disorders of nutrition
Metabolic and Bariatric Surgery
After Metabolic and Bariatric Surgery
After surgery, pain relievers are prescribed. After metabolic and bariatric surgery, some symptoms are common and do not indicate a problem. However, the following symptoms require a call or visit to the doctor: Signs of infection at the incision site, such as redness, severe pain, swelling, a bad odor, or oozing Separation of stitched edges of the incision Continued or increasing abdominal pain Persistent fever or chills Vomiting Persistent bleeding from the incision site Abnormal beating of the heart Diarrhea Dark, tarry, foul-smelling stools Shortness of breath Sweating Sudden paleness Chest pain How quickly people can return to a normal diet varies. For about the first 2 weeks, the diet is mostly liquids. People are asked to drink small amounts frequently throughout the day. They should drink as much fluid as prescribed. Most of the fluid should be a liquid protein supplement. For the next 2 weeks, people should consume a soft diet consisting mostly of mashed or pureed high-protein foods and protein supplements. After 4 weeks, they can usually start eating solid foods. The following can help people avoid digestive problems and discomfort: Taking small bites of food Chewing food thoroughly Avoiding high-fat and high-sugar foods, such as fast food, cakes, and cookies Eating only small amounts at each meal Avoiding drinking liquids when eating solid foods Adjusting to new eating patterns can be difficult. People may benefit from counseling and/or support groups. Usually, people can resume taking their routine medications after surgery. But tablets may have to be crushed, and if people have been taking long-acting or sustained-release formulations of medications, doctors must switch them to immediate-release formulations. People should start walking or doing leg exercises the day after surgery. To avoid blood clots, they should not stay in bed for long periods of time. They can return to their usual activities after about 1 week and to their usual exercises (such as aerobics and strength training) after a few weeks. They should consult their doctor before doing any heavy lifting and manual labor, which should usually be avoided for 6 weeks. People may experience pain, and some have nausea and vomiting. Constipation is common. Drinking more fluids and not staying in bed too long at a time can help relieve constipation. Serious complications, such as problems with the incision, infections, blood clots that travel to the lungs ( Pulmonary Embolism (PE) ), and lung problems, can occur after any operation (see In addition, the following complications can occur after metabolic and bariatric surgery: Blockage of the intestine:In about 2 to 4% of people, the intestine becomes blocked because it becomes twisted or scar tissue forms. A blockage can develop weeks to months to years after surgery. Symptoms include severe abdominal pain, nausea, vomiting, difficulty passing gas, and constipation. In about 1 to 3% of people, the new connection between the stomach and intestine leaks. Leakage usually occurs within 2 weeks of surgery. As a result, the stomach’s contents can leak into the abdominal cavity (peritoneum) and cause a serious infection ( Peritonitis ). Symptoms include a fast heart rate, abdominal pain, fever, shortness of breath, and a general sick feeling. Bleeding:Bleeding may occur at the connection between the stomach and intestine, elsewhere in the digestive tract, or in the abdominal cavity. People may vomit blood or have bloody diarrhea or dark, tarry stools. Gallstones : Stones in the Urinary Tract : Gout : Nutritional deficiencies:If people do not make a concentrated effort to eat enough protein, a protein deficiency may develop. Vitamins and minerals (such as vitamins B12 and D, calcium, and iron) may not be absorbed as well after the surgery.Thiamindeficiency can occur if vomiting continues for a long time. People need to take vitamin supplements and sometimes mineral or other supplements (depending on the type of surgery) for the rest of their life. Reproductive health:Fertility in women of reproductive age may improve after surgery. These women should consider contraceptive choices before and after bariatric procedures, avoid pregnancy prior to surgery, and avoid pregnancy for 12 to 18 months after surgery. Death:In specially accredited hospitals, the mortality rate is 0.2 to 0.3% during the first month after surgery. The risk of death (and serious complications) may be higher at other hospitals. Causes of death include a blood clot that travels to the lungs, a severe infection due to leakage of one of the connections in the stomach or intestine, a heart attack, pneumonia, and blockage of the small intestine. Risk is higher for people who have had blood clots or obstructive sleep apnea and for people who were not functioning well before surgery or require open surgery. Having very severe obesity or being male or older may increase the risk of death. Average weight loss after metabolic and bariatric surgery depends on the procedure. Weight loss is usually described as a percentage of excess weight lost. Excess weight is defined as the difference between a person's actual and ideal weight. Forsleeve gastrectomy,loss of excess weight is 33 to 58% after 2 years. ForRoux-en-Y gastric bypass,loss of excess weight is 50 to 65% after 2 years. ForBPD-DS and SADI-S, people lose 75 to 90% of excess body weight. Although most people gain some weight back, most weight loss can be maintained for up to 10 years. Visits to the doctor are usually scheduled every 4 to 12 weeks during the first several months after Roux-en-Y gastric bypass or sleeve gastrectomy—the time when weight loss is most rapid. Then visits are scheduled every 6 to 12 months. At these visits, weight and blood pressure are measured, and eating habits are discussed. People should report any problems they are having. Blood tests are done at regular intervals. Bone density may be measured to check for bone loss due tovitamin Ddeficiency. Doctors also check whether people are responding differently to certain medications after surgery. These medications include those used to treat high blood pressure ( Medications for Treatment of High Blood Pressure ), Many disorders that were present before surgery tend to resolve or become less severe after metabolic and bariatric surgery. These disorders include some heart problems, Diabetes Mellitus (DM) , Risk of death decreases by 25%, mainly because risk of death due to heart disorders or cancer is reduced. 