The decision to have bariatric surgery is one of the biggest decisions any person can make. Education is paramount to patient success. The process begins with attendance to an informational seminar. The seminar provides information related to the procedures performed. Information on pre and post operative instructions as well as dietary guidelines is also discussed in detail.

Oral Contraceptive Pills (OCP) increase the potential for venous thrombosis (blood clots). You will be asked to discontinue any OCP two months prior to the procedure and not restart for at least 3 months. Using precautions to prevent pregnancy is strongly recommended for the 18 months after surgery.

It is strongly advised to avoid pregnancy during the first 18 months after surgery. During this time period there is rapid weight loss and profound metabolic changes. The potential for malnutrition may place the fetus at risk. Weight loss and bariatric surgery have been demonstrated to improve fertility and it is very important that precautions be taken to avoid pregnancy.

Detailed pre and post operative dietary instructions will be provided at the seminar, office visits, in the hospital and during post operative visits.

In general post operative bariatric patients are moved from clear liquids to regular food items over a period of 3-4 weeks. The progression is clear liquids -> thickened liquids (baby food, creamy soups) -> soft foods (mash potatoes, fish) -> regular foods.

Multivitamin twice a day

• adult multivitamin preferred (ie Centrum)

Calcium with Vitamin D three times a day

• calcium citrate preferred 1500 to 2000 mg a day

Iron once a day

• 325 mg of an iron salt (equivalent to 65mg of elemental iron)

Vitamin B12 once a day

• containing at least 350 mcg of Vitamin B12 (sublingual preferred).

Vitamin D (D2 or D3) 50,000 IU once a week

• available over the counter

Laboratory studies are required at 3 months, 6 months, 12 months and annually thereafter following gastric bypass and sleeve gastrectomy to identify any nutritional issues that require further treatment.

Recommended lab studies:

CBC, electrolytes, glucose, liver function, iron studies, ferritin, Vit B12, 25-Hydroxyvitamin D, Intact PTH, Lipid profile, HgbA1c.

Most individuals will feel well enough to start exercising 2-3 weeks after surgery. Never exceed your comfort level as you begin to become active. Slowly advance activity over a period of 4 weeks.

Return visits depend on the procedure. In general, gastric bypass and sleeve patients will be seen 1-2 weeks after surgery, 6 weeks, 3 months, 6-9 months and then at 1 year. Annual evaluations are recommended thereafter.

Lap band patients are seen at 1-2 weeks after surgery, 6 weeks and then every 4-8 weeks for potential adjustments.

Activity is dependent on the type of hernia and repair. Additional factors such as age, previous medical/surgical history and overall physical condition play a major role in recovery and activity level. In general after laparoscopic hernia repairs patients will be able to use stairs, walk and handle items <15 lbs the day of surgery. Activity will be increased around 3-4. In some cases full activity without limitations can resume at 3-4 weeks.