After the Surgery

If you experience:

  • Severe abdominal pain not relieved by Tylenol
  • Fever with temperature more than 38.5° C
  • Vomiting of blood
  • Shortness of breath with minimal activity
  • Painful, warm, swollen calves
  • General feel of malaise: not feeling well or can’t walk with ease
If you are within 2-3 hour commute from Montreal, present yourself immediately to the Montreal General Hospital emergency room of the McGill University Health Centre and ask that the Bariatric Surgery Team and your surgeon be contacted immediately. You are also strongly encouraged to call your surgeon (Dr. Chow or Dr. Christou) directly using his private cell phone number given to you for this purpose the day of your discharge from the hospital. If you are not able to get to Montreal in time, present yourself to your local emergency room and ask that your surgeon be contacted  be contacted using his private cell phone number given to you for this purpose. Remove the dressings over your small cuts if the nurse has not already done so. Leave the wounds exposed to the air, unless there is a lot of liquid drainage. In that case, apply a clean dressing (which you can obtain from any pharmacy) and call us. You may take showers when you go home and allow soap and water to run over your cuts. Do not rub the face cloth over them as this can dislodge the clips and start bleeding. Let the wounds dry and keep them uncovered. You can walk as much as possible, and you can do all exercises that do not involve severe contact (e.g. play contact hockey or football) including stationary bike, walking or jogging on a treadmill etc. as long as there is no pain. You can drive your car if it feels comfortable and only if you are not taking narcotic medications that can make you drowsy. You can have sex if there is no pain. You can sleep on your belly if that is your preference. You can lift your children without worrying about wound hernia since we do not make a cut up and down your belly with the laparoscopic approach we use for both laparoscopic banding and laparoscopic gastric bypass.

Follow-up with the Bariatric Team

If not already given to you call to make an appointment to see the bariatric nurse within 10-14 days of your surgery. At this visit we will assess your health, the clips will be removed, your weight will be taken and all wounds will be examined. At the 2 week visit you will be given another appointment with your surgeon at 30 days post surgery. At this visit we will again asses your health, your weight will be taken and your diet will be monitored and fine-tuned as needed. You will also be asked to see our dietician at this visit. Subsequent visits with the Bariatric Team will be 3 months after your surgery. Visits with the dietician will also be organized for 3 and 6 months after the surgery. Annual visits are recommended for life thereafter. Weight and diet history will be monitored and you will have appropriate blood tests to ensure that you are not developing vitamin and iron deficiencies.

What to do with medications after surgery?

You may resume taking your regular medications as soon as you go home, unless otherwise instructed by your surgeon or your health care providers. You should avoid medications containing aspirin for 15 days following your surgery in order to reduce the risk of bleeding. It is important to crush your pills before taking them. If they are long acting pills (LA or XL) they must not be crushed. Talk to your pharmacist. Crush all large pills (pain killers, vitamins, etc.) and mix them in the recommended liquid (or pureed food, if you are at that stage in your diet) to prevent them from blocking in the esophagus or obstructing the outlet of your pouch.

After the surgery we expect our patients to follow the following “Golden Rules”!

Activity and Mental State

  1. Exercise at least 30 minutes a day. Physical exercise is critical to the success of your weight loss goals. Exercise consumes energy and burns calories. That is the key to losing weight. You can start with simple exercises such as walking or swimming. With weight loss, it will become easier to exercise. Your ultimate goal is to achieve 10,000 steps per day measured by a pedometer or equivalent exercise activity.
  2. Self-control and motivation. You have taken a major step toward reaching your weight loss goal by choosing to have weight loss surgery. Now you need to motivate yourself to exercise and maintain self control when it comes to your post-surgery diet.

Eating and drinking behaviours

After surgery, you need to make changes in your eating habits in order to reach your desired weight loss goal. It is very important for you to develop appropriate eating habits to prevent enlargement of your new stomach. These changes will also help prevent some of the pain and vomiting experienced by patients who do not follow these recommendations.

  1. Eat only three small meals a day. Weight loss surgery creates a small stomach pouch that can hold a very small quantity of food. If you try to eat too much at one time you may become nauseous and/or vomit. You need to learn how much your “new stomach” can hold and not exceed this amount.
  2. Eat slowly and chew food thoroughly. Once you are beyond the initial five weeks and started on some solid food, be certain to chew your food until it reaches a mushy consistency . Take your time eating each meal (20-30 minutes) and swallow small bites of food. Swallowing chunks of food may block the opening of your new stomach and you will feel pain and may vomit.
  3. Stop eating as soon as you feel full. Sometimes it takes time for you to become aware of the signal that your stomach is full. If you hurry your meal, you may eat more than you need. Try to recognize the feeling of fullness and stop eating as soon as you feel full.
  4. Eat from small plates. Eating from small plates and with small utensils will help to control portion sizes.
  5. Start with your proteins. When eating a meal, start with your proteins, progress to your vegetables, and then finish with the grain products. To avoid trouble tolerating some proteins (meats, chicken, etc.), make sure to add low-fat sauces, gravies, broths, and tomato-based sauces to moisten your meats. This will help the food you eat to ‘go down’ better. Cook your meats with liquids and broths at all times. Think ‘crock-pot’ style of cooking. If you continue to have trouble with meats, consider a meat mallet or a meat tenderizer and cut your meat into bite-size pieces ‘against the grain’.
  6. Savour your foods and avoid distractions. Do not read, text, e-mail or watch television during meals.
  7. Drink a lot during the day. You need to drink large amounts of liquids every day (at least 6-8 large glasses) to prevent dehydration. You can tell if you are drinking enough by looking at the color of your urine. It should be a light “tea color”. If it is dark brown, you are not drinking enough. Remember to drink only water, decaffeinated coffee/tea (no cream), herbal teas, low-calorie flavoured water, or milk. Avoid caffeinated drinks, soft drinks, fizzy water, alcohol and juices.
  8. Try one new food at a time. As you progress through each dietary stage after the surgery, it is important to try one new food at a time. This way, if a certain food is not well-tolerated, you will know which food was the cause.
  9. Do not lie down after eating. This to prevent burning in the centre of your chest, a sign of acid or gastric reflux.
  10. Take your vitamins everyday for life. If you have issues or dislikes for some of the vitamins prescribed, discuss this with our bariatric dietician or nurse for alternate solutions.
  11. Foods to avoid.
Food product Examples Consequence
Concentrated sweets Sugar, juice, pastries, cookies, cake, ice cream, candy/chocolate bars, honey, maple syrup, jam, etc. Dumping syndrome; Reactive Hypoglycemia; weight gain.
Greasy/High fat foods Fatty meats, skin on poultry, bacon, sausage, added fats (i.e. butter, excess oil), heavy cream sauces, fried foods, etc. Dumping syndrome; weight gain.
Carbonated beverages Soda, mineralized water, sparkling water, beer, etc. Increases size of gastric pouch.
Caffeine Coffee, tea, chocolate, energy drinks, etc. Diuretic, fluids loss.
Alcohol Beer, wine, spirits, etc. Irritation to digestive system; weight gain.
Soft “doughy” grain products Untoasted breads, pasta, rice, etc. Dysphagia (“stuck” feeling when swallowing).
Fibrous foods Nuts, popcorn, celery, artichoke, etc. Better to delay consumption until tolerance improves.