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Frequently Asked Questions

Common Questions Regarding Gastric Banding Surgery

Q. What are the advantages of a Laparoscopic Gastric Banding?
A. The laparoscopic gastric band is performed through 4 tiny incisions, and 1 larger incision to accommodate the port. The gastric band does not involve any cutting or rerouting of intestine, and therefore takes approximately 1 hour to perform. You should expect to be discharged the day after surgery. In certain cases you may be discharged on the same day. The gastric band is adjustable and reversible.

Q. What kind of preparation is there before surgery?
A. You should avoid the "last supper" syndrome in the period prior to your surgery. This can lead to significant weight gain and greater difficulty in performing your surgery. We ask that patients stop smoking at least three weeks prior to your date of surgery. You are expected to start a clear liquid diet on the day before surgery. You may not eat or drink anything after midnight on the night prior to surgery unless otherwise instructed. If you are taking medications, please consult your surgeon or primary care physician for instructions on whether to take your medicine on the day of surgery.

Q. How long is the procedure and what is the postoperative care?
A. The procedure takes an average of one hour to perform but may vary depending on your BMI. The whole process from the time you come into the operating room to the time you arrive in recovery is longer to account for anesthesia and awakening afterwards. Therefore, your loved ones should expect to talk to the surgeon approximately 2 hours after you leave them. After the recovery room you will either go to the surgical floor or to the ICU. This will be determined by the surgeon and anesthesiologist at the time of your surgery.

Q. What happens the day after surgery?
Most patients are out of bed and taking 30 cc of water approximately every hour. You will be required to have an esophagram (x-ray of your esophagus and upper part of stomach) and will have to drink a small amount of liquid at the time of this test. The esophagram is performed to evaluate your pouch size, band placement, and flow of liquids through the band. Once your surgeon has determined that you are able to go home, you will be discharged from the hospital. You will be required to follow the dietary modifications as outlined.

Q. How about drains and wound care?
A. You will not have any tubes in your nose or your bladder. There are no sutures or staples to be removed. The incisions will be covered with Steristrips that should be left alone. You may shower 24 hours after the surgery and wash with warm, soapy water.

Q. Could there be complications from the surgery?
A. Yes! Although the band has less complications than a gastric bypass, there are several potential complications of the "LAP-BAND" that you need to understand. The band can slip out of place, allowing the pouch to become quite large and thus ineffective. You can avoid this by not overeating in the immediate post-op period. Early prolonged vomiting can lead to slippage.

The stomach can also herniate underneath the band, again allowing the pouch to enlarge. The band can erode into the stomach causing pain and discomfort. The port can become infected, and may need to be removed. Certain patients will experience delayed emptying of the stomach. This is especially true for male diabetic patients. This means that no liquid passes through the band because of swelling. If this happens, you will need to stay in the hospital for several days until the swelling resolves. If you have questions about the complications call the surgeon to discuss this further.

Q. Do some people not lose weight with the "LAP-BAND"?
A. Adjustable gastric banding is designed to result in a small gastric pouch, which limits the volume of food that can be consumed at any one time. Generally, it does not restrict fluid intake or the consumption of foods that "melt in your mouth", such as sweets. People who eat small quantities of food throughout the day and those who consume large quantities of high calorie beverages will not experience adequate weight loss. In addition, the band NEEDS to be adjusted in order to work effectively. Without the adjustments the band may not allow you to feel the restriction necessary to result in feeling satisfied with small portions and thus lose weight consistently.

Q. What kinds of foods should I be eating?
A. The day after surgery you will begin a clear liquid diet (Stage 2). The day after you return home, Day 2 after surgery, you will progress to protein shakes (Stage 3). This will continue for two weeks. You will then begin soft foods (Stage 4) and continue for the next three weeks. At week five, you will start solid food (Stage 5). You should make an appointment to see the surgeon one week after you have started solid foods. You are required to meet with the dietician prior to starting each new stage of your diet.

Q. Will insurance cover surgery for Morbid obesity?
A. Every insurance company has its own policy regarding this. If you decide to go ahead with surgery, our staff will work with you and your insurance company to obtain the appropriate precertification approval. You need to familiarize yourself with your individual insurance policy in order to provide our office with essential referral forms and other information necessary to expedite the preoperative process, however we will take care of the process for you. You will not be required to call your insurance company or send in any information regarding your precertification.

