Weeks 1-3: Discharge
Most patients go home one or two days after laparoscopic bariatric surgery. You may feel a little worse the first day at home, with a bit more fatigue and pain, but you should feel better day by day after that. You will be provided with phone numbers to access your surgeon and team members at any time. Make sure you have these numbers available and access to a phone at all times. You will not be able to drive after surgery, for as long as you are taking pain medication, generally for 10-14 days- make sure you have family members to drive you home and available to drive you back to the hospital in the first two weeks in the rare instance that a problem arises.
For the first three weeks after surgery, you should eat a liquid diet. We recommend clear liquids for 1-3 days, followed by transition to full liquids within 1-3 days, remaining on full liquids for three weeks. Clear liquids include water, juice (sugar-free ideally), JELL-O, thin soups, broth. Full liquids include thicker soups, blenderized foods (no meats or breads, even if blenderized), pudding, and yogurt. We generally recommend that patients eat 1000-1400 calories per day and 50-70 grams of protein per day after surgery, but it is important to realize that patients will not meet calorie and protein goals for at least 1-2 months after surgery- these calorie and protein goals will be achievable after 1-2 months. The primary goal during the first 1-2 months is to drink enough fluids to stay hydrated. Your body will tolerate 1-2 months of lower calorie and protein intake without problems. Problems with pills are uncommon- most patients can go back to taking pills immediately unless they are very large. Discuss any concerns about specific pills with your surgeon.
Recovery after laparoscopic surgery is usually rapid. It is important to be up and about walking immediately after surgery. Patients should be able to get around the house, prepare meals, and do simple tasks. You may feel some fatigue for a few days, weeks, or even months after surgery - take it easy, avoid exercise beyond walking short distances for the first 2-3 weeks. Watch your balance and makes sure you walk with assistance or near railings or other handholds. Everyone is different- listen to your body, and discontinue activities that cause pain, discomfort, or significant fatigue. Recovery is longer after an open operation.
Complications are rare after laparoscopic bariatric surgery. Most serious complications will occur in the first 2 weeks - during this time, have a low threshold for calling your surgeon if problems or concerns arise. Pain, especially pain that does not improve daily or is severe, fevers, significant nausea, vomiting, and inability to pass gas or stool should prompt a call to your surgeon. Mild nausea, pain that is not severe and improves daily, and constipation are common after surgery and usually not worrisome. Redness or drainage from wounds should be evaluated as well, although this is often not a serious problem. Any problem that arises that worries patient or family members in the first two weeks after surgery should prompt a call to your surgeon.
Most patients should restart all medications they were taking prior to surgery within 1-2 days after surgery. This includes diabetes medications, although patients should check their blood sugars at least daily after surgery. For patients with sleep apnea who use CVPAP, it is important that you continue your CPAP before and after surgery. Patients should check in with their primary care provider within a week of surgery and receive advice on mediation. Avoid aspirin and NSAIDS (e.g., ibuprofen, naproxen) for as long as possible after surgery, but ideally for at least one month.
For laparoscopic operations, you may shower immediately, but keep your back to the water and keep your incisions as dry as possible. After about one week, you can let the incisions get wet but do not submerge completely in a bath or pool, and dry them immediately. By three weeks, bating or pool activity is fine. Occasionally an incision will open up- this is not a major problem - call your surgeon, but usually covering the incision with a Band-Aid is al l that is necessary. Less frequently, incisions may become infected- signs of infection are redness around the wound, or drainage of fluid, and less commonly fevers. Call your surgeons if this problems arises, wound infections are generally easily treated
3 weeks to 3 months:
Patients should slowly transition to solid foods beginning at 3 weeks after surgery. This is a process- begin with small amounts of solid foods such as eggs, fruit, cereal at first, always test a small amount, chew carefully and pay attention to sensations. If a particular food feels like it goes down too slowly or gets "stuck" for a while, put that food aside, and try others- you can retry that food in another couple weeks. If all goes well, introduce meats, starting with chicken and moving to beef and pork, vegetables, breads, and other solids, with the same precautions. By 1-3 months, most patients are eating solid foods. One in twenty patients may develop an intolerance to specific foods especially to meats, rice and breads, that may last longer, and may need to avoid those foods. Persistent or frequent vomiting is not normal and should prompt a call to your surgeon. We generally recommend that patients eat 1000-1400 calories per day and 50-70 grams of protein per day after surgery, but it is important to realize that patients will not meet calorie and protein goals for at least 1-2 months after surgery- these calorie and protein goals will be achievable after 1-2 months..
During this period, patients may begin to see improvement in obesity related disease such as diabetes, hypertension, hyperlipidemia, and sleep apnea. It is important that you work with your PCP to slowly reduce your medications and CPAP settings during this period. Your PCP plays a critical role in this process
Patients can slowly begin exercise 2-3 weeks after surgery. Ease back into exercise. Begin with walking, listen to your body and reduce activity if you feel pain, discomfort6, or significant fatigue. By 4-5 weeks, most patients are back to usual activity and exercise levels.
3 months and beyond:
By 3 months after surgery, most patients after eating solid foods and are able to consume about 900-1200 calories and at least 50 grams of protein per day. This ability will increase with time. Calorie counting should begin at this point- most successful patients are eating 1200-1400 calories per day months and years after surgery- some patients may need to diet a bit in addition to their operation- this process is "doable" after bariatric surgery, unlike before bariatric surgery,. And with calorie counting and monitoring their weight, most patients can maintain weight loss for years after bariatric surgery. Ideally, exercise levels will increase after surgery as you lose weight and in the absence of significant disability or osteoarthritis, you should be exercising more by 6-12 months after surgery than you were before surgery. Water aerobics and cycling are good options for those with arthritis or joint problems. Brisk walking is a great lifelong exercise. Talk with your PCP before initiating or increasing any exercise program and ease into any increased activity to avoid injury. Follow-up after bariatric surgery is lifelong. You should see your surgeon annually. You should see your PCP at least annually. Infrequent long-term complications such as hernias, ulcers, nutritional issues, and gallstones may require treatment months or years after bariatric surgery. Any new problems that involve your health in any way and especially your gastrointestinal tact, including abdominal pain, should be discussed with your surgeon.