Bariatric Surgery Patient Guide: An Overview of What to Expect Before and After Treatment
Choosing weight-loss surgery is an important decision. You should be informed on what to expect. Although our staff will review guidelines during each phase, we provide this overview to get you started.
It’s very important to us that you are completely informed from the beginning. Well before your procedure you’ll talk in detail with our physicians and staff, and get all of your questions answered. We may also want you to meet with other experts who can greatly influence your success, such as dietitians, physiotherapists and psychologists. Depending on your age and medical history we may also require specific pre-operative tests, such as a cardiac workup, blood work, sleep study and psychological evaluation.
The pre-op diet is vital to your success. It gets you into the proper nutritional state for your surgery, reduces fat in and around your spleen and liver to reduce potential bleeding during and after the operation, and shrinks the liver itself. If the pre-op diet is not followed properly, your surgery may have to be postponed. Here are the guidelines you should follow:
If your weight exceeds 300 pounds, a strict high protein, low carb diet should be started ten days before surgery. Four meals per day consisting of 2 protein shakes and 2 meals are consumed. Recommended shakes include Premier Protein, Atkins Advantage, Carbs For Life, and Slim-Fast Low Carb.
- Meal 1 — One protein shake: Premier Protein, Atkins Advantage, Carbs For Life, or Slim-Fast Low Carb
- Meal 2 — One serving of any type of lean meat or fish (5 oz.) and one cup of vegetables: green vegetables such as lettuce, peas, broccoli, green beans or spinach.
- Meal 3 — One protein shake: Premier Protein, Atkins Advantage, Carbs For Life, or Slim-Fast Low Carb
- Meal 4 — One serving of any type of lean meat or fish (5 oz.) and one cup of vegetables: green vegetables such as lettuce, peas, broccoli, green beans or spinach.
Your procedure will be performed laparoscopically in an outpatient surgery center or hospital allowing you to go home within 24 hours. If there are no complications, you should be able to resume normal activities within a week or two.
After your procedure, we will take an x-ray to confirm that the lap-band system is correctly placed or the new stomach outlet is open. We may have you swallow an x-ray enhancing liquid first. Immediately following the operation you may take an occasional sip of water or hold ice chips in your mouth.
Later that day you should take additional fluids such as chicken or beef broth, apple juice, Gatorade, Crystal Light, Cool-Aid, tea, Popsicles and Jell-O. These should be taken in small amounts to prevent nausea and vomiting. We recommend consuming at least 4-5 ounces every hour.
It is very important to immediately begin the post-op diet to allow proper and complete healing, which may take a month or more. It is also important not to stretch the small stomach pouch above the band. Vomiting is of particular concern as it can cause stretching and an increased chance of stomach tissue slipping through the band. Contact our office if you experience vomiting.
Living with the LAP-BAND
The first rule in living and thriving with the LAP-BAND is to remember that weight loss will be gradual – one to two pounds per week is considered successful. However, this success depends on your making real lifestyle changes. Here are our recommendations regarding diet, lifestyle, exercise and band adjustment.
Week 1: Clear liquids
Week 2: Full liquids
Week 3: Pureed foods
Week 4: Mechanically soft foods
Week 5: Ground meats
Week 6: Begin regular foods
Eating Guidelines for Life
- Eat at least three well-balanced meals per day
- Concentrate on solid foods, which will make you feel full faster and for longer periods of time
- Avoid snacking
- Eat small amounts
- Eat slowly. A meal should last 30 to 45 minutes
- Do not gulp foods or fluids
- Chew all foods to a paste consistency. Swallowing chunks of food may obstruct the pouch outlet
- Use a small fork or spoon to control portion size
- Put utensils down between bites and wait one minute between bites
- Stop eating as soon as you feel full. Signs of fullness may include nausea, pain in the upper chest, or pressure below the rib cage
- Avoid foods high in sugar and fat
- Drink plenty of non-caloric liquids between meals
Fluid intake is very important to prevent dehydration and constipation, but it is important not to drink with meals or close to meals, which may cause bloating, nausea or vomiting. Drinking near meals also quickly washes food through, which induces hunger and excess eating. The guideline is to avoid liquids 30 minutes before and 40-60 minutes after meals.