Q. What can I expect at my first visit?
A. Your first visit will be a consultation with the surgeon. You will be questioned regarding your medical history. Detailed information will be necessary regarding previous attempts and failures at weight loss programs. We would like you to bring a list of the medications you are currently taking. Patients who wish to proceed with surgery will be given a list of required tests that need to be completed prior to surgery. These tests can all be done here or if necessary, they can be done at an institution close to your residence.

Q. What can I expect if I decide to go ahead with surgery?
A. The preoperative process usually takes four to eight weeks to complete. You are required to arrange a subsequent appointment at the office to review the results of your tests as well as to discuss the surgery and sign the informed consent forms. At this visit you should be accompanied by a family member, spouse, or significant other who will be your support system before and after surgery.

Q. Are there special instructions for the one to two weeks before my surgery?
A. We recommend that patients who smoke refrain from smoking for three weeks prior to surgery because of the increased risks of pulmonary complications. Patients who take Aspirin, Motrin, or Motrin-like products, Aleve, or special non-steroidal drugs for arthritis or joint pain must stop these 3 days before surgery. These medications interfere with blood coagulation. Failure to recognize this will result in increased blood loss during the surgery. Tylenol is safe to take.

We encourage patients to maintain a healthy, well balanced, low fat diet prior to surgery. It is absolutely necessary to avoid binge eating in the days prior to surgery. Failure to do this can result in increased size of the liver, complicating the surgical procedure. We also encourage patients to avoid alcohol for two weeks prior to surgery.

Q. What is Pre-Admission Testing?
A. Patients are required to visit the Hospital at which they are having surgery several days prior to the scheduled surgery date. During this visit, patients will meet with anesthesia and nursing personnel. Additional testing, including blood work may be done during this visit to complete the preoperative preparation.

Q. What can I expect the day of surgery?
A. Patients must take nothing by mouth after midnight the night before surgery. You may brush your teeth and rinse with a small amount of water. Anesthesiologists may give specific directions for medications either the night before or the morning of the surgery. Patients are expected to be in the Admitting Office of the Hospital two hours prior to their scheduled surgery.

Q. What will my recovery be like?
A. Immediately after surgery, patients are taken to the Recovery Room where they are closely monitored. The surgeon will meet with families immediately after surgery at the family waiting area near the Operating Room. If families are not present at the conclusion of surgery, a call to a family member can be made at your request.

Respiratory support is continued until patients demonstrate that they can breathe spontaneously and sufficiently to maintain adequate oxygen levels in the blood. The breathing tube may result in a minor temporary sore throat after its removal. Patients usually stay in the recovery room approximately 2 hours and are then sent to their hospital room or in the case of same day surgery, sent home. Family members are usually allowed to visit the patient for a few minutes while in the recovery room. Pain is usually minimal and controlled with IV medication or pain pills. Patients are sent home with a prescription for narcotic pain meds for the first few days.

Q. How many days will I be in the hospital?
A. You should expect to leave the hospital the day after surgery unless you have arranged to be sent home on the same day. If you would like to be sent home on the same day, you must discuss this with the surgeon ahead of time so that appropriate arrangements can be made.

Q. When will I be able to drive?
A. You may drive 3 days after your surgery date. After that, it is okay as long as you feel up to it and you are not taking narcotic pain medications.

Q. Will there be any discomfort after my surgery?
A. You can expect some incisional discomfort beginning immediately after surgery. The pain will diminish each day. You will be discharged on oral narcotic pain medication, if necessary. Otherwise you may take Extra-Strength Tylenol.

Q. Can I take over-the-counter medications after my surgery?
A. Yes. Most medications are safe to take after surgery. Tablets or capsules larger than half an inch must be broken or dissolved during the immediate postoperative period. Aspirin, Motrin, and Advil are to be avoided except under rare exceptions because of ulcer risk.

Q. How soon after my surgery can I return to work?
A. The answer to this is variable. The average employer allows up to six weeks for recovery time following upper abdominal surgery through an incision. Most "LAP-BAND" patients who are motivated are able to return sooner. On average, "LAP-BAND" patients return to work in one week.

