Casco Bay Surgery

No tobacco use (cigarette/pipe smoking or chewing) for at least 3 months before the first Bariatric team appointment. 

We require a nicotine level (blood or urine) to be performed after you have quit. Your PCP can arrange the test. We cannot schedule your first appointment until we receive a negative result. We ask that you quit before your appointment in order to avoid weight gain once we have obtained your baseline weight. 

For former tobacco users, we check nicotine levels again a week or two before surgery and have cancelled operations for positive blood tests noticed as late as 15 minutes before surgery. We may occasionally also check nicotine levels for patients who list themselves as non-users in their paperwork. 

We cannot provide prescriptions for nicotine patches or offer much assistance in quitting. You must work closely with your primary care provider (PCP). Be aware that nicotine gum and patches occasionally cause positive nicotine tests even when you're no longer smoking or chewing. 

Chemicals in cigarette and pipe smoke irritate the lining of the lungs. This causes larger amounts of thick, liquid secretions to form and slows the lungs' ability to clear out those secretions. This explains the "smoker's cough" but causes problems even in people who don't have a regular cough. Obesity limits a person's ability to breathe deeply and cough effectively. Pain after surgery and the pain killers we give also limit a patient's ability to clear these secretions. As a result, the secretions build up in the lungs during the first few days after surgery. This causes fevers and greatly increases the risk of pneumonia, a serious complication after this operation. It takes several months for the secretions to diminish after quitting smoking.

Nicotine in tobacco of any sort (smoked or chewed) damages the lining of blood vessels and also causes them to constrict (narrow). This can prevent enough blood from reaching the anastomosis (connection) between your jejunum (intestine) and your new stomach pouch. If this blood supply is damaged there's a higher chance of having a leak at the anastomosis - the most common cause of death after a gastric bypass. The poor blood supply can also cause ulcers to form at the anastomosis months or more after surgery in patients who have started smoking again. These ulcers can burrow all the way through the intestine and leak. Even without a leak, they often won't heal until you stop smoking again. 

We offer surgery to carefully selected patients because morbid obesity is a disease that shortens lives. Our goal is to help you become healthier and live longer. Gastric bypass surgery is successful in most patients but also causes the death of 1 in every 200 people who have the operation. Although less risky, a Lap-Band is still a big operation that has risks to it too. Since quitting tobacco use helps people become healthier and live longer, doesn't require surgery, and has no risk to it, our surgeons require all patients to quit before having surgery. It makes sense. 

If you are still smoking or chewing at the time of your first appointment, it will cause a delay. We will wait until a blood test for nicotine is negative and then add 3 months before seeing you for a second appointment.  

Most people gain a small amount of weight when they quit smoking cigarettes. Another of our policies prevents us from giving surgery dates to people who gain weight between appointments, so you'll have to lose that weight again. This will also cause a delay. 

Nicotine levels are very sensitive and show even small amounts of nicotine in your body. Any tobacco use will raise this level, including sometimes gum or patches, but we have no other way to insure the safety of our patients than to rely on this test. It is important to be free from all forms of tobacco before having the test performed.

Regardless of whether or not you have weight-loss surgery, quitting will help you be healthier and live longer.