The Roux-en-Y Gastric Bypass Surgery

Transcription

1 The Rux-en-Y Gastric Bypass Surgery In this surgery, surgical staples are used t create a small puch at the tp f the stmach. A part f the small intestine (the jejunum) is then attached t this puch. Fd, therefre, bypasses mst f the stmach and the first part f the small intestine (the dudenum). Yu will prbably stay in the hspital fr ne t three nights. Getting Ready fr Surgery Make any necessary arrangements and cmplete paperwrk fr time ff wrk, FMLA, etc. Plan t be ff wrk fr tw t fur weeks depending n the type f wrk yu d. If applicable, make arrangements fr child and pet care during yur hspital stay and fr ne t tw weeks after discharge. D hme chres ahead f time r plan fr help fr the first tw weeks after discharge. Buy fds t puree based n the first phase f yur pst- surgery diet. Cleaning yur bwel f stl is an imprtant part f getting ready fr surgery. Buy and refrigerate ne (10 z.) bttle f Magnesium Citrate, available at any pharmacy. One Day Befre Surgery Fllw yur liquid diet fr breakfast and lunch. Drink nly sugar-free clear liquids after lunch until fur hurs befre surgery begins. Sugar-free clear liquids include: Water Brth Sugar-free Crystal Light Sugar-free ppsicles Sugar-free Jell-O (hmemade frm a pwder; nt pre-made; n fruit r ther add-ins) N juice, alchl r dairy prducts Drink the Magnesium Citrate fr bwel preparatin at 2:00 pm. It tastes best chilled but d nt add extra water r ice. Expect a call frm Surgery Scheduling with yur exact surgery time and the time t arrive at the hspital. Cntact the UW Health Medical and Surgical Weight Management Prgram at (608) if yu d nt receive a call by 3:00 pm. Shwer befre bed. Use Hibiclens when washing yur abdmen. Allw it t stay n yur skin fr at least tw minutes befre rinsing.

2 Day f Surgery If yu take Metfrmin, d nt take it the mrning f surgery. If yu take Insulin, d nt take it the mrning f surgery unless specifically instructed therwise. Unless specifically instructed therwise, take all ther medicines as yu nrmally wuld the mrning f surgery, n later than fur hurs befre surgery. Stp drinking clear liquids fur hurs befre surgery. Shwer again befre leaving hme. Use Hibiclens when washing yur abdmen. Allw it t stay n yur skin fr at least tw minutes befre rinsing. D nt apply any makeup; remve nail plish frm at least ne finger. When yu arrive at the hspital, park in the ramp in frnt f the hspital r fllw signs t use the valet service. Please leave yur hspital bag with a supprt persn t bring t yu nce yu are in yur rm after surgery. If yu use a CPAP machine, please bring this t the hspital. Carry yur machine and mask in with yu when yu arrive at the hspital. It will be used fr yu in a recvery rm after surgery. Enter thrugh the Hspital entrance (t yur left as yu face the building). Fllw Main Street t the D elevatrs. Take the D elevatr t the 3 rd flr and check in at the First Day Surgery Unit (FDS). If yu need help finding yur way ask at the Infrmatin Desk n Main Street. After Surgery Expect surgery t last a few hurs. After surgery, yu are in a recvery rm fr an hur r lnger. After recvery, yu are transferred t yur wn rm. Expect abdminal pain and bruising near yur incisins. Yu may als feel pain in yur neck and shulders frm the gas put in yur abdmen during surgery. Mve slwly. Hld a firm pillw r yur palm ver tender sites when mving, sneezing r cughing. Walking may decrease this pain. Take pain medicine as recmmended. Walking sn after surgery decreases the chances f frming a bld clt. Walking may decrease pain and increase intestinal functin. Nursing staff will help yu t get in and ut f bed and walk three t fur times a day. Fluids are given thrugh yur IV until yur dctr r nurse lets yu knw yu are ready t drink. It may nt be until the day after surgery. When yu are cleared t drink, try t drink small, frequent sips. Remember: n straws, carbnated r sweetened drinks, sda, juice r alchl. Pureed fd is ffered t yu nce yur dctr r nurse lets yu knw yu are ready. Eat the pureed fd very slwly, taking small bites up t ne tablespn ttal (abut the size f yur thumb). Wait at least 30 minutes after yu eat befre sipping water again, and stp at least 15 minutes befre yur next meal.

