Should I stop my medications before surgery?

Some anti-inflammatory medications make bleeding more of a problem and if they can be discontinued without too much discomfort a week or two preoperatively it is desirable.

Should my bowel be cleaned out before surgery?

Some surgeons believe that a 'bowel prep' decreases constipation after surgery and makes managing a colon injury safer. In my experience colon injury is extremely rare and constipation is not a post-surgical problem. Therefore I do not recommend cleaning out the bowel prior to surgery.

Can I shower after surgery?

The reason for not showering after surgery is fear that infection will be introduced into the wound. However nearly all wound infectins come from bacteria present at the time of surgery and the incision itself is sealed within hours after surgery. It is probably even safe to get the intravenous site wet so long as it is reprepped and dressed after the shower.

Can I drive after surgery?

So long as discomfort does not prevent you from rapidly hitting the brake or steering effectively and you are not taking medications that impair your reflexes or judgment, it is safe to drive after surgery.

What happens to the bypassed stomach?

The only change that appears to be of clinical significance is a marked decrease in the production of ghrellin and a consequent marked decrease in hunger sensations.

Can I get pregnant after surgery?

As a generality weight loss increases fertility and improves the likelihood of a normal delivery. However, getting pregnant while rapid weight loss is occurring may not be safe and commonly results in less final weight loss.

How much time should I take off work?

If you have had laparoscopic surgery there are no limitations on your activity except the presence of a drain and your general energy level. Most people are quite ready to return to work in 10 days to two weeks, right after the drain comes out. When circumstances permit some people choose not to return to work until they feel completely 'on top of their game' again and they may take considerably more time off work than a week or two. Following open or incision surgery, heavy lifting must be avoided for eight weeks, Otherwise the timing of a return to work is as for the laparoscopic patients.

What about drinking alcohol after surgery?

The amount of alcohol absorbed before gastric bypass is limited to about 50% by the presence of an enzyme in the stomach which breaks down the alcohol before absorption. After a gastric bypass this enzyme does not come into contact with ingested alcohol and more is absorbed, so it is easier to get drunk. Also alcohol is a significant source of calories: 7 calories per gram as compared to 5 with carbohydrates or protein. After the adjustable band alcohol is digested the same as before surgery.

Are staples used during surgery and, if so, how?

Surgeons use staples much as they use stitches, to hold tissues together. Most abdominal surgery today makes use of both stitches and staples and the choice of which to use has more to do with the surgeon's personal preference than anything else.

Are carbonated drinks bad after surgery?

There is no evidence that carbonated drinks expand the pouch or otherwise impair the surgical result. The bubbles make some people feel 'gassy' and that seems to be commoner after weight loss surgery.

Is diarrhea a problem after weight loss surgery?

The first weight loss procedure was an intestinal bypass and it commonly caused diarrhea. Diarrhea is not a consequence of proximal gastric bypass or the adjustable band. Some increase in the frequency of bowel movements may occur after distal gastric bypass.

Does weight loss surgery cause bad breath?

Weight loss and the breakdown of fats cause the formation of ketones which are volatile and are partially exhaled. The odor however is not unpleasant and has been likened to that of Juicy Fruit chewing gum. It is important however to maintain normal dental hygiene and to brush your teeth even when taking only a liquid diet; otherwise, bacteria accumulate on the tongue and between the teeth and can cause bad breath.

Will I lose more weight on some place of my body than others?

Yes. There is a general tendency for weight loss to occur from the head and neck first and thereafter from the upper body and abdomen but people differ and where you lost weight before is likely where you will experience the most weight loss again.

What about loose skin after surgery?

The amount of loose skin after surgery depends on the amount of weight loss, your age - younger skin is more elastic than older skin - and individual differences. When weight loss is rapid, skin tightening may continue to occur after weight loss has stopped. In general, if you have lost a lot of weight you are likely to have some loose skin and may want some plastic surgery to correct it.

