The Day of Surgery

& Expected Hospital Course

Most patients come the hospital the morning of gastric bypass surgery and spend 2 nights in the hospital. Occasionally, patients may need to stay longer if they are not able to tolerate enough liquids by mouth or have medical problems.

Following is information about what to expect on the day of surgery, the day following surgery, and the rest of your hospital stay.

Day of Surgery

On the day of surgery, you should report to the The Western Pennsylvania Hospital's Ambulatory Surgery Center on the 4th floor of Mellon Pavilion.

Your family should wait for you in the Center's waiting room while you are in surgery. 

A nurse will help you get ready for surgery:

• You will change into a hospital gown.
• Females of reproductive age will have a urine pregnancy test.
• You will be helped onto a stretcher in the preoperative area.
• An intravenous ( IV) line will be started in your arm.

The anesthesiologist will ask you questions and will tell you what to expect in the operating room. This is a time to discuss any anesthesia concerns.

Your surgeon will visit with you and your family prior to surgery.

You will have a chance to see your family before you are taken to the operating room.

You will be given an IV medication to decrease your anxiety, and most patients do not remember much after receiving this medication.

In the operating room, you will be put under general anesthesia, which means you are completely asleep. Once you are asleep:

• A breathing tube will be placed to help you breathe under anesthesia.
• A catheter will be placed into your bladder to collect urine while you are asleep.

The surgery lasts about 2 hours. The surgeon will come and speak with your family once the surgery is completed.

You will wake up in the recovery room. The first afternoon after surgery, patients tend to be ‘groggy’ for a few hours while the anesthetic agents wear off.

Once you are more alert, you will be wheeled to your hospital room, typically on the E9 Surgical Patient Care Unit. Patients are occasionally admitted to the intensive care unit (E7 ICU) the first night after surgery. Patients may be admitted to the ICU if they require close monitoring due to heart disease, breathing problems, or any other severe health condition. After a day or two in the ICU, patients are typically transferred to the Surgical Patient Care Unit.

You will not have a tube in your nose.

You may may have a drain (plastic tube and bulb), placed during surgery, that exits one of the small incisions made for surgery. The drain typically stays in place for 2 days, but it may stay in longer.

The catheter in your bladder is typically kept in overnight and removed the following morning.

For pain control, you will have a ‘patient controlled analgesia’ (PCA) pump, which dispenses pain medicine (morphine) when you push a button. You will also receive IV injections of Torodol for pain. Torodol is similar to Motrin and helps relieve abdominal muscle pain.

You will have sequential compression stockings on your legs to help prevent blood clots. These should remain on your legs when you are not walking the hallways. You will also receive an injection of the anticoagulant ('blood thinner') medication Heparin three times a day.

Patients are strongly encouraged to walk the first night after surgery. You should ask for nursing assistance before getting up for the first time after surgery.

You will receive oxygen through a small plastic tube in your nose for the first night after surgery.

You can plan on being visited frequently by the Bariatric Surgery team (surgeon, physician assistants, residents, and medical students).  Tell the team any concerns you have during these visits to check that everything is going well.

Patients with diabetes will have their blood sugar checked every 6 hours and be given insulin (insulin sliding scale coverage) if the blood sugar is too high. The endocrinology team (physicians and nurses specializing in diabetes care) will also see you.

Day 2

The morning of the day after surgery, you will be visited by the surgery team very early in the morning (about 5:30 a.m.).

Patients should walk more frequently (at least 4 times on Day 2) and avoid lying around in bed.

Some patients have nausea after surgery. This may be due to anesthesia or to the pain medication (morphine) in the PCA pump. If you have nausea, request that an anti-nausea medication be ordered for you; this will be administered IV.

“Gas” pain or discomfort is common the first day or two after surgery.

Patients with sleep apnea should bring their own CPAP machine with them and use it while in the hospital.

Some patients may undergo an X-ray ‘swallow test’.

Patients are allowed to drink liquids the day after surgery. The diet consists of water, diet ice tea, broth, and sugar-free popsicles. One of our dietitians will also visit to review the postoperative diet.

The day after surgery, your pain medicine will be switched from the PCA machine to a liquid medicine (Roxicet – liquid Percocet) that you take by mouth.

Many medications will be restarted the day after surgery; these include Synthroid, antidepressants, and some high blood pressure medications.

Headache is not uncommon the first day or two after surgery, especially in female patients. This is treated with pain medications.

Discharge

You will be discharged to home when you are able to tolerate enough liquids by mouth and when you are medically stable.

Before you leave the hospital, you will be given instructions for your follow-up care.