Post-Op, Aftercare

Most weight loss surgery patients recover from surgery without complications. Although you will have some discomfort from the surgery, you will need to get out of bed and start walking the next day. This activity is crucial in preventing surgical complications, such as blood clots.

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.

The hospital stay for patients who undergo the Roux-en-Y procedure is usually two to four days. Patients who have the LAP-BAND procedure will stay overnight. Before you are discharged, you will receive full instructions for your care at home. You will be scheduled to see your surgeon about one week after weight loss surgery.

At home after surgery

If you have any questions or concerns once you are home, you should call the nurse who works with your surgeon. Specifically call your doctor if you experience any of the following:
• Persistent nausea or vomiting
• Vomiting a bright red or dark brown liquid (go to the emergency room)
• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision(s)
• Any new or unusual pain in your abdomen, chest or legs
• Temperature higher than 101°F
• Passage of very dark stool
• Acute depression or negative emotions

After surgery guide to:
• Eating
• Incision Care
• Follow-up Visits
• Dumping Syndrome
• Exercise
• Activity Restrictions
• Avoid Pregnancy

Eating

At home, you will need to follow specific eating guidelines that your dietitian will have explained to you. For the first six weeks after your weight loss surgery, your diet will consist of liquid/pureed food. This includes foods that are liquid to soft in consistency. Examples of soft consistency foods are scrambled eggs, cottage cheese, sugar-free yogurt, hot cereal and mashed potatoes. You also can drink non-carbonated fluids that are sugar-free and caffeine-free. Good choices are water, milk, sugar-free flavored drinks and high-protein liquid supplements. Your dietitian will recommend liquid supplements to meet your nutritional needs during this time. As your tolerance builds, you will progress to a soft diet and then to regular foods. Your “new” stomach is roughly the size of an egg. It will stretch to the size of a cup in about a year. You can avoid discomfort and complications if you do the following:

• Eat small, frequent meals (five or six) throughout the day. (Your stomach will be too small to hold large meals.)
• Chew all foods slowly and thoroughly. (It may take you up to an hour to complete your meals and snacks.)
• Drink fluids 30 minutes after your meal. Be sure to drink in sips.
• Do not drink fluids with your meals. Your smaller stomach may not be large enough to hold fluids and food at the same time.
• Do not eat sweets.

Avoid foods that cause any discomfort. You might consider keeping a diary of the foods you eat, as well as any foods that are difficult to tolerate. Your diary will help you identify which foods cause discomfort. During follow-up visits, you can use your diary to report any foods you cannot tolerate. Your dietitian will help you plan healthful, appropriate meals. You also will be guided in selecting a variety of foods that are rich in vitamins, minerals and protein so you will stay well nourished. Your dietitian will recommend a multivitamin/mineral supplement. Digestive distress, such as gas and constipation, is common in the first few weeks following bariatric surgery. Unless your physician instructs you otherwise, you can use over-the-counter gas relief medications and stool softeners. If you are constipated, you can add extra fiber to your diet by eating applesauce, oatmeal, and pureed prunes.

These symptoms need to be addressed during initial follow-up with endocrine, nutrition, behavioral health and surgery. To prevent dumping syndrome, DO NOT eat or drink the following:
• Beverages containing caffeine such as coffee, tea or chocolate
• Citrus food or juices such as orange, grapefruit, lemon or lime
• Carbonated beverages
• Sugar and sweeteners such as dextrose, fructose, mannitol, sorbitol, white sugar, brown sugar, syrup, molasses, candy, jelly, desserts, jams or preserves
• Alcohol
• Sweetened beverages including regular soda, coolers, drink mixes, Kool-Aid, fruit punch or undiluted fruit juice

In addition:


• Eat only canned or very tender, well-cooked fruits and vegetables.
• Do not eat any raw fruits or vegetables, except bananas.
• Do not eat the skins of any cooked vegetables or fruit.

Bariatric surgery will change your eating habits quite a bit. Rely on close family members and friends for support and encouragement, as this may be an emotional time in your life. It is important that you keep a healthy mind and body. Keep your follow-up appointments, exercise and learn to cope with emotional difficulties. Your health care team will also be there to guide you after your weight loss surgery.

