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Answers to Your Questions About Bariatric Surgery
Before and after your surgical procedure, you
will likely have questions about the surgery and the recovery
process. Here are some answers to frequently asked questions.
What is the Roux-en-Y Gastric Bypass Operation?
During this surgical procedure, the stomach is
divided into two compartments. The upper part of the stomach,
called a pouch, receives the food that you eat. This new pouch
is approximately 15-30 cubic centimeters (or the size of a golf
ball). While the surgery reduces the capacity of the stomach by
90-95 percent, no part of the stomach is removed or cut away.
Next, an outlet, called a stoma, is created in
the small stomach pouch. This outlet is about 12 millimeters in
diameter – about the size of a dime. The food a person eats
must be able to pass through this opening, which is why it must
be chewed very well. The upper small intestine is then divided
and joined to the new stoma. Food bypasses the lower part of
the stomach and part of the small intestine (which is why the
surgery procedure is also known as the “gastric bypass”). Digestion occurs in the lower intestine.
What happens to the larger stomach partition that
is no longer used?
The larger, lower part of your stomach no longer
receives food, but its gastric juices from this part of the
stomach pass into the intestine and mix with food as they did
before surgery.
Can the stoma
(pouch outlet) narrow down and cause vomiting?
Patients heal at different rates and scar
differently. In some patients, scarring at the pouch’s outlet
can cause their outlet to narrow. This is called Stomal
Stenosis and is usually managed by endoscopic dilatation by a
patient’s surgeon within the first months after surgery. This
may be more common in patients who have the operation performed laparoscopically, than in those patients who have the operation
done “open” with an incision.
Why are staples used in surgery?
Staplers have been used in abdominal surgery for
the past 30 years, and there are few gastrointestinal operations
done without them. In the Roux-en-Y gastric bypass, a special
type of cutting stapler is used when the stomach is completely
divided to create the stomach pouch. It is also used to divide
the small intestine. Compared to old-fashioned methods, the use
of the cutting stapler allows fast, clean and precise division
of the stomach and intestine. Each cut staple line is then
reinforced with sutures.
As healing progresses over the three to four week
period after your surgery, tissue grows over the staples. They
are there permanently and will show up on an x-ray, but they
play no roles in the long-term outcome of the operation, nor are
they associated with any ill effects. This is not to be
confused with the operation commonly called “stomach stapling”,
which uses staples in a far different manner.
Internal staples are not removed. Talk with your
surgeon if you have any questions about your surgical
procedure.
Will the
staples set off the metal detector or the security alarm at the
airport?
It is highly unlikely that the
internal staples described above will set off a metal detector
at the airport. It is recommended, however, that if you ever
require a test called magnetic resonance imaging (MRI), you tell
the people performing the test that you have internal staples.
How long will it take me to recover from surgery?
Recovery from surgery generally takes about six
weeks. Your stomach pouch is swollen after surgery; however,
the swelling will soon subside. It will take about three months
for your stomach to heal fully.
What is the Laparoscopic Adjustable Gastric Band
Operation?
The Laparoscopic Adjustable Gastric Band (or
LapBandŽ) is a procedure that has been performed in Europe and
Australia for about 15 years. In June of 2001, the United
States FDA approved the LapBandŽ as an option for patients who
desire Bariatric Surgery.
The LapBandŽ is a device that is placed around
the upper portion of the stomach to make a “virtual pouch”. The
remaining stomach remains intact, and there is no cutting or
dividing of the stomach tissue. The pouch created by the band
allows the person to feel full after eating small amounts of
food.
Overall, the LapBandŽ is considered “less
invasive” and has a lower early complication rate than the
gastric bypass. Another potential advantage of the band is that
it is adjustable to help ensure optimal weight loss. Although
the band is considered reversible, it is important to understand
that removing the band requires a major abdominal surgery that
may have to be performed using an “open” technique and if the
band is removed, the patient will regain all of their weight. Some of the disadvantages include much slower
weight loss than gastric bypass operations. Another
disadvantage is that the band or port may slip out of position
and may require another operation.
Which Operation is best for me?
It is important to discuss with your surgeon the
reasons why you want to have Bariatric Surgery. No one
operation is perfect, and each type of procedure has its own
risks and benefits.
Learning a new
eating plan
How much food
will my new stomach hold?
