Download What to expect: Third day after Surgery

Gastric Bypass
Surgery
Uretz J. Oliphant, MD
Blair M. Rowitz, MD
Carle Bariatrics
Before Surgery: Months Before
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Quit Smoking and using tobacco AT LEAST
two months before surgery and do not
resume after.
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This can interfere with surgical healing and
create complications down the road
Medications to Avoid
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Discontinue any aspirin products or NSAIDs (nonsteroidal anti-inflammatories: Aleve, ibuprofen, etc.)
These medications should be avoided FOR LIFE to
due to risk of stomach ulcers.
Concerns should be directed to your Primary Care
Provider.
After Surgery Follow Up
After surgery, we will see you for
visits at the following intervals:
 7-10 days
 1 month
 3 months
 6 months
 1 year
 Every 6 months to 1 year
thereafter
Helpful Home Supplies
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Baby Spoon
Sippy Cup
Blender
Vitamins
Purchase Prior to Surgery
Calcium
plus Vitamin D– Calcium Caltrate chews (600mg
Calcium and 400IU Vitamin D)—One chew three times per day
Vitamin
B12 –
500 mcg tablet per day or one injection per month.
Multivitamin – 1 chewable children’s vitamins twice daily (need
not be sugar free and no gummies)
These medications will have to be
taken the rest of your life!
Before Surgery: The Day Prior to Surgery
Maintain a clear liquid diet consisting of
ONLY:
 Clear Broth
 Pear Juice
 Clear Jell-O
 Apple Juice
 Water
 Cranberry Juice
 Popsicles
 Iced Tea
 Black Coffee
What to Expect:
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Report time and location:
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Preop Center will call the day before with time.
One Day Surgery Center is located on North
Tower 2 (NT2)
What to bring
What not to bring
What to Expect: Day of Surgery
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Upon arrival to ODSC:
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Nurse will admit/assess you.
An IV will be started.
Preop blood thinner injection may be given.
Anesthesiologist will see you prior to surgery.
What to Expect: In the OR
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General anesthesia with Endotracheal tube (ET
tube) placement.
Urinary catheter placed after put to “sleep.”
Inflate abdomen with CO2.
Surgery will take approximately 2-4 hours
Recovery room approximately 1-2 hours
Admission to NT 7
What to expect: After Surgery
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Arterial Blood Gas (ABG)
CPAP/BiPAP: used in recovery, night of surgery and after as
needed.
Multiple laparoscopic incisions-with absorbable sutures.
Urinary catheter
Sequential Compression Devices (SCDs)
Pain control
Abdominal binder
Anticoagulation injections: Lovenox or Heparin
Drains
ASBS
What to expect: Evening of Surgery
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Sitting in a chair by the evening. This is a STRICT
ORDER from your physician
NO food or drink.
ASBS
What to expect: First Day after Surgery
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Catheter removal
Walking up and down the hallways
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This is a STRICT order from your physician.
Walk at minimum 3-4 times per day.
Our goal is to prevent blood clots and maintain physical
activity.
Upper GI X-ray will be done.
Assess for any leaks or strictures.
 If the X-ray is normal, a clear liquid diet or “bariatric
first meal” will be ordered.
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Pain and nausea control
What to expect: Second Day after Surgery
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Walking
Diet: You will be encouraged to drink 2 oz. of
fluid every 15-20 minutes
Dressings removal.
Shower
Oral pain medication
What to expect: Third day after Surgery
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DISCHARGE HOME
Medications:
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Liquid Hydrocodone or other pain medication
Lovenox- blood thinner to prevent blood clots
Pepcid- for ulcer prevention
Actigall- for prevention of gallstones (used with
patients who still have their gallbladder)
Diet: full liquid diet for two weeks
Lovenox Injection Sites
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2 inches away from belly button
Rotate your sites with each injection
2 inches away from previous injections
Lovenox Injection Steps
Clean site
Pinch up 2 inches of skin
Insert needle into pinched skin
1.
2.
3.
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4.
5.
6.
45-90 degree angle
TIP-if you insert quickly it will hurt less
Release skin with syringe in place
Push plunger
Remove needle
What to expect: Third day after Surgery
Medications Tips:
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Discharge Instructions will be provided outlining
home medication regimen.
Contact your Primary Care Provider about
resuming preoperative medications.
