GASTRIC SLEEVE SURGERY- THE COMPLETE GUIDE-II

sleeve-gastrectomyAre you ready for surgery?So you want to know what to expect on the day of surgery? Expect to be scared, nervous, and expect everything to go well.

SURGERY DAY

Again, gastric sleeve surgery is a very straightforward procedure with low complication rates. When serious complications do happen, they usually occur the first few days after surgery. So rest easy for your procedure.

You’ll likely be scheduled for an early morning surgery. However, this depends on the surgeon’s and hospital’s schedule.

Prior to surgery you will have followed your two week pre-op diet. You should know what to bring to the hospital. And you’ll know that you can’t eat anything after midnight the night before. Don’t cheat! Surgeries get cancelled all the time because people eat or drink prior to surgery. And if you vomit during your procedure you can get pulmonary aspiration. This is when the contents of your stomach regurgitate and get stuck in your airways. This can be fatal or cause aspiration pneumonia.

Don’t chew gum, drink water, chew tobacco, or take any medications not approved by your surgeon. These may cause your surgery to be cancelled.

sleeve-gastrectomyYou’ll check into pre-op and meet your nurse and your Anesthesiologist. You’ll be given medication to help you relax. Your circulating nurse will come meet you and wheel you back to the OR. Then you’ll be asked to breath in from a face mask and count backwards.

When you wake up you’ll be in recovery and your family will be invited in shortly thereafter. Once cleared, you’ll be wheeled up to your room where the TV and your pain pump will be your new best friend for the night.

Typically, within the first 5 hours after surgery, you’ll be asked to get up and take a few steps. This helps reduce the risk of blood clots and help alleviate some of the shoulder pain associated with the CO2 left in your abdomen from the surgery.

RECOVERY

Recovery from gastric sleeve surgery is painful for some and ‘not too bad’ for others. Each person experiences pain differently and different pain medications work better than others for different individuals.

Some sleeve procedures are outpatient (you can leave the same day as your procedure) and many require 1 or 2 days in the hospital to recover. Some surgeons prefer 3 days while others are comfortable letting you leave the day after surgery.

As always, it’s important that you follow the doctors orders.

Below are some general guidelines after you are discharged from the hospital. You should have more specific guidelines to follow in your discharge instructions or post-op manual.

  • Sip your liquids constantly.
  • It’s easy to become dehydrated. You aren’t getting any liquids from food your first week post-op. Sip slowly, but makes sure you drink plenty.

Bowel movements

Bowel movements may be difficult or painful. This is normal.

However, don’t hesitate to call your surgeon if you are having issues.

Constipation is normal the first week post-operative. Your pain medications can increase constipation.

Medications

Don’t be a tough guy. Take your pain medication when you need them.

You may receive a prescription for Protonix to decrease the acidity in your stomach. This helps with heartburn and may reduce pressure on your healing pouch.

Unless otherwise advised by your surgeon, you can resume taking your medications. All non-time-released medications will likely need to be crushed. Any medication that is time-released should be switched, if possible, to non-time released. Do not crush time-released medications. Ask your doctor about your diabetes medication.

Activity

  • Walk, walk, walk.
  • Walk as much as you can. This helps the healing process and starts you on the path to include exercise daily.
  • Don’t lift anything heavy. This can put undue pressure on your stitches and torso which will be sore.
  • You will feel fatigued and tired for up to a month after surgery.
  • This is due to the reduced calorie consumption. Your body is adjusting.
  • Showering & Bathing
  • Don’t bathe or sit in a hot tub for the first 3 weeks after surgery.
  • Showering is typically OK.

Going back to work.

  • You can typically return in 2 to 4 weeks depending on the physicality of your job.
  • Most people return after 4 to 6 weeks at full strength.

WHEN TO CALL THE SURGEON?

  • Fever over 101.5 with shaking or the chills.
  • Pain that increases over time.
  • Redness, warmth or pus draining from incision sites.
  • Persistent nausea.
  • Inability to swallow liquids.

Remember, don’t hesitate to call your surgeons office if you are worried that something is wrong. You’re not bothering them.

This article walks you through the details of recovery from gastric sleeve surgery.

PRE AND POST-OP DIET

Your diet is going to change after gastric sleeve surgery.

In fact, your diet has to change 2 weeks prior to surgery. So if you’re planning on having a ‘last meal,’ you’ll want to do it before you start the pre-op diet.