When your new stomach pouch has healed, an
average meal will be about ˝ to 1 cup of food or liquid.
What kind of nutrition program will I have after
surgery?
First, you will be on a special eating program
designed to allow your stomach to heal, while you receive the
protein, vitamins and minerals you need. You will begin with
liquids and then progress to pureed, soft and, finally, solid
foods. A patient will usually be permitted to add solid foods
to their eating plan about six weeks after surgery. Your
surgeon and nutritionist will help guide your eating plan
throughout your recovery and will teach you about your new
eating program.
Can I be healthy eating the recommended amounts
of food and fewer calories?
Family members may voice concern about the small
amounts of food and fewer calories that patients eat after
Bariatric surgery. However, this low-volume, low fat and low
sugar-eating program is designed to meet your body’s nutritional
needs. Your nutritionist will teach you this program after your
surgery. You will learn how to keep protein in your eating plan
and about the multivitamins, you will need to take. A
well-balanced nutrition program is very important after surgery
because your stomach will be smaller and hold less.
Are there any foods that I will never be able to
eat after Gastric Bypass Surgery?
Food tolerance is very individual. Some people
eat almost everything they ate before surgery that is low in fat
and sugar. However, they chew more carefully and eat smaller
portions.
Occasionally, patients find there are a few foods
they do not tolerate well after surgery. This usually happens
as they reintroduce solid foods into their eating program. Foods that can provide difficulty include red fibrous meat,
doughy bread, raw fruits, vegetables, and pasta. If you find a
particular food difficult to digest, avoid it for a while, then
try it again later. Over time, your tolerance for these foods
may increase.
How will surgery change my eating habits?
The surgery will change the way you eat and will
reinforce a new eating plan. Because your new stomach is
smaller, you will feel full after eating less food. Your new
meals will also be smaller and more frequent. Your new stomach
pouch will not be able to grind food as it once did, so you will
need to eat small bites and chew food very, very well.
You may choose not to eat certain foods because
they require too much chewing, or they may no longer taste good
to you. In addition, foods high in fat and sugar will not be
tolerated well and can cause a reaction called the “dumping
syndrome”.
What is the “Dumping Syndrome”?
After gastric bypass, your body will be less able
to tolerate “refined” sugars or high amounts of fats. When
these foods are eaten, your pancreas is signaled to secrete
insulin and cause fluids to be drawn into the intestine. This
causes a reaction called the “dumping syndrome”. Common
symptoms include sweating, nausea, dizziness, tiredness, cramps,
vomiting and diarrhea. These symptoms typically last about
60-90 minutes, depending on what and how much the person has
eaten. The symptoms can mimic the flu.
Will the stomach pouch stretch so that the lost
weight is gained?
In most patients, the pouch will stretch some
with time. Weight loss is usually maintained except in those
cases where people persist in eating large quantities of high
caloric fluids. It is more important to avoid stretching the
stoma of the new stomach by persistently overeating, or by not
chewing food well enough. This does not occur easily, but
occurs only by persistently overeating over a long period.
The
surgery is a tool to help you achieve weight loss, but you must
follow the nutritional recommendations for long-term success.
Why do I need to drink 64 ounces of water daily?
Drinking water keeps you from becoming
dehydrated. This is particularly important after gastric
exclusion surgery. You see, many of the foods we eat have a
high water content. For example, vegetables are 80-90 percent
water, and chicken contains about 60 percent water. As your
food portions are smaller after surgery, you will not obtain as
much water from food. You will need to drink more water to make
up the difference. Drinking plenty of water may also reduce
food cravings.
Since you will not be able to drink water quickly
as your stomach heals from surgery, you will need to sip small
amounts of water throughout the day. Carry a water bottle for
convenience and to remind you to keep sipping. The water bottle
should become a familiar sight in and out of your home. If you
do not like your tap water, treat yourself to bottled water. A
slice of lemon can add flavor. Also, consider sucking on ice
chips.
Can I drink coffee and soft drinks for my fluid
requirements?
Do not substitute caffeinated drinks for water
since these only dehydrate your body. They act as a diuretic
and may stimulate your appetite. Also, avoid carbonated
beverages during the first six months after your surgery. Carbonation can cause gas that can be painful. You may drink
diet, decaffeinated soft drinks, but you should let them “go
flat”.