3 Shwering is safe 24 t 48 hurs after surgery. Gently wash yur incisins with mild sap and water. D nt sak in a ht tub r bathtub, r swim until they are healed (abut tw t fur weeks r lnger). D nt use ltin, intment r pwder n incisins. Bwel mvements typically d nt ccur until fur t ten days after surgery. Expect a small amunt f bld in yur stl and fr yur first tw bwel mvements t be very dark t black in clr as yu pass ld bld. This is nrmal. Rest as ften as pssible. Ging Hme frm the Hspital Medicine All medicines must be small (nt larger than a pencil eraser) r taken as a liquid fr fur t six weeks after surgery. A pharmacist will teach yu the safest way t cut, crush r pull apart medicine t change pill size as needed. After fur t six weeks yu may take medicine in yur nrmal way. D nt take anti-inflammatry medicines fllwing surgery, including Ibuprfen, Advil, Mtrin, Naprsyn, Aleve and Celebrex as they can slw dwn healing and may cause ulcers. Acetaminphen Tylenl is safe t take. D nt take Aspirin (unless specifically instructed therwise) Yu will likely g back t taking many f yur pre-surgery medicines after surgery. Sme may be stpped, decreased r changed. We will talk t abut this befre surgery. Yur surgen and hspital pharmacist will talk t yu abut a medicine plan at discharge. New medicines, vitamins and supplements after surgery: Pain medicine (usually Rxicet) will be prescribed at yur discharge. Please have this filled by the hspital pharmacy befre yu g hme. If needed: lw mlecular weight heparin (LMWH) injectins t thin yur bld. If needed, this will be discussed at a pre-surgery visit and reviewed in the hspital befre yu g hme. A nurse will teach yu hw t give these injectins. If yu have yur gallbladder: Actigall (Ursdil) 300 mg taken twice a day fr the first six mnths after surgery t decrease the chance f getting gallstnes as yu lse weight. Prilsec (Omeprazle) (r ther) taken twice a day fr the first year after surgery t decrease stmach acid and increase healing. Clace 100 mg taken nce r twice a day in the first week fllwing surgery (then as needed) t keep stls sft. After yur first bwel mvement, yu may als want t add fiber (such as Benefiber ) t yur water. Chewable multivitamin tw per day fr life Calcium Citrate 1,200 t 1,500 mg (with Vitamin D) taken daily fr life Vitamin D IU taken daily fr life Vitamin B-12 supplement 500 mcg taken under the tngue daily fr life Vitamin B-Cmplex r B-50 taken daily fr life

4 When t Call Yur Dctr Shrtness f breath r chest pain: call 911. Increased pain, tenderness, swelling r redness in abdmen, feet, legs r arms. Temperature ver F by muth fr tw readings taken fur hurs apart. Increased redness, swelling, tenderness r warmth at incisin sites. Abnrmal drainage such as bld r pus at incisin sites. Pain nt cntrlled by pain medicine. Cnstant heart rate greater than 100 beats per minute. Very dark clred stls after yur first few. Expect yur first tw bwel mvements t very dark t black in clr as yu pass ld bld. This is nrmal. Bright red bld in yur stl. A small amunt f bld in yur stl is nrmal. After first bwel mvement, nne fr fur days in a rw. N bwel mvement fr ten days after surgery Vmiting that will nt g away Nt able t drink r keep liquids dwn If signs f dehydratin (thirst, headache, dry muth, dark r less urine, lightheadedness, weakness, fatigue, nausea) persist. Decreased urine utput. New r wrsening stmach pain and nausea. Pain, nausea r vmiting after eating fds that yu were recently able t eat withut prblems. If prblems with medicines, prtein, vitamins r supplements persist. If running lw n yur pain medicine befre yur next fllw up appintment. Sudden changes in feeling f well- being r mental health. Changes that cncern yu r thers wh care abut yu. Increase in amunt r intensity f anxiety, anger, r depressin. Call the clinic, yur primary care prvider r ther mental health prviders if signs f anxiety, anger r depressin persist. Significant increase in mre than ne f these signs f depressin: Emtinal Signs: Significantly dwn r blue md Lack f pleasure in things yu usually enjy Crying spells Guilt Hpelessness Irritability* Thught Signs: Negative r self-critical thughts (fr example, beliefs f being inferir, defective, bad, etc.) Thughts f hpelessness r I cannt be helped Significant thughts f death Thughts f suicide Ask fr help immediately. Call the clinic, yur primary care prvider r ther mental health prvider. Prblems with cncentratin*, decisin-making, r memry

