Metro Bariatrics - Amir Moazzez MD, FACS

Common Problems After Surgery

Nausea and Vomiting

Eating too fast or not chewing well (you need to chew 25 times before you swallow), eating the wrong foods (foods high in fat or sugar content or too dry), and/or eating too much or drinking liquids with meals can cause nausea and vomiting. If you vomit, take time to think about what may have caused it. If nausea or vomiting occurs after you eat a new food, wait several days before trying that food again. If you’re uncertain, call your surgeon’s office.

Failure to Produce Weight Loss

In most cases after gastric bypass surgery, dietary indiscretion (eating too much and/or eating the wrong foods) is the common cause. In rare occasions, this can happen if the pouch or the outlet stretches, or if a fistula (a connection) forms between the pouch and the bypassed stomach. Food then passes into the larger section of the stomach, permitting overeating. The great majority of pouch or outlet stretching occurs because of overeating.

Gastric banding patients may need adjustment if no restriction if felt. This means that the patient may be able to eat a larger portion than is expected. However, gastric banding patients should keep in mind that the band is designed to limit the amount of food intake, not the types of foods. Unlike gastric bypass patients, gastric banding patients will not become sick if they eat foods high in fat or sugar. If you eat the recommended foods such as meats and vegetables and you vomit afterwards, it is most likely due to the meats being too dry or you are not chewing well before swallowing, rather than you not tolerating this type of foods. This kind of experience has caused some patients to resort to eating greasy or sweet foods (i.e. cheesecake or ice cream) since they will not cause the vomiting, instead of learning to chew well and eating properly prepared foods. Of course, this will cause the slowing of weight loss or in some cases, weight regain.

Prepare a food diary and have it available for reference when you call your surgeon or dietitian. This information will assist him or her in determining the cause of weight loss failure.

Vitamin Deficiency

Weight loss surgery patients must take vitamin supplements for life. Serious problems can occur if you do not take your vitamins and minerals every day. Consequences of vitamin deficiency vary. For example:

Vitamin and mineral levels in your blood must be monitored at least twice yearly. If necessary, your vitamin/mineral supplement doses may be adjusted by your surgeon or dietitian. This is why it’s important for you to continue your follow-up with your surgeon.

Changes in Bowel Habits

Constipation after weight loss surgery is not uncommon and is more likely to occur if you are not drinking adequate amounts of fluid or are taking iron supplements.

Because of potential problems with hemorrhoids, hernias, and intestinal blockages, it is important to prevent constipation. If you are on an iron supplement, it may be necessary to take a stool softener for the first month or so until you can drink more fluids and eat more fiber. Stool softeners (Colace®, Pericolace®, Senokot®, etc.) are available over-the-counter. Generic Colace® is acceptable and is much more affordable. Do not take laxatives on a regular basis.

Other ways to improve regularity: (1) Add fruits and vegetables (pureed for the first six weeks) at every meal. (2) Beginning two months after surgery, add Metamucil®, Fibercon®, Benefiber® or Citrucel® to your diet on a regular basis. (3) Drink lots of water (at minimum eight cups or 64 ounces of fluid per day). (4) Exercise regularly.

If your problem is still not resolved, you may use Dulcolax suppository, Fleet Enema, or Milk of Magnesia. Remember, you must not use these on a regular basis. If you still have a problem, please call your dietitian’s or surgeon’s office.

Temporary Hair Loss

Temporary hair loss can occur from rapid weight loss, but may also be caused by inadequate protein in the diet. This situation is usually temporary and responds to protein supplements.

Gas

Gas problems are also common in the early phase after weight loss surgery. If you have gas pains at home, try simethicone drops, Bean-O, Phazyme, or Gas-X. If the problems continue, call your surgeon’s office.

Diarrhea

If you have diarrhea, limit greasy foods, milk, and milk products. Avoid very hot or very cold foods or drinks. Make sure you drink an adequate amount of fluid. If the diarrhea does not resolve, call your surgeon’s office.

Dumping Syndrome

Commonly seen in gastric bypass patients during the first year postop. This happens when food is taken together with liquids or when sweet or greasy foods are eaten. Eating refined sugars and dense fats, which are “dumped” into the small intestine too quickly, usually causes it. Symptoms include abdominal fullness, nausea, lightheadedness and crampy abdominal pain followed by diarrhea. Usually the dumping syndrome can be controlled by diet and behavioral modification. Eat four to five small meals each day and do not drink fluids with your meals.

Dehydration

Dehydration can occur when you do not drink enough fluids. Make sure you drink at least eight cups (64 ounces) of fluid each day, but not at meal times. Again, remember not to drink more than ½ cup (4 ounces) at one time. Sipping fluid throughout the day will help you meet the fluid requirement.

Left shoulder pain

Some patients may experience pain at the left shoulder or left arm in the early postoperative period. The pain is more commonly observed in gastric banding patients. This is referred pain (pain originating from another part of the body) either from the pouch itself or from the residual gas left inside the abdominal cavity. The pain is usually short-lived and self-limiting. If the pain persist, please call your surgeon’s office.