How to Choose a Gastric Sleeve Surgeon

Once you’ve decided you want to get gastric sleeve surgery in Orange County, CA, the next step is to choose a gastric sleeve surgeon and program.

But how do you go about choosing a gastric sleeve surgeon? What do you look for? The first step is to decide what your #1 most important goal is. What is it you are trying to accomplish with your choice of surgeon and program?

Patients choose gastric sleeve surgeons and programs for all kinds of different reasons. Some choose based on, for example, who has the most convenient office location or appointment times, or who others (family, friends, primary care doctor, insurance company) recommend, or who is the friendliest with the best bedside manner, or who charges the lowest out-of-pocket prices, etc.

All these things are fine as reasons for choosing one surgeon or program over another, as long as they all do the same quality of work, and achieve the same patient outcomes.

The fact is, however, all surgeons and programs don’t do the same quality of work, and don’t achieve the same patient outcomes. Some achieve significantly better outcomes (weight loss results, complication rates) than others.*
Gastric sleeve operations are not all the same

Outcomes Vary Between Gastric Sleeve Surgeons

To understand the magnitude of the variation in outcomes between different surgeons, let’s look at the published gastric sleeve outcomes literature.

One particularly good study, published in 2017, entitled “Variation in Outcomes at Bariatric Surgery Centers of Excellence,” reported that the rate of serious complications after weight loss surgery varied 17-fold (not a typo – 17-fold!) across 165 accredited bariatric surgery center of excellence programs nationwide, from 0.6% to 10.3%. The authors attributed this variation in complication rates to the fact that there were different surgeons at the different centers, with different skill levels and different ways of doing the operations.

Similarly, weight loss results after the gastric sleeve operation have been reported to be anywhere from 40-50% average excess weight loss, to 70-80% average excess weight loss, depending on surgeon/program.* Individual surgeon gastric sleeve leak rates are reported to 0 in >500 operations, to 1 in 25 operations – that is a greater than 20-fold difference between individual surgeons!*
Outcomes vary between gastric sleeve surgeons

Because there is significant variation in weight loss outcomes and complication rates between different surgeons and programs, in my view, the surgeon’s/program’s record of actual patient outcomes should be the #1 consideration when choosing a sleeve gastrectomy surgeon in Orange County, CA.

How I Would Choose a Gastric Sleeve Surgeon

For me, as a weight loss surgeon, choice of gastric sleeve surgeon and program would be a much harder decision than the decision to have the gastric sleeve operation. I would want the surgeon and program with the best outcomes statistics. If getting a surgeon with great outcomes statistics meant I would have to travel across the country, I would with 100% certainty do that. In my view, when it comes to health and well-being, nothing is more important than actual patient outcomes.

The challenge of choosing a gastric sleeve surgeon and program based on outcomes is that outcomes statistics are generally not reported, and not easy to figure out. When it is possible to figure out a surgeon’s/program’s outcomes statistics, it is because the surgeon either has published his/her outcomes, or the surgeon tells you when you ask.

Often, however, surgeons don’t know their own outcomes statistics. To know they must track their outcomes, and this is a lot of (unreimbursed) work, so many (most) don’t do it. My attitude is, if outcomes statistics are not known with certainty, I would have to assume that they are not good.

After outcomes statistics, the two next things I would focus on would be surgeon experience, and evidence that the surgeon/program prioritizes patients first.

More gastric sleeve surgeon experience is definitely better than less experience. More experience, however, does not ensure a record of excellent outcomes. Studies on gastric sleeve leak, for example, show that even among only experienced surgeons, leak rates vary 20-fold between the surgeons with the lowest leak rates and the surgeons with the highest leak rates. When you include less experienced surgeons, leak rates vary as high as 50-fold!*
Gastric sleeve complications

I would also value evidence that a surgeon/program prioritizes patients first. I hate to say it, but there is a strong tendency in the field of weight loss surgery for surgeons and programs to prioritize themselves over patients. This means prioritizing speed of surgery, number of surgeries, and insurance collections. This approach of maximizing collections, in my experience, does not result in excellent patient outcomes!*

Clues as to whether it is the patient or the surgeon getting prioritized first include the surgeon’s/program’s dedication to quality patient care (education, follow-up, support), and the surgeons operative volume per day. If patient education is not a strong focus, patient outcomes are not the priority. If the surgeon operates on more than 4 or 5 patients per operating day, I would worry that quality of surgery is not the top priority.

Summary

There are many great gastric sleeve surgeons out there, but there are also many that are not great. Unfortunately, it is often not easy to tell the good ones from the bad ones. But with some effort to figure out a surgeon’s outcomes, experience, and priorities, it is possible to make a good decision and maximize your chances to get a great gastric sleeve outcome.

Learn more about Dr. Oliak and his Orange County gastric sleeve program.

* Individual outcomes vary after weight loss surgery. Outcomes vary between different surgeons, and outcomes vary between different patients. Past performance is no guarantee of future results.

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