Weight Loss San Diego

Dr. Wael Kouli is board certified and fellowship-trained in bariatric surgery and has performed all forms of bariatric surgery, including LAP-BAND® surgery and the Roux-en-Y Gastric Bypass.


The Prevalence of Obesity

According to the Centers for Disease Control and Prevention, nearly two thirds of all U.S. adults are overweight and one third of all U.S. adults are obese. Each year 300,000 deaths are attributed to poor diet and inactivity.

Obesity is a life-threatening disease affecting millions of Americans. We see many patients requesting cosmetic surgery who cannot qualify because of their weight and it has become a disease of epidemic proportions in the USA.

You’ve struggled with dieting and exercise – perhaps even used medication – to help lose weight. But despite all your best attempts, the pounds just don’t seem to come off and stay off. And, you can’t figure out why.

Take comfort in knowing that you are not to blame. Obesity is a complex disease with numerous causes, many of which you can’t control.

According to the National Institutes of Health, there’s a difference between being overweight and being obese. A person can be overweight for his/her height due to muscle, bone, fat and/or body water. Obesity occurs when a person has too much body fat. For men the level is 25% and greater and for and for women, it is 30% and greater. We use the Body mass index (BMI) to determine overweight and obesity levels.

Those who are morbidly obese put themselves at greater risk for serious illnesses that jeopardize health. That’s why it’s so important to seek help from qualified medical professionals who understand the issues you face and can help guide you in your choice of weight loss options.


Potential Benefits of Weight Loss Surgery

  • Greater than 50% excess weight loss
  • The weight stays off, if the patient is committed to alife-style change
  • Type II diabetes is improved or cured in most patients
  • Hypertension improved or resolved
  • Normalized or decreased cholesterol and lipids
  • Decreased risk of heart attack, stroke and premature death
  • Improvement of sleep apnea
  • Improvement in gastroesophageal reflux disease (GERD)
  • Improvement in joint pain and venous stasis disease


Alternatives to Weight Loss Surgery

Healthy diet and exercise are traditional methods of losing weight. Other alternatives include: Weight reduction programs that charge fees to administer the program, medical treatment by a physician and behavioral modification treatments. Weight loss surgery should only be considered after attempts at traditional weight loss methods have failed.



  • Age 18-65, male or female
  • Willingness to comply with follow-up and diet changes
  • Nonsmoker for at least 2 months
  • Certain medical conditions & surgeries may make weight loss surgery too risky
  • Body Mass Index* (BMI) of 40 to 60, with documented failed medical weight loss efforts (BMI of 35-39 with qualifying medical co morbidities)

* Body Mass Index is a number derived by using height and weight measurements that gives a general indication if
weight falls in a healthy range.


Risks of Weight Loss Surgery

Risks of weight loss surgery will vary for each candidate. Therefore, each person should discuss possible risks with Dr. Kouli.

Risks for weight loss surgery may include:

  • Early Complications: leak, bleeding, infection, anastomotic stricture, blood clots, pulmonary embolism, pneumonia
  • Late Complications: ulcer, hernia, bowel obstruction, anemia, B12 and calcium deficiency, dumping syndrome
  • LapBand Complications: slippage, erosions, port flip or breakage
  • Death

Note: Many patients have temporary hair loss; some patients complain of excess gas or occasional GI upset in the first few months.


Your New Diet

Your diet progresses through phases, starting with clear liquids. Your diet then progresses to full liquids and pureed food over a 4 to 5 week period. Normal foods are then slowly introduced, but in much smaller quantities than before the surgery. Dietary counseling continues indefinitely.



Exercise is critical not only to maximize weight loss but also to improve your cardiovascular health. We recommend that you begin an aerobic exercise routine, such as brisk walking or swimming, even before surgery.


Cosmetic Surgery

You lose fat but not skin. After weight loss is complete (about one year), many patients elect to have the excess skin hanging below the waist removed with an operation called a Panniculectomy. Other cosmetic surgery options include: Removal of excess skin on the arms, neck, thighs, as well as breast and buttock lifts.


Support Groups

Studies have shown that positive results from weight loss surgery correlate with support group involvement. One pre-operative attendance at a weight loss surgery support group is expected. Monthly support group attendance post-operatively is encouraged.



Female patients are advised to wait 12 to 18 months after a gastric bypass before becoming pregnant.



Authorization for weight loss surgery must be obtained from your insurance company prior to scheduling surgery. Each insurance company has different requirements. Physician documentation of morbid obesity to include height and weight over a three year period of time is one example. Documented physician supervised weight loss efforts for six months prior to surgery is another.



Step 1

Contact your insurance company for specific policy information on weight loss surgery. All insurance pre-certifications must be completed before weight loss surgery is scheduled. If you have questions, concerns or need assistance, call Dr. Wael Kouli at 619-435-5880.