What causes hernias?

Hernias occur where the abdominal wall is weaker and from increased intraabdominal pressure. It is somewhat speculative but most incisional hernias probably occur with straining and coughing while the patient is waking up from anesthesia. Patients waking from anesthesia are pain free so when they strain their effort is not restrained. Sudden severe straining after surgery which happens more quickly than can be modified by reaction to discomfort is another likely cause for hernias. Examples include straining from falling, coughing, or vomiting. A sudden response to an unexpected weight (child jumps into your lap) can also cause hernias. A smaller contribution to the development of hernias can come from ordinary efforts that rely on abdominal musculature such as lifting and other forms of exercise. Standard advice is that following open surgical procedures with abdominal incisions, one should not lift a weight greater than 10 lbs for the first month and not greater than 30 lbs for the second month. Risk of hernia after laparoscopy is so low that full activity can be resumed almost immediately.

What type of previous surgeries would prevent me from having laparascopic surgery?

All previous abdominal operations make abdominal laparoscopic surgery more difficult but most do not force us to make an incision. A few, mostly those on the upper stomach like previous weight loss operations, make laparoscopic surgery so difficult that usually we find it is safer to make and incision in order to do the surgery.

What is the significance of the drainage tube?

With regards to the drain: The amount of drainage is not of much significance. If the drainage begins to look like oral intake that is of concern and should be confirmed by drinking something blue or purple (food coloring or grape juice) and seeing if the color appears in the drainage. If it does it should occasion a call to the physician. Drainage or wetness outside and around the drain tubing is usual and does not signify that anything is wrong, in particular it is not a sign of infection. Redness extending more than two inches from the drain site should be seen by the surgeon. The drain is protection against a wound infection at the drain site and against the life threatening consequences of a leak. Leaks are very rare after two weeks. Removal of the drain before two weeks after surgery entails some extra risk. Patients who want the drain removed early should consider the risk. About 2% of patients will develop a leak. It is ok to shower and get incision sites or drain sites wet and soapy after surgery. The area should be dried off afterwards and dressed if wetness at the site might stain clothing. A temperature greater than 101 degrees is reason to call the doctor. Lower temperatures are not usually of much significance. Patients often complain that the drain site hurts and that relates to two considerations: First, the drain is brought out the largest and therefore the most tender port site. Second, the drain is sutured to the skin so that it will not be accidentally pulled out and if it is not taped so that pulling on the drain does not pull on the suture a good deal of discomfort can result from normal activity

What if I'm having constipation?

Constipation after gastric bypass surgery is a common complaint. It is caused by decreased food and water intake and, in some people, supplemental iron, or narcotic pain killers, tranquilizers, and antidepressants. It is often aggravated by weak abdominal muscles or busy schedules wherein people defer having a bowel movement when the urge exists. Our approach is to provide the following advice:

Do exercises that strengthen the abdominal muscles and assist in bearing down. Most people experience the need for a bowel movement after breakfast and that is the natural and easiest time to have a bowel movement and should not be ignored. Increase water intake. An increased intake of any vitamin except B12 and vitamin A tends to produce diarrhea and has not significant other side effects and is helpful in eliminating constipation. Especially useful in this regard is Vitamin C or ascorbic acid since in addition to preventing constipation it enhances the absorption of iron in Trinsicon or other forms. Next add fiber to the diet: Eat high fiber breakfast (bran-based cereals, oatmeal) add vegetables to other meals. Miller's unprocessed bran found in the cereal section of the grocery store can be taken with juice, or sprinkled into salad, meatloaf, cereal, etc. The same thing can be done with Metamucil, or psyllium seed. These are more expensive forms of non-digestible cellulose or fiber. The water content of stool can also be increased with a stool softener, docusate sodium, marketed as Colace, or Peri-Colace or P-Col-Rite. If the above measures are still not correcting the problem the electrolyte laxatives such as Fleet Phospho-Soda, Magnesium citrate, Milk of Magnesia, or Colyte, to name a few, should be tried. Avoid laxatives that directly stimulate the bowel smooth muscle eg. Senecot, as tolerance develops and more and more is required over time.

