What Happens in the Hospital?
Morning of your operationYou should not eat or drink anything after midnight the night before your operation. On the day of surgery, do not take any medications (including heart, blood pressure, and diabetes medications) before seeing the anesthesiologist. She or he will determine which medications to take or to avoid. Inhalers must be taken on the morning of your surgery even if you normally only use them as needed. If on the day of your operation you have a fever, flu, sore throat, diarrhea, or are pregnant, it may be best to postpone surgery. If, for whatever reason, you must postpone your operation, directly notify the Centre Métropolitain de Chirurgie nursing staff by calling 514-332-7091, extension 200.
Where to goAll our surgeries are performed at the Centre Métropolitain de Chirurgie located at 999 Salaberry W. Montreal, Quebec, H3L 1L2. Report to the reception at the Centre Métropolitain de Chirurgie on the day and time designated by our bariatric surgery coordinator.
Please note that your admission time and surgery time are not the same.
It is imperative that you follow the instructions given to you precisely especially the arrival time at the hospital. Only one companion is permitted during your stay. Visiting hours are from 9:00 am to 8:00 pm.
Items to bring with youSpace to store your personal effects is extremely limited. This represents a small carry-on suitcase measuring approximately 23 cm x 40 cm x 55 cm (9 in. x 15.5 in. x 21.5 in.) with wheels and handles, weighing about 10 kg (22 lb.). List of to bring (if applicable):
- Your health insurance card (for identification purposes);
- An up-to-date list of your medications;
- All of your medication that you take regularly, all of which MUST be in their original containers. We cannot accept medications in dosettes prepared by a pharmacist.
- Your inhalers and aerochambers if necessary;
- Your glasses case, denture case and hearing aid case;
- Your case and solution for contact lenses;
- Slip-resistant slippers;
- Sanitary napkins;
- A robe, nightgown or pyjamas;
- A personal hygiene kit (toothpaste, toothbrush, soap, etc.).
- Loose-fitting, comfortable clothing adapted to your surgery for your return home;
- Books and silent entertainment (iPod, laptop, etc.). Bring earphones with you in order to keep a quiet and respectful environment for other patients recovering from surgery.
- If you use special equipment for sleep apnea, you should bring your machine to the hospital.
- Bring the Weight Loss Surgery Information folder given to you at the office consult.
Admission to hospitalYou will be received by a member of the nursing staff who will also complete your admission procedures with you. You will:
- Fill out a health questionnaire that will be added to your file;
- Show your health insurance card to identify yourself and so that we can record its number (it’s the law);
- Provide an updated list of your medications. These medications must be in their original containers – we cannot accept medications in dosette containers prepared at home or at the pharmacy.
- Take your blood pressure, pulse, and temperature;
- Ensure that all required information is in your medical file;
- Ask you to sign a consent form for surgery and for anesthesia;
- Ask, if you are woman of childbearing age, for a urine sample to perform a pregnancy test;
- Weigh you;
- Answer all of your questions;
- Fit you with an identification bracelet;
- Guide you to your room;
- Ask you to wear a hospital gown, remove your underclothes, dentures, glasses or contact lenses, and to replace your tampon with a sanitary napkin;
- Administer, if necessary, premedication tablets to prevent postoperative pain and reduce the risk of nausea and vomiting.
AnesthesiaThe anesthesiologist will meet with you prior to your surgery to decide, together, based on your medical history and planned surgery, which type of anesthesia to use. For bariatric surgery we use general anesthesia: The anesthesiologist will introduce enough medication intravenously to make you sleep through the surgery.
In the operating roomA member of the operating room nursing staff will again verify your identity and your medical file. Should you have any questions, do not hesitate to ask. Upon arrival in the operating room, we will assist you onto the operating table. The operating room is cool and has many devices with special lighting. You will be affixed with various devices in order to monitor your condition throughout the surgery, such as your heart rate and blood pressure. For general or regional surgeries, an intravenous infusion will be introduced by a member of the anesthesiology team to keep you hydrated and to administer medications during your surgery. Generally, the team present in the operating room is made up of your surgeon, an assistant (if necessary), an anesthesiologist, a member or members of the nursing staff, a respiratory therapist, and an attendant.
