Operative Follow-Up

• Eating too fast, too much, or drinking with meals may cause vomiting. Keeping a food diary will help you determine if vomiting is caused by the types of foods you are eating or if there is a problem.
• Dumping Syndrome is severe diarrhea, nausea, lightheartedness, and stomach cramps. Dumping syndrome is caused by eating and drinking at the same time and by eating sweets or foods high in sugar. Do not drink fluids with your meals and never eat sweets.
• Gas Problems are also common after weight loss surgery. If you have pains at home try antacids.
• Constipation after bariatric surgery is not uncommon and is more likely to occur if you are taking iron. It may be necessary to take a stool softener for the first month or so, until you can drink more fluids and eat more fiber. Other ways to improve regularity include:
• Eat fruits with soluble fiber like apple, cereals like oatmeal (cooked not instant) and/or stewed prunes daily.
• After 4 weeks, eat more fruits, vegetables, beans and whole grains (e.g. cereals with 5g or more of fiber per serving).
• Drink lots of water.
• Exercise daily.

• Excess weight places extra stress on the chest cavity and lungs after surgery, resulting in the risk of pneumonia after bariatric surgery. For these reasons, we encourage patients to be up and ambulant at early as 4-6 hours after surgery. The more active you are postoperatively, the lesser the issues with Blood clots in the legs (venous thrombosis) are another possible postoperative problem. This risk can best be reduced by exercising the leg muscles to promote blood flow. Walking is the ideal exercise, although even moving the feet and ankles up and down while lying in bed helps.
• Incision infections can occasionally occur following bariatric surgery. Minimally invasive (laparoscopic) bariatric surgery reduces the chance of incision infection.
• A leak at one of the staple lines in the stomach is a slight possibility. Most leaks are treated nonsurgical with drainage and antibiotics and heal with time. Occasionally, a very serious leak requires emergency surgery.

Consult your surgeon in case you have any of the above medical symptoms.

The follow-up visits permit early recognition of vitamins, minerals, protein and iron deficiencies or other problems so that appropriate treatment can be given. Biochemical tests like vitamin B1, B2, B6, B12, Vitamin A, and Vitamin D, Folic acid, Calcium, Magnesium, Iron, Phosphorous, Zinc, Copper, proteins, etc are given at 3 month follow up visit and deficiencies if any are treated accordingly with supplements.Kindly note that over the counter supplements are not good enough as they will not be absorbed with efficiency after bariatric surgery. Their recommended allowance is not good enough as well. Hence Bariatric specific supplements are recommended. Their concentration is very high and absorbed faster as well.

After weight-reduction surgery, the body may not absorb certain vitamins and minerals. Follow-up visits with your physician/nutritionist will determine which vitamin and mineral supplements are necessary after surgery. The need for vitamin and mineral supplements is especially evident in people who have a very, very long limb Roux-en-Y gastric bypass. This surgery can be associated with frequent diarrhea and failure to absorb enough calcium and iron. Complications of this malabsorption may include:

• Anemia due to deficiency of iron or vitamin B12.
• Neurological complications from vitamin B12 deficiency.
• Kidney stone disease due to changes in how the body absorbs calcium and oxalate.
• Possible bone disease due to mineral or vitamin D deficiency.
• Dehydration is a possible complication following weight-reduction surgery, as patients are no longer able to drink large quantities of liquid at one time.

In the first three to six months after surgery, as the body reacts to rapid weight loss, you may experience one or more of the following changes (some changes are due to a slowing of the body’s metabolism from weight loss and usually resolve with time):

• Body aches
• Feeling tired (flu like)
• Feeling cold when others feel comfortable
• Dry skin
• Hair thinning and hair loss
• Changes in mood
• Relationship issues

• An uncommon complication of gastric bypass surgery is an ulcer developing where the small intestine attaches to the upper part of the stomach. Ulcers are more likely to develop in people who take aspirin or nonsteroidal anti-inflammatory agents.
• A hernia or weakness in the incision sometimes occurs and needs to be repaired. Hernias are less common after laparoscopic surgery.
• A narrowing or stricture of the opening (stoma) between the stomach and intestine is a rare complication that can occur. Fixing this complication may require another surgery. More commonly, an outpatient procedure can expand the narrowed area with a dilating tube passed to the stomach through the mouth.

The follow-up visits permit early recognition of vitamin, minerals, protein and iron deficiencies or other problems so that appropriate treatment can be given. Biochemical tests like vitamin B1, B2, B6, B12, Vitamin A, and Vitamin D, Folic acid, Calcium, Magnesium, Iron, Phosphorous, Zinc, Copper, Proteins, etc are given at follow up visit at 6 month and 12 months) and deficiencies if any are treated accordingly with supplements. Proteins need not be continued if you are having adequate proteins every day. However, vitamin ins and minerals will continue for long term based on the nutrition reports during every visit.

• Not losing “enough” weight. Though most patients lose enough weight to significantly improve their health, some are not happy with the results. This can often be avoided by having realistic expectations prior to surgery.
• Emotional stress. Bariatric surgery leads to many changes, positive and negative, which taken together can become stressful. However, you can take several steps to prepare yourself mentally for the challenges.