Bariatric Surgery Questions

Patients often have questions before and after their procedure. See below for a list of the most frequently asked questions about bariatric surgery.

Diet and Exercise

Will I be given eating guidelines to follow?

Surgeons provide patients with materials that clearly outline their expectations regarding diet. 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 and starchy snacks, and by strictly following the guidelines set by your surgeon.

Do I meet with a nutritionist before and after surgery?

You will meet our nutritionist where a brief overview of your dietary modifications after surgery will be discussed. Our dietitian will visit you in the hospital after your surgery. Following this, they will be in close phone contact with you throughout your 4 stages of eating after surgery. A nutritionist is available for phone consultation on an "as needed" basis for any questions you may have relating to nutrition.

Will I be miserably hungry after weight loss surgery since I can’t eat very much?

Most patients say no. In fact, for the first 4-6 weeks, patients have almost no appetite. Over the next several months the appetite returns, but it tends to be a “normal” type of hunger.

What is dumping syndrome?

Dumping syndrome after gastric bypass surgery is when foods with a high concentration of sugar (candy, cake, ice cream and cookies) go too rapidly into your intestinal tract causing diarrhea and crampy abdominal pain. This can be followed by dizziness and lightheadedness.

Most people with dumping syndrome can develop symptoms 10 to 30 minutes after eating. Others may have symptoms one to three hours after eating.

With proper dietary changes, you can avoid dumping syndrome. Changes might include eating smaller meals and limiting high-sugar foods. In more serious cases of dumping syndrome, you may need medication.

How soon after surgery should I begin taking vitamins?

Actually, you should begin multivitamin and calcium supplements about two weeks before your surgery. Remember to take the “chewable” version as directed. Take the adult form, which is usually one pill per day.

Should I take iron supplements?

Yes. It’s important to remember that multivitamins don’t usually contain enough iron to provide sufficient amounts. That’s why some patients will have to add iron supplements to their diet. This is especially important for women who are still having monthly periods.

Should I take calcium supplements?

Yes. Calcium is extremely important for good health, especially in women. Be sure your calcium supplements also contain Vitamin D, a substance that’s important in helping the body to absorb calcium.

Can I drink alcohol after the surgery?

Alcohol will be absorbed very quickly. Patients who have been through bariatric surgery will notice that even relatively small amounts of alcohol can have a large impact. It is very important that only small amounts of alcohol are consumed at one time. You also have to remember that alcohol brings along added calories. Small amounts of wine or an occasional cocktail may be enjoyed without harm.

Can I eat spicy or heavily seasoned foods?

It’s a good idea to avoid spicy or heavily seasoned food for the first six months after surgery. Most individuals will be able to tolerate some spicy foods after a period of time. After that period, it is advised that you go very cautiously in adding new foods or recipes.

Will I need to watch my salt intake?

In general, the average person takes in too much salt. If you have high blood pressure, you will have to particularly be careful about your salt intake.

I know I should be sure to eat enough protein. How much is the right amount?

For most people, 40 to 65 grams a day are generally sufficient. After bariatric surgery however, you will need more protein because of rapid weight loss. You will be advised by a dietitian on the proper amount of protein your will need, which is generally 65 to 80 grams in you diet.

What is the best source of protein?

Eggs, low fat cheese, cottage cheese, tofu, fish, dark meat chicken and turkey are all good protein sources.

I’ve been told I shouldn’t eat much red meat after surgery. Why not?

Red meat carries a high percentage of gristle. When the gristle isn’t chewed thoroughly, it can block the outlet of your stomach pouch, causing significant discomfort. For that reason, most patients should initially avoid red meat until cleared by your surgeon.

Should I avoid snacks between meals?

Yes. Snacking on starchy foods between meals can add hundreds of calories to your intake each day. It could also slow down your weight loss progress. For many patients, keeping a bottle of water nearby and watching your intake of starchy foods is a good way to avoid snack cravings.

Are milk products a potential problem?

Unfortunately, the answer is often yes. Milk contains a sugar that isn’t easily digested (lactose) and remains intact until it reaches the lower bowel, where certain types of bacteria metabolize it. Depending on their individual reaction to lactose, some patients will experience gas, cramps and diarrhea after consuming even small amounts of milk.

Why do I need to drink large amounts of water?

It’s simple: when you shed excess pounds, your body needs to eliminate many waste products, and most of the elimination is carried out via urine. But these waste products can cause crystals to form in the kidney, resulting in painful kidney stones. Drinking more water helps your body to eliminate more waste, thus protecting against stones. This strategy also helps promote weight loss. Water fills the stomach, triggering the “full” feeling that will help you eat less. Also, some patients experience sharp fatigue after surgery, frequently caused by dehydration.

Staying properly hydrated is extremely important.

How long will I have to go without solid foods after surgery?

Four weeks without solid foods is the usual recommendation from surgeons. A liquid diet (perhaps followed by pureed foods for a while) will be required in order to adjust to your new eating patterns.

Pre-operative Process

If I want to have bariatric surgery, how long do I have to wait?

After you have attended a seminar, a one-on-one consultation can be scheduled with one of our surgeons within a week or two. If the surgeon and patient agree it is appropriate to move forward with bariatric surgery, preoperative tests must be completed. There are also insurance requirements. Some insurance plans require diet documentation; therefore the amount of time you have to wait may vary from a few weeks to several months. Insurance authorization for bariatric surgery is the final step.

Why does it take so long to get insurance approval?