What if I'm having gas?

Excessive air swallowing is probably the commonest cause and may result from deliberately belching to relieve a sense of fullness or from swallowing frequently as sometimes occurs with anxiety and nervousness. A deliberate change in behavior is usually effective. Simethicone, marketed as Gas X, helps reduce large bubbles of gas to small ones and may relieve the cramping sensations. Nullo which is a chlorophyll derivative also may be helpful.

After gastric bypass, excessive dietary intake of fat increases intestinal transit time and delivers undigested food to the colon. Food in the colon is broken down by resident bacteria and results in a very malodorous gas. A restriction of dietary fat intake may be sufficient to eliminate the problem. Bismuth subgallactate marketed as Devrom (1-800-972-5184) is also helpful. If the problem occurs soon after a distal gastric bypass, Pancrease - a pancreatic enzyme supplement - taken with meals may be useful.

Milk sugar called lactose is digested by an enzyme called lactase the production of which declines with age and following gastrointestinal surgery. Lactase tablets, drops and milk products with pre-added lactase are available. Beans, cauliflower, onions, broccoli and other vegetables contain complex carbohydrates (oligosaccharides) which are broken down in the colon to form gas. Beano contains a-galactosidase which helps to convert the oligosaccharides to simple sugars which can be absorbed and gas is thereby prevented.

An alteration in intestinal flora usually caused by antibiotics may produce gas. Ultraflora - a bacterial preparation - may be given to repopulate in intestinal tract normally. When the cause is fungal overgrowth, Diflucan (fluconazole) may be effective. Flagyl is sometimes tried to suppress anaerobic bacterial growth in bypassed portions of the intestine.

Other causes are gallstones, diverticulosis, irritable bowel syndrome, and parasites, and, rarely, cancer of the ovary or bowel.

Is hair loss typical?

Hair loss is commonly assumed to be due to lack of adequate dietary protein but a clear cause and effect relationship is lacking. Nevertheless, one should measure the prealbumin, and if it is low, increase protein intake. Ephedrine is said to be effective in restricting protein weight loss and enhancing fat weight loss. Hair loss due to dietary restriction is nearly always temporary. Rogaine and Nexium shampoo have both been reported to be effective and should be tried if the loss is excessive.

What is Coastal Obesity's relationship with physicians I already see?

If your physicians have doubts about bariatric surgery we provide literature and attempt to educate them as to its merits. In any case we work with them to be sure that you are in the best shape you can be so that surgery may be safely done. Afterwards we send them a summary of your surgery and hospitalization with pertinent laboratory results and a letter describing your future needs as a gastric bypass patient.

How is laparoscopic gastric bypass different than open gastric bypass?

Laparoscopic gastric bypass is accomplished with 5 small incisions rather than one long incision. A camera is placed through one of the incisions and long instruments through the others. The operation is performed while watching a video screen. The actual operation on the stomach and intestine is the same with both approaches.

The gastric bypass open incision is approximately 3/4 of the distance from the breastbone to the belly button. That is about 4-5 inches in some people and as much as 15 inches in others.

Is laparoscopic gastric bypass safe?

Many studies done by experienced laparoscopic bariatric surgeons have demonstrated laparoscopic gastric bypass to be safe. Laparoscopic gastric bypass is technically demanding and studies show that the amount of experience a surgeon has contributes to safety.

How does laparoscopic gastric bypass compare to open gastric bypass?

Laparoscopic gastric bypass results in a shorter hospital stay, less pain, less scarring, and a quicker return to usual activities. Complications such as wound infections and wound hernias are nearly eliminated with the laparoscopic approach. The risk for serious complications (such as leak) is similar with both laparoscopic and open gastric bypass.

