PATIENT EDUCATION BOOKLET SURGERY FOR SEVERE OBESITY

PATIENT EDUCATION BOOKLET
S U R G E R Y F O R S E V E R E O B E S I T Y
HOW SURGERY HELPS YOU LOSE WEIGHT
HOW SURGERY HELPS YOU LOSE WEIGHT
BEFORE SURGERY
BEFORE SURGERY
STARTING LIQUID AND FOOD
STARTING LIQUID AND FOOD
SIDE EFFECTS
SIDE EFFECTS
RECOVERY AT HOME
AFTER SURGERY
RECOVERY AT HOME
AFTER SURGERY
DO’S AND DON’TS
LOSING WEIGHT AFTER SURGERY
DO’S AND DON’TS
LOSING WEIGHT AFTER SURGERY
TIPS FOR CHANGING YOUR EATING
TIPS FOR CHANGING YOUR EATING
ADDING EXERCISE
PREGNANCY PLANNING
ADDING EXERCISE
PREGNANCY PLANNING
YOUR DECISION
YOUR DECISION
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GASTRIC BYPASS ROUX-EN-Y

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CONTENTS
HOW SURGERY HELPS YOU LOSE WEIGHT
3
SIDE EFFECTS
4

BEFORE SURGERY
5
DAY OF SURGERY
5

AFTER SURGERY
6
2
STARTING LIQUID AND FOOD
7

RECOVERY AT HOME
8
LOSING WEIGHT AFTER SURGERY
9
TIPS FOR CHANGING YOUR EATING HABITS
10

ADDING EXERCISE
10
PREGNANCY PLANNING
11
YOUR DECISION
11
RESOURCES
11
HOW SURGERY HELPS YOU LOSE WEIGHT
BEFORE SURGERY
STARTING LIQUID AND FOOD SIDE EFFECTS
RECOVERY AT HOME
AFTER SURGERY
DO’S AND DON’TS
LOSING WEIGHT AFTER SURGERY
TIPS FOR CHANGING YOUR EATING
ADDING EXERCISE
PREGNANCY PLANNING
YOUR DECISION

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Choosing bariatric surgery to reduce your weight is a major decision. For success, both
your mental and physical effort will be needed. This booklet gives you information about
the bariatric surgery, tips for before and after surgery care, your recovery at home, and
changing your eating habits to healthfully lose weight after surgery.
Gastric bypass surgery for severe obesity creates a new small stomach that limits the
amount of food you can comfortably eat and absorb. The surgery can be performed one
of two ways:
q Through an incision down the middle of the abdomen.
q Using a telescope (laparoscope) and specialized instruments through a set of smaller
incisions.
Your surgeon will discuss the type of surgery that is best for you.
Roux-en-Y Gastric Bypass Surgery (Figure 1) combines gastric reduction with a small
intestine bypass. The stomach is divided and a new small stomach “pouch” is created
with sutures or staples. The new stomach pouch holds up to 1 oz. Since a section of the
small bowel is attached to the pouch, the shorten bowel absorbs less food than before.
As a result, you eat less food. This method helps weight loss but still requires changing
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your eating lifestyle.
HOW SURGERY HELPS YOU LOSE WEIGHT
A gastric bypass procedure will not
stomach
make you lose weight. It can only
help you reduce calories successfully.
small intestine
The surgery limits the amount of
food you can comfortably eat at any
one time and causes malabsorption
of some of the foods you eat. It is not
Duodenum
an easy way out. If you overeat with
your small stomach, you will fail to
Roux-en-Y
lose weight or regain the pounds
stomach bypass:
you initially lost.
large portion of
stomach and
duodenum
By eating only at mealtimes and only
bypassed
until you feel satisfied, your daily
“Y”
food intake will be small enough to
Connection
lose the weight. However, it will be

