GASTRIC BYPASS DIAGNOSIS AFTERCARE
Category: General Surgery
Abstract : A diagnosis of obesity relies on the patients medical history and on a body
weight assessment based on the body mass index (BMI) and on waist circumference
measurements. According to the American Obesity Association (AOA), a BMI greater
than 25 defines overweight and marks the point where the risk of disease
increases from excess weight. A BMI greater than 30 defines obesity and marks
th
A diagnosis of obesity relies on the patients medical history and on a body
weight assessment based on the body mass index (BMI) and on waist circumference
measurements. According to the American Obesity Association (AOA), a BMI greater
than 25 defines overweight and marks the point where the risk of disease
increases from excess weight.
A BMI greater than 30 defines obesity and marks
the point where the risk of death increases from excess weight. Waist
circumference exceeding 40 in (101 cm) in men and 35 in (89 cm) in women
increases disease risk. Gastric bypass as a weight loss treatment is considered
only for severely obese patients. To prepare for surgery, the patient is asked
to arrive at the hospital a few hours before surgery. While in the preoperative
holding room, the patient meets the anesthesiologist who explains the procedure
and answers any questions. An intravenous (IV) line is placed, and the patient
may be given a sedative to help relax before going to the operating room.
Aftercare
In most cases, gastric bypass is a patient-friendly operation.
Patients experience postoperative pain and such other common discomforts of
major surgery, as the NG tube and a dry mouth. Pain is managed with medication.
A large dressing covers the surgical incision on the abdomen of the patient and
is usually removed by the second day in the hospital. Short showers 48 hours
after surgery are usually allowed. Patients are also fitted with Venodyne boots
on their legs to massage them. By squeezing the legs, these boots help the blood
circulation and prevent blood clot formation. At the surgeons discretion, some
patients may have a gastrostomy tube (gtube) inserted during surgery to drain
secretions from the larger bypassed portion of the stomach. After a few days, it
will be clamped and will remain closed. When inserted, the g-tube usually
remains for another four to six weeks.
It is kept in place in the unlikely event that the patient may need direct
feeding into the stomach. By the evening after surgery or the next day at the
latest, patients are usually able to sit up or walk around. Gradually, physical
activity may be increased, with normal activity resuming three to four weeks
after surgery. Patients are also taught breathing exercises and are asked to
cough frequently to clear their lungs of mucus. Postoperative pain medication is
prescribed to ease discomfort and initially administered by an epidural. By the
time patients are discharged from the hospital, they will be given oral
medications for pain. Patients are not allowed anything to eat immediately after
surgery and may use swabs to keep the mouth moist. Most patients will typically
have a three-day hospital stay if their surgery is uncomplicated.
Postoperative day 1
The NG tube is removed in the morning after surgery.
The patient is allowed sips of water throughoutthe day. The patient is assisted
to get out of bed and encouraged to walk. It is very important to walk as early
after surgery as possible to help prevent pneumonia, blood clots in the legs,
and constipation.
Postoperative day 2
If the patient has tolerated water intake on day 1, he
or she may begin taking clear liquids. Patients are encouraged or helped to walk
in the hallways at least three times a day and are encouraged to use the
breathing machine. The urinary catheter is removed from the bladder. Patients
given oral pain medications, crushed, chewed, or in liquid form.
Postoperative day 3
Patients are advanced to a more substantial diet that
usually includes milk-based liquids. When the diet is tolerated, pain is well
controlled on oral pain medication, and patients are able to walk independently,
they are discharged from the hospital. A dietitian usually visits the patient
prior to discharge to review any questions about diet. Although most patients
spend three days in the hospital, they may remain longer if they have
postoperative nausea, fevers, or weakness.
Additional tests are performed at a later stage to ensure that there have
been no surgical complications. For example, a swallow study may be performed to
make sure that there is no leak where the pouch and intestines have been joined
together. Sometimes chest x rays are also performed to make sure that there are
no signs of pneumonia. Blood tests may be required. These and other
postoperative tests are performed on an individual basis as determined by the
surgical team.
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