post-op follow-up

Operative Follow-Up

Follow-ups are an integral part of your weight loss journey. If you’re considering surgery, dedication is needed to attend these follow-ups regularly. It involve consultation with the Surgeon, Nutritionist and others in intervals of 1 week, 1 month, 3 months, 6 months, 9 months and 1 year after the surgery. You will be meeting the team once in six months in the second year and annually for further follow-up after two years. These follow-ups require you to undergo some blood tests, the results of which you and the team will review together. The team at the Institute will call you during the month of the follow-up as a reminder for you. If you are unable to meet us in person, we encourage you to have the follow-up with us over phone, email or Skype.

SHORT TERM FOLLOW-UP

Short term follow-up up to 3 months after surgery is essential to prevent any serious surgical and nutritional issues. Postoperative dietary changes (including vitamin, mineral, and possibly liquid protein supplementation), exercise, and lifestyle changes should be reinforced by counselling by the Bariatric team and support groups. Counselling by the Nutritionist is important in making the transition from pureed to solid foods. This will help emphasize the importance of appropriate food choices to maintain a balanced diet and avoid high-calorie liquids and soft foods, which can defeat the purpose of the operation. Apart from dietary advice, we also advise exercise which is the most important key to success with bariatric surgery. Short term goal should be to walk 30 minutes per day, 5 days per week and long-term goal is to exercise 45 minutes to one hour daily. Emotional changes may persist and some patients feel like they are on an “emotional roller coaster”. These feelings are completely normal and usually, go away. We have a Bariatric counsellor to help patients overcome this.

short term
  • 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.

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.

LONG TERM FOLLOW-UP

Long term care of the postoperative Bariatric surgery patient is recommended for the lifetime of the patient, with at least 3 follow-up visits (6 months, 12 months, 18 months  and 24 months after surgery) with the bariatric surgery team and annually after 2 years. The six months and nine month follow-ups are crucial in helping the bariatrics team ascertain what your weight loss pattern has been like, and gives valuable information about your nutritional status: are you eating the right kinds of food, are there any vitamin or mineral deficiencies that need to be addressed, have your eating habits and preferences changed, etc. It also helps us identify any improvements in the condition of lifestyle diseases such as diabetes, hypertension and others. One-year follow-up will help the team reassess the lifestyle changes, medications and supplementations and modify or stop as per requirements. Subsequents follow-up and nutritional assessment once a year is done to make sure there is no deficiencies to avoid long term consequences of nutritional issues. Balanced diet, brisk physical activity and active lifestyle will help maintain good quality of life for a lifetime.

long term

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.

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.

REDUCE YOUR RISKS

  • Don’t smoke or drink. It may cause reflux or marginal ulcers
  • Move around. Get up and walk as soon and as much as possible after surgery. This reduces the risk of blood clots and improves lung function.
  • Long before surgery, start practicing the eating habits that will be necessary after surgery to achieve success: counting calories, reading labels, preparing weekly menus, etc.
  • Don’t overeat, even if its a small piece / bolus. It may cause discomfort, nausea and vomiting leading to electrolyte imbalance.
  • Practice your new way of eating. Get accustomed to the small and frequent post bariatric surgery diet.
  • Attend support group meetings. Learn from others. Most Bariatric surgeons agree that ongoing support after Bariatric surgery leads to the greatest level of success.
  • Consult your bariatric surgeon in the initial follow-up period for any symptom both related and non-related to the surgery. You might be over or under prescribed and your bariatric team can optimise your treatment.
  • Practice your new way of eating. Get accustomed to the small and frequent post bariatric surgery diet.
  • Attend support group meetings. Learn from others. Most Bariatric surgeons agree that ongoing support after Bariatric surgery leads to the greatest level of success.
  • Consult your bariatric surgeon in the initial follow-up period for any symptom both related and non-related to the surgery. You might be over or under prescribed and your bariatric team can optimise your treatment.
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