What to Expect after Weight-loss Surgery

In the Hospital

Patients may not eat overnight following surgery. The day after surgery, an upper gastrointestinal series is performed to make sure there is no leak or blockage in gastric bypass patients and to ensure good positioning of the band and no blockage for gastric band patients.  As a precaution, we also routinely perform an ultrasound of the lower extremities to make sure that there are no blood clots. After that, patients may begin a clear liquid diet. Patients are discharged home the day after surgery or the second postoperative day, depending on how well they feel. Patients go home on a 10-day course of a blood thinner, which, according to a study by Dr. Raftopolous, significantly decreases the incidence of postoperative blood clots. In addition, gastric bypass patients will be discharged with a small drainage tube.

At Home

 

Diet

Patients remain on a clear liquid diet during the first week after surgery. During the second week skim milk and protein shakes are added. At the end of the second week, patients are advanced to a pureed diet for a month. Following that, they move to a soft diet.

Adherence to postoperative dietary guidelines, adequate protein intake, and physical activity are three elements of success. A daily protein intake of 60 grams or higher, along with the avoidance of foods high in carbohydrates and calories, provides the basis for a successful outcome. Failure to follow an appropriate postsurgical diet and ingestion of foods high in carbohydrates can produce unpleasant symptoms such as diarrhea, nausea and abdominal cramping also known as "dumping syndrome." In addition, eating too much or too fast, or mixing liquids with solids, can result in vomiting or intense pain under the breast bone.

Because gastric bypass results in only partial absorption of many of the nutrients in food, it is usually necessary for patients to take vitamin and protein supplements to prevent deficiencies. Malabsorportion can also result in a temporary increased loss of hair. Hair growth usually returns to normal in a few months. In our experience, adequate protein intake, vitamin supplementation, and routine monitoring of vitamin and mineral levels, electrolytes, liver enzymes, thyroid hormones and hemoglobin every three months after surgery can almost eliminate the likelihood such problems. We also recommend long-term use of antacid medications after surgery, because  they reduce the incidence of ulcers. Smoking is strongly discouraged after bariatric surgery because it can cause ulcers.

Mike and Margaret walkingExercise

 

Exercise has been shown to increase the percentage of excess weight loss following surgery and increase the percentage of muscle mass retained during the period of rapid weight loss. Patients should begin walking as soon as possible following surgery.

Looking your Best

Following weight-loss surgery, patients can be left with excess skin. Routine physical activity and muscle strengthening exercises can significantly reduce the amount of excess skin following weight loss. Plastic surgery procedures, such as body contouring, can also help correct such problems.

The Tummy Tuck

We offer panniculectomy with abdominoplasty or "tummy tuck" to carefully selected patients. We have been successful so far in every instance to get them covered through the patient's insurance without any direct cost to the patient.

Tummy Tuck 1The "tummy tuck" can be done either through a "bikini" incision to address laxity at the lower abdomen or through a combination of a "bikini" and an upper abdominal vertical incision to address laxity at both the upper and lower abdominal wall. 

Tummy Tuck2   

 In either instance the umbilicus or belly button is detached from the surrounding skin and fat, it is preserved and re-attached to the new skin flaps that we create.

It is essential to understand that the "tummy tuck" will significantly improve the skin laxity that results from the surgical weight loss at the expense of long skin incisions which, if made properly can be very fine in appearance and not very obvious.

Most common complications of "tummy tuck" include loss of the belly button, bleeding that may require blood transfusion and infection of the flaps that may require surgical debridement. At the Bariatric Center we have not experienced any of these complications so far. "Dog ears" and flap asymmetry may also occur as a result of the significant "whole body" laxity in some cases which is impossible to address with a "tummy tuck." All of our patients stay at the hospital one night and are discharged home the next day with two drains that will be removed in one of the next office visits.

Follow-up Visits

We strongly believe that the surgeon should be involved in the follow-up care and all patients are seen by the surgeon every time that they return to our clinic for follow-up. It is our experience that patients who follow-up routinely after their surgery lose more weight and experience fewer side effects or serious complications. All patients are requested to observe a follow-up schedule:

After Surgery...      Meet with...  Purpose of Visit 
5-7 days     bariatric surgeon    

drain removed, add

protein shakes and milk

to diet

2 weeks     bariatric surgeon follow-up
6 weeks bariatric surgeon follow-up
3 months bariatric surgeon vitamin level check
6 months bariatric surgeon

vitamin level check

and health questionnaires

9 months

bariatric surgeon

or physician's assistant

vitamin level check
12 months bariatric surgeon

vitamin level check and health

questionnaires

Every 6 months for

5 years

bariatric surgeon follow-up

Annually thereafter

for a lifetime

bariatric surgeon follow-up