Common Questions Regarding Gastric Bypass Surgery

Q: What are the advantages of a laparoscopic Gastric Bypass?

Ans: The laparoscopic gastric bypass is performed through four tiny incisions. This results in much less pain and discomfort following surgery. In addition, it allows the patient to be up and about faster and more comfortably, thus decreasing the chances of developing pneumonia or blood clots. The absence of a large incision decreases your chances of developing a wound infection or incisional hernia that might require further surgery. The Gastric Bypass results in a higher average weight loss, approximately 75% excess body weight loss, in approximately two years. The gastric bypass is also maintenance free. There are no artificial materials to rely upon.

Q: What kind of preparation is there before surgery?

Ans: You should avoid the “last supper” syndrome in the period prior to your surgery. This can lead to significant weight gain and greater difficulty in performing your surgery. We ask that patients stop smoking at least three weeks prior to your scheduled date. You are expected to start a clear liquid diet on the day before surgery and do the bowel preparation as prescribed by your surgeon. You may not eat or drink anything after midnight on the night prior to surgery unless otherwise instructed. Your surgeon and anesthesiologist will discuss which medications will be taken the day prior to surgery.

Q: How long is the procedure and what is the postoperative care?

Ans: The procedure takes an average of two to three hours to perform but may vary depending on your BMI. The whole process from the time you come in to the operating room to the time you arrive in recovery is much longer to account for anesthesia and awakening afterwards. Therefore, your loved ones should expect to talk to the surgeon approximately four hours after you leave them. After the recovery room you will either go to the surgical floor or to the ICU. This will be determined by the surgeon and anesthesiologist at the time of your surgery. The day of surgery you will continue with nothing by mouth but will be up walking with assistance on average five times. On the second day post-op, you will go to the radiology department for a special X-ray, (UGI), to test your new anatomy. If your test is negative, you will begin your Stage I diet. The following day you will be advanced to the Stage II diet and you will typically be discharged home.

Q: How about drains and wound care?

Ans: Typically, there are no drains in the nose or mouth. You will have a small drain on your left flank that will be removed before you go home. There are no sutures or staples to be removed. The incisions will be covered with steristrips that should be left alone. You may shower 48 hours after the surgery and wash with warm, soapy water.

Q: Could there be complications from the surgery?

Ans: Yes! Although the complication rate is low it is still a concern. The laparoscopic gastric bypass is major surgery and there is a risk of death following this procedure depending on your other medical problems. The chance of a major complication, such as a leak is 0.5%. Other possible complications include stricture, obstruction, blood clots, ulcer and wound infection. This was covered during our information seminar and will be discussed during your consultation.

Q: What can I expect at my first visit?

Ans: Your first visit will be a consultation with the Bergen Bariatric Surgery team. This includes the nurse, the insurance specialist, office manager the dietician and the surgeon. Your medical history will be reviewed. Detailed information will be necessary regarding previous attempts and failures at weight loss programs with both supervised and unsupervised diets. We would also like you to bring a list of the medications you are currently taking. Patients who wish to proceed with surgery will be given a list of required tests that need to be completed prior to surgery. These tests can all be done at the Hospital, or, if necessary, they can be done at an institution close to your residence.

Q: What can I expect if I decide to go ahead with surgery?

The preoperative preparation usually takes four to eight weeks to complete. You are required to arrange a subsequent appointment at the Center to review the results of your tests as well as to discuss the surgery and sign the informed consent form. At this visit you should be accompanied by a family member, spouse, or significant other who will be your support system before and after surgery.

Q: Are there special instructions for the one to two weeks before my surgery?

Ans: We recommend that patients who smoke refrain from smoking for three weeks prior to surgery because of the increased risks of pulmonary complications.

Patients who take aspirin, Motrin, or Motrin-like products, Aleve, or special non-steroidal drugs for arthritis or joint pain must stop these at least 3 days before surgery. These medications interfere with blood coagulation. Failure to recognize this will result in increased blood loss with the surgery. Tylenol is safe to take.

