Life After Surgery

Our Frequently Asked Questions section references accepted standard of practice and guidelines from regulatory and professional organizations including the National Institutes of Health (NIH), American College of Surgery (ACS), American Society for Metabolic and Bariatric Surgery (ASMBS) As always, please check with your healthcare provider to determine their individual practices, guidelines and what they recommend for you.

What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:
  • Our surgeons and bariatric team will provide you with special discharge instructions and dietary guidelines. You will need to follow these guidelines closely. It is important to follow these and ask questions in order to avoid risks to the weight loss surgery performed. Allowing time for proper healing of your new stomach pouch is necessary and important whether you have staples or a band.
  • When able to eat solids, eat 2-3 meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and protein supplement drink. Protein should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
  • Never eat between meals. Do not drink beverages that aren't zero calorie. No carbonated beverages after Gastric Bypass Surgery.
  • Drink 64 oz or more of water each day.
  • Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added 3-4 days per week, as instructed by the exercise specialist
How does exercise work with weight loss surgery?
When you have weight loss surgery, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for 30 minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead. Our exercise specialist will work with you to determine what types of exercise is best.
What is the right amount of exercise after weight loss surgery?
Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery - the patient must be out of bed and walking. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient's overall condition The program Exercise Specialist will be evaluating your activity level post operatively and prescribe an exercise routine for you. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.
Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) allowing you to adequately nourish a fetus. You should consult your surgeon and gynecologist as you plan for pregnancy.
What if I have had a previous weight loss surgical procedure and I'm now having problems?
Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.
What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, 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 - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known. In the BPD procedures, some portion of the stomach is completely removed.
How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created to measure in volume at 1/2oz to 1oz (15-30cc). The gastric band procedure places a band device that can be adjusted to make the upper portion of the stomach small enough that small amounts of soft, smash consistency foods and liquids can pass through. In the first few months there is natural tissue swelling due to surgery. Over time this swelling will decrease and you may find you are able to eat more Portion control is important to keep your stomach size in good shape. The same is true for gastric banding however it is known that when you loose weight or able to eat more you need a band adjustment.
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 will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples 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. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.
Will I be able to take oral contraception after surgery?
Yes, most patients have no difficulty in swallowing these pills. Remember, some form of contraception for at least 1 year after weight loss surgery is required. We recommend you discuss the best method for you with your gynecologist.
Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit.
Is there a difference in the outcome of surgery between men and women?
Both men and women respond well to this surgery. In general, men lose weight slightly faster than women.
Will I be asked to stop smoking?
Yes, patients are required to be smoke free for at least 3 months before surgery.
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.
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 20-40 pounds per month, or maybe when they've lost more than 100 pounds and they're 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. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.
What can I do to prevent excess hanging skin?
Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as cosmetic surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds.
Will exercise help with excess hanging skin?
Unfortunately, most patients may still be left with large flaps of loose skin regardless of their exercise routine. However exercise is good in so many other ways that a regular exercise program is always recommended.
Will I be miserably hungry after weight loss surgery since I'm not eating much?
Feeling hungry after weight loss surgery depends on the type of procedure. Most patients having the gastric bypass or the gastric band report no appetite (feeling physical hunger) for the first 4-6 weeks after surgery. Appetite (physical hunger) will gradually increase especially as you become more active and burning calories. Patients who have gastric banding might experience earlier physical hunger then the gastric bypass patient. This is an indication that the gastric band needs to be adjusted.
What if I am really hungry?
First ask yourself if you are physically hungry ( that is your body needing fuel for energy, vitamins and minerals) or "head" hungry (that is eating for boredom, stress, sadness, special occasions, routine). If you are physically hungry than eat appropriately considering healthy food choices, portion control and number of meals. For patients with gastric banding consider also the possible need for an adjustment. Remember a balance of protein, fruits/vegetables and whole grains is a must. Also not to drink liquid with your meals.
Will I have to change my medications?
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds 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 NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
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 bowel) can advance. Approximately 20% of patients develop a hernia. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.
Is blood transfusion required?
Infrequently: If needed, it is usually given after surgery to promote healing.
What is phlebitis and is it preventable?

Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:

  1. Early ambulation
  2. Special stockings
  3. Blood thinners
  4. Sequential compression boots or wraps for the lower legs
Will I lose hair after surgery? How can I prevent it?
Many patients experience some hair loss or thinning 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 taking the required daily vitamin supplements which includes a multivitamin containing zinc and a good daily volume of fluid (48 to 64 ounces).
Does hair growth recover?
Most patients experience natural hair re-growth after the initial period of excess weight loss decreases.
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.
What is the "Candida Syndrome"?
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.
What causes it to appear?
It is promoted by the use of most antibiotics and some other medications, by stress, by reduced immune response, and by diabetes.
Can it be cured?
There are several effective medications now available for treating the overgrowth of Candida.
What is sleep apnea (SA)?
It 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.

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