What to Expect the Day of Your WLS SurgeryDecember 11, 2015
Bariatric surgery is a highly specialized procedure that requires extensive preparation by both doctor and patient, so it is important for you to know what to expect for WLS.
In our practice, we have found that the better prepared and knowledgeable our patients are prior to surgery the better the outcome. Indeed the process of undergoing bariatric surgery involves several months of preoperative preparation and testing. And starting the week prior to surgery, the preparation becomes even more intense.
Below is a detailed description of the patient’s experience during the procedure and more importantly a guide for how patients can be best armed with knowledge and preparation to make the surgery as beneficial as possible leading to a full recovery and great weight loss.
Only One Week To Go!
One week prior to surgery, patients should stop taking medications that increase bleeding. For example, anti-inflammatory medication such as ibuprofen aspirin, Motrin, Naproxen, Vitamin E among others may increase bleeding and may cause ulcers and therefore should be stopped at least one week prior to surgery. Please be sure to ask your doctor for special instructions if you are taking blood thinners or medications such as Coumadin, Warfarin and Plavix.
The week prior to surgery, for patients of Bariatric Associates, we recommend that patients obtain specific foods such as Diet Jell-O (avoid red colored Jell-O), sugar free beverages (non-carbonated), low sodium broth, decaffeinated coffee or tea, protein shakes, chewable or liquid multivitamins, chewable vitamin D and Calcium, or sugar free popsicles (no red colored ones).
Patients should also stock up on all medications that they will need to take after surgery. Have your prescription filled, especially your pain medications. Our patients have found it very useful to have a reclining chair to use so they can avoid feeling any on the incisions when lying flat in the bed. A shower chair is also extremely helpful to have at home as they can provide balance in the shower when patients can be unsteady
Patients need to pack a bag for the hospital including a copy of advanced directives, insurance card, driver’s license or photo id, as well as a list of current medications. Please leave jewelry, valuables and large amounts of money at home.
We advise our patients to bring loose-fitting clothes for the trip back home after discharge, a small fan on their bedside to stay cool. In addition, our patients have enjoyed having a journal in which to record their recovery. Months and years after surgery, many patients look at their journals with great pride in what they have achieved for themselves.
Tomorrow is Surgery Day!
Confirm your transportation to the hospital for the day of surgery. In addition, be aware that you will not be allowed to drive at least 1 week after surgery and you need to make the necessary arrangements for transportation. Starting midnight prior of surgery, please do not eat or drink anything including water unless instructed to do so.
Prior to coming to the hospital on the day of surgery, be sure to remove any makeup and body and facial piercings. We strongly advise that patients arrive two hours prior to scheduled surgery which will allow for the nursing and tech staff to complete necessary paperwork, start IVs and other surgical prep.
Surgery Day Is Finally Here!
On the day of surgery, patients need to register at the front desk and present all necessary documentation noted above. Afterward you will be seated in a waiting area until called into the preoperative area.
Patients are then placed in a pre-operative room where they will be given a hospital gown, removing all jewelry, makeup, etc. Hospital personnel will provide you with a garment bag where you can put all of your clothes, shoes and other valuables. These items will be delivered to your room after surgery. Please do not leave any valuables in the garment bag.
To start the preparations for your surgery, a nurse will check your blood pressure, temperature and verify information obtained from you previously. If you needed to eat or drink after midnight, please let the staff know immediately. The nurse tech will insert an intravenous catheter in your arm and start IV fluids. This catheter will be used for administering medications during the course of surgery and post-op.
Once these preliminaries have been completed, patients are transferred to the OR Holding Area where they will wait while hospital personnel are preparing the operating room. Nurses will once again verify all information and answer questions. If medications are ordered prior to surgery, patients will receive them here. Patients will also meet the anesthesiologist prior to surgery in this area.
Getting Ready for WLS!
When the surgeon and the operating room staff are ready, the patient is transferred to the operating room table and put in the proper position for surgery. The anesthesiologist will administer medications to help the patient relax and sleep before the surgeon starts the procedure. Patients will be asleep during the entire procedure and will not feel anything.
After the procedure, patients are transferred to the post anesthesia care unit at which time family and friends will be given an update on the patient’s condition by the surgeon. Patients are usually held in the post anesthesia care unit from 30 minutes up to several hours, depending on several factors including pain level, nausea, vomiting and other symptoms. Pain medications and anti-nausea medications will be available to try to make you as comfortable as possible. Patients’ legs are placed in Flowtrons boots that alternatively pump air to prevent blood clots.
Once vital signs, pain and nausea are stabilized, patients are moved to a room, and transferred into bed. Gastric bypass, Duodenal Switch and Vertical Sleeve Gastrectomy patients will have a Pulse Oximeter applied on your finger overnight that measures the amount of oxygenation in your blood and a Telemetry Monitor will also be applied to the chest to monitor heart rate. In order to keep air flow in your lungs optimal, our patients are taught how to use Incentive Spirometer. Every patient gets his or her own Spirometer and will be encouraged to use it few times every hour in correlation with deep breathing exercises.
Finally a WLS Post-Op!
We encourage patients to use their Incentive Spirometer for deep breathing exercises and to walk around the nurse’s station to help mobilize the gas in the abdomen. Although difficult work, this is important to their recovery and worth the effort. Patients are provided with small 1 ounce cups to measure their fluid intake.
Lap Band patients are started on bariatric Stage 1 diet (clear liquid after the surgery) and gastric bypass, duodenal switch and sleeve gastrectomy will be started the day after surgery on a clear liquids diet unless ordered otherwise. The nursing staff will help and provide all necessary instruction as to food intake.
Post-operatively the nurses measure urine output and provide medication to alleviate pain, nausea, and/or vomiting. Patients are permitted to shower the second day after surgery. After surgery, patients will be examined by the surgeon and other doctors including a metabolic physician as well as other medical specialists depending on the patient’s individual medical conditions the day after surgery.
We weigh patients prior to discharge and we will provide with special instructions to take home with after surgery including the first week after surgery diet instructions. A follow up appointment and instruction how to contact the surgeon 24/7 are given to the patient.
During the first week after surgery, patients are placed on a clear liquids diet requiring that they drink 3-4 ounces of clear liquids very slowly every hour. It is recommended to keep sipping as much as it is tolerated through the day. (Dark yellow urine it is a fairly good indication that one must drink more water). An average of minimum 64 ounces of clear liquids per day it is necessary. The liquids should not be carbonated and must be sugar free. Clear liquids would include water, sugar free Jell-O , sugar free Kool-Aid, Sugar-free Tang, high-protein chicken and or beef clear broth, decaffeinated coffee or tea, diet Snapple, crystal light, sugar free popsicles, as well as a liquid protein. If patients feel fatigue, sluggish, dizzy or develop headaches it is an indication that they are dehydrated and need to drink more fluids.
These are the practices and guidelines our patients follow with great success and preparation. Of course, be sure to follow any and all directives provided by your surgeon and his staff so that you too can enjoy a safe recovery and great weight loss.
ABOUT THE AUTHORDr. Val Andrei is one of New Jersey's most experienced bariatric surgeons, specializing in the Laparoscopic Adjustable Gastric Banding (including LapBand and Realize Band), Gastric Bypass, Gastric Sleeve, Duodenal switch and revisional procedures. Dr. Andrei is founder of the Laparoscopic Bariatric Surgery Program at St. Peter's University Hospital and previously served as Director of the Bariatric Surgery Program at Robert Wood Johnson University Hospital. He currently is in private practice and has performed more than 2,000 laparoscopic weight loss procedures.