In This Section:
Work through this list of general pre-operative instructions to increase the safety and comfort of your surgery.
Getting prepared for your weight loss surgery involves more than the doctor’s appointments, support group building and psychological readying you’ve been experiencing. It also involves some old fashioned pre-operative instructions that increase the safety and comfort of your surgery.
In this section we will discuss the first group of instructions which involve behavior modifications that should take place in the months and weeks before surgery.
1. Start taking a multi-vitamin everyday: Once you have made the decision to have surgery, even if the actual procedure won’t happen for six months, you should begin taking vitamins. Not only will this improve your health and your body’s ability to heal, but it will also help your body avoid nutritional deficiencies that can be experienced after certain kinds of weight loss surgery. Getting into the habit of taking vitamins before surgery will help you remember to take them afterward.
2. Stop smoking: Smoking can increase your chances of having blood clots in your legs or getting pneumonia, two of the potential complications of anesthesia use. Additionally, it reduces your circulation so that your skin cannot heal as quickly and it prevents your lungs from working properly as it collapses tiny sacs of air within them. Smoking can even cause increased stomach acid production which can give you gastric ulcers after surgery. Therefore it is vital that you stop smoking at least 30 days prior to surgery.
3. Start an exercise routine: Adjusting to life post-surgery is challenging enough without adding the confusion of a new and unfamiliar workout routine. By exercising for a few weeks prior to surgery you can create a schedule and routine that will be easy to keep after surgery.
4. Limit or avoid alcohol. Alcohol is very high in calories with no nutritional value. When you begin rapid weight loss after bariatric surgery, your liver becomes especially vulnerable to toxins such as alcohol.
Alcohol can cause Dumping Syndrome.
5. Arrange for time off of work: Most patients are able to return to work no more than two weeks after surgery, but you need to discuss that with your doctor. Be sure to take the right amount of time off for your surgery so you can allow the healing process to do its work before you begin stressing your body with movement and travel. While it is not necessary to disclose to your employer the nature of your surgery, you should explain that your movements could be limited for several weeks after your return.
Next, let's discuss the preparation you must complete during the final days before your surgery.
The Week Before Surgery
The short list of tasks you need to accomplish in the week leading up to your bariatric surgery.
The week before your surgery is a time filled with excited anticipation and perhaps the nagging worry that any pre-op surgery patient feels. Many questions run through your mind and you may begin to feel overwhelmed and as though you have lost control.
There are many thing that you can do to feel in control of the procedure you are about to have. While you must rely on the skill of the bariatric surgical team on the day of surgery, you can take your fate and success into your own hands by following all the proper pre-op instructions.
1. Avoid or restrict the drinking of carbonated beverages: Carbonated beverages are infamous for causing gas. You need to limit the amount of these beverages you drink during the week before surgery so you do not have any additional gas or associated discomfort to deal with.
2. Avoid or restrict the amount of alcohol you drink: After your surgery, your liver may become extremely sensitive. Because alcohol damages the liver and is considered a toxin, you could be setting yourself up for pain and further liver damage by drinking during the week before your surgery.
3. Practice breathing and coughing: Being under anesthesia can increase your risk of pneumonia so coughing after surgery to expel mucus is extremely important. Because of the nature of your surgery though, you won’t be able to cough as you normally do so you need to practice splinting your abdomen with a pillow. Simply place the pillow over your abdomen and your hands on top of that, put a little bit of pressure on the abdomen and then cough. Practicing this before surgery is a must. It is also important to consciously breathe deeply. Fill your lungs with air and hold it for three seconds. Release the air with force as though you are blowing out a candle. Practicing each of these techniques three or more times a day during the week before surgery will help make it easier once surgery is complete.
4. Adjust your medications: Your doctor will discuss with you any changes you need to make in your medications during the week before surgery but, in general you should stop taking any blood thinners, herbal medications that thin blood or pain relievers with aspirin. You should also stop taking vitamin E and all appetite suppressants.
5. Eat only clear liquids until midnight: You can eat a normal breakfast in the day of your surgery, but after that you must take nothing but clear liquids like water, gelatin, popsicles and coffee until midnight. After midnight you cannot take ANYTHING by mouth other than the medications you have been instructed to take.
6. Pre-admittance: You will need to complete your hospital pre-admittance several days before the surgery. At that time you will have lab work, a chest x ray and an EKG. If you become ill in the days before surgery notify your doctor so that he or she can ensure you are safe for surgery.
The Day Before Surgery
Your pre-op instructions for showering and eating prior to your bariatric procedure.
Whether you’re having a gastric bypass, LAP-BAND adjustable gastric band, duodenal switch, or sleeve gastrectomy surgery follow this schedule the day before to help your procedure go smoothly and safely:
In the morning
Shower with Hibiclens®, an antibacterial soap the pre-op nurse at the hospital gave you when you pre-registered. Be sure to lather up and rinse thoroughly, including your navel. (Please inform the office if you are allergic to Hibiclens*!) You can use your own shampoo.