- Sip water all day
- Do not use a straw, which can fill your stomach with air
- Avoid regular soft drinks and adding sugar to beverages
- Avoid carbonated beverages for one month after surgery to prevent bloating
- Avoid high-calorie liquids, which impart calories without making you feel full. Most fluids long term should be non-caloric such as water, Crystal Light, sugar-free Kool-Aid, coffee and unsweetened tea
- Avoid alcoholic beverages
Constipation may occur after surgery and is typically caused by decreased intake of food, fiber and fluid. To prevent constipation it is important to eat high-fiber foods and drink plenty of fluids – we recommend a daily minimum of 64 ounces. It also may be helpful to have baby prunes or unsweetened prune juice. High-fiber foods have the added benefit of slowing the emptying of your stomach.
Red meat such as steak, roast beef, and pork is high in muscle fiber, which is difficult to break down even with a great deal of chewing. Other problem foods include:
- Dry meat
- Un-toasted bread
- Doughy bread
- Peanut butter
- Membrane of citrus fruits
- Seeds and skins of fruits and vegetables
- Dried fruit
- Fibrous vegetables such as corn, asparagus, and celery
- Greasy or fried foods
Behavior Modification Techniques
- Do not eat in front of the TV
- Do not read while eating
- Pre-portion your food and put the box or package away
- Keep tempting foods out of the house
- Do not go to the grocery store hungry
- Make a shopping list and stick to it
- Use smaller plates and bowls
- Keep healthy foods readily available
- Focus on activities other than eating
- Brush your teeth after meals or if feeling the desire to eat
- Do not eat standing up at parties or buffets
- Do not stand at the food table at parties
- Offer to bring a healthy food item to parties
- Park you car a good walk from your destination
- Take the stairs instead of the elevator
- Keep a food and exercise diary
Creating a daily exercise habit is absolutely critical to your long-term success, even more than diet compliance. You must exercise at least 30-minutes a day, every day. Any activity that increases the heart rate for an extended period is acceptable, including walking, running, swimming, aerobics and hiking. The key is to find activities that you enjoy and make them part of your daily routine.
The LAP-BAND’s adjustability is one of its great advantages. Six weeks after surgery you may require an adjustment. This is also known as a fill, due to the fact that fluid is added to the band.
Three main factors are used to determine whether or not to make an adjustment: weight loss, level of hunger, and degree of restriction. If you are not losing the targeted one to two pounds per week, you feel ravenous, or you’re able to eat bigger meals, then it is time to do a fill.
Most adjustments can be done in the office in less than 5 minutes. If the adjustment port cannot be accessed in the office, fluoroscopy or X-ray may be necessary. The first adjustment is done no sooner than six weeks after the procedure. Subsequent adjustments are done at four to six week intervals based on the three factors mentioned above.
It is important to look for any negative symptoms after a fill, such as chest pains after eating or drinking, nausea, vomiting and reflux. These may indicate that the LAP-BAND is too tight. More subtle signs are nighttime coughing, choking and an inability to eat a range of foods. It is important to remember that weight loss should be gentle and gradual. You must resist the desire to have the band be too tight too fast, which can lead to dysfunctional eating habits such as converting to a liquid-only diet. If obstructive symptoms are present, the band should be loosened.
The amount of post-surgery weight loss varies from patient to patient depending on several factors such as age, starting weight, exercise level, metabolism and eating habits. But the most important factor is your overall commitment to a new lifestyle. The goal isn’t just to lose weight, but to gain life. Your new lifestyle will perpetuate itself – you lose weight, you feel better, your life improves, you lose more weight.
Remember, good health is the objective, which is why the weight loss must be gradual. While obesity carries serious health risks, so does weight loss that occurs too rapidly. Losing one to two pounds a week in the first year is possible with one pound a week more likely. On average, patients lose about 45-60% of their initial weight in the first 12 to 18 months.