When to Call A Surgeon After Having Metabolic SurgeryAugust 5, 2020
I always encourage my patients to call me if they have a question about something. Oftentimes I hear, “I didn’t want to bother you, doc” or “I didn’t think it was a big deal.” As a patient, I want you to know that calling your surgeon is really not a big deal and it is definitely not bothersome.
There are situations in which you absolutely should call and I think it is worth discussing some of these situations in more detail. Fortunately, complications after metabolic surgery are rare and you will not need to call your surgeon most of the time. (5)
The majority of metabolic surgeons take great pride in not only operating on their patients but also having them as patients for their entire lives. Metabolic surgery outcomes have improved significantly since the implementation of diet and exercise programs designed to optimize patients preoperatively (1, 2, 3, 4).
Optimizing patients before surgery and setting expectations as well as discussing the post-operative course is essential for success. As an example, my patients receive extensive reference materials with common questions that occur post-operatively. Make sure you receive something like this from your team and have it handy for reference during your journey.
There are common reasons to call your surgeon post-operatively regardless of the type of metabolic surgery that you have undergone. Many post-operative issues are common and can be handled over the phone. If you have a life-threatening concern, then call 911. However, I recommend always calling your surgeon prior to going to the emergency department.
Many times you can save a large ER copay and may not even need to leave the house. We will look at both early complications which occur within the first week and late complications, which can occur after the first week.
Early Post-Operative Situations
Within the first week after surgery, several scenarios can occur. Leaks, obstructions, wound infections, bleeding, and deep vein thrombosis (DVT) with or without pulmonary embolism account for the majority.
- Fever: If you are experiencing fevers, over 100.4 Fahrenheit, you should always call your surgeon. Chills or rigors, with or without a fever, should warrant a call as well.
- Leg Pain: If you are having any calf or thigh pain that is worse when you put weight on your foot, a DVT may be developing. Swelling frequently, but not always, accompanies this diagnosis.
- Chest Pain: If you have chest pain or shortness of breath, this should always warrant a call and, if severe, a visit to the emergency room.
- Bleeding: Sometimes, bleeding can occur from the incisions. Usually, this can be controlled with 5 minutes of steady pressure over the incision. If this does not work, call your surgeon. Bleeding can also occur at the connections between the bowel that are made during surgery. This can present with vomiting of bright red or dark red blood and/or having bowel movements that are bright red or dark. These signs should trigger a call to your surgeon.
- Leaks: One serious post-operative complication is a leak. Regardless of surgery type, leaks can happen and usually occur within 3-7 days after surgery. Leaks are very rare; however, the symptoms should definitely warrant a call to your surgeon. Typically, patients will feel “not right.” Frequently, the heart rate is elevated and there is abdominal pain. If you have a decrease in appetite and have fevers with these symptoms, you should call your surgeon as soon as possible. Do not wait until the morning if any of these symptoms occur.
Late Post-Operative Situations
Once you have made it past the first week, there are some new considerations that warrant a call to your surgeon.
- Hernias: If you notice a bump at any of your incisions with or without redness and tenderness, you may have a hernia at a port site or an infection at a port site. Fevers and chills may accompany infections while hernias may contain a segment of intestine, which can lead to nausea and vomiting and the inability to pass gas or have a bowel movement.
- Internal Hernia: Another type of hernia that can occur after gastric bypass is an internal hernia. These hernias are different from hernias that occur in the incisions because they occur inside the abdomen when the small intestine becomes trapped in the blood vessels that supply the bowels.
These hernias can present with sudden abdominal pain that may be associated with nausea and vomiting. Not infrequently, internal hernias can come and go and can be difficult to diagnose, as they may not be present on a CT scan at the time of evaluation.
They typically occur in the first 1-3 years and frequently are associated with patients that lose 100 or more pounds. If you have pain that comes and goes, it is important to let your surgeon know so that a correct diagnosis can be made.
- Ulcer: If you are having new-onset difficulty with swallowing or you notice that foods are getting stuck frequently, you should call your surgeon. After a gastric bypass, the connection between the stomach and the small intestine may become narrowed or develop an ulcer.
Typically, this happens at around 3-6 weeks after surgery. The narrowing or ulcer is typically treated with endoscopic dilation that can be performed as an outpatient procedure.
It is important to call as soon as symptoms begin so that scarring does not occur, which will make dilation more difficult and less likely to be successful. Strictures can also occur with sleeve gastrectomy and again, any difficulty swallowing food should warrant a call to your surgeon.
- Weight Plateaus: One often-overlooked reason to call your surgeon and his or her team is if you have reached a plateau. Very frequently, patients will lose a significant amount of weight in the first few years. It is normal for weight loss to slow down and you will most likely reach a new steady weight at around 18 to 24 months. I always recommend that my patients follow up with me yearly for the rest of their lives.
Studies have shown that routine follow-up after bariatric surgery is associated with better outcomes (6, 7). It is important to follow-up because it creates a sense of accountability for both the patient and the surgeon.
- Regular Blood Work: Additionally, it is important to check blood work at least yearly to ensure that vitamin and mineral deficiencies are not developing.
Call Your Surgeon
In summary, if you are thinking about calling your surgeon, you should pick up the phone and do it. When you have metabolic surgery, you are forming a life-long partnership with your surgeon and his or her team.
I personally take great pride in seeing my patients return yearly and watching them reach and maintain their goals. Also, I have been to many conferences and meetings and have noticed that the great majority of my colleagues share the same sentiment. So get on the horn and reach out to your surgeon because the only dumb question is the one that you didn’t ask!
- Preoperative evaluation in bariatric surgery. F. Schlottmann MD
- Is social support associated with greater weight loss after bariatric surgery? M. Livhits
- Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update. Mechanick JI
- A focus on surgical preoperative evaluation of the bariatric patient-the Cleveland clinic protocol and review of the literature. Eldar, S
- Outcomes after bariatric surgery according to large databases: a systematic review. Balla, A
- The rollercoaster of follow-up care after bariatric surgery: a rapid review and qualitative synthesis. Parretti, HM
- Long-term nutritional follow-up post-bariatric surgery. Montastier, E
ABOUT THE AUTHORTyler Bedford MD, is a board certified general surgeon and fellowship trained in advanced laparoscopic and bariatric surgery at Summa Akron City Hospital. He specializes in abdominal laparoscopic surgery, minimally invasive weight loss surgery (Laparoscopic Roux-en-Y Gastric Bypass, Laparoscopic Banding, and Laparoscopic Sleeve Gastrectomy), laparoscopic treatment of abdominal/inguinal hernias, and laparoscopic colon resection for both benign and malignant disease.