What to Expect in the First Month after Bariatric Surgery

Written by Michelle Benish, APRN, C.N.P., M.S.N.. Michelle is a nurse practitioner for the bariatric surgery practice in Rochester, Minnesota.

Hospital stay and hydration

• Following bariatric surgery, patients are typically in the hospital 1-2 nights. Patients are discharged home once they are able to tolerate clear fluids to keep themselves hydrated, and pain and nausea are under control. It is important to slowly advance patient's diet following bariatric surgery to allow appropriate healing. Patients are on a clear liquid diet for 1 week following surgery followed by a blended diet (baby food-like consistency) for 2-4 weeks, then a soft diet, and eventually back to normal textures of foods but with much smaller portions than they are used to. Patients will follow closely with a dietitian to help them through this process. Following bariatric surgery hydration is extremely important. Patients are unable to take a large gulp of water as their stomach will not be able to accommodate this; therefore, we encourage patients to take small sips of water throughout the day. We also recommend avoiding the use of straws as this can lead to drinking too fast and increased air in the stomach causing discomfort and gas. Ultimately, the goal for hydration is 64 oz of fluid per day. Patients may not meet this goal of 64oz until closer to 3 weeks postoperatively. It also is important to remember if taking multiple medications, patients will need to take 1 pill at a time with a small sip of water, wait a period of time before taking additional medication. If taking too many pills at one time, patients may have pain or even vomiting.

Protein and vitamins

• Starting on week 2, patients are encouraged to start protein supplements such as protein shakes. The goal for protein is at least 60 g of protein per day. Patients will also start a chewable multivitamin twice daily, calcium twice daily, vitamin D3 once daily, and a vitamin B12 monthly injection. The first Vitamin B12 injection is given in the hospital and patients will be discharged with a prescription for vitamin B12 injections to administer at home every month.

Side effects of surgery

• Patients may have some pain or discomfort after surgery. While in the hospital, the hospital team will manage this pain with a variety of pain medications. Patients will be discharged with a prescription for pain medication if needed. Often, patients experience more discomfort in the right upper quadrant of the abdomen and this is due to retracting the liver at the time of surgery. Patients are encouraged to continue taking Tylenol on a schedule, listen to their body, and rest to allow for healing. Patients will not be allowed to lift greater than 10 lb for 4 weeks following laparoscopic surgery. If patients undergo an open (large incision) surgery, the patient will not be able to lift greater than 10 lb for 6 weeks. The surgical team can provide paperwork for FMLA if needed. We encourage patients to stay as active as possible following bariatric surgery, however short, more frequent walks are encouraged as opposed to long walks.
• Patients can expect to lose weight the most rapidly in the 1st 6 months post bariatric surgery. As the body reacts to rapid weight loss, patients has may experience some nausea and vomiting, body aches, feeling tired, feeling cold, dry skin, hair thinning and hair loss, mood changes, or concerns about self-esteem her personal relationships. With rapid weight loss, patients can experience extreme fatigue. Patients typically feel best when they are meeting their hydration goal of 64 oz per day and protein goal of at least 60 g of protein per day.

Follow-up

• You will receive a phone call from a registered nurse approximately one month after surgery. The first post-operative visit is 3 weeks following surgery with the surgery team and a dietitian. Long term follow up will be with our endocrinology department, dietitians and psychologist. These visits are arranged between 2-3months following surgery, 6 months, 12 months and every year thereafter.