Life After Surgery

How soon will I be able to walk after surgery?

Almost immediately after surgery, you will be required to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks down the halls the next day and thereafter. Walking is the most effective means to decrease your risk of having a pulmonary embolus. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

How soon can I drive after surgery?

For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 7-14 days after surgery.

What's so important about exercise?

When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for 20 minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead.

What is the right amount of exercise after weight loss surgery?

Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery - the patient must be out of bed and walking. The goal is to walk further on the next day, and progressively further every day after that, including the first few weeks at home. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient's overall condition. Some patients who have severe knee problems can't walk well, but may be able to swim or bicycle. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity over time.

What if I have had a previous weight loss surgical procedure and I'm now having problems?

Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women wait at least 1.5 to 2 years after the surgery before becoming pregnant. Approximately 1.5 years post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy. You will also have to be under the care of an obstetrician familiar with the needs of patients who have had weight loss surgery.

What happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.

How big will my stomach pouch really be in the long run?

In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces. Drinking fizzy drinks like soda and overeating can stretch the size of the pouch out and make the operation less effective.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

What if I'm not hungry after surgery?

It's normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.

Is there any difficulty in taking medications?

Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.

Will I be able to take oral contraception after surgery?

Most patients have no difficulty in swallowing these pills.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.

Is there a difference in the outcome of surgery between men and women?

Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.

If I continue to smoke, what happens?

Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues.

How can I know that I won't just keep losing weight until I waste away to nothing?

Patients may begin to wonder about this early after the surgery when they are losing 10-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition. That being said, all patients do need to take vitamins to replenish their mineral supplies.

What can I do to prevent lots of excess hanging skin?

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. It is generally not recommended to have surgery for skin removal until at least two years post-operatively, at which time your weight loss has begun to stabilize.

Will I be miserably hungry after weight loss surgery since I'm not eating much?

Most patients say no. In fact, for the first 4 to 6 weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger.

What if I am really hungry?

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch and avoid starches that will cause an insulin surge.

Will I have to change my medications?

Your primary care doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, Motrin, naproxen, etc.) may create ulcers in the small pouch or the attached bowel and therefore should not be taken unless approved by your surgeon. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.

What is a hernia and what is the probability of an abdominal hernia after surgery?

A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia after an open procedure, but only about 1% of patients that have laparoscopic surgery will develop a hernia. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.

Is blood transfusion required?

Infrequently: If needed, it is usually given after surgery to promote healing.

What is phlebitis and is it preventable?

Phlebitis is the undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including: Early ambulation, blood thinners and special wraps around the lower legs.

Will I lose hair after surgery? How can I prevent it?

Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc and biotin supplement, and a good daily volume of fluid intake.

Does hair growth recover?

Most patients experience natural hair re-growth after the initial period of loss.

What are adhesions and do they form after this surgery?

Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.

What is sleep obstructive apnea (SOA)?

It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery, but it is dependent on the amount of weight lost. A follow up sleep study is necessary before stopping the CPAP or BiPAP.