Why aren't all gastric bypasses done laparascopically?

Laparoscopic gastric bypass is a difficult operation to learn to do safely. It also takes longer and is more expensive. The result is that most gastric bypasses in the United States are done open at this time. For most patients laparoscopic surgery is better (less pain, shorter hospital stay, less scarring, quicker return to usual activities). As more surgeons learn to do laparoscopic gastric bypass safely and patients demand it, more laparoscopic gastric bypasses will be done.

Is laparoscopic surgery right for me?

Laparoscopic surgery is a good choice for most people. People who have had previous bariatric surgery or surgery on the stomach are probably better candidates for the open approach. People with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.

Can the surgery be reversed?

Yes, but it would take another operation. No one, in my experience, has asked to have the surgery reversed.

What are the main risks of surgery after gastric bypass?

Put simply the main risks are death and complications. Mortality risk reported across the US is 0.5% or 1 patient in every 200. By recent count our mortality risk is less than one patient in every 500 gastric bypasses. The commonest causes for death are pulmonary emboli and infections. The commonest complications are wound infections, strictures, and hernias. The risks after adjustable band surgery and after gastric bypass are different (see Information Seminar). The major problems that occur with any frequency after gastric bypass are 1) leakage from the bowel connection to the pouch, 2) pulmonary emboli, 3) bowel obstruction or kinking, 4) bleeding, 5) stricture. The major problems after an adjustable band are 1) erosion, 2) slippage or herniation of the stomach up through the band, 3) pulmonary emboli, 4) esophageal dilatation.

What are the symptoms of a leak?

The symptoms can vary from sudden severe abdominal pain, weakness, chills, and abnormal drainage to no symptoms and unusual looking material coming from the drain site. The treatment depends on the severity of the leak but varies from no treatment, to hospitalization and iv's, to re-operation.

What are the symptoms of a pulmonary embolus?

Shortness of breath and pain on breathing. Treatment involves giving 'blood thinners,' anti-coagulants, and hospitalization.

What are the symptoms of a bowel obstruction?

Waves of abdominal pain, nausea and vomiting sometimes preceded by a loose bowel movement. Treatment involves surgery, usually laparoscopic, and correction of the kink or obstruction.

What are the symptoms of a stricture?

A stricture or too much narrowing at the connection of the pouch to the intestine is usually experienced as progressive difficulty with swallowing: first solid foods, then soft foods, finally liquids won't pass through. The treatment is endoscopy and balloon enlargement of the opening.

How would I know if I was bleeding?

Bleeding usually occurs in the first day or two after surgery and is recognized by a fast heart rate, weakness, paleness, and abnormal blood tests.

How is erosion recognized and treated?

If the band rubs on the stomach too much it can wear through into the lumen of the stomach where it can contact swallowed food and saliva. This may result in an infection which usually is seen as redness and swelling at the adjustment site. Sometimes no infection results and weight loss and a sense of restriction disappear. Treatment is removal of the band surgically. It can be replaced later or a gastric bypass can be done later.

What happens if 'slippage' occurs?

Slippage usually occurs in the first two weeks after surgery and is experienced as vomiting everything that is swallowed. It can be treated by taking the fluid out of the band and in most cases it can be re-inflated in two or three weeks. Sometimes surgery is necessary.

How do I know if I have 'esophageal dilitation' or enlargement?

A difficulty with swallowing is the usual experience. It is corrected by deflating the band, taking the fluid out, for a week or two. Sometimes the band has to be removed.

Are there long term risks after surgery?

Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur.

What are the risks of hernias after surgery?

Less than 1% after laparoscopic surgery and about 10% after the open procedure.

What is the risk of an ulcer?

Pretty small. We see one about every year or two.

Gastric Bypass FAQ

Pre-operative Questions

The Early Post-Operative Period (the first month)

The Late Post-Operative Period