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Post Operative Instructions

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Post Operative Instructions

POST-OPERATIVE INSTRUCTIONS

YOU WILL NOT BE ALONE. Bariatric patients have to make significant changes to their lifestyle after their surgery. This includes changes to their diet as well as changes to their daily routines and the inclusion of an exercise program into their lives. Dr. Neil Floch, Dr. Craig Floch, Dr. Abe Fridman and their team will provide you with unending support and guidance through out your post-operative period and beyond. Our team, including the doctors, office staff and support groups will always be at your side to encourage and support you.

MOST WEIGHT LOSS SURGERY PATIENTS RECOVER FROM SURGERY WITHOUT COMPLICATIONS. Although you will have some discomfort from the surgery, you will have to get out of bed and start walking the same 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 until you are breathing well on your own.

The hospital stay for patients who undergo the Laparoscopic Roux-en-Y Gastric Bypass procedure is usually two days. Patients who have the Laparoscopic Adjustable Gastric Banding procedure will go home the same day or remain overnight. The Laparoscopic Gastric Sleeve usually requires a two night stay/ Before you are discharged, you will receive full instructions for your care at home. An appointment will be scheduled to see your surgeon about one week after your weight loss surgery.

IN THE HOSPITAL

  • You will wake from surgery in the recovery room, and your doctor will see you there and speak to you. But, you may not remember it because of the anesthesia, so he will speak to your family.
  • You will remain in the recovery room for approximately 1-2 hours. You may experience some nausea and/or pain. You may see drains protruding from your belly, which will be removed before you go home. If you have sleep apnea you will remain in the recovery room for 3 hours.
  • If you are staying overnight or more than one day, you will be transferred out of the recovery room to a room on the post-surgical floor.
  • The nurses will ask you to sit up and perform deep breathing exercises using an incentive Spiro meter. You will be started on small sips of water, and be asked to stand up and walk. It is imperative that you begin walking as soon as possible to prevent blood clots.
  • If you tolerate small sips of water the day of surgery, you will be advanced to stage one of your diet.
  • Once your surgeon is satisfied that your digestive system is functioning properly, you will be discharged home. Any drains or catheters will be removed prior to your discharge.

AT HOME AFTER SURGERY

ONCE HOME, IT IS IMPORTANT TO FOLLOW ALL OF THE INSTRUCTIONS YOU HAVE BEEN GIVEN. You should follow the proper diet stage as directed by the nutritionist and/or doctor. You should begin taking a daily multivitamin and any other nutritional supplements as directed by your nutritionist.

  • You will be out of work for 3 days to 1week following a banding procedure and 1-2 weeks following a gastric bypass.
  • You should already have made a follow-up appointment with our surgeons or physician’s assistant approximately 7-10 days following surgery. If you had not done so, please call our office to schedule your visit as soon as possible.
  • We have made available to you a Daily Intake Log and Your Personal Weight Loss Log to assist you on your weight loss journey. Please click on each log to download a copy.
    Daily Intake Log
    Weight Log

If you should experience any of the following call our office and request to speak to Dr. Floch:

  • Shortness of breath
  • 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 101oF
  • Passage of very dark stool
  • Acute depression or negative emotions

Please do not hesitate to contact our office with any questions or difficulties you may be experiencing. One of our surgeons is on call at all times should the need arise.

AFTER SURGERY GUIDE TO

  • NUTRITIONAL GUIDELINES
  • INCISION CARE
  • FOLLOW UP VISITS
  • EXERCISE
  • DIET RESTRICTIONS
  • PHYSICAL ACTIVITY RESTRICTIONS
  • PREGNANCY RESTRICTIONS

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.

Diet After Bariatric Surgery

CLICK HERE FOR ALL 5 DIET STAGES
 

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

Bariatric surgery will make a tremendous change in your eating habits.

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 in the shower. Avoid soap because it may burn, Do not take a tub bath or use a Jacuzzi, pool or hot tub until your incision is fully healed. It can take 1-2 weeks to make that happen. Call our office 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 101oF
  • Any new or unusual pain in your abdomen, chest or legs

Steri-strips will fall off after 7-10 days. If they do not, you may remove them yourself in the shower. Staples are rarely used but will be removed in the office after 7-10 days. If you develop a red rash on your wounds that is the shape of the bandage, it can be treated with hydrocortisone cream.

