Frequently Asked Questions

Minimally Invasive Surgery

Why do we need a new way to do minimally invasive surgery and why do Robotic Surgery?

Despite the widespread use of minimally invasive or laparoscopic surgery in today's hospitals, adoption of laparoscopic techniques, for the most part, has been limited to a few routine procedures. This is due mostly to the limited capabilities of traditional laparoscopic technology, including standard video and rigid instruments, which surgeons must rely on to operate through small incisions.

What is Minimally Invasive Surgery (MIS)?

MIS is surgery typically performed through small incisions, or operating ports, rather than large incisions, resulting in potentially shorter recovery times, fewer complications, reduced hospitalization costs and reduced trauma to the patient. While MIS has become standard-of-care for particular surgical procedures, it has not been widely adopted for more complex or delicate procedures – for example, prostatectomy and mitral valve repair. Many surgeons have been slow to adopt MIS for complex procedures because they generally find that fine-tissue manipulation – such as dissecting and suturing – is more difficult than in open surgery. Intuitive Surgical's technology usinf the da Vinci Robot, however, enables the use of MIS techniques for complex procedures.

What exactly is Laparoscopy or Minimally Invasive Surgery?

Laparoscopy is a Minimally Invasive Surgical (MIS) procedure in which a surgeon gains access to the abdominal cavity by way of small incisions in the abdominal wall.  An instrument called a laparoscope is used to give the surgeon an exceptionally clear view of the inside of the abdominal cavity. This surgical approach is considered “minimally invasive” because of the very small incisions used.

Weight Loss Surgery

Will I need to have another surgery to remove excess skin after weight loss?

Every patient handle weight loss differently, and it is impossible to predict who will have problems with excessive skin after surgery.  If this does become a problem for you, once your weight loss has stabilized (1 - 2 years after surgery) we will refer you to a plastic surgeon to discuss the removal of excess skin.

Can I get pregnant after surgery?

Yes, you can. Pregnancy places a physical demand on your body. It is important to wait a year if possible after surgery, to ensure you and your baby are able to get all the vitamin and nutrients that are essential for pregnancy

What about hair loss after surgery?

Some patients experience thinning and/or hair loss after surgery. The dietitians have found several dietary supplements that may be effective in minimizing this condition. Usually this can be avoided and is temporary. It is also related to increasing protein in your diet.

How long will I be out of work?

1- 2 weeks is the typically time of recovery from abdominal surgery. This will vary from patient to patient .  The type of work will also influence how soon you may return.

When will I have to see the doctor after the Gastric Sleeve surgery?

You will see your surgeon 7-10 days post surgery, and then 1,3,6,9, and 12 months, or earlier as needed.

What are the dietary restrictions following weight loss surgery?

Following surgery, you will need to follow specific eating guidelines. Registered dietitians work directly with bariatric surgery patients to provide dietary education before and after surgery.

What about exercise after surgery?

Light exercise, such as walking, should begin immediately after surgery. Vigorous exercise will be gradually introduced in six to eight weeks. Exercise will not only keep you feeling well and energized, but it also helps burn fat and calories. For many people, returning to physical exercise is an important step toward feeling better.

Will My Stomach Stretch to its Original Size After My Sleeve Gastrectomy?

The stomach can never stretch back to original size. Patients who continue to overeat and lead sedentary lifestyles following surgery risk increasing their new stomach size and weight.

What are the Risk Factors for Being Obese?

  • Type II Diabetes
  • High blood pressure
  • Heart disease
  • Cancer
  • Osteoarthritis of weight - bearing joints
  • Respiratory problems
  • Gastroesophageal reflux disease
  • Infertility, Gestational diabetes, Pre-eclampsia
  • Urinary stress incontinence
  • Menstrual irregularities
  • Depression
  • Suicide
  • Alzheimer's disease

Am I a Candidate for Weight Loss Surgery?

According to the 1991 National Institute of Health criteria, bariatric surgery is offered to individuals with Body Mass Index (BMI) > 40, or individuals with BMI > 35 and obesity-related illnesses such as diabetes, obstructive sleep apnea, high blood pressure, joint disease, etc. To determine your BMI, use the BMI calculator.
  • 100 lbs or more over ideal body weight or
  • Have a Body Mass Index (BMI) of 40 or greater or
  • Have a BMI of 35 or greater with two or more obesity-related co-morbidities (medical problems) such as diabetes, obstructive sleep apnea, high blood pressure, joint disease, etc.
People who have not yet tried traditional weight loss techniques are usually not candidates for bariatric surgery. Usually, you have to have tried and failed to lose weight using traditional methods.  While surgery is a proven weight loss tool, it should not be the first option.    

