Weight Loss Surgery Questions

My Weight Loss
Surgery Questions

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31. It sounds like the ‘diet’ you are advocating for post-op is a high protein, low carb diet. Are post-WLS patients in ketosis? Do you advocate patients following a ‘diet’ plan like Atkins or do you advocate high protein but low fat?

Yes, post-op gastric bypass patients are in ketosis especially right after surgery when caloric intake is very low. The diet we advocate includes fruits and vegetables, with an emphasis on protein as the main element of each meal. We advocate a low fat diet. Atkins diet restricts carbohydrates severely (including fruits) and allows seemingly unlimited fats.

32. Will I be able to eat fresh fruits eventually after WLS? I love fruits of all kinds.

You may eat fruit to your heart's content....But it is a trial and error situation for awhile determining just how soon you can tolerate some of the more fibrous fruits...you may never be able to eat apple skins, pear skins, or other such fibrous parts of the fruit. You may also drink fruit juices, but since they are so high in calories, we recommend no more than 8 ounces of fruit juice a day.

33. Give me a sample ‘meal’ for someone 6 months post-op. Type of food and quantity they should eat? How about 1 year post-op?

Ideal meal: 1/2 animal protein, 1/4 fruit, 1/4 vegetable, carbs in place of fruit if desired (potato, pasta, tortilla, rice). Sample: 3 oz. Chicken breast, 1/4 cup of peas, 1/4 baked potato with Tablespoon of "Take Control" (butter). Or...one half of a hamburger with cheese, tomato, lettuce, 1/2 of a pear. This type of meal can be eaten at about 3-6 months after surgery.

34. I’m employed outside the home full time. I’m also a college student (online). Do you think I can still keep up my classes and have this surgery and allow for recovery time w/o skipping a semester of class?

I do not think you will have to suspend any class time. If you do not have any complications that would prolong your recovery (rare, but it happens) your studies should be achievable.

35. How many times has Dr. Johnell found leaks from the post-op leak test and had to re-operate to fix them?

Patients tell me that the Gastrografin drink taken for the upper GI is pretty yuck! But, the radiologist makes you drink much less than the average UGI patient if that's any consolation! I have also been told that the drink is NOT as bad as the Fleets Phospho-soda that is taken the day before surgery. Believe it or not, leaks are not often seen on the UGI. The most benefit from this exam is insuring that there is no obstruction so that water can safely be taken. On occasion, patients have enough swelling to obstruct the outlet of the pouch (after GBP) and must stay NPO (or nothing by mouth) for another day or so. Dr. Johnell has had very few patients with leaks. I believe, fewer than five in a series of 137 as of 10/02.

36. What other tests are required before and after surgery?

Tests that are standard in our program for pre-op patients are EKG, CXR, pulmonary function studies, clotting studies, arterial blood gases on room air, blood chemistries, and complete blood count. Patients with thyroid problems, cardiac problems, pulmonary problems, etc., may need further evaluation by a specialist to be cleared for surgery. After surgery on the GBP patients, we check blood work every 3-6 months to look for anemia, and other indications of nutrition problems. The tests include blood chemistries, blood count, B12, Folate, magnesium, albumin, ferritin, and iron studies.

37. What is the incidence of the staples used to create the pouch coming apart at a later date, say years later?

To my knowledge, there has not been an incident of staples coming out years later in a gastric bypass patients where the pouch has been completely separated from the larger stomach called the "remnant." Staple lines commonly break down in WLS where the stomach remains intact. The body finds a way for food to break through the staple line...and patients gain most of their weight back when the line is disrupted.

38. How many times has Dr. Johnell had to do a second operation on a patient for a complication? What sorts of complications has he seen?

In our program, probably 10 to 15 patients have had to go back to the OR. We have seen a variety of reasons for re-op. Internal hernias resulting in twisted or obstructed bowel, leaks at the upper or lower anastamoses (connection), and bleeding, are some of the problems we have seen.

39. Does Dr. Johnell have his patients wear a ‘binder’ after surgery? Some of the books on WLS I’ve read they talk about patients wearing this to minimize discomfort of the incision.

Patients wear an abdominal binder after "open" gastric bypass. The laparoscopic patients do not need this.

40. How do you decide how much, when, and if to reduce someone’s medications for diabetes, hypertension, etc. post-op? Is this decision made by Dr. Johnell or your PCP? Is your PCP involved in your care during your hospital stay? What is their role post-op?

The PCP follows you after surgery to determine the need for any changes in your medications. After gastric bypass, the changes may be rapid and occur immediately after surgery. Dr. Johnell does not manage these medical problems once you leave the hospital. If your PCP is on staff at NCMC, Dr. Johnell will ask your PCP to see you in the hospital. We ask that just as soon as you get your surgery date, you should make an appointment with your PCP for follow-up the week following your discharge from the hospital. Medication changes are not as dramatic in the Lap-Band patients, so they may make an appointment for the second or third week following surgery. Diabetics should closely monitor their own blood sugars at home.

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mossman2@attbi.com
Last updated on 11/1/02