5 Physical Changes r Cncerns: Changes in yur sleep (significantly mre r less than nrmal) Changes in appetite* (significantly mre r less hungry nt caused by bariatric surgery) Decrease in energy* Behaviral Changes r Cncerns: Withdrawing r islating frm family, friends, supprt netwrk and scial activities Inactivity lack f interest and initiative Any ther symptms that cncern yu *Irritability, prblems with cncentratin, changes in appetite and decrease in energy are all cmmn symptms while recvering frm bariatric surgery and nt necessarily related t depressin. Please call the clinic, yur primary care prvider r ther mental health prviders if these are nging cncerns. In the case f urgent suicidal thught, plan r intent t act, immediately dial 911. Healthy Living: Onging Care and Fllw-Up Befre yu are discharged frm the hspital after surgery, ur team schedules yur first pst-surgery fllw-up visits. It is very imprtant that yu cmmit t visits with ur team at: Tw weeks after discharge Six weeks after discharge Three mnths after discharge Six mnths after discharge One year after discharge Annually fr Life Eating and Drinking: Water is yur first pririty. Drink plenty f fluids, sipping six t eight glasses r mre f water all day between meals. Wait at least 30 minutes after yu eat befre sipping water again, and stp at least 15 minutes befre yur next meal. Use a timer. Remember: n straws, carbnated r sweetened drinks, sda, juice r alchl. Yu g hme n a pureed diet. Refer t the diet prgressin taught in class and by yur dietitian. Eat the pureed fd very slwly, taking small bites (each bite is abut a teaspn in size). One t three tablespns f fd shuld take yu abut 20 t 30 minutes t eat. Use a timer. Fur tablespns is ¼ cup.

6 Remember: n sugar r fds high in sugar and n fatty fds as they may cause dumping. Add prtein shakes t yur menu; try t drink tw t three prtein shakes a day. Plan t eat fd r drink a prtein shake abut every three hurs. Activity and Lifestyle: Regular activity is essential after surgery. As yu heal, walk arund yur hme r neighbrhd a few times a day, gradually building up as yu are able. D nthing mre strenuus than walking (fr example, n vacuuming r exercise equipment) and d nt lift mre than 20 punds fr six weeks r until cleared by yur dctr. D nt drive while taking narctic pain medicine. Cntinue wearing lse fitting, cmfrtable items f clthing. Rest as ften as pssible. Stay smke, nictine and tbacc-free. Pay attentin t yur mental health and watch fr sudden changes in yur verall feelings r mental health; increase in frequency r intensity f anxiety, anger, r depressin; changes that are cncerning t yu r thers wh care abut yu. Call the clinic, yur primary care prvider r ther mental health prviders if signs f anxiety, anger r depressin persist. Remember that surgery, weight lss and maintaining a healthy lifestyle are all significant changes fr yu and thse arund yu. Talk penly with yur supprt netwrk and use available resurces t help yu thrugh changes. Our health psychlgists and ther team members are available t help yu address anxiety, depressin, relatinship changes, and ther cmmn stresses yu may face. What t watch fr: Expect pain abut yur abdmen and bruising near yur incisins after surgery. Yu may als feel pain in yur neck and shulders frm the gas put in yur abdmen during surgery. Mve slwly; hld a firm pillw r yur palm ver tender sites when mving, sneezing r cughing. Walking may decrease this pain. Pain medicatin is given thrugh yur IV at first. Later, yu are given liquid pain medicine rally. Take pain medicine as recmmended. Fatigue is cmmn. Get plenty f rest and stay hydrated. Nausea r vmiting; pain when eating r drinking: Make sure yu are nly drinking sips and chewing and eating very slwly. Dumping is a reactin t sugar r a similar natural sweetener and fatty fds. Yu may feel lightheaded, heart palpitatins, sleepiness and discmfrt in yur abdmen, nausea r urgent diarrhea. This may last fr a few hurs. Feeling n hunger is nrmal. Use a timer as a reminder f scheduled meals. Yu may have cravings.