Why should I have my weight loss surgery with Dr. Rekkas?

Dr Rekkas offers a specialized, multi-disciplinary Bariatric Surgery team who works with you on an individual basis to provide you with the knowledge and skills needed to be successful after your weight loss surgery.  He  completed a fellowship specializing in Bariatric and Minimally Invasive Surgery and is well qualified to help you loose weight.  He was the first surgeon to bring the gastric sleeve procedure to Manatee County. We provide a comprehensive network of support which includes: nutritional education and counseling, support group meetings to help you deal with the nutritional, lifestyle, and emotional changes you will experience. Our staff includes surgeons, physicians, physician assistants, nurses, dietitians, and psychiatrists, all of whom specialize in bariatrics and are available for life long care and support.

Does my insurance cover weight loss surgery?

Most insurance companies have determined weight loss surgery to be a covered benefit for obesity and obesity related co-morbidities. We will work with you to contact your insurance provider to determine if weight loss surgery is a covered benefit under your policy and to see if they have any additional criteria. Insurance providers are changing their individual criteria for weight loss surgery at least every enrollment period. Please check with your provider frequently to see if their criteria have changed.

What are the potential risks and complications bariatric surgery?

Bariatric Surgery Risks

  • Abdominal hernia
  • Chest pain
  • Collapsed lung
  • Constipation or diarrhea
  • Dehydration
  • Enlarged heart
  • Gallstones, pain from passing a gallstone, inflammation of the gallbladder, or surgery to remove the gallbladder
  • Gastrointestinal inflammation or swelling
  • Stoma obstruction
  • Stretching of the stomach
  • Surgical procedure repeated
  • Vomiting and nausea
Note: Your weight, age and medical history play a significant role in determining your specific risks. Your surgeon can inform you about your specific weight loss surgery risks.

Risks Associated with Abdominal Surgery

  • Bleeding
  • Pain
  • Shoulder pain
  • Pneumonia
  • Complications due to anesthesia and medications
  • Deep vein thrombosis
  • Injury to stomach, esophagus, or surrounding organs
  • Infection
  • Pulmonary embolism
  • Stroke or heart attack
  • Death
Note: Risks are associated with any type of surgery, including abdominal surgery. These risks are greater for individuals who suffer from obesity.

Mortality rates

According to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement, the gastric bypass complication rate in the hands of a skilled surgeon is roughly 5%, and the operative mortality (death) rate is roughly 0.5%.21

Sleeve Gastrectomy Surgery Risks and Complications

As with any surgical procedure, there are potential risks and complications that can occur with sleeve gastrectomy. We’re committed to providing you with the information you need to make a well-informed decision about your surgery. Although these problems rarely occur, we want you to know the facts.

Potentially serious complications


  • Perforation of stomach/intestine or leakage, causing peritonitis or abscess
  • Internal bleeding requiring transfusion
  • Severe wound infection, opening of the wound, incisional hernia
  • Spleen injury requiring removal/other organ injury
  • Gastric outlet or bowel obstruction


  • Pneumonia, atelectasis (collapse of lung tissue), fluid in chest
  • Respiratory insufficiency, pulmonary edema (fluid in lungs)
  • Blood clots in legs/lungs (embolism)


  • Myocardial infarction (heart attack), congestive heart failure
  • Arrhythmias (irregular heartbeats)
  • Stroke (cerebrovascular accident)

Kidney and liver:

  • Acute kidney failure
  • Liver failure
  • Hepatitis (may progress to cirrhosis)


  • Anorexia nervosa, bulimia
  • Postoperative depression, dysfunctional social problems
  • Psychosis
  • Death

Other complications (may become serious):

  • Minor wound or skin infection/scarring, deformity, loose skin
  • Urinary tract infection
  • Allergic reactions to drugs or medications
  • Vomiting or nausea/inability to eat certain foods/improper eating
  • Inflammation of the esophagus (esophagitis), acid reflux (heartburn)
  • Low sodium, potassium, or blood sugar; low blood pressure
  • Problems with the outlet of the stomach (narrowing or stretching)
  • Anemia, metabolic deficiency (iron, vitamins, minerals), temporary hair loss
  • Constipation, diarrhea, bloating, cramping, malodorous stool or gas
  • Development of gallstones or gallbladder disease
  • Stomach or outlet ulcers (peptic ulcer)
  • Staple-line disruption, weight gain, failure to lose satisfactory weight
  • Intolerance to refined sugars (dumping), with nausea, sweating, weakness