After all of your consultations are completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to begin the approval process. The time it takes to get an answer can vary from 3-4 weeks or longer if you are not persistent in your follow up. Most treatment centers have insurance analysts who will follow up regularly on the approval process. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

What are the routine tests before surgery?

Certain basic tests are performed prior to surgery, including blood tests and urinalysis. Other tests, such as sleep studies, GI evaluation, cardiology evaluation, or a psychiatric evaluation may be requested.

Why do I have to have a GI evaluation?

Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc. may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. Up to 15% of patients with reflux symptoms may show early changes in the lining of the esophagus. Esophageal changes could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable treatment program can be planned.

Why do I have to have a sleep study?

The sleep study detects a tendency for abnormal stopping of breathing typically associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery you will be sedated and will receive narcotics for pain. Narcotics further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time, so it is important to have a clear picture of what to expect and how to handle it.

Why do I have to have a psychiatric evaluation?

The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists or psychologists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?

Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. When medical problems are related to the patient’s weight, they might also increase the need for surgery.

Post-operative Care

How long do I have to stay in the hospital?

The hospital stay (including the day of surgery) can be 1-2 days for a laparoscopic gastric bypass or sleeve, depending on the health of the patient.

Will I be in a lot of pain?

Every attempt is made to control pain after surgery to make it possible for you to move about 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 upon your type of surgical procedure, are available. Ask your surgeon about other pain management options.

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. Once you leave the hospital, you may be able to care for all your personal needs but you will need help with shopping, lifting, and with transportation.

When can I take a shower or bath?

You can shower the day after your surgery, but you cannot take a bath (immerse under water) for 2-3 weeks after surgery.

What do I do if I develop a fever?

A fever is not considered significant until your temperature is above 100.5. If it is above 100.5, call your surgeon.

When can I return to work?

This depends on the individual and the type of work that the person does. Some people with desk jobs or jobs with limited movement can go back as early as 2 weeks after surgery. Patients with more lifting in their jobs usually go back to work in an average of approximately 4-6 weeks.

When can I start working out or doing heavy lifting?

Workout exercises like walking on a treadmill are acceptable and can be performed as little as 10 days after surgery. All patients are encouraged to walk as much as possible and it is expected that this will start immediately after surgery. Any heavy lifting (over 10 lbs.) is discouraged until at least 8 weeks from your surgery date. Since every patient is different, the details and approval for any exercise program should be discussed and approved by your surgeon.

When can I drive?

Getting back behind the wheel depends mostly on the patient. If you are still taking oral pain medications, you should not drive since it will dull your reflexes. 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 post-operative office visit (usually one week to 10 days 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.

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.

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.

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

Ambulation is important after surgery. Walking shortens the time before you will pass gas. Passing gas is expected one to two days following surgery. Sometimes your first bowel movement may take a little longer, in the range of two to three days. This can vary for each individual patient.

Will I feel bloated after my surgery?

Feeling bloated immediately after surgery is not uncommon. This occurs because of air placed into your abdomen and some manipulation of your intestine. The feeling of bloating may be relieved walking, but may require that you to receive an enema, which will also help. Once you start passing gas, the feeling bloating generally resolves.

What are the chances I’ll get a blood clot (phlebitis)?

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, blood thinners and SCD (sequential compression device) boots. Despite these precautionary measures the risk of phlebitis or blood clots remains.

Is blood transfusion required?

With minimally invasive surgery, the need for a blood transfusion is very infrequent.

What is a hernia, and what is the chance 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 using a laparoscopic approach. If a hernia does occur following surgery, it may have to be repaired.

Will I have trouble 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.

Will I have to change my medications?

Your requirement for medication after surgery may change. You will receive discharge instructions on what meds you may need to continue to take or what meds will be discontinued immediately. For meds that need to be continued, the dosage may change. 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. Diuretic medications can cause dehydration. It is very important that you stay hydrated after you surgery, so those types of meds are often discontinued when you are discharged from the hospital.

Is there anything I can do to prevent excess hanging skin as I lose weight?

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 reconstructive surgery to remove loose or excess skin after losing their excess weight. Removing excess skin may not be approved by some Insurance plans. Excess skin removal is more likely to be approved by your insurance plan if there is a medical reason to do so, like pain or infection in the skin folds. Ask your surgeon about your need for a skin removal procedure.

How will my body know when to stop losing weight? Will I become malnourished?

Bariatric surgical procedures are designed not to allow you to lose too much weight, so there is a built in safety factor. It is important to remember that bariatric surgery is only a tool. In order for you to lose all of your excess weight, you will have to concentrate on lifestyle changes in terms of your eating habits. It is not unusual for patients to lose as much as 20-40 pounds in the first month after surgery. The weight loss will slow down after the first month. The amount of weight that you lose per month after that will depend on your starting weight or BMI. Follow-up visits are very important so that adjustments can be made in your food intake. It is very unlikely that you would lose weight to the point of malnutrition.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing permits. Many patients experience a drop in desire for about 6 weeks.

Will I be able to take oral contraception after surgery?

It is recommended that you wait at least 30 days before starting back on oral contraceptives.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women who have bariatric surgery wait at least 18 months after the surgery before becoming pregnant. Approximately 18 months post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.

Will the staples in my abdomen set off metal detectors in airports? Can I have an MRI test in the future?

The staples used on the stomach and the intestine are very small. The staples used are inert in the body and do not cause an allergic reaction. The staple material is also non-magnetic, meaning they will not be affected by MRI. The staples will not set off airport metal detectors.

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