit.

I would also ask about an emergency---where do they transfer you to. No one likes to think something could happen, but it is always better to prepare for the worst and hope for the best.

You usually get to meet with your anesthesiologist prior to ANY surgery, to discuss any prior issues with anesthesia etc. So you might ask about meeting with them, that would open another door for you to look into.

I have had knee surgery several times and they might consider it being done in the office, although it is a separate unit....in the same complex---and is a full Ambulatory Surgical Center----and is fully staffed, and superior to our local hospital for that type of thing, and that may be what he has, somewhere near his office----as Karen said---well worth calling and asking some questions. If they are not willing to discuss anything with you---then I would suggest another Dr. anyway.

The band can be fickle, and you need to have a Dr. and team you can rely on for questions to be answered---so test them now!

Kat

Thank you ladies for your insight. You're absolutely right -- might as well test them early! I'm calling the office right now and will let you know what they say...

Okay, so I called and they said that they do the procedure at the local hospital's ambulatory center, which would be just fine because it's a top notch facility with all the appropriate professionals attending. However, I am positive that the surgeon said they do the procedure "right here in the office" so I'll have to talk to him directly about that. I went to the orientation with a friend who also heard the same thing I did, but I'll give him a chance to explain. His native language is not English so it may have been a communication glitch.

To be continued...

Possibly referring to fills "right here in the office"? That would be normal.....

Ambulatory surgical centers are VERY common for this surgery!

Bet that relieves your mind a bit, it would mine!!!

Kat

Is the ambulatory care center "attached" to the hospital? My concern would be in an emergency, how quickly you could get to the hospital - but I'm a very nervous person. LapBand surgery has become more common now, but I'd worry about if there was some unexpected kind of complication.

I went on a tour of my facility. It was a wing on the 6th floor of a regular hospital, set aside just for bariatric surgeries. (Bypass and LapBand). I was quite impressed and it DEFINATELY put my mind at ease. The regular ER and hospital was just downstairs. It was amazing the lengths they went to to make the patients comfortable. All the wheelchairs, the doorways, the toilets, the gurneys, the beds and the showers were larger and wider for bariatric patients. It was marvelous. Each room was like a bedroom at home. Hardwood floors, rockers, sofa beds for the spouse, wallpaper, dimmer switches for the lights, armoirs for your clothes, and I even got slipper socks for my feet. I was totally relaxed when I checked in. What a difference it made!!

I would be comfortable in a Dr's own surgical center (In his office) IF I was having a procedure that could be done with IV sedation but I would NOT be comfortable anywhere but a hospital or facility attached to the hospital if I was having general anesthesia.

Lap band is done with general anesthesia.

Examples of procedures done with IV sedation, colonoscopy, endoscopy, removal of wisdom teeth, minor knee surgery etc.

With the huge growth in cosmetic surgery popularity and more and more "average" people wanting procedures done, there's lots of surgical centres attached to cosmetic surgery practices here now. And the eye specialist I see has a surgical facility at his office also. Also, there's tons of day procedure surgical centres around.

So you'd assume standard operating procedure - sterility, same sort of staff - anaesthetist, theatre nurses, surgeons etc, same facilities, and a recovery area staffed with professionals, just no overnight stay in a hospital.

If it were me, I'd be happy enough with that, but just make sure that IS the situation. There's no way he'll be opening you up in his actual office! But I'd still want to see the facilities.

But you have to weigh it up - the point about general anaesthesia is a good one - for me, I was a low risk patient, under 40, BMI of 35, in good health and quite fit. If I had a BMI of 50 and couldnt walk up stairs, had high blood pressure and sleep apnoea, I think I'd want to be in a hospital equipped to handle an emergency and with an intensive care unit for afterwards. Having to access that by ambulance in the middle of a crisis is not a good thought.