GASTRIC BYPASS DIAGNOSIS AFTERCARE

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.