Q. Are there long term problems from the surgery?
A. The "LAP-BAND" does not create the same long term nutritional problems as the Gastric Bypass. However, because you will be on a restricted diet, you need to take a multivitamin. Although the "LAP-BAND" is theoretically reversible, it is intended to stay in place even after you have lost your desired weight. Removal of the band can result in subsequent weight gain. Other complications such as slippage and erosion may also occur and will need to be evaluated by your doctor.

Q. How much weight should I expect to lose?
A. Most patients will lose approximately 8-20 lbs in the first two weeks. You should expect to lose 1-2 lbs a week after that. By maintaining your recommended diet and joining an exercise program you can exceed these averages. You should see the surgeon within 10 days of your surgery and then at approximately six weeks to be evaluated for an adjustment. You need to see the surgeon once a month to follow your weight loss and be evaluated for an adjustment. On average most patients will require 3-4 adjustments.

Q. What kind of diet will I follow after the surgery?
A. Initially your diet will consist of clear liquids only and in small amounts. We encourage drinking water in small sips throughout the day in order to maintain hydration. In close consultation with your dietician and surgeon, your diet will be progressively increased from protein shakes to pureed food, and eventually regular meals at five weeks. Please realize that not all foods will agree with you initially. Bread and meats may not pass through the band. In addition some patients complain that some foods are more difficult to digest in the morning. Please consult the dietary guidelines for more information.

Q. Can I expect changes in my bowel habits?
A. Yes! Constipation is quite common particularly if you are taking iron. Dietary manipulation can be most helpful, in particular, drinking more water and adding more fiber to your diet. You should avoid laxatives unless otherwise recommended. If you have diarrhea, you should discuss it with your doctor.

Q. What happens if I get pregnant?
A. If you become pregnant, please notify the office immediately. The band can be loosened or even removed to accommodate the increased need for calories. In addition, the vomiting that occurs with morning sickness can result in slippage or herniation and may also necessitate loosening or removal of the band.

Q. What kind of support is available after the surgery?
A. In addition to seeing your surgeon regularly for follow-up, we expect you to attend the monthly support group meeting.

Q. Who is a candidate for this surgery?
A. Morbid obesity is defined as being at least 100 pounds over your ideal body weight. Patients with a body mass index (BMI) greater than forty or thirty-five with significant comorbid conditions such as high blood pressure, diabetes, sleep apnea, arthritis, etc. can be considered candidates for this surgery. This surgery is a last resort solution for weight loss. You must first try other medical attempts at weight loss before considering surgery.

Q. What is Body Mass Index (BMI)?
A. The BMI is a ratio between your weight in kilograms and your height in meters squared that helps to determine the degree of obesity. Individuals with a BMI greater than 40 are considered to have clinically severe obesity.

Q. How do I know if I need an adjustment?
A. At the time of surgery, the band is completely deflated. No adjustments are made until six weeks after surgery. The reason for this is to allow for the swelling that commonly happens after surgery to subside. At six weeks, you will have already been on solid food for one week. We will check to see how hungry you feel and how much weight you have lost to decide if you need an adjustment. Most patients will require 3-4 adjustments in the first year. You will be seen in the office once a month after that until you are feeling full after small meals and are losing about 5 lbs a month.

Common Questions Regarding Gastric Bypass Surgery

Q. What are the advantages of a laparoscopic Gastric Bypass?
A. The laparoscopic gastric bypass is performed through five tiny incisions. This results in much less pain and discomfort following surgery. In addition, it allows the patient to be up and about faster and more comfortably, thus decreasing the chances of developing pneumonia or blood clots. The absence of a large incision decreases your chances of developing a wound infection or an incisional hernia that might require further surgery. The Gastric Bypass results in a higher average weight loss, approximately 75-80% excess body weight loss, in approximately one year.

Q. What kind of preparation is there before surgery?
You should avoid the "last supper" syndrome in the period prior to your surgery. This can lead to significant weight gain and greater difficulty in performing your surgery. We ask that patients stop smoking at least three weeks prior to your scheduled date. You are expected to start a clear liquid diet on the day before surgery and do the bowel preparation as prescribed by your surgeon. You may not eat or drink anything after midnight on the night prior to surgery unless otherwise instructed.

