Kamran Borhanian, MD
09/10/2005
The Operation:
We will be performing a laparoscopic Roux-en-Y Gastric Bypass . The operation involves extensive re-routing of the food flow through your stomach and upper intestine in such a way that your appetite will be diminished, and less of what you eat will be absorbed. This combination of effects is what allows a motivated patient to maintain substantial weight loss on a long-term basis. Be prepared to spend 1-3 nights in the hospital, although this will vary according to how quickly you progress after surgery.
Recovery:
Because the operation is usually performed through small incisions, we'll put little or no restrictions on your physical activity after the operation. Your level of discomfort should prevent you from over-exerting yourself. As long as you don't lift or strain beyond the point where it hurts, you should be fine. Your pain will most likely fade rapidly, so you should be able to return to work or resume normal activities within a few weeks, depending on the activities. You may resume showering and are encouraged to walk the day after surgery. You can remove the butterfly tape sutures after a week.
Pain Relief:
1.
Take Liquid Tylenol 650 mg every 6 hours as needed for pain relief.
2. You may take 15ml or 1/2 oz. of Lortab every 4 hours as needed for discomfort
that remains after taking Tylenol. This is a narcotic pain killer. If you use it
you must beware of becoming drowsy or inattentive, and you will not be able to
drive or operate dangerous equipment. It can also cause nausea and constipation.
We will substitute if you can not take hydrocodone.
3. Avoid aspirin, ibuprofen, Advil, Motrin, Aleve (or any other non-steroidal anti-inflammatory drug - NSAID). These medications can be too harsh for your gastric (stomach) pouch during the first month.
Medications
1. Take two chewable Flintstones Vitamin Plus Iron daily and one TUMS (for the
calcium)
2. Take Pepcid chewable 10 mg 2 tablets twice a day for the first year to decrease stomach acid production, to prevent ulcers and bleeding. If you were taking an acid-suppression medication (for example Zantac, Prilosec) before surgery you may use that instead.
3. Resume all other usual medications unless I instruct you otherwise. Be aware that diabetes medications can often be cut back or discontinued right after surgery. If you have diabetes, monitor your blood sugar closely and contact us or your primary doctor if you have questions about dosing.
Most Frequent Problems
Discomfort
- Abdominal soreness and a dull shoulder & neck ache are the most
common immediate problems after waking up. The shoulder ache usually lasts a day
or two but some soreness under the ribs on the left side can last for a couple
of weeks. Despite this, the most important thing you can do for yourself in the
hospital and at home is to get out of bed and take short walks. This helps keep
your lungs expanded to avoid fevers and pneumonia and keeps the blood moving in
your legs to prevent dangerous blood clots.
Trouble eating - After the first
month you'll gradually increase what you're able to eat. This can be the most
frustrating period of your recovery. Everybody has trouble eating at times for
the first few months. Some days you'll be able to eat everything easily, but
other days you might vomit the same foods without apparent explanation even from
us. Always remember you're not alone. We're just a phone call away to help or at
least reassure you.
Dumping Syndrome - This is common after gastric bypass surgery. It is characterized by any combination of severe fatigue, flushing/sweating, heart palpitations, cramping and diarrhea soon after eating even a small meal with processed sugars as a major ingredient.
Wound drainage & infection – It is not unusual for an incision to drain bloody fluid after you go home. This is not dangerous because it is almost always fluid that collected under the surface right after surgery and is not new bleeding. It will stop draining after all the fluid comes out, usually within a few days. Infections are uncommon and rarely serious after a laparoscopic operation. The incision most likely to cause trouble is the bigger one under your ribs on the left side. An infection will be red, warm, firm, and tender. The infected fluid will look more like pus than like blood. Call the doctor if you feel the wounds may be infected.
Reasons To Call Immediately
1.
Pain not controlled by your medication.
2. Persistent vomiting or dry heaves.
3. Fever palpitations and wound redness or persistent leakage from an incision.
4. Unusual or one-sided leg swelling, particularly if painful or tender (might
be a blood clot).
5. Sudden shortness of breath that doesn't improve with 5-10 minutes of rest
(might be a leak or blood clot).
6. Any questions or concerns what-so-ever.
Call 803-324-5858 for any problems any time or come to the ER