Casco Bay Surgery

Laparoscopic (or Open) Gastric Bypass
Post-Operative Instructions

Pre-Operative Appointment

Hospital: Maine Medical Center – Brighton Campus (not the main hospital)

Report to: Pre-Admission Testing    Date:                  Time:

Surgery Appointment

** Don't eat or drink after midnight before surgery (except to take your usual medication). **

Maine Medical Center Location:  Bramhall Campus (the main hospital, in Portland)

Report to: ASU                                   Date:

Arrival Time:                                       Approximate Surgery Time:

 ** Surgery date is tentative until insurance approves. We will submit to the insurance company. **

The Pre-Admission Unit (PAU) is located at the Brighton Campus of Medical Center. At this appointment you will meet a member of the anesthesia team who will talk to you about general anesthesia and assess your risks of undergoing anesthesia. You might have an EKG and blood work at this appointment.

The anesthesiologist will also review with you which medications you should take the night before surgery and which ones you should take with a sip of water the morning of surgery. This is very important. If you have any questions about this, ask them to write down your instructions for you.

If you take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Advil, Aleve, Motrin, Naprosyn or Celebrex, you should discontinue those 10-14 days before surgery. They can cause bleeding. If this creates a problem for you or you have any questions about it, please call the Bariatric Surgery Center.

If you're a former smoker who quit shortly before joining the Bariatric Program, a nicotine level will be checked.

You will also be weighed. If your weight has gone up since your last visit to the Bariatric Surgery Center, your surgery might need to be delayed.

Description of the Operation

We will be doing a laparoscopic (or open) Roux-en-Y Gastric Bypass for you. The operation involves extensive re-routing of the food flow through your stomach and upper intestine in such a way that your appetite will be diminished, and less of what you eat will be absorbed. This combination of effects is what allows a motivated patient to maintain substantial weight loss on a long-term basis. Be prepared to spend 1-2 nights in the hospital, depending on how quickly you recover. 

Your Recovery

Because of the way your operation will be performed (laparoscopy), we'll put little or no restrictions on your physical activity after the operation. Your level of discomfort should prevent you from over-exerting yourself. As long as you don't lift or strain beyond the point where it hurts, you should be fine. [If you have a standard open operation, you should avoid heavy lifting and straining for 8 weeks after surgery to allow your incision to heal properly.] Your pain will most likely fade rapidly, so you should be able to return to work or normal activities within a few weeks, depending on the activities. You may resume showering and are encouraged to walk the day after surgery. Simply let the pieces of tape we use to close your skin fall off on their own.

Pain Relief (after going home from the hospital)

1. Take Extra Strength Tylenol (or generic acetaminophen) 1000mg as needed to control discomfort.

2. Take 1-2 Oxycodone 5mg tablets every 3 hours as needed for discomfort that remains after taking Tylenol. This is a narcotic painkiller. If you use it you must beware of becoming drowsy or inattentive, and you will not be able to drive or operate dangerous equipment. This drug can also cause nausea and constipation. You may want to take an over-the-counter stool softener (such as Citrucel or Colace) while you are on this painkiller. If you can't take Oxycodone (the ingredient for Percocet and Tylox) we will substitute a different painkiller. 

3. Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). These medications can be too harsh for your gastric (stomach) pouch during the first few months and can cause ulcers.

Other Medications

1. Take one chewable Centrum multivitamin daily and two Viactiv chews (for the calcium) daily. At the three-month check we'll have you start taking daily Vitamin B-12.

2. We will send you home with a prescription for medication to decrease production of stomach acid (usually Protonix or Prevacid). Take it once a day for the first two months to protect your new pouch and prevent ulcers. If you were taking a similar medication before surgery (such as Prilosec or Nexium), you may use that instead.

3. Resume all other usual medications unless we instruct you otherwise. Be aware that diabetes medications can often be cut back or discontinued right after surgery. If you have diabetes, monitor your blood sugar closely and contact your primary care doctor (or us) if you have questions about dosing.

