Preparing for your Surgery-1

Laparoscopic Weight loss surgery is a complex surgery. The best preparation is to understand the risks and potential benefits and to closely follow our instructions.

Before the surgery

  • If you smoke, stop smoking for at least a month before surgery.
  • You will need to find someone to take over your responsibilities while you are in the hospital and after you go home to recover from the surgery (for example, taking care of the children, managing your business, etc.).
  • Make sure you follow your high protein, low carbohydrate diet (Optifast) before the surgery as instructed.
  • Be certain to follow our instructions regarding any medications you may be taking to control other health conditions.

After the Operation

Your operation will last from 30-90 minutes depending on your BMI, the type of surgery chosen and previous surgeries if any. After the operation you will be brought to the recovery room, where you will slowly wake up from the anesthetic. The nursing team in the recovery room will be checking you closely during this period. From the recovery room, you will be transferred to your room where you will be given oxygen and your blood oxygen level will be continuously monitored using an oxygen saturation monitoring device. This is just a precaution because up to 40% of morbidly obese patients have Obesity Hypoventilation Syndrome or Sleep apnea. This, together with the anesthetic can result in low oxygen levels in the blood which can be harmful.

Pain control

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 of 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 nigh of your surgery. The only pain medication you will need when you go home is acetominophen (Tylenol). If you have pain not relieved by tylenol (you can even use the double strength tablets or elixir) please call us.

Dressings and Tubes

The dressing covering the incision sites will be removed the day after the operation. You can have a shower that day and as many as you want afterwards. 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 cuts. Bacteria cannot grow in a dry environment. Our 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 coming 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 2 weeks.

Exercise

After 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 anesthetic. 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. These symptoms will be lessened by moving slowly; they will diminish with time.

What will I eat?

A liquid diet will be provided.

When do I go home?

Laparoscopic adjustable gastric band surgery patients go home the same day after their surgery. Laparoscopic gastric bypass surgery or laparoscopic vertical sleeve gastrectomy patients go home 1-2 days after their surgery. Dr. Naif Alenazi will discharge you himself from the hospital. He will answer any last minute questions and review your diet plan one more time. We ask our out-of-town patients to stay in Riyadh for a few days after they leave the hospital before they fly home.

At home after the surgery

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 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. 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.

When do I see the Bariatric Surgeon Again?

You will be given an appointment one week after surgery for checking the wounds and general condition. At the 1 week visit you will be given another appointment with Dr. Naif 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. Annual visits are recommended for life. 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. Laparoscopic Adjustable Gastric Banding patients will have additional visits scheduled as needed to adjust their band, usually every 8 weeks, depending on your progress, until band adjustment is optimal.

What will I eat?

Once you have left the hospital, you will need to make sure you follow the “What to eat the first 5 weeks after surgery (all types)” menu plan, available from our Downloads page. Remember that your new stomach pouch is very small and will not be completely healed. Please follow this plan otherwise your pouch can burst. THIS CAN KILL YOU! In addition, follow these instructions to minimize problems:

  • Take small sips of water very frequently to prevent dehydration.
  • Look at your urine when you go. It should have a light tea color. If it has a dark red-Brown color you are not drinking enough water.
  • When eating, take no more than 2 tablespoons over 10-15 minutes. Use a teaspoon to avoid taking too much food at one time.
  • Stop eating as soon as you feel full.
  • Coffee and tea are not recommended because they have almost no nutritional value and reduce iron absorption if taken with food.

What about my medication?

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 obstructing the outlet of your pouch.

  • universite de montreal
  • American Society for Metabolic and Bariatric Surgery
  • mount sinai
  • Prince Mohamed bin Abdulaziz Hospital
  • International Federation for the Surgery of Obesity and Metabolic Disorders
  • King Khalid University Hospital
  • American Association of Bariatric Counselors
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • mc gill
  • Society for Surgery of the Alimentary Tract
  • surgery for obesity and related diseases
  • The International College of Surgeons (ICS)
  • juniper online journal of case studies
  • Obesity Medicine
  • journal of universal surgery
  • american journal of innovative research & applied sciences
  • asian council of science editors
  • medcrave
  • APMBSS
  • insight knowledge
  •  American College of Surgeons
  • Specialized Medical Center
  • Abdul Al Rahman Mishari Hospital