Oct. 28, 2022 - Weight Loss Surgery in Delaware: What Can I Expect After Surgery?

This Bariatric Friday Kemal Erkan, Chairman of American Surgery Center, is talking with Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS), who specializes in weight loss surgery, also known as bariatric surgery. Bariatric surgery is the most effective treatment for morbid obesity. Morbid obesity is when a person’s weight is approximately 100 pounds above than their ideal body weight. An ideal body weight is determined by a person’s body mass index (BMI). An individual with a BMI of 40 or higher is considered morbidly obese. The American Society of Metabolic and Bariatric Surgery has recently published new criteria for bariatric surgery. Previously, a person with a BMI of 35 and associated illness was eligible for bariatric surgery; however, that has since been revised to a BMI of 30 with associated illnesses. Associated illnesses, also known as comorbidities, are illnesses related to weight such as hypertension, type 2 diabetes, and many more. They have also noted that a person with a BMI of 35 and zero comorbidities may be eligible for bariatric surgery. Dr. Irgau explains that the reasoning is, “the only way they (the patients) could qualify for the surgery was for them to continue to gain weight, which is absurd. So we are saying don’t wait for a patient to get to a body mass index of 40 if they have reached 35 and have struggled to lose weight in any way, you should be able to offer them bariatric surgery.”

Erkan mentions Karen, Patrick, and Denise – three patients currently going through their bariatric surgery journey. Each of these patients have different issues related to their morbid obesity they are striving to correct prior to surgery. Patrick is 30 years old and has worked to get his TSH down prior to his procedure. Denise is 32 years old and is taking hemoglobin supplements. Karen is 52 years old and suffers with diabetes; she has worked to lower her A1C as she progresses through this journey. With all these varying factors, Erkan asks Dr. Irgau what the patients can expect following their quickly approaching date of bariatric surgery. “The points we are going to address are going to be fairly valid for all three of them, whether they’re having the sleeve or the gastric bypass… the main difference is that with the gastric sleeve, we actually divide the stomach and remove a portion of the stomach… with the gastric bypass we divide the stomach, but also we reroute the intestine.” He continues to explain, “In the short term, a day, two days, or a week after surgery, there is the recovery phase”. The question asked most frequently by patients is the amount of pain and discomfort they will have after the procedure. Dr. Irgau explains that patients often do not feel an insurmountable amount of discomfort following the surgery. This is due to their preemptive methods and the fact the surgery is done laparoscopically, with small incisions. Patients typically only take pain medication a couple days after the surgery, but no longer than that. In the past, nausea and vomiting were a major side effect to undergoing weight loss surgery; however, Dr. Irgau reports that patients do not experience this symptom because of the preparation done prior to surgery.

Patients also frequently ask what their diet will be like after bariatric surgery. Dr. Irgau states that patients must be on a strictly liquid diet for the first two weeks after bariatric surgery. Following the liquid diet, the patient will then transition to a pureed diet. “The best analogy for a pureed diet is baby food,” he states, “it’s only after the fourth week that our patients are encouraged to introduce chewable food. Dr. Irgau continues, “it’s actually dangerous for them to try to chew something so early after surgery, and that is because the wound on the stomach or intestine is so fresh that if they inadvertently were to swallow something without chewing it, they will have a big chunk of food there that could put pressure on the stomach and put them in danger of leakage or disruption of that wound of the stomach”. These instructions are crucial when it comes to diet progression following the procedure.

A patient’s taste and smell could also be affected following the surgery. The drastic change to the digestive system affects the other related organs; this could lead to a patient disliking items

they enjoyed prior and vice versa. Strong smells are often disturbing to patients who have undergone bariatric surgery and could lead to nausea or vomiting. One may also be hyperaware of the process of swallowing which could lead to slight discomfort or difficulty.

Activity level following bariatric surgery is another major change. “Our rule is you have to move,” Dr. Irgau states, “movement is not only okay, it is absolutely critical for their recovery.” Movement minimizes complications while enhancing the recovery. Within two hours of the surgery being completed, patients are told to be up and walking. There are limitations regarding activity. For example, a patient should not be lifting greater than 15 pounds or participating in abdominal exercises for the first month; however, patients are encouraged to walk on the treadmill or utilize stationary bikes.

After the bariatric procedure, the patient needs to take certain medications, a combination of newly introduced ones as well as ones they were taking prior to the surgery. Dr. Irgau mentions, “All patients will be taking an antacid medication, this is something that reduces acid in the stomach. Patients who still have their gallbladder… we will want them to take a medication called Ursodiol which is a medication that actually decreases the risk of gallstones and gallbladder problems as they are losing weight fast.” Gallbladder problems associated with rapid weight loss was such an issue in the past that, many years ago, surgeons would remove the gallbladder in tandem with the bariatric procedure. Ursodiol reduces the need to remove the gallbladder because it minimizes the associated problems. “Another medication which is very important… is blood thinning medication,” Dr. Irgau explains. This medication is taken for approximately 30 days. Patients are able to take these medications in pill form, which was not true in the past. It is important that patients are monitored following the surgery to see how the medications they needed prior to surgery are affecting them after surgery.

Bariatric surgery is a huge life-changing event. Erkan stresses, “our patients really need to follow through with the care that we are providing because every time I see someone who is coming back for weight regain, those are the ones who are not actually following through with their appointments.” Erkan then segues into stress and sleep after bariatric surgery. Dr. Irgau explains that often patients sleep better when they have lost weight; even patients with sleep apnea are experiencing better quality sleep. He does mention that “if patients are on a CPAP machine, we want them to continue utilizing that CPAP machine until they have been told to stop by their provider.” Regarding stress and mental health, when patients have lost weight and their overall health is improving, they become more satisfied with their quality of life and have a better outlook. With that, there are some psychologically significant changes that may occur as well. “They may have difficulty recognizing themselves,” Dr. Irgau explains referring to a patient looking at themself in the mirror after losing the weight. He states, “physical changes can bring about changes in how they are perceived by their loved ones; for instance, there could be changes in relationship”. Other changes that may occur following the procedure include hair thinning, fatigue, acid reflux symptoms, bowel habit changes, and more.

Patients are encouraged to bring up any and all topics they are struggling with during their followup appointments to their team, and if it is an urgent matter patients should not hesitate to pick up the phone and call. Dr. Irgau conveys, “we want to make sure that patients know that we are there not just for their physical health but also to provide support when they encounter challenges emotionally.” Erkan emphasizes, “If the problem is there, the only way we can actually take care of this is by going through with your appointments… it’s not going to be fixed overnight. It is the most effective way to fix it, but in order for that to be permanent… you need to follow through with your instructions from our program.” There are a multitude of professionals within American Surgery Center that can aid in addressing a patient’s problem; it is a great resource for patients to be successful.