Q. How long is the procedure and what is the postoperative care?
A. The procedure takes an average of three hours to perform but may vary depending on your BMI. The whole process from the time you come in to the operating room to the time you arrive in recovery is much longer to account for anesthesia and awakening afterwards. Therefore, your loved ones should expect to talk to the surgeon approximately 4 - 6 hours after you leave them. After the recovery room you will either go to the surgical floor or to the ICU. This will be determined by the surgeon and anesthesiologist at the time of your surgery. On the second day post-op, you will go to the radiology department for a special X-ray, (UGI), to test your anastomosis. If your test is negative, you will begin your Stage I diet. The following day you will be advanced to the Stage II diet and you may be discharged home.

Q. How about drains and wound care?
A.You will have a nasogastric tube (NGT) in your nose immediately following surgery. This will be removed on the second day after your surgery, if your x-ray test shows no leak or obstruction. You will also have a JP drain on your left side that will be removed before you go home. There are no sutures or staples to be removed. The incisions will be covered with steri-strips that should be left alone. You may shower 48 hours after the surgery and wash with warm, soapy water.

Q. Could there be complications from the surgery?
A. Yes! Although the complication rate is low it is still a concern. The laparoscopic gastric bypass is major surgery and there is a 1% risk of death following this procedure. The chance of a major complication, such as a leak is 3%. Other possible complications include stricture, obstruction, blood clots, ulcer and wound infection. This was covered during our information seminar and will be discussed again during your consultation.

Q. What can I expect at my first visit?
A. Your first visit will be a consultation with the surgeon. You will be questioned regarding your medical history. Detailed information will be necessary regarding previous attempts and failures at weight loss programs. We would like you to bring a list of the medications you are currently taking and their dosages. Patients who wish to proceed with surgery will be given a list of required tests that need to be completed prior to surgery. These tests can all be done at the Hospital, or, if necessary, they can be done at an institution close to your home.

Q. What can I expect if I decide to go ahead with surgery?
A. The preoperative process usually takes four to eight weeks to complete. You are required to arrange a subsequent appointment at the office to review the results of your tests as well as to discuss the surgery and sign the informed consent form. At this visit you should be accompanied by a family member, spouse, or significant other who will be your support system before and after surgery.

Q. Are there special instructions for the one to two weeks before my surgery?
A. We recommend that patients who smoke refrain from smoking for three weeks prior to surgery because of the increased risks of pulmonary complications.

Patients who take Aspirin, Motrin, or Motrin-like products, Aleve, or special non-steroidal drugs for arthritis or joint pain must stop these at least 5 days before surgery. These medications interfere with blood coagulation. Failure to recognize this will result in increased blood loss with the surgery. Tylenol is safe to take. We encourage patients to maintain a healthy, well-balanced, low calorie, low fat diet and avoid binge eating in the days prior to surgery. We also encourage patients to avoid alcohol for two weeks prior to surgery.

Q. What can I expect the day of surgery?
A. Patients must take nothing by mouth after midnight the night before surgery. You may brush your teeth and rinse with a small amount of water. Anesthesiologists may give specific directions for medications either the night before or the morning of the surgery. Patients are expected to be in the Admitting Office of the Hospital two hours prior to their scheduled surgery.

Q. What will my recovery be like?
A. Immediately after surgery, patients are taken to the Recovery Room where they are closely monitored. The surgeon will meet with your family immediately after surgery at the family waiting area near the Operating Room. If families are not present at the conclusion of surgery, a call to a family member can be made at your request. Respiratory support is continued until patients demonstrate that they can breathe spontaneously and sufficiently to maintain adequate oxygen levels in the blood. The breathing tube may result in a minor temporary sore throat after its removal. Also, in the operating room, a nasogastric tube is placed through the nose, into your new small pouch. This drains the small stomach and allows it to remain at "rest" for one to two days after surgery.

Q. What will my incision look like?
A.The minimally invasive laparoscopic technique to accomplish the Gastric Bypass operation requires five, quarter inch incisions. These wounds are closed with absorbable sutures and steri-strips. You will have a J.P. (Jackson Pratt) drain on the left side of your abdomen which will be removed on your day of discharge. If it is necessary to convert to open surgery, then an upper abdominal incision is performed. The incision runs from the lower aspect of the breastbone to just above the umbilicus (belly button). The skin incision is usually closed with metal staples and covered with a dry dressing.