You’ll need to start a clear liquid diet at noon and continue it throughout the day to prepare your digestive tract for surgery. This diet ensures you’re hydrated but your stomach and intestines are mostly empty. And clear means just that – if you can see through it and it’s not sugary, fatty or alcoholic, you’re good to go:
• Broth or bouillon
• Soups (strained – no solids)
• Iced tea
• Sugar-free drinks
• Gelatin (no fruit added)
If Dr. Ayoola instructs you to, you can also have protein drinks such as Profect, Nectar and Isopure. Just make sure to consume no more than the amount allowed. Also, take any medicines as directed by Dr. Stewart.
In the evening
Shower with Hibiclens again. Remove any fingernail polish.
Don’t eat or drink anything, including gum or mints. You can brush your teeth and rinse, but don’t swallow any water. The same goes for the following morning – brush and rinse, don’t swallow.
You’ll be a bit hungry when you check into the hospital in the morning, and while that may be a little uncomfortable it’s just the right preparation for a safe and smooth procedure.
Any questions about getting ready for surgery? We’re here to help. Call to speak to a nurse at 940-382-9429.
The Day of Your Surgery
How to arrive at the hospital ready for bariatric surgery.
Imagine what it will be like the day of your surgery. No more waiting, wishing and wondering—it will be time to actually take the first real step in your final weight loss journey as you prepare to become a new weight loss success story. But it is not all excitement on the day of surgery. The procedure you are about to undergo requires some preparation from you.
Some of your preparations will take place at home before you come to the hospital and others will take place at the hospital. In this section, we will discuss all the big and little things you must do before you get to the hospital.
Day of Surgery Home Preparations
1. Take a shower with the antiseptic Hibiclens. You can wash your hair and brush your teeth as normal but do not swallow any water if it’s after midnight the night before surgery.
2. Do not apply any make-up, false eyelashes, lotions, creams, or moisturizers. There is no need to get pretty for surgery and your skin needs to be free of all lotions.
3. Do not wear any jewelry and be sure to wear loose clothing that is comfortable and slips on easily. Your shoes should also be easy to put on. Remember, you need to put on the clothes and shoes after your surgery so they can’t have waistbands that will irritate your incision or complicated straps.
4. Do not eat anything or drink anything after midnight the night before surgery. Take any medications that your doctor has instructed you to take and avoid those your doctor asked you not to take prior to surgery (like blood thinners). If you need water to take the medication, be sure to only take a very small amount.
5. If you have sleep apnea and use a C-PAP or Bi-PAP machine you need to bring your mask with you. The actual machine will be provided for you at the hospital, you simply need to bring your mask.
6. Bring all of your medications, your driver’s license and your insurance cards with you for surgery.
7. You will not be able to drive home after surgery, so make sure you have someone there to pick you up. This person must be able to take and understand the post-op instructions given by your doctor.
8. Lastly, make sure you get to the hospital by the appointed time.
The next group of steps involve those things you and your medical team must do at the hospital to ready yourself.
In the Hospital
What you can expect to happen when you arrive at the hospital.
After reporting to the registration desk at the hospital, your real adventure begins. You will be taken to the appropriate area and the nurses will start your IV. It is then that you will get a dose of antibiotics in order to help prevent any infections. Lastly, you will get a dose of Heparin in the form of an injection to your abdomen. This will help lower your risk of developing blood clots.
Next you will proceed into the operating room. It is at this point that your anxiety may begin to set in. This is completely normal; anyone heading into surgery, no matter how well prepared, is bound to feel some anxiety. In the room with you will be the surgical team which will include the nurses, surgeon, surgical assistant and anesthesiologist. The surgical team understands the anxiety most patients experience as they follow through with their weight loss goals.
You will be given medication through an IV that will make you drowsy and you will be connected to machines that monitor your blood pressure, heart rate and other vital signs. The anesthesiologist will wait until you are fully asleep and then will place an endotracheal tube into your mouth and then your windpipe to make sure your airway stays open and you can continue to breathe. Between the anesthetic gas and your medications you will sleep through the surgery and experience no pain. During this time, your oxygen level will be monitored and you will be watched for any side effects of anesthesia. The surgical team is devoted to your success and health and will keep a vigilant watch on all of your vital signs during surgery.
The last step is the actual operation. The amount of time the surgery takes will depend on the type of surgery you get. In addition to completing all of the necessary steps of this type of surgery, Dr. Ayoola will perform a liver biopsy to make sure it is healthy and shows no signs of liver disease.
Once the surgery is complete, your incision will be dressed and the surgical team will move you to the recovery room to monitor you for a few hours.
