Counseling by the clinical dietician will be provided to each patient. At this time all the food groups will be reviewed and once again we will emphasize the need to take small bites and swallow slowly. During your hospital stay, your diet will be as follows:
Gastric Bypass/Duodenal Switch
Gastric Banding/Sleeve Gastrectomy
Post-Operative Discharge Instructions & Follow-Up
You should be ready to go home on the second or third day after surgery unless your surgeon tells you that he/she plans to extend your hospital stay. If you are having a Lap Band procedure, you may go home the same day of surgery. If you have any questions or concerns once you are home, call your surgeon or the nurse practitioner.
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body is recovering from the stress of a major operation and because weight loss is occurring during this time the feeling of weakness may be somewhat prolonged.
Follow up after surgery is extremely important. The operation is only one part of the course to a good result. Success is not determined at the time of discharge. Weight loss will occur for 12 to 18 months following the operation. Participation in the behavior modification program is VITAL to the long term maintenance of weight loss achieved. Counseling by the dietician is important in making the transition from pureed to solid foods. This will help emphasize the importance of appropriate food choices to maintain a balanced diet and avoid high calorie liquids and soft foods, which can defeat the purpose of the operation.
CONSUMING TOO MANY CALORIES CAN DEFEAT ALL GASTRIC REDUCTION OPERATIONS. The follow up visits permit early recognition of vitamin and iron deficiencies or other problems so appropriate treatment can be given.
For Gastric Bypass, Duodenal Switch and Sleeve Gastrectomy patients the first postoperative visit will be 2-3 weeks after discharge. Visits will then be at 6-weeks, 3 months and 6 months after the operation. Six months after surgery, follow-up visits are scheduled every 6 months to one year for life. Follow-up after this surgery is forever, and will need to be arranged if you leave the area.
For gastric banding patients, the first postoperative visit will be 2-3 weeks after discharge and the second, 5-6 weeks after discharge. Then visits are scheduled every 2-4 weeks until the LAP-BAND is adjusted appropriately for you. We then recommend monthly follow-up visits for the first year, every 3 months for the second year and yearly starting the third year after surgery.
Exercise is the key to success with the Gastric Bypass and Lap Band surgery. Your short term goal is to walk 30 minutes per day, 7 days per week. Your long term goal is to exercise 45 minutes to one hour daily, longer if possible.
If you have joint problems or arthritis and cannot walk distances, swimming may be easier on your joints. Ask you surgeon when it is okay to swim (usually 3 to 4 weeks after surgery). You may go up and down stairs as tolerated.
No driving for 2 weeks after surgery or until there is no pain or discomfort that might interfere with emergency maneuvers. Also, overstraining your muscles may increase the risk of developing a hernia while healing. Therefore, stop any strenuous activity if it becomes uncomfortable for you during the first month. In general, lifting anything over 10 lbs. during the first month may overstrain your muscles.
If you work at a desk, you will be allowed to return to work when you feel up to it. Your surgeon will require you to stay out of work for 6 weeks (open gastric bypass)); 4 weeks (lap gastric bypass) or 2 weeks ( Lap-Band) if your job is more physically demanding.
Care of Your Incision
If still in place, remove the outer bandage 3 days after surgery. Do not remove the steri-strips (i.e. adhesive strips) over the incision for one week or until they become loose. They will curl and fall off. If they are still in place 2 weeks after your surgery, gently peel them off. You can do this in the shower. Some itching at the incision is normal during healing. Do not scratch the area.
Can I shower or bathe?
It is OK to shower with soap. Pat the incision dry after showering. Do not take a bath or soak in water for one month.
Care of Your Gastrostomy Tube (G-tube)
Only patients having major revisional surgery usually get a G-tube. If you have had a G-tube placed during surgery, you will receive special instructions about the care of the tube. The G- tube is usually removed on the first or second follow-up visit. The tube will be connected to a drainage bag the first few days you are in the hospital. A special clamp will be applied to the tube to allow you to disconnect the bag before you go home. A nurse will show you how to use the clamp. The tube will remain clamped while you are at home unless you need to open it to release gas. You may shower and use soap with the G-tube. After showering, use a Q-tip dipped in Hydrogen Peroxide to clean the skin around the tube. Put clean gauze around the tube. Check the skin around the tube for any signs of infection including increased redness, swelling, pain or pus. Report any concerns to your surgeon. You may request a visiting nurse to assist in the care of the G-tube.
You MUST avoid getting pregnant for 18 months after surgery. Pregnancy would be very dangerous for your and for your baby during the first year after surgery and may cause birth defects. For this reason, you need to take precautions to prevent pregnancy. Rapid weight loss increases fertility, so you will need to be EXTRA careful. Effective birth control used properly and with all intercourse is essential to avoid pregnancy.