Incision Care

Even though you may have staples or steri-strips on your incision when you are discharged, you may wash your abdomen with mild soap and water in the shower. Do not take a tub bath or use a Jacuzzi, pool or hot tub until your incision is fully healed. Call your doctor if you experience any of the following:

• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision
• Temperature higher than 101°F
• Any new or unusual pain in your abdomen, chest or legs

Follow-up Visits

Regular follow-up visits are scheduled during the first year after weight loss surgery to check your overall physical and mental health, metabolism and nutritional status. It is crucial to your health that you keep these follow-up appointments. Many patients will need plastic surgery one to two years after weight loss to remove skin folds around the abdomen. Your first follow-up visit with your bariatric surgery doctor surgeon will be seven to 10 days after discharge. Subsequent visits are scheduled for one month, three months and every three months thereafter for the first year. After the first year, follow-up visits are required on a yearly basis. You also will be scheduled to see the dietitian and psychologist about one month following discharge and for regular follow-up visits to help you adjust to life after bariatric surgery.

A lifetime commitment to follow-up

With a weight loss treatment, one of the most important components is the commitment to follow-up. We look forward to working with you in reaching and maintaining your health goals. Compliance to a follow-up scheduled is very important. Regular follow up visits are essential to evaluating your health and instrumental in achieving your weight loss goals. During visits, we will evaluate your compliance with lifestyle changes and validate progress.

Your required follow-up visit pattern after weight loss surgery is as follows:
• Five to seven days- initial post-operative evaluation
• One month- physician evaluation; psychological and nutritional follow up as needed
• Three months- assessment of diet, compliance with vitamins and exercise; psychological follow up as needed
• Six months- physician evaluation and blood work
• Nine months- assessment of diet, compliance with vitamins and exercise
• Twelve months- physician evaluation and yearly blood work
• Yearly for life- physician evaluation and blood work.

Missing office visits could compromise the outcomes of your weight loss surgery. Long-term follow-up care is mandatory for success.

Weight loss surgery nutritional guidelines

Purpose:

This diet is designed to restrict caloric intake to produce desired weight loss, to help develop appropriate eating habits and to prevent disruption or obstruction of your pouch. In addition, it is strongly recommended to pursue weight loss in preparation for surgery. Even a small amount of weight loss may contribute to a decreased surgical risk during bariatric treatment.

Main Focus:

1. Drink enough fluids to keep your body hydrated
2. Eat adequate protein
3. Take required vitamin and mineral supplements to meet Recommended Daily Allowances.

Diet Principles:

1. Drink 6-8 cups of fluid each day
• Sip one cup of liquid over an hour
• Stop drinking within 30-60 minutes of a meal
• Sip allowed beverages slowly
• Do not use a straw
2. High calorie foods, beverages, and snacks are omitted.
3. When your doctor gives you permission, vitamin/mineral and calcium supplements are required daily. Additional vitamin B12, iron, and zinc may be recommended.
4. Eat very slowly. Foods need to be thoroughly chewed to prevent blockage.
5. Stop eating as soon as you are full. Indications of fullness are: a) a feeling of pressure in the center just below your rib cage, b) a feeling of nausea, c) a pain in your shoulder area or upper chest. Contact your doctor if the above symptoms persist or worsen.
6. Include protein first at each meal to help maximize protein intake. As your pouch expands, you may only need to eat 3 meals and 1-2 high protein snacks each day.
7. The diet will be advanced gradually, depending on tolerance:
Phase I Clear liquid diet (in hospital only)
Phase II Full liquid diet (1-2 weeks)
Phase III Puree diet (2 weeks)
Phase IV Soft diet (2 weeks)
Phase V Regular diet (after 1-2 months)

Dumping Syndrome

Dumping syndrome is fairly common following bariatric surgery, particularly if you don’t follow all of the special dietary instructions given to you. The signs of dumping syndrome are:
• Nausea
• Vomiting
• Bloated stomach
• Diarrhea
• Excessive sweating
• Increased bowel sounds
• Dizziness
• Emotional reactions