Dear

Description of the Operation
You will be having a laparoscopic (or open) Roux-en-Y Gastric Bypass. The operation involves extensive re-routing of the food flow through your stomach and upper intestine in such a way that your appetite will be diminished, and less of what you eat will be absorbed. This combination of effects is what allows a motivated patient to maintain substantial weight loss on a long-term basis. Be prepared to spend 1-2 nights in the hospital, although this will vary according to how quickly you progress after surgery.
Your Recovery

Because the operation is performed laparoscopically, there are few to no restrictions on your physical
activity after the operation. Avoid lifting or straining beyond the point where it hurts. If you had a
standard open operation, you should avoid heavy lifting and straining for 8 weeks after surgery to allow
your incision to heal properly. Your pain will probably fade rapidly, so you should be able to return to work or normal activities within a few weeks, depending on the type of work you do. You may resume showering when you return home. Do not remove the pieces of tape placed over your incisions; simply let them fall off on their own. You are encouraged to get up and walk frequently after surgery to prevent blood clot formation.
Pain Relief (after discharge from the hospital)
1. Take Extra Strength Tylenol (or generic acetaminophen) 1000mg as needed to control 2. Take 1-2 Oxycodone 5mg tablets every 3 hours as needed for discomfort that remains after taking Tylenol. This is a narcotic painkiller. If you use it you must beware of becoming drowsy or inattentive, and you will not be able to drive or operate dangerous equipment. This drug can also cause nausea and constipation. You may want to purchase an over the counter stool softener to take while you are on pain medicines (such as Colace). If you can't take Oxycodone (the ingredient for Percocet and Tylox) we' will substitute a different painkiller. 3. Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). These medications can be too harsh for your gastric (stomach) pouch during the first month.
Other Medications

1. Take two chewable multivitamin daily and 2-3 chewable calcium daily. At the three-month check we will have you start taking daily Vitamin B-12. 2. We will send you home with a prescription for medication to decrease production of stomach acid (usually Protonix or Prevacid). Take it once a day for the first two months to protect your new pouch and prevent ulcers. If you were taking a similar medication before surgery (such as Prilosec or Nexium), you may use that instead. 3. Resume all other usual medications unless we instruct you otherwise. Be aware that diabetes medications can often be cut back or discontinued right after surgery. If you have diabetes, monitor your blood sugar closely and contact your primary care doctor or us if you have
Fluids & Diet
Fluid intake is extremely important the first month of your recovery. You must also take in enough liquids to prevent dehydration. Dehydration can cause nausea, fatigue, lightheadedness and dark urine. Before you go home, you should have been given a Bariatric Surgery Center water bottle. By filling this bottle 4 times a day with any type of sugar-free liquid and drinking it, you will get the required amount of fluid daily ( 8 cups or 64 oz). It is essential that you adhere strictly to the Gastric Bypass Diet. You should already have a copy of the Gastric Bypass diet. If you have misplaced your copy, contact the Bariatric Surgery Center (207-761-5612) and we will provide you with another copy. During the first month after your surgery, your new gastric pouch is fragile and must be protected from over-filling and violent vomiting. You must try to take in enough protein after your surgery to help your healing process and to prevent malnutrition. Our dietitians are available to assist you at the Bariatric Surgery Center.

Most Frequent Problems
low your ribs, on the left side, is the most common problem immediately after waking up from surgery. This soreness can last for a couple of weeks. Despite this soreness important thing you can do for yourself in the hospital and at home is to get out of bed and take short walks. Walking helps keep your lungs expanded to avoid fevers and pneumonia and keeps the blood moving in your legs to prevent dangerous blood clots. Dehydration k enough fluid you will be become dehydrated. Dehydration can cause you to feel nauseated, fatigued, and lightheaded (especially when standing up). You will notice that you will urinate less often, urinate smaller amounts and have darker urine than normal. To correct th drink more often. Don’t hesitate to call us at the Bariatric Surgery Center for advice. Wound Drainage & Infection It is not unusual for an incisi oody fluid after you go home. Usually this is fluid that accumulated under your skin right after surgery and is not new bleeding. This is not dangerous. The incision will stop draining after all the fluid comes out, usually within a few days. on and rarely serious after a laparoscopic operation. The incision most likely to cause trouble is the bigger one under your ribs on the left side. If you have an infection, your incision will be red, warm, firm, and tender. The infected fluid will look more like pus than like blood. Once the infected fluid finds its way out of the body through the incision (sometimes with our assistance) the infection will usually just clear up on its own. Sometimes we will prescribe an antibiotic for a few depending on the amount of redness and firmness. After an open operation (not laparoscopic) wound infection can be a more serious problem that requires nurses to visit your home daily for a few weeks or longer to help take care of the wound. h ter your surgery, you will gradually increase what you are able to eat. This can be a frustrating period of your recovery. Everybody has trouble eating at times for the first few months surgery. Some days you will be able to eat everything easily, where on other days you might vomit the same foods. About 15% of our patients will require an outpatient gastrointestinal endoscopy the first few months y. The purpose of this procedure is to stretch a narrowing (stricture) at the pouch connection to the intestine. Our experience shows that most people simply improve their ability to tolerate foods on their own and do not require and endoscopy. Always remember you're not al ne. We
Most Frequent Problems (continued)

Dumping Syndrome
Dumping Syndrome is common after gastric bypass surgery. It is characterized by any combination of
, sweating, heart palpitations, cramping and diarrhea soon after eating even a small meal with concentrated sugar in it. You can avoid Dumping Syndrome by avoiding concentrated sweets like cake, cookies, pie, syrups and regular soda.

Reasons to Call the Bariatric Surgery Center or Your Surgeon (Casco Bay Surgery)

1. Pain not controlled by your medication
2. Persistent vomiting or dry heaves
3. Fever and wound redness or persistent leakage from an incision 4. Unusual or one-sided leg swelling, particularly if painful or tender (might be a blood clot) 5. Sudden shortness of breath that doesn't improve with 5-10 6. Any questions or concerns what so ever call the Bariatric surgery Center at 207-761-5612. If you call us during the first few weeks after surgery please be ready to tell us your heart rate. If you don’t remember how to measure your heart rate, we will ask you to count your own pulse for us ow-Up Appointment
hould already have a scheduled follow up appointment with the surgeon. The Bariatric Nurse will call you in a few days to check on your recovery and give you your post-op appointment with the

Source: http://www.mmc.org/workfiles/mmc_surgery/Discharge_Instructions_Gastric_Bypass_1.09.pdf