Post-Operative Process

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What can I expect after bariatric surgery?

Your bariatric surgeon will give you detailed instructions on how to care for yourself after your procedure. These instructions will include information on medication dosage, diet, and follow-up appointments. Your return to work will likely be within one to three weeks following surgery, depending upon your procedure and overall health. You will be able to perform moderate levels of activity approximately three to six weeks later.

Why did my surgeon leave a drain in place and how do I take care of it?

The drain is called a Jackson-Pratt drain. You can see the exterior portion of the drain only. The interior portion of the drain resides inside your body and is located near the new connection between your stomach pouch and your bypassed limb of intestine. It has been placed as a precaution just in case your staple line leaks. If it were to leak, the drain would catch leaking stomach juices and allow it a path for removal from your body to prevent you from getting sick. Care of the drain is simple and requires that you empty the drain every 24 hours or when it fills up. You should record the amount of fluid in cubic centimeters every time you empty the drain and write it down on your log sheet which you would have received when you discharge from the hospital. Also, your discharging nurse should go over drain care and how to empty the drain prior to discharge.

When can I return to work?

This depends on the individual and the type of work the person does. People with desk jobs or more sedentary work can go back as early as seven days after surgery. Patients with more lifting in their jobs usually go back to work three weeks after surgery. Most patients who have had the laparoscopic gastric bypass procedure return to work within three weeks of their surgery.

When can I start working out or do heavy lifting?

If your surgeon does not repair a hernia during your gastric bypass, you can start doing mild exercises in as little as seven to 10 days after surgery. More intense workout regimens should be avoided until three weeks after surgery. Heavy lifting is okay six weeks from your date of surgery.

When can I drive?

The time a patient starts driving is variable and depends mostly on the patient. If you are still taking oral pain medications, it is recommended that you do not drive. If you are still having a significant amount of muscle pain it is recommended that you do not drive as the pain may slow your movement when you need to hit the brakes or turn rapidly. In general, we recommend that you have someone bring you to your first postoperative office visit (usually one week from the day you had surgery). Your surgeon will ask you about your level of pain and your use of pain medications and will often allow you to drive after this point.

When can I take a bath or shower?

You can shower the day after your surgery but you cannot take a bath (immerse in water) for two to three weeks after surgery. It is okay to shower with your drain hanging at your side in the shower.

What if I develop a fever?

Your surgeon does not consider a fever significant until your temperature is above 100.5. If it is above 100.5, call your surgeon.

What if one of my incision sites looks red and becomes painful to the touch?

This may represent an infection and is almost always at the incision to the left-most side of your body. The incision is treated by opening the wound in the office and packing twice a day with sterile, moist gauze as well as oral antibiotics.

Will I run out of pain medication at home?

Most patients do not take pain medications after one week and thus will not run out of medications. If you do not use all your pain medications we ask that you discard the remainder. We will authorize a prescription refill for patients requiring further pain medication. Most patients have the most pain at the incision on the left-most side of their body. This site is where one of the surgical staplers is introduced into your abdomen during the operation. In order to do this, your surgeon has to stretch your muscle and tissues at this incision to be able to fit the stapler into your abdomen. This is why this site is usually the most painful. However, this site is also where infections of the skin, muscle, and tissues occur in 5% of patients. Sometimes, this incision must be opened up by your surgeon in the office. If the incision is reopened you will typically need to pack the site with moist gauze for two to three weeks.

Is it true that my bowel movements and flatus will have a different smell?

Some patients will complain that their flatus is particularly foul smelling; however, most patients do not notice a difference.

How long will it be before I pass gas or have a bowel movement after surgery?

Although this can vary, it usually takes two to five days after surgery before gas is passed. Your first bowel movement after surgery usually occurs at this time as well.

Will I feel bloated after my surgery?

Immediately after surgery you will feel bloated due to the gas placed into your abdomen from the laparoscopic procedure as well as the gas that was placed into your intestines during the endoscopy performed at the time of your gastric bypass. The feeling of bloating usually resolves when you start having flatus. Some patients will experience cramping after surgery which is usually related to the buildup of gas in the intestines from the surgery. This "gas pain" usually resolves with flatus.

Will I get a copy of suggested eating patterns and food choices after surgery?

