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Patient Experience Post-Operative Care

Gastric Banding Surgery Discharge Instructions

Now that you are ready to go home here is some information to help you take care of yourself.

What medicines must I take and how do I take them?

So that the medicines can be absorbed and used by your body, you must:

Crush all non-chewable tablets and open all capsules. Mix powder with food.
Chew any chewable tablets completely then wash them down with liquid.
You may take liquid forms of your medicines, when available. Shake the bottle well before you pour the medicine dose.

	Medicine	Dose	Comments
1	Prilosec^®	Take 20mg once a day for four weeks	Open one 20mg prescription capsule OR two over-the-counter 10mg capsules into pureed food.
2	Lortab^® Elixir (Hydrocodone/Acetaminophen)	Take ½ - 2 teaspoons of the 7.5mg elixir every 4-6 hours as needed.	Once your discomfort lessens, change to Extra-Strength Tylenol^® every six hours as needed. Take 2 tablespoons of liquid (equal to 1000mg) or two tablets (crushed).
3	Multivitamin with minerals	Take 2 children's chewables every day.	You can choose another form/type. Check your diet booklet.
4	Calcium		Check your diet booklet to choose a form/brand and to find the amount that you need to take every day.

Medicines to avoid!

Do not take aspirin or aspirin-containing products. Do not take non-steroidal anti-inflammatories such as ibuprofen (Advil^®, Motrin^®, etc.) and naproxen (Naprosyn, Aleve^®, etc.). They may cause ulcers in your pouch. Check with us if you are not sure which medicines you can take.
If you need to take any of these kinds of medicines, even once, call the Obesity Center. You may need a medication to protect your stomach, or a different prescription.

How do I care for my incision?

Remove the bandage 3 days after surgery if it is still on. Leave the Steri-strips^® [strips of tape over the incision (cut)] in place; they will curl and fall off. If they are still in place 2 weeks after your surgery, gently peel them off. You can do this in the shower. The incision (cut) may itch during healing; this is normal. Do not scratch the area.

Can I shower or bathe?

It is OK to shower with soap. Pat the incision dry after showering. Do not take a bath or soak in water for one month.

What kind of activity is allowed?

Do not drive until your pain is resolved and does not require medication. Pain can make it hard to move quickly. Stop any strenuous activity if it is uncomfortable during the first month. Walk as much as is comfortable for you. Your goal for the first 4 weeks after surgery is to walk 30 minutes per day, 7 days per week.

How do I manage constipation?

If you do not have a bowel movement within 5 days of surgery, try Milk of Magnesia^® (2 Tablespoons, twice a day). If this does not work after one day, try a Dulcolax^® suppository or Fleets^® enema. If none of these measures help, call the Obesity Center.

What do I do if I vomit?

If you vomit, you have probably eaten or drunk too quickly and/or too much or the food may have been too solid. Wait four hours and then try one ounce of liquid that doesn't have sugar. If this liquid does not make you nauseous or vomit, then take only liquids until the next day. Then you can try pureed foods again. If vomiting continues, call the Obesity Center.

May I become pregnant?

We recommend that you avoid getting pregnant for 18 months after surgery. Rapid weight loss increases fertility. Birth control must be used correctly and all the times to avoid pregnancy, even if you were not able to get pregnant in the past.

Diet Notes
FOR OUTPATIENTS ONLY When you arrive home on the day of your surgery	You can have water, chicken broth, diet gelatin and decaffeinated tea. You should drink only *1 to 2 ounces* of any of these liquids up to every *20 minutes* while you are awake. *If you can not tolerate these liquids, call your surgeon's office. Do not* try pureed foods.
FOR ALL PATIENTS Starting the day after surgery and for 2 weeks	Consume *pureed* foods that are no thicker than applesauce. *If you had trouble tolerating liquids in the hospital OR you did not tolerate pureed food on the day of discharge*, follow the dietary instruction of your surgeon/surgeon representative when you are being discharged. Most likely, you will be instructed to follow a liquid diet for one week before trying pureed food.
1^st week after discharge	Consume *one ounce* of a *pureed* food OR one to two ounces of *liquid* no more frequently than every *20 minutes* while you are awake.
2^nd week after discharge	Continue *pureed* foods but start to eat 4 to 6 mini-meals every day.
3^rd week after discharge	Continue to eat 4 to 6 mini-meals per day but switch to *soft solid food* (see your diet booklet for details).
Every day	Consume *one* high protein drink. Make sure that you make 1-2 choices from the milk group and 4-6 choices from the protein group. Eat slowly! Stop eating when you are comfortably satisfied. Do not spend more than 30 minutes eating.
More about liquids	Try to drink 64 ounces of liquid without caffeine *each day after the first week. Wait at least 60 minutes after eating before you start drinking. Stop drinking 15 minutes before you eat. Drink slowly and do not use straws. Do not* drink *carbonated* or *alcoholic* beverages for *one month* after surgery.

When do I follow-up after surgery?

You will meet with your Surgeon/ Nurse Practitioner and Dietitian 2 to 3 weeks and 5-6 weeks after surgery. We recommend that you see your Nurse Practitioner and Dietitian: every 2-4 weeks until the band is adjusted appropriately for you, then monthly for the remainder of the first year, every 3 months for the second year and every year thereafter. You should have received dates and times for your first two follow-up visits with your pre-operative instructions. If not, please call the Center to schedule them.

When will I get my gastric band adjusted?

The first adjustment of your gastric band may be done at the 5-6 week visit in the office. We will evaluate the need for additional adjustments at each follow-up appointment. You must go back to one pureed meal (or liquids) and then soft solid foods for two days (or longer if necessary) after each adjustment.

When do I come back for my Upper GI test?

If you did not have an Upper GI test in the hospital, you must have one at our office before your 5-6-week follow-up visit. You should have received this appointment with your pre-operative instructions for the same day, if possible, as your 2-3 week follow-up appointment. Without the test results, we will not be able to make your first band adjustment. If you do not have this appointment, please call the Center to schedule one.

When should I call the Obesity Center?

Call us if you notice:

Increasing redness, swelling, heat or pain at an incision
Drainage from an incision
A fever greater than 101ºF
Abdominal pain
Frequent vomiting
Shortness of breath
Generally not feeling or doing well

EMERGENCY TELEPHONE NUMBERS

Call 212.305.4000 with any problems.
After 5PM, call your surgeon:

Dr. Marc Bessler	on	212.305.9506
Dr. Beth Schrope	on	212.305.9441
Dr. Daniel Davis	on	914.787.4000
Dr. Akuezunkpa Ude	on	212.305.2676

This information is brief and general. It should not be the only source of your information on this health care topic. It is not to be used or relied on for diagnosis or treatment. It does not take the place of instructions from your health care providers. For answers to your health related questions, talk to your health care providers for guidance before making a health care decision.

Copyright NewYork-Presbyterian Hospital. 2003. All rights reserved.
Revised: 2001, 4/02, 4/03, 1/04, 12/04, 9/05, 5/06, 8/06, 10/06