To avoid nausea, do NOT take vitamins and
minerals on an empty stomach.
Do not take vitamins and minerals with
caffeinated beverages.
Avoid taking Calcium with Multivitamin
What to expect: Third day after Surgery
DISCHARGE HOME
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Activity:
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Walking and climbing stairs may be resumed
immediately
Start gradual and progress as tolerated.
Goal: Walking 2 miles daily within 2 months
What to expect: Third day after Surgery
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DISCHARGE HOME
Activity Restriction:
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X
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No lifting ANYTHING more than 10 pounds for
ONE MONTH—this includes children and
animals.
No heavy housework or laundry for ONE MONTH.
No driving for one week and off pain medication.
What to expect: Third day after Surgery
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DISCHARGE HOME
Activity Restriction:
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No sexual intercourse for ONE MONTH:
Rapid weight loss increases fertility
Birth control measures must be taken upon
resuming sexual activity.
Do not risk pregnancy for two years after surgery.
What to expect after arriving home
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Hair loss
Emotional changes
Irregular periods
These changes are only temporary.
Potential Postoperative Complications
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Stomach Ulcers
 Burning abdominal pain and possible
vomiting.
Potential Postoperative Complications
Stomal Stenosis
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Can occur approximately one month after surgery.
Symptoms include:
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Vomiting after eating, worsening as time goes
on.
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Having the sensation of foods “sticking”.
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Inability to tolerate foods that were once eaten.
Potential Postoperative Complications
Dumping Syndrome
 SEVERE diarrhea, nausea,
lightheadedness, stomach cramping, and
sweating.
 May occur if liquids are consumed with
meals OR after eating sweets.
How to avoid dumping syndrome
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Remember to drink fluids ½ to 1 hour after
meals.
6-8 8 oz. glasses of water per day = 64
ounces of fluid per day.
Avoid all sweets and sweetened
beverages.
Artificial Sweeteners are acceptable.
Please Call if you experience…
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Redness, swelling or drainage from the
incisions.
Fever greater than 101 degrees.
Increase pain at incision site.
Elevated heart rate. Pulse 110 or greater,
sustained.
Shortness of breath.
Worsening abdominal pain.
Please Call if you experience…
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Vomiting
 Call the office if persistent vomiting
occurs.
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Bariatric Clinic number (217-383-3240)
If occurs after hours, call the Patient
Advisory Nurse (217-383-3233)
Diet: Full Liquids
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Two full weeks following surgery.
Only liquid form, since your stomach is tender and swollen.
Full Liquid diet ONLY.
Liquids should be free of lumps and pieces of food.
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Refer to nutritional booklet for list of foods and sample menu
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Protein
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Your body needs protein to heal.
Complications if you DO NOT get enough protein:
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Infection
Delayed healing time
Loss of muscle mass
Hair Loss
High protein foods:
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Seafood/Fish
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Tuna, salmon, shrimp, clams, crab meat…
Other Meats
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Lean beef, lean pork, venison, wild game, chicken and
turkey
Dairy
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Egg/Egg beaters
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Low fat cottage cheese
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Light or non-fat yogurt
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Skim or 1% milk
Diet: To avoid weight gain
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Surgery is a tool to keep the weight off.
Foods with high calories MUST BE AVOIDED
 Chips and the chip aisle
 Fast Food
 Fried Foods
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French Fries
Onion Rings
Pork Rinds
Popcorn
Nuts
Diet: Sugars to Avoid
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Read food labels carefully.
If sugar is listed as one of the first 3 ingredients-DO
NOT eat that food
Sugar is AKA (also known as):
Brown Sugar
Corn Sweeteners
Fruit Sugar
Honey
Levulose
Maple Sugar
Raw Sugar
Sucrose
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Confectioner’s
Sugar
Dextrose
Glucose
Invert Sugar
Maltose
Maple Sugar
Sorbitol
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Corn Syrup
Turbinado
Fructose
Granulated Sugar
Lactose
Mannitol
Sorghum
Xylitol
Emotional Distress—Mourning the loss of
food
Questions or Concerns:
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We want your recovery to go smoothly!
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If you have any concerns or questions
between scheduled visits, please call the
General Surgery Department at (217) 3833240.
Thank you for letting Carle serve you!
Created June 2013; reviewed 2/3/16