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up to you to choose the healthiest foods for successful weight loss. Be sure you are
willing to change your eating habits. If not, you will be wasting your time and money by
having bariatric surgery. You will be most successful if you also make changes in your
work, exercise and use of leisure time.
You should consider gastric bypass surgery a permanent procedure. If your stomach
returns to normal size, you will most likely gain back any lost weight.
Remember, there are no guarantees for any weight loss method, including surgery.
Success is possible only with maximum cooperation and commitment to behavioral
change and medical follow-up. This cooperation and commitment must be carried out
for the rest of your life.
SIDE EFFECTS
Gastric bypass surgery makes it hard to eat large meals, to eat quickly and to tolerate
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certain foods, especially those high in sugar. It also makes it hard for your body to absorb
vitamins and minerals, such as iron, calcium and vitamin B12.
To be healthy, you will need to have regular blood tests to find out if you have vitamin/
mineral deficiencies. You will need to take supplements of these nutrients for the rest of
your life, as stated in your nutritional guidelines booklet. Not taking vitamins/minerals
may lead to osteoporosis (fragile bones), anemia and/or nerve injury.
You may experience “dumping syndrome,” which could happen if you eat or drink foods
high in sugar. You may feel sweaty, nauseous, faint or have diarrhea.
Transient hair loss can occur when the body is experiencing a drastic reduction in
calories and subsequent weight loss. This will resolve itself when nutrition and weight
stabilizes.
Some people develop an intolerance to milk products.
Muscle loss can occur after weight-loss surgery. Loss of muscle mass is preventable
with exercise and a high-protein diet, which is discussed in the nutritional guidelines
booklet.
You may experience a change in consistency and frequency in bowel movements,
because you will be eating less food.

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BEFORE SURGERY
If you smoke, it is strongly recommended that you stop before surgery. Smoking can
be more dangerous to your health than obesity. Smoking paralyzes the lining of your
air passages. It hinders proper function of your lungs and heart, and can contribute to
delayed healing.
Do not have a bariatric surgery while you have any other acute medical problems. If
you are getting a cold or have a sore throat, ear infection, kidney or bladder infection, or
open wound or sore, call your doctor. It may be safer to reschedule your surgery. If you
have diabetes, it is best to have controlled blood sugars prior to surgery.
If you are taking any medications, ask your surgeon which ones are safe to continue
taking. Also be sure to tell your surgeon and nurses of any herbs, herbal teas, vitamins
and other over- the-counter medications you are taking.
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Begin taking two showers a day a few days before you enter the hospital. Wash very
well from your chest to below your waist. Make sure to clean between any folds of skin.
A special antiseptic rinse (Triseptin) will be given to you prior to your surgery. The exact
instructions of use will be given to you by a nurse.
DAY OF SURGERY
An IV will be placed in a vein on the back of your hand, your arm or under your collar bone.
This will provide you with fluids before and during surgery. The IV will be taken out after
surgery when you can begin drinking sufficient fluids for your body requirements.
An anesthesiologist will talk with you about the anesthesia you will be given to put
you to sleep during surgery. He or she will put an endotracheal tube in your windpipe
(trachea) through your mouth or nose. Your throat will be numbed with a spray.
The anesthesiologist moves air in and out of your lungs through this tube while you are
asleep during surgery.