Recovering from Bariatic Surgery
You won’t remember much about the immediate post-operative period as you recover from anesthesia. Here is a description of what will be happening.
After your gastric bypass, LAP-BAND adjustable gastric band, sleeve gastrectomy, or duodenal switch surgery, you’ll progress through a series of steps with your care team that will get you on the mend and feeling good as soon as possible.
The key thing to remember in the post-surgical phase is that everything is manageable. You may feel a little pain, but it can be managed with medication. You may even feel a little disoriented, but that feeling will fade quickly as you ease back into daily life.
Your first stop: recovery
Most patients have very little memory of their stay in the recovery room, and it’s common to feel drowsy and confused when you first wake up. You may notice that you’re connected to monitors to keep track of your vital signs, and there are nurses nearby. You will be in the recovery room for about 90 minutes, or until you are awake and alert and your vital signs are stable, and then you’ll be taken to your room.
Back in your room
On the day of your procedure, you’ll probably feel tired and sleep most of the time. This is just what your body needs to begin the healing process. During this time, you’ll continue to be monitored closely; nurses will check on you every hour at first and then every other hour as you rest. You can have ice chips if your mouth is dry. You may have had a catheter placed in your bladder during surgery. It will be removed in a day if your urine flow is adequate.
Typically, your first day post-surgery is not a good time to have visitors. You’ll be sleeping most of the time, and nurses will be monitoring you closely and continuously. Ask friends and family to wait until the following day or later to pay you a visit. You’ll both be able to enjoy it more that way.
The first few days
This is a critical time for your stomach and intestines to heal. You will slowly progress from sips of water to clear liquids depending on which surgery you had. You’ll continue to get heparin every 12 hours while you’re in the hospital, and there is additional medication available for nausea or pain or if you run a temperature.
Everyone’s perception of pain is different. It is important to inform your nurse if you need pain medication.
If you have diabetes, your blood sugar will be checked every six hours and you’ll be given insulin if needed.
Coughing and deep breathing are important to prevent complications such as pneumonia. Your breath volume will be measured regularly to ensure it is sufficient. You’ll also have pumps on your feet throughout your stay to prevent blood clots. They should only be removed when you are sitting up in a chair or walking.
You will be encouraged to walk several times while you are in the hospital. Each day you’ll notice your strength returning.
As you recover, you may experience fatigue, nausea, sleeplessness, surgical pain, weakness, lightheadedness, loss of appetite, gas pain, flatus, loose stools, and emotional ups and downs. These are normal and will pass in time as you continue to heal.
A little discomfort is normal and quite manageable. Here is some advice on evaluating and managing discomfort after your bariatric surgery.
It’s normal to experience some pain while you recover from gastric surgery. But you don’t have to suffer your way through it; your bariatric surgery team can offer you safe and effective medication to make you more comfortable. In fact, controlling pain can help you heal better and avoid complications. When you feel good, you’ll be able to walk and perform deep-breathing exercises, which can prevent pneumonia and blood clots.
Tell them if it hurts
Everyone’s perception of pain is different. If you feel uncomfortable, let your nurse know. You and the hospital staff are a team working together to manage your pain. Be as accurate as you can about your level of discomfort to help your nurse determine the best medication and to chart your progress over time.
One way to describe your pain level is to use a scale of 0 to 10, with 0 for no pain at all and 10 for the worst pain possible. You can also describe your pain as none, mild, moderate or severe.
Plan ahead for comfort
Some people report that if they wait until their pain is intense, it’s much harder to control when they do take their medication. Increasing your activity can also increase your need for pain relief – if you’re comfortable lying down, you may still need medication for walking around.
Some patients are reluctant to take pain medication because they’re worried they could become addicted. But patient research has clearly shown that the risk is very low when medication is used for a specific medical purpose. So no worries – let yourself get comfortable so you can heal.
The risk of becoming addicted to pain medications is very low when it is used for a specific medical purpose.
Moving After Bariatric Surgery
How will your activity be restricted after bariatric surgery? Find out here.
After your weight loss surgery, you must take care of your body in order for it to heal. This means that there are many activities you should avoid, all for varying periods of time. Following is a guide to activity for the first few months after surgery.
General Activity after Bariatric Surgery
The first week after surgery is the most physically exhausting, so don't feel bad if you find that you tire easily. Listen to your body and be very conservative in your activities during this time. You should not do more than light housework duties for the first three to six weeks.
Bathing and Swimming
After weight loss surgery, you may take showers. Tub baths are not advisable for the first two weeks after laparoscopic surgery and for the first four weeks after an open procedure. Swimming can be enjoyed four weeks after your weight loss surgery, providing your incision has healed.
When showering, you'll probably want to change your gauze dressing. You can begin doing this about 24 to 48 hours after you've had surgery. When you remove the gauze, you might notice some adhesive stuck to your skin. Remove it gently and do not use any harsh or abrasive soaps that could irritate your skin. Goo-Gone (available at stores like Walmart) is a safe way to remove the remaining adhesive. If you have Steri strips, you do not need to remove them before showering.
