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Department of Surgery
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 Obesity

Columbia University Center for Metabolic and Weight Loss Surgery
Patient Experience  Day of Surgery


On the Day of Surgery

  • It is important that you do not eat or drink anything after midnight, unless you have medications to take (take only with a sip of water).
  • Most of your medications, if you take any, should be taken right up until the time you come to the hospital. This is especially true for heart medications, blood pressure medications, and diuretics (water pills). Take only with a sip of water.
  • If you take insulin, take only half of your normal morning dose, at your usual time.
  • On the day of surgery, shower or bathe well, paying particular attention to the operative site.
  • Bring all medications that you are currently taking with you to the hospital.
  • Do not bring any valuables with you to the hospital.
  • On the day of surgery, report to the Vivian & Seymour Milstein Family Heart Center, 173 Fort Washington Avenue, 3rd floor registration. This building is adjacent to the Milstein building. Plan to arrive around 2 hours before the scheduled time for surgery (unless given another time by the surgeon's office).

Your Hospital Stay

When you wake up from surgery, you will probably already be in the recovery room or go there shortly. Once your breathing is normal and vital signs are stable, which usually takes several hours, you will be taken to a monitored hospital room. If all goes well and the oxygen levels in your blood are okay, you will go to a regular hospital room the next day.

Tubes and Drains

When you are asleep in the operating room, two other tubes will be placed while you are under anesthesia: a tube to breathe for you while you are asleep and a catheter in your bladder to collect urine. The catheter will stay in until the day after your surgery or possibly longer. You may have a sore throat from the tube in your nose and the breathing tube used during surgery. This soreness will usually go away in a day or two.

Occasionally, a tube may be placed through the nose into the stomach at the end of surgery. If placed, this nasogastric tube will remain in place postoperatively until it is determined that your stomach is healing well. This tube removes secretions from the upper portion of the stomach and helps prevent distention of the upper pouch. In our program, a nasogastric tube is rarely used and is reserved for only complicated situations.

Rarely, your surgeon may also choose to place a tube through your skin into the bottom part of your stomach. This tube is called a Gastrostomy tube or G-tube. G-tubes are not routinely placed, but may be necessary to keep the bottom part of your stomach from getting too bloated. If you have had stomach surgery in the past, you are more likely to have a G-tube placed. G-tubes are often used for patients who are having revisional surgery.

Pain Management

Patient Controlled Analgesia (PCA) is the method of pain management used for Gastric Bypass patients. A medication, such as Demerol or Morphine, will be given through an IV or an epidural and the dosage is controlled by the patient within pre-set limits. PCA allows you to receive small doses of pain medicine frequently, which provides steady pain relief. After surgery, a nurse in the recovery room will set up your PCA and will instruct you on how to use it. When you want to give yourself a dose of medication, you just push a button. PCA will not let you give yourself too much medication. PCA does an excellent job of controlling your pain. It does not, however, take away all of your pain. You will be very sore for the first couple of days; however, your soreness will rapidly decrease over the next few days. We also use Toradol which is an injectable non-steroidal anti-inflammatory. Tylenol is also frequently used to decrease the amount of narcotic needed.

Activity and Circulation

Activity is a very important part of your recovery and weight loss. Activity helps to prevent pneumonia, blood clots, and constipation and increases weight loss. For these reasons, your exercise program will start while you are in the hospital. You will get out of bed and walk the evening of your surgery. Most patients will be assisted out of bed on the evening of surgery. You will start walking in the hall the day after surgery.

Compression hose are plastic sleeves that will be wrapped around your legs during surgery and while you are in bed after surgery. They gently squeeze your legs and help blood circulate in your legs and feet. These hose will help prevent blood clots from forming in the veins of your legs. You will wear the compression hose for the first 2-3 days while in bed. Your nurse can send cool air through the hose if your legs become hot.

Breathing Exercises

You will be provided with an "Incentive Spirometer" after surgery. It is very important to take about ten deep breaths into the spirometer every hour to help prevent pneumonia, lung collapse and other breathing problems. Coughing and deep breathing will also help to prevent breathing problems. Holding a pillow over your incision will help with discomfort during coughing. If you have asthma, you will need to bring your asthma inhalers with you to the hospital.

If you have been diagnosed with sleep apnea through a sleep study, you will remain on breathing monitors in a monitored bed overnight or until you are breathing well on your own. If you use a C-pap machine at home, you will need to bring it with you to use in the hospital.

Tests After Surgery

You will receive nothing by mouth following surgery. This allows time for return of GI function and helps reduce the possibility of leaks.

Patients who have received a banded gastric bypass operation will have an upper gastrointestinal X-ray test, also known as an "upper GI." For this procedure, you will drink special liquids and X-rays will be taken. This test lets us know that a leak has not developed from the small stomach pouch. To relieve discomfort, ask your nurse for pain medication or push your PCA button before your upper GI.

Gastric banding patients are taken for an upper GI the morning after their surgery if they stay overnight in the hospital. If they go home the day of surgery, they must go for an upper GI before an adjustment will be done.

Necessity of an upper GI in patients who have received gastric sleeve or duodenal switch procedures varies, and is determined by the surgeon.


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