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A urinary catheter will be inserted prior to surgery and will stay in for the first 24-48
hours after surgery. It will be removed once you have adequate urinary output. This will
enable the nurses to make sure that your kidneys are functioning properly.
A nasogastric tube will be inserted into your stomach during surgery. This tube is
necessary to drain any blood or mucous from your stomach after your surgery. In
general, the tube will be removed the morning after surgery when an X-ray confirms
that the surgical site is not leaking.
A drain or drains, called Jackson-Pratt, will also be placed on one side of the abdomen.
These drains are used to collect any excess fluid and blood from your abdomen. You will
go home with them and the surgeon will remove them in the office. There will be NO
bathing until they are removed, as the insertion area needs to be kept dry to prevent
infection. You will be taught how to care and drain them before you are sent home from
the hospital. You will be responsible to record the output every 8 hours while at home.
You will be connected to a heart monitor for about 24 hours after surgery. It will monitor
your heart for any abnormally fast or slow rhythms. Your doctor will write an order to
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discontinue it when you are stable.
AFTER SURGERY
The length of the procedure depends on various factors, which will be discussed with
you by your surgeon. After that, you will spend time in the recovery room. You may feel
confused when you begin to wake up. Many people may be working around you and
you will see a lot of equipment. This is normal and is no cause for alarm. You will be
taken to your room when your doctor gives an order to do so.
You may still have the endotracheal tube when you wake up from surgery. Your breathing
may be aided with a machine. Breathe normally and try to relax, letting the machine do
the breathing for you.
Your doctor will adjust the machine for more or less air, according to the amount of
oxygen and carbon dioxide in your blood. You will not be able to talk if you have an
endotracheal tube. You can signal to the nurse if you feel that you need more air. The
tube will be taken out as soon as you are breathing deeply and no longer need help
from the machine.

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After surgery, be sure to follow all the instructions given by your doctors and nurses. Tell
them right away if you experience pain or about any concerns you may have.
It is important that you cough and breathe deeply. Mucus develops in your lungs from
the anesthetic. Coughing and deep breathing help to clear it. You must cough and take
deep breaths every two hours starting after surgery until you go home. This can be quite
painful after gastric surgery, but it is very important to prevent pneumonia, or atelectasis,
which are both infections of the lungs.
The nurses and respiratory therapists will help you. The nurses will give you pain medicine
when needed. You will be instructed how to use the incentive spirometer. This device
will help you to take deep breaths to prevent pneumonia.
You will also need to move and walk the evening of your surgery. Walking helps expand
your lungs. It also increases blood circulation in your legs to help prevent blood clots.
You will need to help move yourself. A physical therapist will be assigned to help you
walk and get out of bed, but you will need to walk as often as possible. Again, pain
medication will be available should you need it. Managing any pain you may have will
be an important part of your care.
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You will be given anticoagulant injections while you are in the hospital. This medication
thins the blood and helps prevent blood clots. Another measure used to prevent clots is
a sequential compression device. It includes sleeves that wrap around your legs and are
attached to a machine. The machine, used to promote the circulation of your legs, will
inflate the sleeves, and you will feel a slight squeezing sensation around your legs. This
device should be turned on whenever you are sitting or lying in bed.
STARTING LIQUID AND FOOD
The day after surgery, after the nasogastric tube is removed, you can begin to
drink liquids, if you have no complications.
Your schedule of drinking and eating is likely to be:
q
From midnight before your surgery until after your surgery, until the nasogastric tube
is removed-nothing by mouth. An IV will provide your fluids.
q Immediately after your operation, IV fluids will be given to ensure adequate
hydration.
q Once you begin to take things by mouth, you will start with sugar-free clear liquids,

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such as juice, broth, Crystal Light or Jell-O. Take it slowly. You do not have to drink all
you are given. Remember, your new stomach is the size of a slim banana and holds
about 1-5 ounces at one time.
q On the second day of eating, the dietitian will meet with you to review your diet and
answer any questions you or your family may have. It is important for you to learn to
drink about two ounces of sugar-free fluids every hour to maintain hydration.
q Your diet will be advanced based on the recommendation of your surgeon.
RECOVERY AT HOME
Do:
q Slowly increase your activity. Following the tips listed below will help speed up your
recovery.
q Walk as much as you can without getting overly tired.
q Slowly increase the distance you walk.
q
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Follow your physician’s recommendations about activities, such as driving and
resuming sexual relations.
q Follow your prescribed diet including drinking adequate amount of fluids.
q Take your vitamins and protein supplements.
q Walk and move about when you are up. This will help your circulation.
Do not:
q Drive a car or use machinery while you are still taking pain medications.
q Drive a car until your doctor gives you permission.
q Climb more stairs than what is needed to get to your bedroom, the bathroom, or
outside.
q Lift anything heavier than 10 to 15 pounds for at least six weeks.
q Go back to work until your doctor says it is okay.
q Stand or sit for more than a short time.
You may experience feelings of sadness and loss after your surgery. These feelings are
common and should pass as you became more active and adapt to the lifestyle changes.
Joining a support group will help you cope with these feelings. However, if these feelings
are overwhelming, you should seek professional help.
It is common to feel weak and tired after leaving the hospital. Your body is recovering
from the stress of a major operation. Because weight loss is occurring during this time,
the feelings of weakness may be prolonged. Following your prescribed diet, drinking
adequate amounts of fluid and taking your vitamins may help.