Driving after Bariatric Surgery
Because you may encounter overwhelming fatigue and because the movement of the steering wheel may irritate your incision, driving should be avoided for the first two weeks after weight loss surgery. If you are on a narcotic pain medication, then you should avoid driving until you no longer take that medication.
Sitting, Standing, and Climbing
Because you'll tire easily during your weight loss surgery recovery, you should not sit or stand for long periods of time. Instead, you should be resting comfortably in a reclined position. You may climb stairs when necessary, but be sure to hold the railing to avoid any loss of balance and subsequent falls.
When you have a laparoscopic procedure, you can begin lifting, pushing, moving, or pulling weights that exceed 15 pounds about four weeks after surgery. If you've had an open procedure, you should wait about eight weeks after your weight loss surgery.
Symptoms to Expect
What symptoms are normal after surgery and which ones are reasons for concern?
No matter how minimally invasive, surgery is surgery, so you can expect a few side effects after it is over. Of course while some side effects may be normal, others may be an indication that there is an infection or other underlying problem so it is important to pay attention to the intensity of your side effects and let your doctor know if anything seems abnormal.
Symptoms to Expect During Recovery
Swelling and bruising: A moderate amount of bruising and swelling is to be expected after the surgery. If you notice the swelling becoming excessive and you experience tenderness with it, you may have an infection and should contact your doctor.
Pain and discomfort: If you were to assign your pain to a scale of 0-10 with 0 representing no pain and 10 representing severe pain, you can expect post-surgery pain to be in the 1-6 range. Anything beyond that should be brought to your doctor’s attention.
Numbness: Your body is full of tiny little nerves and during surgery many of them can be cut when the incision is made. It could take up to three months for the sensation to come back to that area—if it ever does. If you use a heating pad in the area of your incision, be sure to limit the time you use it to no more than 20-minutes so that you don’t inadvertently burn yourself.
Itching: Any time you have a cut or wound that is healing, you will experience itching. The same holds true for the incision for your weight loss surgery. Eventually, your steri-strips will fall off and you can begin using vitamin E or a topical antibiotic on your incision to ease the itching and help the healing. Remember, don’t drown your incision in topical ointments and vitamins, just dab a small amount.
Scars and Redness: Initially after weight loss surgery, you will experience red, purple or dark pink scarring in your incision area. You must use sunscreen to protect this delicate skin even if it is underneath a bathing suit. Within about one year the scar should fade.
Leaving the Hospital
Once you leave the hospital you will be taking care of yourself. Here is a list of things to keep in mind as you travel home and in the first few hours as you settle into your new routine.
When you leave the hospital after weight loss surgery, the care of your wound, appetite, and health falls to you. This may seem overwhelming, but if you follow a few simple rules, you will heal and thrive well.
The Drive Home
- Some people must travel great lengths to reach their doctor. If your trip home from the doctor's takes over an hour, it's important that you take steps to stimulate your circulation. Get out of the car every hour and walk around briefly.
- If your incision is uncomfortable, you may splint it with a pillow. Make sure that you still wear your seatbelt.
- Your circulation is still a concern once you’ve arrived home, so be sure to walk around your home or yard every two hours during the day and early evening. In between walks, while seated, make sure you keep your legs in an elevated position. Avoid crossing your legs.
- Make special arrangements to help you avoid unnecessary difficulties like stairs and potential slip-and-falls in bathrooms without safety rails. You may need to arrange a sleeping area downstairs for the first few days after surgery.
- You'll be sent home with an incentive spirometer to help regulate your breathing. Make sure that you use it at least four times each day, or according to your doctor’s orders.
- Monitor your post-operative pain levels. Measure your pain with a scale that ranges from 1 to 10, with 1 representing barely any pain and 10 representing pain so severe you want to go to the hospital. Once your pain level reaches 5, you should take your pain medication in order to head your pain off at the pass and avoid suffering too much. If you experience shoulder pain or pain at the site of your gastric band port, a walk might help reduce it.
- Keep your incision point, drainage tube, and (for gastric band patients) port clean and dry according to your doctor’s instructions.
- Make sure you follow all the guidelines of the post-surgery diet. Focus on high-protein, low-starch foods, eat slowly, chew well, and do not drink when you eat. Remember to drink 40 to 64 ounces of fluids in between meals.
- Take all medications and vitamins as directed. If you have special problems or irritations, you can take Gas X, Milk of Magnesia, Tylenol and Motrin (for headaches, and not frequently), Pepto-Bismol, and Prilosec. For sinus problems, you can take Robitussin expectorant. No substitutions for these over-the-counter medications should be made unless your doctor recommends it.