We also encourage patients to maintain a healthy, well-balanced, low calorie, low fat diet and avoid binge eating in the days prior to surgery. We also encourage patients to avoid alcohol for two weeks prior to surgery.

Q: What can I expect the day of surgery?

Ans: Patients must take nothing by mouth after midnight the night before surgery. You may brush your teeth and rinse with a small amount of water. Anesthesiologists may give specific directions for medications either the night before or the morning of the surgery. Patients are expected to be in the Admitting Office of the Hospital two hours prior to their scheduled surgery.

Q: What will my recovery be like?

Ans: Immediately after surgery, patients are taken to the Recovery Room where they are closely monitored. The surgeon will meet with your family immediately after surgery at the family waiting area near the Operating Room. If families are not present at the conclusion of surgery, a call to a family member can be made at your request. Respiratory support is continued until patients demonstrate that they can breathe spontaneously and sufficiently to maintain adequate oxygen levels in the blood. The breathing tube may result in a minor temporary sore throat after its removal. When you awake, you will be connected to an IV and a pain medicine pump. You will also have a catheter in your bladder that is placed while you are asleep as well as compression boots on your legs.

Q: What will my incision look like?

Ans: The minimally invasive laparoscopic technique to accomplish the Gastric Bypass operation requires four, quarter inch incisions. These wounds are closed with absorbable sutures and Steri Strips. You will have a J.P. (Jackson Pratt) drain on the left side of your abdomen which will be removed on your day of discharge. If it is necessary to convert to open surgery, then an upper abdominal incision is performed. The incision runs from the lower aspect of the breastbone to just above the umbilicus (belly button). The skin incision is usually closed with metal staples and covered with a dry dressing.

Q: How many days will I be in the hospital?

Ans: The median length of stay is two to three days.

Q: When will I be able to drive?

Ans: You may drive after 5 days, as soon as you feel up to it, and as long as you are not taking narcotic pain medications.

Q: Will there be any discomfort after my surgery?

Ans: You can expect some incisional discomfort beginning immediately after surgery. The pain will diminish each day. For the first two to three days, patients control their own post-operative pain medication with a hand held device. You will be given instructions regarding this. By walking and stretching immediately after surgery, this discomfort and muscle spasm can be reduced. You will be discharged on oral narcotic pain medication, if necessary

Q: Can I take over-the-counter medications after my surgery?

 Ans: Yes. Most medications are safe to take after gastric bypass surgery. Tablets larger than the size of a pencil eraser must be broken or dissolved during the immediate postoperative period. Pills may be placed in sugar free applesauce to help them to go down easier. Aspirin, Motrin, and Advil are to be avoided except under rare exceptions because of ulcer risk.

Q: How soon after my surgery can I return to work?

Ans: The answer to this is a variable. The average employer allows approximately six weeks of recovery time following upper abdominal surgery through an incision. Most gastric bypass patients who are motivated are able to return to work earlier. Laparoscopic patients may return to work as soon as two weeks.

Q: Are there long term problems from the surgery?

Ans: The Laparoscopic Gastric Bypass is a well-tolerated procedure, however nutritional deficiencies can occur. For example, following surgery there will be a decrease in the absorption of certain vitamins and minerals such as vitamin B 12 or minerals such as calcium, iron, and zinc despite what you eat. These problems can be avoided with adequate supplementation and communication with your dietitian and surgeon. Failure to take vitamins and supplements on a regular basis can result in serious neurologic complications. Other problems such as stricture, ulcer and intestinal obstructions can occur.

Q: How much weight should I expect to lose?

Ans: Most patients will lose approximately 75% of their excess body weight. By maintaining your recommended diet and joining an exercise program you can exceed these averages. Most of the weight loss takes place in the first year but should continue for up to two years. Five to ten percent of patients may fail to lose weight or regain the weight. This usually happens in patients who do not comply with their prescribed diet and either stretch the pouch or widen the anastomosis.

Q: What kind of diet will I follow after the surgery?