PRE-OP DIET

Your pre-op diet will start 2 weeks before your surgery date. The pre-op diet is important because it helps to reduce the size of your liver prior to surgery. This makes surgery easier for your surgeon and reduces your intra-operative risks.

Details on a typical pre-op diet can be found here.

POST-OP DIET

Do not eat celery after gastric sleeve surgery.They say it takes tasting a food 20 times to develop a liking for it. Keep that in mind as you struggle through the first few months of adopting a new diet after surgery. With a small stomach, it’s utterly important that the food you do eat is nutrient dense. This means you should be eating foods like vegetables, lean protein sources and whole grains.

Most doctors recommend you eat a good portion of your calories via lean meat. However, it should be noted that there are some very successful vegetarians that have had gastric sleeve surgery.

Dr. Garth Davis at The Davis Clinic in Houston is a bariatric surgeon and a vegetarian. Many of his patients have become vegetarians with great success.

Your post-op diet greatly depends on how far out you are from surgery. The stages below are typical recommendations after gastric sleeve surgery. For a more detailed look what you can and can’t eat after surgery, we recommend this article.

Stage 1 – The first week after surgery

Clear liquids only. These include:

  • Water
  • Decaf Tea
  • Sugar-free Posicles
  • Broth

Stage 2 – Week 2

Full liquid diet with protein shakes.

Stage 3 – Week 3

Soft-pureed foods. These include:

Soups

Scrambled Eggs

Cottage Cheese

Stage 4 – Week 4

Soft foods.

Boiled chicken.

Fish

Cereal

Mashed potatoes.

Stage 5 – Week 5 and beyond

Introducing real foods.

Introduce small amounts of foods.

Chew well and eat slowly.

Eat 3 small meals a day.

Eat a small, healthy, nutrient dense food as a snack if needed.

Get your protein but don’t forget vegetables and fruit.

DAILY VITAMINS & SUPPLEMENTS

You’ll need to ensure you are getting enough vitamins after gastric sleeve surgery. This is also true for gastric bypass (slightly more supplements are required) and true for Lap Band patients (less vitamins are required).

Check with your surgeon when to start iron post-operatively.

Take on an empty stomach.

Ferrous Fumarate 29mg – NOT the more typical ferrous sulfate (ferrous sulfate is not absorbed well after bariatric surgery).

Do not take with your Calcium Citrate.

Calcium Citrate – Taken 3 times daily.

Begin 1 month after surgery.

  • Liquid or chewable form and should be taken in 500 mg doses with at least one hour in between doses.
  • Do NOT take Calcium at the same time as Iron.
  • Wait at least 2 hours between taking your multivitamin/iron and your calcium.
  • 1500 to 2000 mg daily.
  • Vitamin B12 – May be recommended. Check with your doctor.

Typically taken once per week.

  • 5000 to 7500 mcg.
  • Available in sublingual (under the tongue), injection, or nasal spray.
  • Should NOT be taken in pill form after surgery.

Protein Supplements

Protein is important after gastric sleeve surgery. It’s recommended that you get at least 60 grams of protein per day after surgery. You can opt for protein supplements from Wal-Mart or other retailers. However, most physicians prefer a bariatric specific protein supplement.

COMPLICATIONS

You should have a good understanding of possible complications during and after your surgery. The most worrisome complication from gastric sleeve surgery is a staple line leak.

Staple line leaks can occur during or after surgery. During surgery, they are typically noticed and fixed before completing the surgery – no big deal. However, if they go unnoticed, you will start to get sick shortly after surgery.

Staple line leaks typically occur during the first month after surgery. They can be triggered by eating improper foods or from the tissues of your stomach not healing. This, in turn, leads to the staples detaching from the thin, devascularized tissue which then leads to a leak.

A staple line leak leads to a major infection as your stomach juices enter your abdomen. The signs and symptoms are tachycardia , fever, chest pain, and pain in your belly.

Most staple line leaks occur within 14 days of surgery. See your doctor immediately if any of these symptoms are present.

The risk of death from gastric sleeve surgery is low.

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Author: hopeobesitycentre

Today, bariatric surgery is not as uncommon as it was a few years ago. With a number of clinics dedicated to the treatment of obese people, what makes Hope Obesity Centre unique is the post operative care rendered to the patients.

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