Surgeons provide patients with materials that clearly outline their expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on patient compliance with these guidelines. You must do your part by restricting high-calorie foods, avoiding sugar, snacks and fats, and by strictly following the guidelines set by your surgeon.

Do I meet with a nutritionist before and after surgery?

You will meet one of our registered dietitians at your initial evaluation where a brief overview of your dietary modifications after surgery will be discussed. Our registered dietitian will visit you in the hospital after your surgery. Follow up appointments with our registered dietitian will provide support and is crucial to your success. A registered dietitian is available for phone consultation on "as needed" basis for any questions you may have relating to nutrition.

What is phlebitis and is it preventable?

Phlebitis is undesired blood clotting in veins especially of the calf and pelvis. It is not completely preventable but preventive measures will be taken, including: early ambulation, special stockings, blood thinners and SCD boots (sequential compression devices). Despite these precautionary measures the risk of phlebitis or DVT remains.

Is a blood transfusion required?

Infrequently. If needed, it is usually given after surgery to promote healing.

What is a hernia and what is the probability of an abdominal hernia after surgery?

A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia after "open" surgery. This is a rare complication after the laparoscopic approach. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.

Will I have to change my medications?

Your primary care physician or other medical doctor will determine whether medications for illness such as blood pressure and diabetes can be stopped when the conditions and symptoms improve or resolve after weight loss surgery. For meds that need to be continued the vast majority can be taken the same as before weight loss surgery. Sometimes a change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced food intake after weight loss surgery potassium levels are already likely to lower. When potassium levels get too low, it can lead to fatal heart problems.

What if I am really hungry?

Extreme hunger is usually caused by the types of food you are consuming, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch. It is recommended to drink water before a meal.

Will I be miserably hungry after weight loss surgery since I’m not eating much?

Most patients say no. In fact, for the first four to six weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger.

Will exercise help with excess hanging skin?

Exercise is good in so many ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with large flaps of loose skin depending on the pre-surgery weight and fat distribution.

What can I do to prevent lots of excess hanging skin?

Many people heavy enough to meet the criteria for bariatric surgery have stretched their skin beyond the point at which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after losing their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). Some insurances do pay to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

How can I know that I won’t just keep losing weight until I waste away to nothing?

Patients may wonder about this early after the surgery when they are losing 20-40 pounds per month or when they’ve lost more than 100 pounds and they’re still losing weight. Two things happen to allow weight to stabilize. First, a patient’s ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better and there is some expansion in pouch size over a period of months. The bottom line is that in the absence of a surgical complication patients are very unlikely to lose weight to the point of malnutrition.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about six weeks.

Will I be able to take oral contraception after surgery?

Most patients have no difficulty in swallowing these pills.

Is there any difficulty in taking medications?

Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.

What if I’m not hungry after surgery?

It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well there is a level of confidence that your appetite will increase with time.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see except as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, meaning they will not be affected by MRI. The staples will not set off airport metal detectors.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women who have the Roux-en-Y gastric bypass/sleeve or the Lap Band wait at least 18 months after the surgery before a pregnancy. Approximately 18 months postoperatively your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. Those patients who have Lap Band surgery may require removal of the fluid from the band if pregnancy ensues. The Lap Band itself will generally not need to be removed. You should consult your surgeon as you plan for pregnancy.

What is done to minimize the risk of deep vein thrombosis/pulmonary embolism or DVT/PE?

Because a DVT originates on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with sequential leg compression stockings and given a blood thinner prior to surgery. Both of these therapies continue throughout your hospitalization. The third major preventive measure involves getting the patient moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs. You may be required to continue blood thinning therapy for two weeks after you are discharged from the hospital.

How soon will I be able to walk?

Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and each day thereafter. On leaving the hospital you may be able to care for all your personal needs but will need help with shopping, lifting and with transportation.

How long do I have to stay in the hospital?

The hospital stay (including the day of surgery) can be one to two days for Lap Band surgery, two to three days for a laparoscopic gastric bypass/sleeve, and three to five days for an open gastric bypass.

Will I have a lot of pain?

Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. While you are still in the hospital, a Patient Controlled Analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand may be used by your physician. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.

We’re here to help. Call 877-834-7264 for more information or to request an appointment with a bariatric specialist at MacNeal Hospital.