Ans: On the day after surgery, once your x-ray study has been evaluated, your diet will begin with water only (Stage 1). The following day, you will advance to clear liquids (Stage 2). We encourage drinking water in small sips throughout the day in order to maintain hydration. On discharge, your diet will also be progressively increased to protein shakes (Stage 3). This will continue for two weeks and then you will begin pureed foods. This will continue for 6 weeks. Approximately eight weeks after surgery you will start solid foods (Stage 5). Please realize that not all foods will agree with you initially, and certain foods you may never be able to tolerate well. As you try new things, occasional vomiting is not unexpected. If you experience prolonged vomiting to all foods you should call the center immediately.

Q: Can you expect changes in your bowel habits?

Ans: Yes! Constipation is quite common particularly if you are taking iron. Dietary manipulation can be most helpful, in particular, drinking more water and adding more fiber to you diet. Upon discharge, you should be sipping water constantly when you are awake. This should be held one half hour before to one half hour after meals. You should avoid laxatives unless otherwise recommended. If you have diarrhea, you should discuss it with your doctor. Avoiding greasy foods and milk products may help to reduce the problem.

Q: Should you plan to get pregnant?

Ans: You should avoid pregnancy in the first year after the surgery. Oral contraception should be discontinued one month prior to surgery and not restarted for one month after surgery as it does change the bodies clotting abilities. Even though sexual activity can be resumed when you feel up to it, barrier contraception must be scrupulously adhered to during this period. It is difficult to maintain adequate nutrition for the fetus while you are losing weight rapidly so plan pregnancy should be deferred for one year after surgery.

Q: What kind of support is available after the surgery?

Ans: You will visit with your surgeon quite often initially as well as with the dietician. You should plan to see your surgeon at one week following surgery, then at one month, three months, six months, one year, and yearly thereafter. This surgery requires a lifelong commitment to follow-up. In addition, we have a support group that meets on a regular basis that we encourage you to attend.

Q: When do I return to the doctor’s office for my post-op checkup?

Ans: You will be seen within seven to ten days after discharge for wound check. During the next four weeks you will interact with the dietician as your diet progresses from liquids to pureed food and then to solid food. You will be seen in the center again at three months postoperatively. Subsequent visits consist of nutrition checks at six months, one year, and then annually. Because of the complexity of this surgery and the potential for nutritional issues associated with massive weight loss, regular nutritional follow-up is expected. Patients are expected to comply with this. Patients who live outside the area can have their follow-up locally with their primary doctor in communication to Bergen Bariatric Center.

Q: Can I expect to lose hair after surgery?

Ans: Transient hair thinning occurs in a certain percentage of our patients during the first six months after surgery. The cause of this is unknown but probably reflects rapid weight loss and the relatively limited food intake. No specific nutritional deficiencies have been linked with this hair loss. The problem is always temporary and no one has progressed to develop significant permanent hair loss. Maintenance of adequate protein intake, approximately 60 grams per day, can lesson this issue. The dietician will work with you on this in both the pre and post operative period.

Q. What is dumping syndrome?

Ans: Dumping Syndrome can occur after any surgery that changes the normal way in which food leaves the stomach. It occurs when food passes too quickly (“dumped”) from the stomach into the small intestine. In response, water from the surrounding blood vessels is drawn into the small intestine, usually resulting in a combination of the following symptoms: abdominal fullness, nausea, light-headedness, sweating, cramping, rapid heartbeat, and diarrhea. Symptoms can occur 10-20 minutes after eating a meal and/or 1-3 hours after eating. Refined sugars, high fat foods, overeating and drinking liquids with meals are the usual culprits.

Q: What about consumption of Alcohol after surgery?

Ans: After gastric bypass surgery, the absorption of alcohol is changed by the bypass limb. Patients report a quicker intoxication after a smaller quantity of alcohol followed by a more rapid sobriety. It is important to understand how your new system will react to these changes after surgery before resuming old habits. Also important, aside from the side effects, Alcohol also contains a large number of calories. A large consumption can affect weight loss.