Ask Your Doctor Discussion Guide:
Preparing for Your Weight Loss Procedure
Ask Your Doctor Discussion Guide
Best for: pre-op consultation with surgeon
Pre-Operative Weight Loss Surgery Plan What do I need to do weeks prior to my weight loss surgery?Your surgeon and his or her staff will provide you with written instructions about what and what not to do in the weeks and days prior to your operation. The presurgery routine for bariatric operations is very similar to most other types of operations:
- If you smoke, you should stop at least two weeks prior to surgery. Smoking may decrease your lung capacity and delay the healing process after surgery.
- You will meet with a nutritionist or your surgeon, who will provide you with a detailed eating plan to follow at least a week prior to surgery.
- You should set aside time to shop and prepare some food and to obtain other household items you will need immediately after surgery.
- On the day before the surgery, do not eat or drink anything after midnight, but do continue to take your prescription medications, with small sips of water, unless your surgeon instructs you to do otherwise.
- Take all of your medications with you to the hospital. If you have sleep apnea and use a continuous positive airway pressure (CPAP) machine, bring it with you also.
- Bring casual, comfortable clothing that will be easy to take off and put on after surgery. Leave jewelry and other valuables at home.
The amount of time required for the surgery will depend on the type of procedure you are having. In general, a more complicated procedure, such as gastric bypass, takes about two to three hours. An adjustable gastric band procedure requires much less time: typically about an hour. However, you may be in the operating room for two to three hours or possibly longer as the hospital staff may require more time to set up your operating room, administer anesthesia or prepare you for the procedure. If complications occur during surgery, the operation may take longer than anticipated, and more recovery time may also be required.
What will happen immediately after the surgery?Your surgeon will check your progress to make sure you dont have any immediate complications. He or she may have an X-ray taken right away or before you leave the hospital. As soon as possible after your surgery, the hospital staff will assist and encourage you to get up and start walking. The sooner you are up, the faster you will recover. You may initially experience nausea and/or vomiting, which are common side effects of anesthesia.
You may be given ice chips to start and then be allowed to start drinking small sips of water within a few hours of your operation.
How long will I remain in the hospital after the surgery?- If you have had an adjustable gastric band placed and are doing well after surgery you may be allowed to go home the same day; however, many patients will stay overnight and go home the day after surgery.
- If you have had gastric bypass surgery, you may be required to stay in the hospital for at least two to three more days.
- If complications occur during or immediately after surgery, more recovery time may be required.
Regardless of the type of surgery you have, when you are discharged your surgeon and the hospital staff will send you home with very specific instructions about:
- Any medications and nutritional supplements you will be taking
- Signs and symptoms of surgery complications (infection or bleeding, for example)
- An eating plan indicating what types of foods you may eat and when you may eat
- Physical activity and exercise plan
- Support group therapy
Immediately after surgery, your eating behaviors will need to be permanently altered as you will no longer be able to consume large amounts of food at any given time. This will not only reduce the likelihood of your experiencing severe abdominal pain and vomiting, but it will also minimize your chances of having major complications from your surgical procedure, such as large particles of food becoming lodged in your esophagus, stomach or gastrointestinal tract.
The day after surgery you will probably feel much better, and you will begin consuming a liquid diet (small amounts of food in liquid form), progress to soft foods (such as low-fat yogurt) and eventually introduce solids approximately four to six weeks after your surgery. Your solid food needs to be soft, moist and well-chewed to avoid abdominal discomfort or nausea.
Gradually, you will progress to eating 1/2 to 1 cup of food per meal as your stomachs capacity to hold food increases. However, your now-smaller stomach will not be able to hold more than 1 cup of food at a time.
If you have had gastric bypass surgery, you should avoid eating meals high in simple carbohydrates (sugars) that are rapidly absorbed by the body and cause the stomach contents to move too quickly through the small intestine. This reaction, commonly referred to as “dumping syndrome” is associated with very unpleasant symptoms such as abdominal pain, bloating, weakness, sweating, nausea and sometimes diarrhea.
Eating suggestions for both types of surgical procedures include:Beverages:
- Sip liquids slowly between meals during the day. Liquids keep you hydrated, and it is wise to carry a bottle of water with you at all times. Good choices for liquids include water or skim, low fat or soy milk (up to 24 ounces per day), low calorie beverages or tea.
- Avoid drinking anything for 30 minutes before or after each meal as your stomach can no longer handle a large volume of both food and liquids at once.
- Avoid high-calorie beverages such as alcohol, milkshakes, fruit juices/drinks and meal replacements. Eating high-calorie beverages and soft foods that easily pass through the opening to the stomach can lead you to not lose weight or even to quickly regain weight.
- Avoid carbonated beverages such as soda, which may cause bloating.
Eating a balanced diet:
- Because you will be eating much smaller amounts of food per meal, the types of food you select should be high quality and packed with nutrients, offering a lot of nutritional value for the fewer calories you now consume.