Q. How many days will I be in the hospital?
A. The median length of stay is three to four days.

Q. When will I be able to drive?
A. You may drive after 3 days, as soon as you feel up to it, and as long as you are not taking narcotic pain medications. You must be off narcotic pain medication (i.e. Percocet) at least 24 hrs before driving yourself.

Q. Will there be any discomfort after my surgery?
A. You can expect some incisional discomfort beginning immediately after surgery. The pain will diminish each day. For the first two to three days, patients control their own post-operative pain medication with a hand held device. You will be given instructions regarding this. You will be discharged on oral narcotic pain medication, if necessary.

Q. Can I take over-the-counter medications after my surgery?
A. Yes. Most medications are safe to take after gastric bypass surgery. Tablets larger than half an inch must be broken or dissolved during the immediate postoperative period. Pills may be placed in sugar free applesauce to help them to go down easier. Aspirin, Motrin, and Advil are to be avoided except under rare exceptions because of ulcer risk.

Q. How soon after my surgery can I return to work?
A. The answer to this is a variable. Most laparoscopic gastric bypass patients may return to work as soon as 2 weeks. Patients who have the open gastric bypass may require 3 4 weeks out of work.

Q. How soon after surgery can I resume heavy lifting?
A. You can resume lifting 3 weeks after surgery.

Q. Are there long term problems from the surgery?
A. The Laparoscopic Gastric Bypass is a well-tolerated procedure, however nutritional deficiencies can occur. For example, following surgery you will not be able to absorb adequate amounts of vitamin B12 or minerals such as calcium and iron, despite what you eat. These problems can be avoided with adequate supplementation and communication with your dietitian and surgeon. Failure to take vitamins and supplements on a regular basis can result in serious neurological complications. Other problems such as stricture, ulcer and intestinal obstructions can occur.

Q. How much weight should I expect to lose?
A. Most patients will lose approximately 75% to 80% of their excess body weight. By maintaining your recommended diet and joining an exercise program you can exceed these averages. Most of the weight loss takes place in the first year but should continue for up to two years. Five to ten percent of patients may fail to lose weight or regain the weight. This usually happens in patients who do not comply with their prescribed diet and either stretch the pouch or widen the anastomosis.

Q. What kind of diet will I follow after the surgery?
A. On day 2 after your surgery, once your x-ray study has been evaluated, your diet will begin with water only (Stage 1). On day 3 you will advance to clear liquids (Stage 2). We encourage drinking water in small sips throughout the day in order to maintain hydration. On day 4, your diet will be progressively increased to protein shakes (Stage 3). This will continue for two weeks. You will then begin pureed foods (Stage 4). This will continue for 4 weeks. At approximately eight weeks after surgery you will start solid foods (Stage 5). Please realize that not all foods will agree with you initially, and certain foods you may never be able to tolerate well. As you try new things, occasional vomiting is not unexpected. If you experience prolonged vomiting to all foods you should call the office immediately.

Q. Can you expect changes in your bowel habits?
A. Yes! Constipation is quite common particularly if you are taking iron. Dietary manipulation can be most helpful, in particular, drinking more water and adding more fiber to your diet. You should avoid laxatives unless otherwise recommended. If you have diarrhea, you should discuss it with your doctor. Avoiding greasy foods and milk products may help to reduce the problem.

Q. Should you plan to get pregnant?
A. You should avoid pregnancy in the first year after the surgery. It is difficult to maintain adequate nutrition for the baby while you are losing weight rapidly.

Q. What kind of support is available after the surgery?
A. You will visit with your surgeon quite often initially as well as with the dietician. You should plan to see your surgeon at one week to 10 days following surgery, then at one month, three months, six months, one year, and yearly thereafter. This surgery requires a lifelong commitment to follow-up. In addition, we have a support group that meets on a regular basis that we encourage you to attend.

Q. When do I return to the doctor's office for my post-op checkup?
A. You will be seen within seven to ten days after discharge from the hospital. During the next four weeks you will interact with the dietician as your diet progresses from liquids to pureed food and then to solid food. You will be seen in the office again at one month and then three months postoperatively. Subsequent visits consist of nutrition checks at six months, one year, and then annually. Because of the complexity of this surgery and the potential for nutritional issues associated with massive weight loss, regular nutritional follow-up is expected. Patients are expected to comply with this. Patients who live outside the area can have their follow-up done locally with communication to the surgeon.