7 Changes in fd taste and preferences are nrmal. Yu may find that sme f the fds yu liked befre surgery may nw taste different r even repulse yu. If this happens, knw that it ften ges away ver time, while ther fds may n lnger be tlerated. Experiment slwly and try fds again after sme time t determine what wrks fr yur bdy. Dehydratin may happen if yu are nt drinking enugh water. Signs f dehydratin include thirst, headache, dry muth, dark r less urine, lightheadedness, weakness, fatigue, and nausea. Call the clinic if signs f dehydratin persist r yu are nt able t keep liquids dwn. Cnstipatin is cmmn after any surgery. Stay hydrated. Eat pureed fruit and vegetables fr fiber and bulk t help prduce gd bwel mvements. Add fiber (such as Benefiber ) t yur water and take yur stl sftener as recmmended. Strictures While yu are healing, scar tissue in yur stmach (puch) may shrink. If this happens, the pening between yur stmach (puch) and yur intestines may becme t small fr fd t pass thrugh. Yu may feel pain r vmit after eating fds that yu were able t eat recently withut prblems. Call the clinic if signs f a stricture persist. Buyer s Remrse, Yu may have thughts f What have I gtten myself int? and ther strng feelings in the days and weeks after surgery. Yu may feel mre pain than expected r have cmplicatins r symptms yu were nt expecting. Yu may feel a sense f lss f a best friend r grief as yu are less able t turn t fd t cpe. This is a nrmal respnse t the many changes and limitatins yu are faced with fllwing a majr surgery. Try t take cmfrt in the fact that these are all very nrmal things and yu are nt alne in experiencing them. Many patients have felt this way. Over time, they felt better and life became easier. The bdy heals, and new habits are frmed. Life after surgery becmes easier. Yu will feel better and better! Talk t yur supprt netwrk and resurces available t yu during this time. Hair lss and lss f muscle strength may happen. Stay active and keep track f yur prtein intake, aiming fr 60 grams r mre per day. Keep drinking ne t tw prtein shakes a day. Be sure t include a prtein surce at every meal and snack. Excess skin may happen as yu lse weight. Nystatin pwder may help prevent rubbing r chafing and limit yeast infectins. Regularly lift extra skin t allw sun expsure and drying in the skin fld areas. Call the clinic r yur primary care prvider if yu see a rash r think yu have an infectin. Hernias happen when a structure pushes int a space nt nrmally ccupied. The mst cmmn hernias in adults are when the intestines push thrugh a defect in the abdminal wall, creating a large, uncmfrtable bulge in the abdmen. Incarcerated hernias develp when intestines becme trapped r pinched. This is painful and cnsidered a surgical emergency.

8 Ulcers are small ersins in the stmach (puch) r intestines which may develp if yu smke r use tbacc r nictine prducts. Ulcers can be very painful and dangerus after surgery. Signs f ulcers include stmach pain and nausea with eating with every meal and very dark clred stls. If an ulcer is bleeding, yu may ntice very dark clred stls. D nt take anti-inflammatry medicines n a regular basis and d nt smke r use tbacc r nictine prducts t decrease the chances f ulcers develping. Call the clinic if signs f ulcers persist. Smking and the use f tbacc r nictine prducts, D nt smke r use tbacc r nictine prducts. They are harmful t yur health and may increase the chances f ulcers and strictures develping.. Anti-inflammatry medicines, including Ibuprfen, Advil, Mtrin, Naprsyn, Aleve and Celebrex may cause ulcers. Tylenl is safe t take. D nt take anti-inflammatry medicines n a regular basis. D nt take Aspirin (unless specifically instructed therwise). Malnutritin if yu are nt taking vitamins and supplements as recmmended r have significant, persistent truble getting in all necessary nutritin, fluids and prtein. Weight regain can happen. It is cmmn t have a five t ten pund weight regain. This is nt cncerning unless yur weight cntinues t increase. Yu can wrk against the surgery by eating and drinking mre calries than yu need. Eating calrie-dense fds, excessive grazing/snacking, drinking sweetened drinks, sda, juice r alchl, as well as inactivity are cmmn causes f weight regain. If yu see yur weight cntinue t increase, cntact the clinic. Changes in relatinships may happen. Lk fr supprt by cntacting the clinic t schedule an appintment with a health psychlgist. Seek cunseling if needed. Slips, relapse, and set-backs may happen. Respnd quickly and treat each as a learning pprtunity. Avid harsh self criticism. Try t identify what caused the slip r made yu vulnerable, and hw yu culd d it differently next time. Stay cnnected! Attend ur free mnthly patient supprt grup held at UW Health East Clinic the secnd Mnday f every mnth at 5:30 pm. Cntinue t learn, read bks, view websites and talk with thers wh have had weight lss surgery fr infrmatin, supprt and sharing f experiences. Remember that keeping healthy living a fcus and a pririty requires time, attentin, effrt and supprt. Thank yu fr chsing the UW Health Medical and Surgical Weight Management Prgram. We are cmmitted t helping yu reach and maintain yur health gals with educatin and supprt thrughut yur weight lss jurney. Please cntact us at (608) with questins at any time.

9 Phne Numbers Mnday t Friday, 8:00 am t 5:00 pm (608) Tll Free: UW Health Medical and Surgical Weight Management Prgram Hspital Operatr (24-Hur: Evenings, Weekends and Hlidays) (608) UW Health Surgery Clinic Gld Team ask fr the dctr n call fr yur Bariatric surgen In an Emergency 911 Yur health care team may have given yu this infrmatin as part f yur care. If s, please use it and call if yu have any questins. If this infrmatin was nt given t yu as part f yur care, please check with yur dctr. This is nt medical advice. This is nt t be used fr diagnsis r treatment f any medical cnditin. Because each persn s health needs are different, yu shuld talk with yur dctr r thers n yur health care team when using this infrmatin. If yu have an emergency, please call 911. Cpyright 2/2015. University f Wiscnsin Hspitals and Clinics Authrity. All rights reserved. Prduced by the Department f Nursing. HF#7750.