Post Surgery

Postoperative In-hospital Care
Patients are not allowed to 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 Lap-Band patients. After that, patients are started on a clear liquid diet. Although it is not routine for other practices, we also routinely perform an ultrasound of the lower extremities to make sure that there are no blood clots. 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.

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:

  • One week after surgery
  • Two weeks after surgery
  • Six weeks after surgery
  • Three months after surgery
  • Every three months thereafter for the first year
  • Every six months after the first year

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 completely reduce to zero the likelihood of occurrence of such problems. We also recommend long-term use of antacid medications after surgery since they reduce the incidence of ulcers. Smoking is strongly discouraged after Bariatric surgery as it can cause ulcers.

Exercise

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.

Cosmetics
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.