Step 2

Call 619-435-5880 for an appointment.

Step 3

Attendance at a seminar at a support group meeting prior to your appointments is strongly advised. Please call our office for a seminar schedule.

Step 4

A complete medical examination including: lab work, EKG, ultrasound of the gallbladder and chest x-ray may be required after your initial appointment with Dr. Kouli.

Step 5

Medical clearance by a family physician or internist is required for surgery. Psychological clearance is also required.

Step 6

Preoperative appointments with Dr. Kouli, the Program dietitian will be scheduled, along with a pre-anesthesia exam.

Step 7
Weight Loss Surgery

Laparoscopic (Minimally Invasive) Gastric Bypass

Recently, surgeons have performed several anti-obesity operations including gastric bypass using minimally invasive techniques. This approach uses five or six tiny incisions instead of one large incision to perform the operation. These operations require two skilled, well-trained surgeons, skilled assistants and many new specialized instruments.

During the procedure, a Laparoscope is inserted into the abdomen. This provides the surgeons with a magnified view on a TV monitor. The result is better visualization throughout the procedure, allowing for more precise work.

By eliminating the large abdominal incisions, bowel manipulation and extensive dissection, patients are assured a faster recovery. Further advantages of the laparoscopic approach include less pain following the surgery, less scarring, and likely an earlier discharge.


Risks of Bariatric Surgery

Bariatric surgery is major surgery, even with minimally invasive surgical techniques. The operation requires general anesthesia, at least two to four days of hospitalization, and several weeks of physical recovery. Furthermore, as with any major operation, there are risks.

General Risks

All abdominal operations carry these risks:

  • bleeding
  • infection in the incision
  • potential problems with the heart and/or lungs
  • obstruction (blockage) of the intestine caused by adhesions
  • hernia through the incision; rejection of suture materials
  • risks associated with general anesthesia (these risks are not significantly greater in most morbidly obese patients than in patients with lower body mass indexes


Risks of Gastric Restrictive Operations

Potentially fatal risks include leaks from the stomach or intestine and embolism (blood clots). The chances of these complications occurring are between 1% and 2%. The risk of death associated with bariatric surgery is less than 1%.

Early Risks

1. Leakage of fluid from the stomach or intestine through the staples or sutures which results in abdominal infection. This potentially serious (but rare) complication usually requires a second operation for drainage of infection.

2. Injury to spleen. This is a very uncommon complication which may require removal of the spleen if bleeding cannot be controlled.

The incidence of early postoperative complications is under 5%.

Late Risks

1. The formation of ulcers in the stomach or small intestine. This is an uncommon complication which occurs in approximately 4 out of 100 patients after gastric bypass surgery. Ulcers are more common in smokers and patients taking medications for arthritis.

2. Dumping. Patients may develop loose stools and/or abdominal cramps shortly after eating certain types of foods. These symptoms can be avoided by not eating the offending foods. Diarrhea is uncommon after gastric restrictive surgery and can be successfully treated with medication. Dumping is occasionally associated with brief periods of light-headedness, sweating or heart palpitations due to low blood sugar. These symptoms can usually be reduced by drinking a sweet liquid like fruit juice.

3. Obstruction of the opening of the stoma. This rare complication occurs in less than 1 out of 100 gastric bypass patients and can occur when a piece of food becomes lodged in the stoma. When this happens, the piece of food is removed through a tube (endoscope) passed from the mouth into the stomach.

4. Vitamin and/or iron deficiency. This may occur in a mild form in as many as 40 percent of patients after gastric bypass. Iron and some vitamins, most notably Vitamin B-12, are primarily absorbed in the stomach and upper part of the small intestine which is bypassed. Both the vitamin and iron deficiencies are easily treated by either oral supplementation or injections. Women who are regularly menstruating will need additional iron supplements.

Low calcium and protein levels and deficiencies in fat soluble vitamins (A,D,E) are known to occur after Gastric Bypass. Gas, flatulence and diarrhea may be more prominent after gastric bypass.

5. Inaccessibility of the lower stomach and upper intestine to diagnostic tests such as upper GI (barium) x-rays and upper GI endoscopy. When the stomach is closed off in a gastric bypass, there is no way for contrast material or an endoscope to reach the bypassed stomach (the part of the stomach below the staples). This would make diagnosis of a problem, such as an ulcer of the lower bypassed stomach, more difficult. The incidence of problems occurring in the bypassed part of the upper GI tract is extremely low.

6. Staple disruption can occur at any time after these operations, but is uncommon. If staples pull out, the feeling of fullness will probably disappear. A second operation may be required (restapling).

7. Hair loss may be a temporary problem for some patients within the first six to twelve months after the operation. This is largely due to vitamin deficiency. There is no specific remedy other than proper nutrition and multivitamin supplements.

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