After the operationYour operation will last from 60-150 minutes depending on your BMI, the type of surgery chosen and previous surgeries if any. A stay in the recovery room is required. This stay may vary between 45 minutes and 2 hours depending on the type of surgery and the recovery time. You will be under the continuous supervision of the nursing staff who will regularly verify your pulse, oxygen saturation, blood pressure, respiration, pain, dressings, etc., until your transfer to the care unit. If you experience any nausea, pain, or discomfort, do not hesitate to mention this to the staff as they are there to help you. Upon your return from the recovery room, you will be transferred to your room where an attendant will help you from your stretcher and into bed. The nursing staff will check your pulse, blood pressure, respiration, dressing, pain, etc. You will be given oxygen and your blood oxygen level will be continuously monitored using an oxygen saturation monitoring device. We do this as a precaution because morbidly obese patients may have obesity hypoventilation syndrome or sleep apnoea. This, together with the anaesthetic can result in low oxygen levels in the blood which can be harmful. If you have undergone surgery that does not require hospitalization (day surgery), you will stay in the care unit for a period of about 2 to 3 hours, after which your discharge will be authorized and you will be allowed to return home with your companion. Recovery time may vary according to your ability to recover.
Pain-relief supportPostoperative pain varies from person to person. It is essential to relieve your pain, to rest, and to gradually resume your daily activities. Unrelieved pain can slow recovery and have a negative impact on sleep, digestion, and anxiety. The nursing staff will frequently ask you to describe your pain on a scale of zero to 10, zero meaning a complete absence of pain and 10 indicating the worst pain. Remember that the more intense the pain is and the longer you wait, the more difficult it is to completely relieve it. If you are at home, use this pain scale to determine when you should take an analgesic. Be sure to follow the prescription and your pharmacist’s recommendations. With the laparoscopic approach to weight loss surgery used in all our patients, pain and discomfort are minimized. Immediately after the operation you will experience some abdominal discomfort from the carbon dioxide gas used to blow up your belly for the surgery. Most of this gas is removed at the end of the operation. The remaining gas will be absorbed into your blood and removed by breathing it out your lungs over the next 36 hours. Even though your nurse may give you very strong pain medicine, this discomfort will be a bit unpleasant the night of your surgery. The only pain medication you will need when you go home is acetaminophen (Tylenol). In some cases you will receive a prescription for a stronger pain medication (narcotic like oxycodone). If you have pain not relieved by the medications, please call your surgeon.
Dressings and tubesOur patients have no tubes coming out of their noses or their bellies. In special circumstances (say difficult anatomy we find in less than 0.5% of cases), a small tube may be placed in the belly and come out next to a cut with a small bulb attached to it. This is a precaution to catch any leakage that may occur from your new stomach stitches. The tube will remain there for the first 3-4 days to help drain any infection that may occur after the surgery. The nurse will clean the site daily and empty the drainage regularly. The tube may be removed before you go home or in the office at your 2 week follow-up appointment. You can have a shower the day after the operation and as many as you want afterwards. The dressing covering the incision sites will be removed when you take your shower the day after the surgery. The cuts are closed with surgical staples that will be removed 2 weeks after the surgery. We ask that you leave the cuts uncovered and open to the air. Do not put any creams or ointments over the incisions. Wait for your bariatric nurse to assess your incisions 1 month after surgery before applying anything to them.
Activity after surgeryAfter surgery you will be expected to participate actively in your care. You need to take an active role in preventing complications and promoting the natural healing that will occur. As soon as you are awake we will encourage you to do breathing exercises at least every hour. Deep breathing and coughing is necessary to clear the lungs of the mucus that develops after you have been under an anaesthetic. The day of your surgery, the nurse will help you get up and sit in a chair. You will be assisted when walking more frequently and for longer distances in the following days. Getting out of bed is important to help your circulation, as well as to help expand your lungs and get rid of secretions. When you are getting up for the first time, it is normal to feel dizzy and weak as well as to feel some pain.
What will I eat?A special bariatric surgery diet will be provided.
When do I go home?Laparoscopic gastric bypass patients stay 2 nights at the hospital and will then go home. Laparoscopic sleeve gastrectomy patients can usually go home the day after their surgery. Your surgeon will discharge you from the hospital. He will answer any last minute questions and review your diet plan one more time. He will give you an envelope with follow-up information and a prescription for your vitamins and supplements. You will start your vitamins about 2 weeks after your surgery. Plan for an accompanying adult to leave the CMC with you as it is strictly forbidden to leave unaccompanied, with your vehicle, or in a taxi.
- Pack loose-fitting clothing and comfortable, easy-to-slip-on shoes for your return home ;
- Choose a responsible person to be by your side for your first 24 hours at home as you will require help to move around, with personal care, and with your daily activities;
- Have a thermometer at home to check your temperature;
- To facilitate rest, prepare meals in advance; enough to cover the first few days of your return home ;
- Remember to ask your surgeon about claiming a leave of absence from work and, if applicable, to suspend any gym memberships.
- We ask our out of town patients to stay in the Montreal for a few days after they leave the hospital before they fly home.