You will need to take the following medications as directed after discharge. Keep in mind that unless liquid medications are used, all pills need to be crushed. Capsules should be opened and the powder added to the food.
Medications to Avoid
DO NOT take the following medications, as they may cause ulcers in your pouch:
If you need to take any of these medications for any length of time, call your surgeons office. You may need a medication to protect your stomach or an alternate prescription medication.
You will have to take vitamins and minerals daily for the rest of your life to prevent deficiences. Gastric Bypass patients will have to take a multi-vitamin with minerals, calcium with vitamin D, iron and vitamin B12 (the 12 should be a subscript). LAP-BAND and Sleeve Gastrectomy patients will have to take a multi-vitamin with minerals and calcium with vitamin D. Duodenal Switch patients will have to take a multi-vitamin with minerals, calcium with vitamin D, iron and ADEK's (the fat soluble vitamins A, D, E and K).
Your dietitian will discuss this with you in more detail. Vitamin and mineral levels in your blood must be monitored at least yearly. This is one reason that you must return to see your surgeon and dietician at least once a year for a follow-up visit.
Be prepared for emotional ups and downs after surgery. Some patients feel like they are on an "emotional roller coaster". These feelings are completely normal and usually go away. Sometimes it helps to talk with gastric bypass nurse or another gastric bypass patient.
Eating too fast, too much, or drinking with meals may cause vomiting. Most patients will, at some point, vomit. It may be caused by a "stomal stenosis" or by something you may have done to cause vomiting. If you vomit, stop and think about what may have caused it. For example, did you eat too fast; did you eat too much? If the answer is "no" or if you are unsure, call the surgeons office.
Keeping a food diary will help you determine if vomiting is caused by the types of foods you are eating or if there is a problem. Before you call the office it is helpful to write down what you have eaten and if it made you vomit.
Dumping Syndrome is severe diarrhea, nausea, lightheadedness, and stomach cramps. Dumping syndrome is caused by eating and drinking at the same time and by eating sweets or foods high in sugar. DO NOT drink fluids with your meals and NEVER EAT SWEETS.
Gas Problems are also common after the weight loss surgery. If you have pains at home, try simethicone drops, Bean-O, or Gas-X.
Constipation after Gastric Bypass surgery is not uncommon and is more likely to occur if you are taking iron. Because of possible problems with hemorrhoids, hernias, and intestinal blockages, it will be important for you to prevent constipation. It may be necessary to take a stool softener for the first month or so, until you can drink more fluids and eat more fiber. Other ways to improve regularity include:
If you continue to have problems try a Milk of Magnesia (2 tablespoons, twice a day). If you still experience a problem, try Ducolax suppository or Fleets enema. If any of these problems continue, call your surgeons office.
Long Term Expectations
Weight loss after surgery is gradual and occurs at the greatest rate in the first several months after surgery. The consistency rather than the rate of weight loss is most important in the long run.
After the first few months the rate of weight loss will decrease, this is related to the decrease in the amount of fat. Very few patients will reach ideal body weight. Patients who come within 50 percent of the ideal body weight are considered successes. The heaviest patients must lose the most weight to become successful.
THE MOST COMMON REASONS FOR FAILURE ARE POOR FOOD SELECTIONS, GRAZING AND LACK OF EXERCISE. Patients may lose track of the new eating habits and return to some of the bad eating habits which contributed to their obesity in the first place. In most cases, these bad habits can be corrected through early intervention by a dietician and minor changes in the diet. This is why regular follow-up is so important after this type of surgery.
Medical problems related to the obesity generally improve as weight reduction occurs. Blood pressure, blood chemistry like glucose for diabetics and blood fat in patients with hyperlipidemia will be routinely followed. Patients are encouraged to visit their primary medical doctors at regular intervals for adjustments in medications. Communication to your primary care physician is very important for the smooth coordination of care.
Gastric Bypass is potentially reversible. Reversal requires another operation of the same, or greater, magnitude with the same, or greater, risks. Reversal of this operation is very uncommon and rarely occurs beyond 6 weeks from the time of surgery. Stretching of the upper part of the stomach may occur but is almost never a reason for inadequate weight loss.
Billing & Payment
Many insurance companies provide coverage for gastric reduction operations because this type of surgery is for prevention and treatment of obesity associated health risks and not for cosmetic reasons. Our clerical staff can inform you as to whether or not one of our surgeons accepts your insurance. They will also help you get approval for the surgery from your insurance company.
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