Avoid the use of straws. With a straw, you can
drink large amounts of fluid without realizing it and overfill
your stomach pouch. In addition, you can swallow air that can
cause discomfort.
Can a person drink alcohol after gastric
exclusion surgery?
Alcohol can slow down a patient’s weight loss. It contains a lot of calories, and is not nutritional. After
surgery, alcohol enters the blood stream more quickly than
before surgery. The intoxicating effects of alcohol occur
sooner than before surgery and after smaller amounts are
ingested. It is best to avoid drinking alcohol for at least six
months after surgery, since it can be irritating to the stomach
pouch. Also, remember a person must not drink and drive.
Can I smoke
after surgery?
This is not advisable. Smoking stimulates
gastric secretions that can irritate the lining of the stomach.
This irritation can cause chronic gastritis and ulcers in the
stomach and small intestine. Patients who smoke after Bariatric
Surgery have a higher likelihood of developing ulcers in the
pouch which can be difficult to treat.
Why do I need to take chewable multivitamins on a
regular basis?
Since you are eating less food, smaller amounts
of vitamins and minerals are entering your system. You also
absorb fewer vitamins and minerals. When you take a
multivitamin/mineral supplement that provides 200 percent of the
United States Recommended Daily Allowance (U.S. RDA), you make
up for the fewer nutrients you absorb from food. Do not
prescribe vitamin supplements yourself. Many are toxic in larger
amounts.
I have already
had my surgery, but I do not seem to be hungry. Why?
Patients report different reactions to food after
surgery. Some find that they are not hungry for the first
several weeks and have to “force” themselves to eat the number
of recommended meals. Remember, the size of your stomach is
smaller after surgery, so it will take less food to make you
feel full.
Your first nutritional goal is to drink 64 ounces
of fluid daily. Your second goal will be to meet your daily goal
for protein grams. This will become important when you begin
the full liquid stage of your eating program. Remember too,
that fluids can be good sources of protein. The recipes you
receive for the full liquid phase of the nutrition program are
designed to contain concentrated sources of protein. These
should help you meet both your protein and fluid requirements.
You might also find it helpful to give yourself cues on when to
eat. Some people set the alarm on a wristwatch as a reminder of
a mealtime.
What if I am feeling hungry?
The feeling of hunger immediately after surgery
can indicate that the liquids are not remaining in your stomach
long enough for you to feel “full”. However, it is important
that you follow the nutritional guidelines that allow your pouch
to heal from the surgical procedure.
If you are hungry, once you are on pureed, soft
and solid foods, it could mean that you are spacing your meals
too far apart, and you may need to eat more frequently. It
should also take less food at each meal for you to feel full
than before surgery. Remember that hunger can be a subjective
sensation.
How can I tell when I have had enough food?
If you have trouble telling when you are getting
full, make sure your portions are no more than ˝ to 1 cup of
food or liquid for each meal. Once you have attained your weight
goal, a nutritionist can answer any questions you might have
about your food selection to help you maintain your weight
level.
Whey do I
think about the high fat and high sugar foods that will not be a
part of my new eating program?
A craving for a particular food is usually
triggered by an emotional or hormonal need. Sometimes after
surgery, patients grieve over losing the freedom of food choice
that they had before surgery. It can be difficult emotionally to
have a restriction on the kind and amount of food you can eat.
Feelings of loss must be dealt with as part of the healing
process in your path to recovery.
To prevent cravings, you may need to space your
meals more evenly throughout the day. If thirst triggered the
craving, make sure you drink enough water. If you are bored,
distract yourself with some exercise or activity. When you
increase your activity level, glucose is released into your
system and oftentimes may end your craving. In addition,
participating in an activity you enjoy may distract your
craving. If you wish to learn new coping and problem solving
skills, referral to a therapist can be arranged. You also may
find participation in a support group helpful after your
surgery.
Following your weight loss progress
When should I weigh and measure myself?
We recommend that you only weigh and measure
yourself once a week. Plan to weigh and measure yourself on a
regular schedule, at the same time of day and in similar
clothing.
Will my weight loss ever hit a Plateau?
Eventually you will hit a weight loss plateau
when you notice you are not losing pounds or inches. Your body
may simply be adjusting to the chemical and biological changes
that occur during weight loss. During this time, you may still
need to change the size of your clothing as your weight
redistributes itself.