Diet & Fluids

This is the most important part of your first-month recovery. It is essential that you adhere strictly to the Gastric Bypass Diet. You should already have a separate copy of the diet. If not, contact the Bariatric Surgery Center (207-761-5612) to get another copy. During the first month your new gastric pouch is fragile and must be protected from over-filling and violent vomiting (occasional vomiting is almost unavoidable). You must also take in enough liquids to prevent dehydration and enough protein to prevent dangerous malnutrition. Dehydration can cause nausea, fatigue, lightheadedness and dark urine. Before you go home you should be given a Bariatric Surgery Center water bottle. By filling this 4 times a day with any type of sugar-free liquid and drinking it, you will get your required daily fluid amount of 8 cups (64 oz.). Our dietitians are available to assist you during weekdays through the Bariatric Surgery Center.

Most Frequent Problems

Discomfort - Abdominal soreness below your ribs on the left side is the most common problem after waking up and can last for a several of weeks. Despite this, the most important thing you can do for yourself in the hospital and at home is to get out of bed and take short walks. Walking helps keep your lungs expanded to avoid fevers & pneumonia and keeps the blood moving in your legs to prevent dangerous blood clots that can travel to your lungs.

Dehydration – If you don’t drink enough you will be become dehydrated. You might then feel nauseated, fatigued, and lightheaded (especially when standing up) and you might urinate less often & smaller amounts and have darker urine than normal. To correct this problem, drink more often. Don’t hesitate to call us at the Bariatric Surgery Center for advice. 

Wound drainage & infection – It is not unusual for an incision to drain bloody fluid after you go home. This is usually not dangerous because it is almost always fluid that collected under your skin right after surgery and is not new bleeding. It will stop draining after all the fluid comes out, usually within a few days. Infections are uncommon and rarely serious after a laparoscopic operation. The incision most likely to cause trouble is the bigger one under your ribs on the left side. An infection will be red, warm, firm, and tender. The infected fluid will look more like pus than like blood. Once the fluid finds its way out of the body through the incision (sometimes with our assistance), the infection will usually just clear up on its own. Sometimes we'll prescribe an antibiotic for a few days, depending on the amount of redness and firmness. After an open operation (not laparoscopic) this can be a more serious problem requiring nurses to visit your home daily for weeks or longer to help take care of the wound.

Trouble eating - After the first month you'll gradually increase what you're able to eat. This can be a frustrating period of your recovery. Everybody has trouble eating at times for the first few months. Some days you'll be able to eat everything easily, but other days you might vomit the same foods. About 15% of patients will require outpatient GI endoscopy in the first few months to stretch a narrowing (stricture) at the pouch anastomosis, but most people simply improve on their own. Always remember you're not alone. We're just a phone call away to help or at least reassure you.

Dumping Syndrome - This is common after gastric bypass surgery. It is characterized by any combination of severe fatigue, flushing/sweating, heart palpitations, cramping and diarrhea soon after eating even a small meal with processed sugars in it.

Reasons to Call the Bariatric Surgery Center (207-761-5612)

1. Pain not controlled by your medication.
2. Persistent vomiting or dry heaves.
3. Fever and wound redness or persistent leakage from an incision.
4. Unusual or one-sided leg swelling, particularly if painful or tender (might be a leg blood clot).
5. Sudden shortness of breath that doesn't improve with 5-10 minutes of rest (might be a lung blood clot or a leak).
6. Any questions or concerns what so ever.

If you call us during the first few weeks after surgery be ready to tell us your heart rate. If you don’t remember how to measure it then be ready to feel and count your own pulse for us on the phone.

Follow-Up Appointment

You should already have a scheduled follow-up appointment with your surgeon. The Bariatric Nurse will call you a few days after surgery to check on your recovery and to give you your post-op appointment with the Bariatric Surgery Program.

The Bariatric Surgery Center
12 Andover Road
Portland, Maine 04102
(207)-761-5612
Toll-Free: (866)-268-9274
Fax: (207)-253-6073

Last updated 5/18/08