Q. Can I expect to lose hair after surgery?
A. Transient hair thinning occurs in twenty to thirty percent of our patients during the first six months after surgery. The cause of this is unknown but probably reflects a combination of rapid weight loss, relatively limited food intake, and hormonal changes. No specific nutritional deficiencies have been linked with this. The problem is always temporary and no one has progressed to develop significant permanent hair loss. There is no harm in taking Biotin vitamin supplement to decrease hair loss or Zinc 200 mg three times daily for 3 weeks only! There is no restriction on how long you can take Biotin.

Q. What is dumping syndrome?
A. Dumping Syndrome can occur after any surgery that changes the normal way in which food leaves the stomach. It occurs when food passes too quickly from the stomach into the small intestine. In response, water from the surrounding blood vessels is drawn into the small intestine, usually resulting in a combination of the following symptoms: abdominal fullness, nausea, light-headedness, sweating, cramping, rapid heartbeat, and diarrhea. Symptoms can occur 10-20 minutes after eating a meal and/or 1-3 hours after eating. Refined sugars and high fat foods are the usual culprits.

Common Questions Regarding Gastric Sleeve Surgery

Q. How does the Gastric Sleeve work?
A. It is a non-reversible restrictive procedure in which the size of the stomach is reduced to 15-35% giving it the shape of a banana or a tube. It limits the amount of food one can consume.

Q. How is the sleeve performed?
A. It is performed laparoscopically through tiny incisions on the belly.

Q. What will my incisions look like?
A. The minimally invasive laparoscopic technique used during the Gastric Sleeve operation requires five, quarter inch incisions. These wounds are closed with absorbable sutures and steri-strips.

Q. How much weight should I expect to lose after a Sleeve Gastrectomy?
A. Sleeve Gastrectomy patients should expect to lose an average of 55% of their excess weight.

Q. How long does the procedure last?
A. The average operating room time is 1.5 to 3.5 hours.

Q. How long will I be in the hospital?
A. The hospital stay is usually 2 to 3 days.

Q. How soon after my surgery can I return to work?
A. The answer varies on the patient's health. Most laparoscopic gastric sleeve patients may return to work as soon as two weeks after the surgery.

Q. What kind of preparation is there before surgery?
A. The "last supper" syndrome should absolutely be avoided in the period prior to surgery. This can lead to significant weight gain and greater difficulty in performing the surgery. We ask that patients stop smoking at least three weeks prior to their scheduled date. Patients are expected to follow a clear liquid diet on the day before surgery and do the bowel preparation as prescribed by their surgeon. There is no eating or drinking anything after midnight on the night prior to surgery unless otherwise instructed.

Q. What can I expect the day of surgery?
A. Patients must take nothing by mouth after midnight the night before surgery. Brushing one's teeth and rinsing with a small amount of water is permitted. Anesthesiologists may give specific directions for medications either the night before or the morning of the surgery. Patients are expected to be in the Admitting Office of the Hospital two hours prior to their scheduled surgery.

Q. Can I take over-the-counter medications after my surgery?
A. Yes. Most medications are safe to take after Sleeve Gastrectomy surgery. Tablets larger than half an inch must be broken or dissolved during the immediate postoperative period. Pills may be placed in sugar free applesauce to help them to go down easier. Aspirin, Motrin, and Advil are to be avoided except under rare exceptions because of the ulcer risk.

Q. What will my recovery be like?
A. Immediately after surgery, patients are taken to the Recovery Room where they are closely monitored. The surgeon will meet with their family immediately after surgery in the family waiting area near the Operating Room. If families are not present at the conclusion of the surgery, a call to a family member can be made upon request. Respiratory support is continued until patients demonstrate that they can breathe spontaneously and sufficiently to maintain adequate oxygen levels in the blood. The breathing tube may result in a minor temporary sore throat after its removal.

Q. Should you plan to get pregnant?
A. You should avoid pregnancy in the first year after the surgery. It is difficult to maintain adequate nutrition for the baby while you are losing weight rapidly.