If plateaus continue for more than a few weeks,
review your nutrition plan and activity level. Are you following
the nutrition guidelines for portions, protein and fluid intake
and limiting fats and sugars in your food selections? Decreasing
your activity level can also contribute to a weight plateau.
Review your activity level and see if your level of physical
activity can be increased. If you are weight training (with your
doctor’s approval), remember that muscle weighs more than fat,
and this may temporarily slow down your weight loss. If you are
building muscle, you probably are losing inches even though you
are not losing pounds.
Do not be concerned if your weight plateaus more
than once during your weight loss. If a plateau continues for
more than a few weeks, review your nutrition plan and your
exercise program. Speak to a nutritionist about any concerns
you have and for more ideas on the best way to end a plateau.
Why is Activity so important or me after surgery?
Exercise maximizes weight loss and helps to
maintain a healthy body. After surgery, you not only need good
nutrition, you need to take the time for regular activity. You
can build exercise into your daily schedule, or it can be as
easy as walking to do your errands. Here are some reasons why
physical activity is important to you:
ˇ
Exercise increases your metabolic rate, which can help you lose
weight faster.
ˇ
Exercise is fat burning.
ˇ
Exercise improves your mood and feeling of well being by
secreting endorphins (chemicals) into your body.
ˇ
Exercise causes a person to feel less hungry.
ˇ
Exercise increases muscle tissue, which, unlike fat, constantly
burns calories (even when the body is resting).
ˇ
Exercise will decrease muscle breakdown while losing weight.
ˇ
Exercise helps to alleviate constipation.
ˇ
Exercise can improve sexual activity.
There are many more reasons for exercise. Why not
consider the benefits of joining an aerobic fitness program? Use
your increasing energy to discover (or rediscover) some new,
active interests.
What will my rate of weight loss be after
surgery?
Patients do not lose pounds and inches at the
same pace from week to week. Weight loss is greatest in the
first three months after surgery. A person usually loses at
least 20 percent of his/her excess body weight at three months,
and 50-70 percent at one year. As you begin to near your weight
loss goal, weight loss will slow to approximately one to three
pounds per week.
How does a menstrual cycle effect a woman’s
weight loss?
Women should consider their normal menstrual
cycle when they weigh themselves. If you typically gained weight
during your period before surgery, you will probably continue
this pattern after surgery. Remember that water weighs more than
fat. This fluctuation of water in your body due to your
menstrual cycle may result in a temporary slowing of, or slight
gain in, your weight.
Will surgery affect a woman’s chances of
pregnancy?
We recommend that women avoid pregnancy for the
first two years after surgery. After that period, a woman should
have a normal pregnancy. It is essential to discuss any plans
for pregnancy with your surgeon and nutritionist, as well as an
obstetrician, before surgery. An obstetrician and a nutritionist
must follow a woman’s pregnancy closely.
I have heard that some people experience hair
thinning or loss after gastric exclusion surgery. Will this
happen to me?
Major surgery, rapid weight loss and changes in
eating behavior and activity level can produce stress on the
body. Hair loss may be a reaction to this stress. Patients who
experience some hair loss usually notice it occurs three to five
months after surgery. This is temporary, and you will not lose
all of your hair. It will grow back. However, you can minimize
chances of hair loss by sticking to the daily vitamin, mineral
and protein guidelines prescribed.
How often will I follow up in the office with
progress checks after surgery?
Most patients have their first appointment with
the surgeon seven to ten days after surgery. The next three
follow-up appointments occur at four weeks, 8 weeks and three
months after surgery.
The surgeon in consultation with the patient
schedules additional follow-up appointments and postoperative
medical tests, but they occur at least annually. Laboratory
analysis of your blood is done at scheduled intervals after your
surgery.
How often do I follow up with my therapist?
If you were receiving treatment from a therapist
before surgery, we advise you to continue keeping your
appointments after your hospitalization.
Can I take my antidepressant or antianxiety
medication?
If you were taking an antidepressant or other
psychopharmacological medication before your surgery, we
recommend you resume use in consultation with your surgeon and
prescribing doctor. You may need to cut some medications into
pieces before swallowing, or they may be available in an elixir.
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