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What to Expect Before, During and After Surgery


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    Before and after any surgical procedure, there is a checklist of routine tests and lab work that keep Dr. Artuso abreast of any potential for complications. These tests will also be useful tools to measure the progress of the patient’s health and weight loss.

    Most patients will receive an appointment for an initial consultation within 7-10 days after they call the office, sometimes within the same week. After the patient is initially seen, most patients will receive their surgery within 4-6 weeks barring any unforeseen issues (i.e. insurance difficulties, life-threatening medical conditions, etc.)

    Our one-day evaluation allows patients to receive all the tests necessary to achieve insurance approval in one day. This simplifies the pre-op certification process for the patients and is especially helpful for our out-of-town patients or patients traveling great distances.

    Pre-Operative Instructions

    Although pre-operative instructions are tailored to the individual patient, below are general instructions given to all patients:

    1. Patients should refrain from smoking for at least one month prior to bariatric weight loss surgery. Non-compliance puts you at risk for more complications, including increased time spent on the ventilator in the ICU (Intensive Care Unit) and a more protracted and difficult post-operative hospital stay with an increased risk of pneumonia developing after weight loss surgery.

    2. Aspirin, Motrin, Aleve, Excedrin or other arthritis medications must be stopped 2 weeks prior to bariatric weight loss surgery. They slow the clotting of blood and can result in increased blood loss during surgery. If you are taking a blood thinner prescribed by your physician, the patient will receive more specific instructions customized for their own needs.

    3. Binge eating prior to bariatric surgery can also impede the surgery and provide you with a less than optimal result.

    4. Alcohol intake must also be stopped at least three weeks prior to bariatric surgery, and any history of chronic alcohol or substance use must be communicated with Dr. Artuso.

    5. There will be certain pre-admission testing, individualized for each patient, but as a general rule, patients will undergo blood tests and a routine chest x-ray and EKG.

    6. Patients may also be prescribed medications to be taken pre-operatively to prevent further weight gain prior to surgery.

    7. Discuss with Dr. Artuso your options in case a blood transfusion becomes necessary. If a transfusion is likely, he may recommend that you donate your own blood in advance. If this is not possible, you may have family or friends who may be able to donate their blood for you.

    8. Stop estrogen supplements one week prior to surgery

    9. Stop any oral diabetic medications the day before the surgery.

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    Travel & Accommodations

    The New Image Weight Loss Center cares for many patients traveling long distances. The initial consultation and necessary pre-operative evaluations can be performed in 48 hours in special circumstances and bariatric surgery scheduled shortly thereafter.

    Accommodations

    Below is a list of area Hotels which are conveniently located to The New Image in Dobbs Ferry, New York:

    Ardsley Acres (914) 693-2700
    Hampton Inn (914) 592-5680
    Ramada Inn (914) 592-3300
    Marriott Hotel (914) 631-2200
    Tarrytown Hilton (914) 631-5700
    Holiday Inn (914) 476-3800

    Area Information

    Dobbs Ferry is a town located in Westchester County located 20 miles north of New York City. It is easily accessible via major highways and it is 15 miles from the Westchester County airport. You may call the center for more specific information.

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    What will happen during bariatric weight loss surgery?

    Patient will be given an IV for fluids and any medications that may be necessary before, during or after surgery. The patient will also have a urinary catheter put in place.

    At all times, Laparoscopic surgery is the priority of The New Image and patient will have approximately 4-5 small incisions approximately 1-2 inches long which will require only small bandages. On rare occasions, it is necessary to have open surgery which would require the surgeon to make larger, more invasive means to do the surgery. If this is the option that has been chosen, the patient would have one large midline bandage. The bariatric weight loss surgery will generally take 2-3 hours and about 2 hours in the recovery room.

    After the appropriate procedure has been completed, the patient will be transported to the ICU (Intensive Care Unit) where (s)he would stay to be closely monitored for approximately 24 hours. This time may be longer or shorter depending upon the patient’s condition and type of surgery performed.

    On the first day after weight loss surgery, a GI swallow will be performed in order to confirm that the surgical site is healing properly. Patient will be allowed to have a clear liquid diet up until the day (s)he is discharged.

    Patient will be given pain medication for pain and discomfort. Patient will be asked to rate his/her pain. A "0" meaning no pain, a "5" is moderate pain and a "10" is the worst pain you can imagine. Some words you can use to describe the pain are "dull", "throbbing", "shooting", "aching" or "intense". This is helpful to the doctors and nurses to help prescribe the pain medication that will be most effective for you.

    Patients will be encouraged to walk which will help their circulation, their breathing and also to relieve any gas pains.