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When to call your doctor:
You will need to make an appointment to see your surgeon within 5-7 days after surgery.
You should call your doctor’s office if you have any questions or problems.
You must call your doctor immediately if you notice any of the following
symptoms:
q Persistent nausea and vomiting.
q Fever greater than 101 degrees Farenheit.
q Increased abdominal pain.
q Pus or increased redness around the incisions.
q Severe shoulder pain.
q Chest pain or shortness of breath.
q Pain, swelling or redness in one or both of your legs.
LOSING WEIGHT AFTER SURGERY
Many things affect weight loss, such as age and sex, as well as your physical condition
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and weight at the time of surgery. If you are very overweight, you have more to lose and
probably will lose more quickly. Most patients can lose up to 30 percent of their excess
weight in six months, and 60 to 80 percent of excess weight as early as one year after
surgery. This is an average – some people lose more and some less. Age, exercise and
how well you follow your nutritional guidelines play a great role in how much you may
lose.
After surgery, your small stomach and its small outlet reduce your hunger and the
amount you can eat. It is up to you to choose the best and healthiest foods for successful
weight loss. The following tips, along with the nutritional booklet, will help you make
smart changes in your eating habits. Seeing a registered dietitian after surgery may help
you adjust to your new way of eating. These changes are yours to make. The pride you
feel and improved health also will be yours.
TIPS FOR CHANGING YOUR EATING HABITS
Your diet will consist of high-protein, low-fat and low-sugar foods. Your diet will be
advanced on the recommendation of your surgeon to a full liquid diet, then to puréed,
and later to a soft/regular diet, as tolerated.

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For the first few weeks after surgery, you will feel very full with one-third to one-half cup
of liquid. Slowly you will be able to have a bit more at one time.
Then, follow the tips below along with your nutritional guidelines booklet:
q Eat only three small meals and two high-protein snacks per day.
q Drink fluids only between meals. You need to stop drinking fluids 30-60 minutes
before and after meals.
q Drink at least 64-100 oz. of fluid each day to prevent dehydration and constipation.
q Eat slowly. Gulping your food or drinks will make you feel uncomfortable and may
make you vomit. When you begin eating solid food, chew until the food is a liquid
consistency.
q Do not have high-calorie, low-nutrient drinks, milkshakes, beer and other alcoholic
drinks. These drinks give you many calories and will impair your weight loss.
Carbonated drinks such as soda or sparkling water may also stretch your new
stomach.
q Do not graze. Constant nibbling defeats the purpose of your surgery, and you will not
lose weight.
q Do not eat sweet foods since they may give you unpleasant symptoms such as
sweating, faintness and/or flushing (dumping syndrome).
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q Eat a variety of foods. Always choose protein first, then vegetables, fruits and whole
grains.
q Stop eating as soon as you feel satisfied. You will not be able to eat all the food you
want.
q Taking a few extra bites and frequent overeating can stretch the stomach pouch and
limit your weight loss.
ADDING EXERCISE
Exercise is important to include in your daily routine for good health and weight loss.
Choose exercise that you enjoy. Swimming, bicycling, tennis, jogging and brisk walking
use up the most calories. Exercises, such as sit-ups, leg lifts, weight-lifting, pilates and
yoga help to tone muscles. However, we cannot guarantee that these exercises prevent
loose, saggy skin if you lose a lot of weight. Check with your doctor before starting active
and/or toning exercises.

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