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Life After Surgery

What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:

Can I get pregnant after weight loss surgery?
Yes, but it is strongly recommended that women wait 18 months to two years after the surgery before becoming pregnant. After about 18 months, your body will have stabilized. Due to the nutritional issues related to both pregnancy and bariatric surgery, you should consult your surgeon as you plan for pregnancy.

In gastric bypass, what happens to the lower part of the stomach that is bypassed?
The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food.

How big will my stomach pouch really be in the long run?
The stomach pouch is created at one to two ounces (25 to 45cc). In the first few months it is rather stiff due to natural surgical inflammation. About six to 12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of three to six ounces.

Patients with a gastric band will achieve optimum stomach size to hold four to six ounces of solid food per meal. This is achieved through regular appointments with Dr. Scott and having adjustments as needed.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples you use in the office. The staple materials are also non-magnetic, which means that they will not be affected by MRI and will not set off airport metal detectors.

What if I'm not hungry after surgery?
It's normal not to have an appetite for the first month or two after weight-loss surgery.  Patients state that prior to surgery they would “live to eat” but now they “eat to live”.

Is there any difficulty in taking medications?
The absorption of most medications will remain the same after surgery. Most pills or capsules are small enough to pass through the new stomach pouch. The exception is extended release medications. If you take this type of pill you should talk with your primary care physician about having it changed if you notice decreased efficacy.

Most all medications are tolerated following weight loss surgery but patients should use caution when taking a non-narcotic pain medicine such as Motrin, Advil, ibuprofen, aspirin, Alleve, or other nonsteroidal anti-inflammatory drugs (NSAIDS).  If you must take these NSAID medications you may, but we advise patients to also take an acid reducing pill such as Prilosec OTC (over the counter) to help protect their stomach against the ulcer forming properties of the NSAIDS.

Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Studies have demonstrated an increase in sexual desire and satisfaction following weight loss surgery.

Will I be asked to stop smoking?
Patients are required to stop smoking at least six weeks before surgery and remain smoke free for the remainder of their life.

If I continue to smoke, what happens?
Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection and interferes with blood supply to the healing tissues. Also, it will increase the possibility of stomach ulcers after surgery.

How can I know that I won't just keep losing weight until I waste away to nothing?
Patients may begin to wonder about this early after the surgery when they are losing 20 to 40 pounds per month, or when they have lost more than 100 pounds and they are still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. In the absence of a surgical complication, patients are unlikely to lose weight to the point of malnutrition.

What can I do to prevent lots of excess hanging skin?
When skin loses its elasticity and is unable to reform, some patients will choose to have plastic surgery to remove loose or excess skin. Generally only 10 percent of patients seek plastic surgery consultation. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Dr. Scott and Dr. Adams generally will not recommend surgery for skin removal until at least 18 months after your surgery and weight loss has been stable for three months.

Will exercise help with excess hanging skin?
Exercise is good in so many ways that a regular exercise program is recommended. Unfortunately, it has not been proven to prevent excess skin.

Will I be miserably hungry after weight loss surgery since I am not eating much?
Somewhat surprisingly, most patients say they transition from “living to eat to eating to live” with good control of their hunger. Even if hunger eventually returns, the restriction gained by the small stomach pouch helps provide satiety or relief of hunger after minimal intake.

What if I am really hungry?
This is usually caused by consuming the wrong types of food, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch and avoid starches that will cause an insulin surge which can lead to hunger.

Will I have to change my medications?
Your doctor will determine whether medications can be stopped when the conditions for which they are taken improve or resolve after weight-loss surgery. For medications that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight-loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and nonsteroidal anti-inflamitory drugs (NSAIDS) (most over-the-counter pain medicines). NSAIDs may create ulcers in the small pouch or the attached bowel and therefore, should only be taken when approved by your surgeon. Since patients are consuming less fluids after surgery, the need for diuretics diminishes and places the patient at risk for dehydration.

What is a hernia, and what is the probability of an abdominal hernia after surgery?
A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20 percent of patients develop a hernia after an open procedure, but only about 1 percent of patients that have laparoscopic surgery will develop a hernia. Most of these patients require a repair of the herniated tissue.

Is blood transfusion required?
Very infrequently; Dr. Scott and Dr. Adams are very conservative and cautious about administering blood products.

What is DVT and is it preventable?
DVT, or deep venous thrombosis, is undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:

  • Early ambulation
  • Special calf exercises
  • Blood thinners
  • Pulsatile boots

Will I lose hair after surgery? How can I prevent it?
Some patients experience thinning of hair after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc supplement, adequate iron intake and a good daily volume of fluid intake.

Does hair growth recover?
If patients experience hair thinning, most experience natural hair re-growth after an initial period of loss and frequently it is more full than prior to surgery.

What are adhesions, and do they form after this surgery?
Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems and are rare following laparoscopic surgery.

What is the Candida Syndrome and is it preventable?
Some patients have a type of yeast present on the surface of their skin, intestine or vagina at the time of surgery. This leads to overgrowth in certain circumstances. A whitish coating may occur on the tongue or throat. This syndrome is associated with a frothy mucous, nausea, difficulty swallowing, sore throat, loss of taste and appetite, and occasionally abdominal bloating and diarrhea. It is promoted by the use of most antibiotics and some other medications, by stress, by reduced immune response, and by diabetes. There are several effective medications now available for treating the overgrowth of Candida.

What is sleep apnea?
Sleep apnea is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.