Questions that I asked the Surgeon and staff (and answers)

Sep 08, 2010

1. Are there any reasons why the procedure may not be performed after you open me up? If there is too much scar tissue and not enough viable tissue to do the RNY
2. If this is Lap surgery, is there any situation that might cause you to switch to an open? Cannot access area to operate due to too much scar tissue, liver and other organs in the way
3. What percentage of your patients receiving the revision surgery from the Nissen to RNY have had major complications? What kind? Why do you think these happened? Only had 1-2 patients that had problems with scar tissue, leaks or problems with the diaphragm
4. How small will my stomach be after RNY surgery? Approximately the size of an egg / 30 cc
5. Are you planning a distal RNY or a proximal RNY? What is the difference?   Proximal - Difference is proximal is higher up for re-attach of intestines and distal is lower. Usually distal is done for those weighing into the several hundreds and need the weight to come off faster with less absorption.
6. If RNY, how much of my intestine will be bypassed?  About 2 feet / 100 cm, They tend not to go more than that so as to leave enough in case you develop problems later down the road. They do not do less because they want the organs to sit inside in a good enough fashion that is natural
7. What is the advantage to having this much bypassed as opposed to less/more? Too little can cause bile in the pouch because of the short length. Too long can cause gas and bloating because of too much food sitting and not being processed.
8. Am I able to have upper GI tests or Endoscopy tests after a RNY ? An endoscopy can still be done, but just not on the blind stomach (part that is detached), you should avoid an upper GI unless done at a bariatric hospital because the liquid intake is different for the tests. You can still do an MRI but a CT scan may be different. Could not remember the reason why if it had to do with the dye or not. That was all I got for now, I was trying to think of any scenarios or tests that would be needed
9. What is the average length of stay at the hospital for Laparoscopic?   Open? Laproscopic 2-3 days, Open 6-7 days
10. What is the average recovery time at home before resuming work? Laparscopic 2-3 weeks, Open 4+ weeks
11. Is the RNY reversible?  What is the procedure to reverse? Over time the pouch created could stretch back almost to the normal size of a stomach if you are not careful. The RNY in extreme emergency cases may be not so much reversible depending on the circumstances, but can be done as some sort of revision to something else. It is risky and can cause more problems because of the anatomy change. Basically try to put the anatomy back to the original anatomical configuration as best as possible. It is complicated and could cause other problems down the road.
12. Is there a possibility that I will experience problems with the GERD again? This should not occur because there will be basically 3 surgeries going on for me, Take down the Nissen Fundoplication, repair the base of the esophagus if needed, do the RNY procedure
13. Will I need to take antacids after surgery? Possibly Pepcid AC for 2 weeks post-op as chewable or liquid
14. How soon after surgery can I exercise? What exercises should I avoid? Wait at least 6 weeks for Zumba and Tennis or anything active like that, swimming ok after 2-3 weeks as long as it is gentle movements
15. In case of an emergency that cannot wait for office visit, what type of ER Doc should see me? Always try to get to a hospital with a Bariatric program
16. Will I have problems with diarrhea or gas post-op? How can this be treated? Yes diarrhea and gas are possible the anesthesia takes approx 30 days to fully leave your body. GasX does not necessarily speed up the process, walking does. The gas is elsewhere in your body and eventually gets absorbed into your intestines, etc and out as farts, etc (sorry had to be blunt). The diarrhea occurs because of the different eating habits, more water, less solid food. In time this also passes as long as you are eating balanced foods.
17. Will I need to wear a girdle after surgery? You don’t have to wear one but if it makes you feel better you can use Spanx or something similar as long as it is not too tight.
18. How many follow up visits are scheduled post-op? And how often?  Will find out about post op after surgery. I think it is possibly 2 weeks, 1 month, 3 months, 6 months and either 9 months or 1 year then once a year afterwards.
19. How much weight loss is considered "too fast" and would be cause for concern? At first weight will come off quickly then taper off to 1-3 lbs a week average. Any faster than that will have to assess diet and speak to nutritionist.
20. How do you avoid Hypoglycemia? Avoid by making sure to have enough protein in the beginning of the day, eat per guidelines and avoid sweets. Make sure to drink enough fluids and get proper rest at bedtime. If you experience problems see the nutritionist for assistance with diet.
21. I know a blockage can occur. How would I know there was a problem? What would I experience if there was a blockage? you will know if blockage as you will experience extreme pain, nausea, possible vomiting. Get to ER that has bariatric program to be checked.
22. I have read that if you have a blockage to drink a mixture of water and meat tenderizer. Is that true? If not, how do you get the food unblocked? Do not use the water / meat tenderizer LOL, Blockage not always cauesd by food, could be narrowing somewhere along the line, stricture, etc.
23. Will I have drainage tubes in my incision or elsewhere? How many and for how long? Depending on how the surgery goes there may be a drainage tube in one of the ports used for the laparoscopic tools. This will be removed prior to leaving the hospital.
24. How can this surgery affect health problems I might develop later? Cancer (treatment), need for stronger meds for arthritis, osteoporosis, etc.? Always take supplements as told to, have proper nutrition habits. If problem should occur in blind stomach would have to cut hole leading from outside of body into the blind stomach and stick camera down in there to check it. If problems develop in re-routed intestines would have to do the same as the endoscopy cam sent down throat can only go so far. There is always possibility of developing arthritis and osteo prior to surgery and it can advance afterwards if you are not geting enough vitamins and calcium.
25. Is there any risk of cancer or other problems in the bypassed portion of the stomach? How will these be detected post-op? Anything can happen whether or not you have the surgery. As far as detecting in the “blind” stomach an incision would have to be made on the surface and into the detached / blind stomach and a camera sent in to look around
26. I know a blockage can occur. How would I know there was a problem? What would I experience if there was a blockage? Extreme pain anywhere from chest to lower abdomen, not able to pass gas or move bowels, vomiting, etc.
    
     
27. Can I take Tylenol or Tylenol PM before surgery?   Tylenol is ok to use but discontinue use of Ibuprofen

28. Do I have to do anything special the last few days before surgery, such as a special soaps or laxatives, etc? Nothing to eat after midnight, do not have to take any special medicines, shower then use Hibiclens (sp?) 3 days in a row before surgery.

29. How are the incisions going to be closed? Staples? Stitches? Other? There will be staples, dissolvable sutures and non dissolvable sutures. My surgeon also adds a few sutures on the staple line just to be certain.

30. Do you cut the acid producing nerve to prevent ulcers? Yes it is cut

31. During lap surgery, are you able to "check" other organs? Just the organs in the general area of the surgery

32. How long will I be in surgery for RNY? Because this is a revision from the Nissen Fundoplication to a RNY 2-5 hours depending on scar tissue, etc.

33. What are your standing orders re being contacted by nursing staff if I feel I need you or if prescribed pain management isn't working? Patient Controlled Pump with pain killer, then at home liquid Roxicet most likely

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