AFTER GASTRIC BYPASS SURGERY
Immediate Post-operative Period
: Patients will first go to the recovery room after the operation is over. There he/she will be closely monitored while waking up from anesthesia. Family members are usually not allowed because of Government rules concerning privacy of other patients.
Transfer to the Floor/ICU
: After the recovery period the patient will go to a floor or ICU bed. He/she should be awake or easily arousable at this time. The head of the patient’s bed should remain elevated 30 degrees. Family members can visit with the patient after he/she has been assessed by the receiving nurse. A patient will need to request pain controlling medication and anti-nausea medication from his/her nurse
4 Hours Post-op
: With assistance from a nurse the patients needs to walk outside the room, in the hallway, at least 20 steps. This is to avoid certain problems, especially blood clots in the veins of the legs. It is probably one of the most important things the patient does for him/herself around the time of the surgery. After walking, the patient will be allowed to take low sugar liquids by mouth. Initially this is usually ice chips and sips of water. However, broth, sugar free Jell-O, sugar free popsicles and no calorie-non carbonated drinks are encouraged.
: Patients who have gastric bypass will stay overnight in the hospital to be watched closely. Bleeding which could require transfusion will almost always occur in the first 12 hours. Unfortunately, symptoms of bleeding may be absent, so the patient should be monitored for signs of bleeding such as a fast heart rate or dizziness. If there are no signs of bleeding the patient will receive a blood thinner shot under the skin every 12 hours. He/she will also have low-sugar liquid meals at regular intervals. Patients who are tolerating liquids, walking, and who have normal vital signs will usually be discharged from the hospital within 24 hours from the end of the operation.
At Home – Week 1
: All necessary previous medications should be taken at the prescribed intervals after returning from the hospital. Tablets will need to be crushed and capsules opened for the first week. Usually these are taken with water or crystal light. Any medication that can be skipped should wait until 1 week post-op. Examples are: cholesterol medications, previous pain medications, muscle relaxants, special vitamins, etc. Absolutely necessary blood thinners such as aspirin, plavix or coumadin should be restarted 48 hours after surgery. If any signs of bleeding occur they should be discontinued and the patient should call the office immediately. Diabetes medications should be reduced to ½ dose, and blood sugar levels should be monitored every 6 hours if the patient is on any insulin. If you are on diabetes medication, make an appointment to see the prescribing physician within 2-3 weeks.
: Patients can do their activities of daily living (ADL) such as going up steps, or taking care of themselves in the bathroom or shower. The patient does not need special assistance from someone else. He/she should not stay in bed; moving about and even light exercise are encouraged. Strenuous activities, such as lifting more than 20 lbs, are not allowed.
: Patients should remove the top layer of dressings 48 hours after surgery. This includes the plastic covering and gauze over the incisions. The thin tapes on the skin – the steri-strips – should be left alone. These will peel up after a week or so and can be removed by the patient at that time. Do not attempt to remove any suture material. The sutures are absorbable and will not need to be removed.
Local Anesthesia Catheter
: Most patients will have a local anesthesia catheter that travels through a tunnel under the skin to the left side incision (this is the incision that hurts the most). The catheter delivers local anesthesia for approximately 2 days, keeping the site numb. The patient should remove the catheter after the reservoir is empty. Simply take off the plastic covering over the entry site and any steri-strips as well. Slide the catheter out and, if necessary cover with a small gauze dressing or band aide (the site may bleed slightly after removal). Please read the brochure from the company that makes the catheter and call their toll-free number with any questions.
: Showering with mild soap and water is allowed once the top bandages have been removed - 48 hours after surgery. It is OK to get the steri-strips wet. Do not submerge the incisions in a bath until 3 weeks post-op. Similarly, the patient should not go swimming for several weeks after surgery.
: After gastric bypass the patient will be on a clear liquid low sugar diet for 7 days. Please see the diet section for a description of the diet. Do not attempt to take soft or solid foods yet as these could breakdown the upper connection staple lines and lead to a leak. Also, avoid carbonated beverages until 1 month after surgery. Caffeine is allowed (with sugar substitutes and non dairy-low fat creamer).Concentrated fruit juice and processed sugars should be avoided to avoid cramping, flushing and diarrhea which are the symptoms of the dumping syndrome.
: A typical patient will be able to drive his/her car approximately 4-5 days post-operatively. However, different people have different responses to the pain from the operation. Driving should only be attempted if the patient feels that he/she can turn the wheel or apply the brakes in an emergency
. If not, the patient should not attempt to drive.
APPOINTMENT 1 week Post-op
Call the office to schedule an appointment 1 week after surgery. We will see how you are doing and check the incisions at this appointment.
: All previous medications should be resumed and can be taken normally (i.e. as whole pills or capsules). Diabetes medications should remain at ½ the previous dosage, and the patient should make an appointment to see the prescribing physician to alter the dose. If the patient has not had his/her gallbladder removed then he/she should start taking Actigall (ursodiol) 2 times a day for the next 6 months. This medication helps prevent gallstones and gallbladder attacks which could lead to an emergency operation.
: The patient’s activity level should gradually be increased. All exercise is allowed after 3 weeks, including strenuous activity and lifting can. Normal sexual activity can occur as soon as the patient feels comfortable enough.
Return to Work
: Patients with a desk or sedentary job will be able to return to work 7-10 days after the operation. Those who have strenuous occupations will have activity and lifting limitations until 3 weeks after surgery. Patients who desire to return to work sooner than 7 days may do so, as long as they do not attempt to do strenuous activities that stress the abdominal wall.
: From 7 days to 1 month after surgery gastric bypass patients are asked to stay on a soft mechanical low sugar diet. Generally this includes any food that can easily be mashed with a fork - that is also low in fat and sugar. Please see the diet section for a more complete description.
: A multivitamin with folic acid (folate) should be started one week after surgery. Although this can be chewable, it is not necessary. The patient should take some form of a multivitamin indefinitely.
APPOINTMENT 1 Month
Schedule an appointment for 1 month after surgery. It will be necessary to have blood tests done a few days before the appointment. This will include blood counts, electrolytes, calcium, iron, vitamin B1, vitamin B12 and folic acid levels.
After 1 Month
: ad lib
: The patient will be switched to a solid low fat-low sugar diet. Almost all types of foods are allowed. High fat and foods with concentrated sugars are to be avoided. The patient may have no-sugar carbonated beverages at this time (diet soft drinks).
: Continue the multivitamin
Blood work, as described above, will be done prior to each visit. If any unpleasant symptoms occur that could be related to your Gastric Bypass call the office immediately. Please see the section on problems that can occur after Gastric Bypass.