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    Post-Operative Instructions

    For the first week at home, the patient will be on a clear liquid diet of approximately 3oz. for each meal.

    Approximately 10 days after surgery, patient will return to The New Image Center for their first post-operative visit. If the diet is being well tolerated, patient will then be able to have soft or pureed food for the next two weeks. At the patient’s second post-operative visit, Dr. Artuso and the patient will select a solid food diet. It should be noted that red meat, including beef, pork, venison or lamb, should not be eaten.

    You may experience either constipation or diarrhea for several days after bariatric surgery, but if it continues, you must notify Dr. Artuso. You will also have to practice deep breathing exercises after surgery in order to prevent lung problems after surgery. Leg exercises will be recommended to maintain adequate circulation while resting in bed. Sometime a (SCD) Sequential Compression Device may be used while you are in bed and unable to walk. This device in attached to your legs and helps to inhibit the formation of blood clots and improve circulation.

    As soon as your IV is removed, you may shower. Your incision may be exposed to water and you will be encouraged to wash it gently with soap, water and a clean cloth. Gently rub the area to remove any debris or discharge that may accumulate on the incision. It is normal for a small amount of bleeding to occur while washing.

    You may experience some fluid draining from the incision. This is a serum, or tissue fluid, which accumulates in the abdominal wound after surgery. Occasionally this is not absorbed and may drain. If this occurs, change bandages frequently until the drainage stops. If the drainage is heavy, does not slow down, or is foul smelling, please contact Dr. Artuso for further instructions.

    Always remember to wash your hands before and after touching your incision. This will reduce the risk of infection.Cover the incision with dry, sterile gauze and secure it with surgical tape. Make sure to change the dressing frequently.

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    Will I need medical supplies?

    The only medical supplies that will be needed are simply dry bandages, such as gauze and surgical tape.

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    When can I return to work?

    The answer will be different for everyone and also different depending upon the particular surgery that was performed. Some highly motivated patients return to work in as little as 2 weeks. The average employer allows between 6-8 weeks for recovery for upper abdominal surgery. They will have to "take it easy" and refrain from any physical activities for 4-6 weeks. Most gastric bypass patients who are motivated are able to return to work sooner than that.

    Once the patient is cleared by Dr. Artuso, (s)he will be encouraged to walk in order to speed recovery. You can start slowly and gradually increase the length of time you walk, but you are not to exert yourself. You should not lift anything greater than 5-10 pounds or do any heavy housework such as vacuuming. Light housework is acceptable. Climbing stairs is generally permitted but patients are advised to go slowly.

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    Complications

    Some of the possible complications for this surgery include infection in the abdomen or at the incision site, abscess, peritonitis, sepsis, gastric leak, bowel obstruction, bleeding and death in rare instances. All of these complications are rare.

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    Side Effects

    Due to the physical changes caused by surgery, there are possible side effects that could result. Due to the restrictive eating, there is a potential for deficiencies in protein as well as certain vitamins and minerals. Therefore it will be recommended to take any over-the-counter multivitamin fortified with iron, calcium and other nutritional supplements.

    Some patients experience nausea, food intolerance, changes in bowel habits/movements, transient hair loss and loss of muscle mass. It is important to understand that, for patients who do experience these normal side effects, they are temporary.

    You may experience constipation after weight loss surgery. This is normal and drinking plenty of fluids will help to alleviate this condition.

    Gallbladder disease is a potential side effect due to the rapid weight loss after surgery. In order to minimize this risk, Dr. Artuso may prescribe medication which would be taken regularly for several months after surgery.

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    Risks

    As with any major abdominal surgery there are always potential risks, but are further complicated in operations on severely obese patients. The potential surgical risks include respiratory problems, infection, bleeding, bowel obstruction, leakage of bowel connection and obstruction of the stomach outlet. Although these risks are minimal, it is always best be aware of them.

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    Recovery Time

    Patients will need to rest approximately 2-3 weeks after surgery and can resume normal physical activity in approximately 4-6 weeks. All this will be discussed at your post-operative visits with Dr. Artuso.

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    How much weight will I lose?

    The amount of weight loss depends upon the type of surgical procedure performed, the patient’s starting weight pre-operatively, and the compliance and motivation of each particular patient. The average patient experiences a weight loss of 55-70% of their excess weight (the amount of weight the patient is overweight) in 12-18 months after surgery. Most patients still remain somewhat overweight, although a small percentage of patients (3-5%) may reach or approach very closely their ideal weight. Even if an ideal weight is not achieved, the weight loss experienced is usually well enough to significantly improve or cure many of the medical problems associated with being overweight or obese.

     
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