- A daily multivitamin is often prescribed after all types of bariatric surgery to compensate for reduced food intake and, with the gastric bypass, the nutrients that may no longer be absorbed in the bypassed areas of your stomach and intestines. Additional nutritional supplements may be prescribed to prevent vitamin and mineral deficiencies.
- Your long-term eating plan should be low in fat and sugar and high in protein.
Ask your doctor and/or nutritionist about specific instructions just for you.
When should I start exercising? What types of exercise are recommended in the long term?You should try to walk from day one. Your doctor and the hospital nurses will let you know when it is time to “get up.” This is the beginning of your exercise program, and walking will also speed your recovery. Take it easy at first, but then begin adding more distance as you feel stronger.
- Avoid swimming until your incisions have healed completely. However, once these have completely healed, swimming is a generally well-tolerated form of exercise because it is low impact.
- Do not perform any vigorous exercise such as lifting anything weighing more than five pounds until six to eight weeks after surgery.
- Ask someone to assist you with strenuous household chores and shopping. Talk with your doctor about when and what type of exercise program you should begin.
Be sure to consult with your doctor before starting any exercise plan.
When will I return for a follow-up appointment with the surgeon?You may have a follow-up appointment with your surgeon within one to two weeks after surgery (or sooner, if you experience any complications). At this appointment, your surgeon will ensure that you are recovering normally, examine your surgical incision(s) and speak to you about diet, exercise and other activities. If you have an adjustable gastric band, you will need to return at around four to six weeks after surgery for your first opportunity for a band adjustment. In general, adjustable gastric banding patients will have several more visits for adjustments, especially in the first year after surgery.
What types of symptoms require me to immediately call my doctor?Most people recover from surgery without any problems. However, if you experience any problems during your recovery or at any time after surgery, please call your surgeon. Dont be afraid to call your surgeon if you experience anything unusual or if something just feels wrong. Call immediately if you have:
- A fever of 101 degrees or higher
- Sudden shortness of breath, chest pain or a rapid pulse (over 120 beats per minute that does not slow with rest)
- Pain, redness or swelling in one or both of your legs
- Pain, swelling or fluid leaking from your surgical incisions
- Severe diarrhea, excessive nausea or vomiting
- S Severe abdominal pain
In the case of a medical emergency or when you are out of town, you will need to go to the nearest emergency room facility. You should let the medical personnel there know that you have had a gastric bypass or an adjustable gastric band implanted. Ask the emergency room doctor to call your surgeon.
When can I return to work?Most people are able to go back to work in typically less than a week after having an adjustable gastric band procedure, and within two to three weeks after gastric bypass surgery. This will not only depend on the type of surgery you have, but also how well you are recovering and what kind of work you perform.
How soon will I begin losing weight?Successful weight loss results depend on your willingness to adopt a long-term plan of healthy eating and regular physical activity. You should begin losing weight immediately after gastric bypass surgery. After adjustable gastric banding surgery, some people start losing weight right away with a feeling of restriction and satisfaction with very small meals. However, most adjustable gastric banding patients will not have optimal restriction until after they return for adjustments (band fills), which are very individualized to each patients needs. How much you lose will depend on many factors.
If you had a restrictive procedure (adjustable gastric banding), you can expect to lose about 40–60% of your excess weight in the first two years after surgery.
If you had a restrictive/malabsorptive procedure (such as gastric bypass), you could expect to lose about 50–70% of your excessweight in the first two years.
(Excess weight is the amount of extra weight above an acceptable weight range for your height.)
After three to five years, the amount of weight loss is about the same for both adjustable gastric banding and gastric bypass procedures. With the gastric bypass procedure, many people lose a significant amount of weight in the first two years after surgery, but some will regain the weight in the years following. Weight loss with adjustable gastric banding is typically slower and dependent upon follow-up visits and band adjustments. The best way to maintain your weight loss is to continue the lifestyle changes you adopted immediately after surgery. Continuous follow-up with your surgeon is essential as well.
What about support groups?Ask your surgeon about participating in support group therapy classes. Ongoing attendance at support groups after surgery leads to the greatest level of success. They offer you an opportunity to meet others who also underwent weight loss surgery and to discuss personal or professional issues that arise from surgery or from a history of obesity. Surrounding yourself with people who understand and support your behavioral goals will increases your chances of long-term success by helping you develop realistic expectations. And you can learn tips for success through their experiences.
What other support do you provide?Psychological counseling, nutrition and exercise are all important aspects of a comprehensive aftercare support program to help you achieve the best results after weight loss surgery. Specifically, your well-rounded support program should include routine consultations with a nutritionist to fine tune your eating plan, exercise classes to help you incorporate physical activity into your daily schedule, participation in support group meetings and working with a therapist to modify your behavior.