Q. What kind of support is available after the surgery?
A. Patients are required to visit with their surgeon quite often initially as well as with a dietician. Plans to see their surgeon at one week to 10 days following surgery, then at one month, three months, six months, one year, and yearly thereafter is most optimal. This surgery requires a lifelong commitment to follow-up. In addition, we have a support group that meets on a regular basis that we encourage patients to attend.

Q. When do I return to the doctor's office for my post-op checkup?
A. Patients will be seen within seven to ten days after discharge from the hospital. During the following four weeks patients interact with the dietician as their diet progresses from liquids to pureed food and then to solid food. Patients will be seen in the office again at one month and then three months postoperatively. Subsequent visits consist of nutrition checks at six months, one year, and then annually. Because of the complexity of this surgery and the potential for nutritional issues associated with massive weight loss, regular nutritional follow-up is expected. Patients are expected to comply with this. Patients who live outside the area can have their follow-up done locally with communication to the surgeon.

Q. When will I be able to drive?
A. Driving is not permitted for 3 days after the surgery date. Following that, driving is okay as long as one feels up to it and is not taking narcotic pain medications (like Percocet).

Q. Will there be any discomfort after my surgery?
A. Some incisional discomfort beginning immediately after surgery can be expected. The pain will diminish each day. Patients are discharged on oral narcotic pain medication, if necessary. Otherwise Extra-Strength Tylenol is permitted.

Q. How soon can I resume heavy lifting?
A. Heavy lifting can resume three weeks after surgery.

Q. Can you expect changes in your bowel habits?
A. Yes! Constipation is quite common particularly if taking iron. Dietary manipulation can be most helpful, in particular, drinking more water and adding more fiber to one's diet. Laxatives should be avoided unless otherwise recommended. If diarrhea persists, it should be discussed with one's doctor. Avoiding greasy foods and milk products may help to reduce the problem.

Q. What advantages are there for having a Sleeve Gastrectomy?
A. Unlike gastric banding surgeries there are no foreign objects are left in the body during the procedure. There is less intense follow-up required with the gastric sleeve because gastric banding requires regular adjustments. Although very rarely, the band used in gastric banding may slip, erode or become infected. Unlike gastric bypass or duodenal switch, there is no bypass of the small intestines with the gastric sleeve therefore there is no malapsorption of nutrients and vitamins.

Q. What kind of diet will I follow after the surgery?
A. STAGE 1: On day 2 after surgery, once an x-ray study has been evaluated, one's diet will consist of water only. STAGE 2: On day 3, the diet advances to clear liquids. We encourage drinking water in small sips throughout the day in order to maintain hydration. STAGE 3: On day 4, the diet progressively increases to include protein shakes. This will continue for two weeks. STAGE 4: Pureed food can be eaten. This will continue for 6 weeks. STAGE 5: At approximately eight weeks after surgery start solid foods can be introduced. It is important to realize that not all foods will be tolerated initially, and certain foods may never be tolerated well. As new things are introduced, occasional vomiting is not unexpected. If prolonged vomiting persists to all foods, the office should be called immediately.

Common Questions Regarding The Endoscopic Outlet Repair Procedure

Q. What are the benefits of the endoscopic outlet repair procedure
A. With traditional revision surgery, scarring and adhesions from the initial gastric bypass procedure often make open or laparoscopic surgery very challenging. Abdominal revision surgery usually takes longer than the original gastric bypass and patients are three times more likely to develop complications. With the endoscopic outlet repair procedure, patients reduce their risks to major abdominal surgery, have less post-operative pain, recover faster and have no abdominal scars. Typically, patients go home the same day, but each patient's discharge will vary based on his/her physician's recommendation.

Q. What are the side effects?
A. It is anticipated that patients will feel little or no discomfort from the endoscopic outlet repair procedure. Minor side effects may include nausea, a temporary sore throat, swollen tongue, and lip pain from the insertion of the endoscope into the mouth.

Q. What is the recovery process?
A. Typically, patients return to their normal routine within 48 hours. Following the endoscopic outlet repair procedure, patients should follow the same diet and exercise regimen they did after their initial bypass surgery.

Q. Will it be covered by insurance?
A. It depends upon the patient's insurance plan. For further information, please speak with your physician at your next appointment.