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 may decide to have plastic surgery one to two years after their weight loss to remove skin folds around the abdomen. Your first follow-up visit with your bariatric surgeon will be seven to 10 days after discharge. Subsequent visits for gastric bypass and gastric sleeve patients 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 every three months and then every six months after the second year. Band patients will be seen 5-10 days following surgery and then once a month for the first year. During the second year they will be seen every three months and then every six months during the following years. 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 bypass and sleeve surgery is as follows:

  • Five to seven days - initial post-operative evaluation and wound check
  • 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, blood work up
  • 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 essential for success.

Laparoscopic adjustable gastric banding patients are seen as follows:

  • Five to ten days – initial wound check
  • One month – first band adjustment
  • Second month – band adjustment and fill
  • Third month – labs and fills
  • Four to five months – nutrition and exercise assessment, band adjustment and fill
  • Six months – labs and fills
  • Seven to eleven months – band adjustment and nutrition and exercise assessment
  • Twelve months – labs and fill
  • Second year – every three months – full evaluation and possible adjustment
  • Third year and lifetime – every six months – full evaluation and possible adjustment

EXERCISE

Exercising helps bariatric patients lose weight more rapidly after surgery. Establishing a gradual exercise and physical activity program
is a key to helping achieve desired weight loss. We recommend that our patients begin an exercise program as soon as our surgeon feels that it is the appropriate time to do so.

Post-Operative ExcerciseFollowing bariatric surgery, the patient takes in fewer calories. As a result, the body, in its search for energy, could begin to burn muscle instead of fat. Exercising alters the metabolism so the body would burn fat instead of muscle.

In addition to helping achieve desired weight loss, an exercise program will also boost your metabolism, decrease risk of cardiac disease, lower blood pressure, tone muscle and increase energy.

Daily physical activity is also instrumental in helping achieve weight loss. Walking, gardening and house cleaning are just a few of our daily activities that will burn calories and contribute to helping lose weight.

We realize the importance of an exercise and physical activity program but will only suggest it when we feel you are physically ready for it.
It will be done in graduated stages so that you will be able to do it without experiencing difficulty. Among our support groups is one that specializes in exercise. Our doctors will guide you through your exercise and physical activity program and will always be available to answer your questions and offer you support and encouragement.

DIET RESTRICTIONS

As with most operations, bariatric surgery also has restrictions that are necessary to follow in order to expedite the healing process and to help achieve successful results.

Our surgeons and dieticians will provide you with specific diet guidelines to follow immediately after surgery and for long-term weight loss. Since bariatric surgery alters the way the body’s digestive track works, patients have to slowly move into a new diet that will emphasize portion size and nutrition. For the first six weeks the diet will consist of liquid/pureed foods because the digestive track needs time to heal. This includes foods that are liquid to soft in consistency. Discomfort and complications can be avoided and desired weight loss achieved by following the bariatric diet provided.

PHYSICAL ACTIVITY RESTRICTIONS

Exercise and physical activity programs help achieve desired weight loss. However we will only suggest it when we feel you are physically ready for it. The day of your bariatric surgery you will be asked to stand or walk. During your hospital stay you will be asked to take short walks. Driving should be avoided for two weeks after returning home if you continue to take postsurgical medications that can make you drowsy. Depending on the type of bariatric surgery you have, you will be home from work anywhere from one to six weeks. You should be back on your regular physical routine after six weeks. Our surgeons will provide you with an exercise and physical activity program that increases in stages following your surgery so that you will be able to handle it without difficulty. Beginning an exercise program in modulation and increasing it in time will help you speed up the weight loss results you want to achieve.

PREGNANCY RESTRICTIONS

It is safe to become pregnant after gastric bypass surgery but it is recommended that the patient wait until 18 months after the surgery when weight stabilizes. The reason we ask for this delay is to prevent the mother and newborn from suffering possible malnutrition.

After band surgery you do not have to wait an extended time to become pregnant. The band can be adjusted so that you do not lose too much weight too fast.

After weight loss surgery problems could occur to the growing fetus because the body goes through potentially stressful changes with substantial nutritional upheaval. Studies have found that patients can experience deficiencies in B12, iron, calcium and vitamin D after undergoing bariatric surgery. It is also possible that patients can experience protein-calorie malnutrition and fat malabsorption. It is quite common for patients to experience nausea after bariatric surgery and it can be exacerbated by morning sickness related to pregnancy. This would increase the difficulty of getting the nutrients needed during pregnancy.

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