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Once surgery has been scheduled and you have completed all of the pre-surgical requirements, you embark on the surgery realm of your weight loss journey.
Following are the next steps that
will occur.
Pre-op
Surgery
Post-op
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Once surgery is scheduled, you will have a pre-operative appointment at Dr. Valentine’s office where Dr. Valentine will perform a physical exam, review medications etc. and go over a pre-op diet with you. Any additional questions you may have will be answered at this appointment. We will also give you information to take with you to your pre-op appointments at either Mercy Medical Center, Treasure Valley Health South or St. Lukes.
You will then have a pre-op appointment at either Mercy Medical Center, Treasure Valley Health South or St. Lukes. Surgery cannot be performed without this appointment.
On the day of surgery, you will be admitted to the hospital. You will meet your anesthesiologist and a variety of nurses and medical assistants. Preoperative time usually lasts about 30 minutes, after which you are taken to the operating room.
Roux-en-Y Gastric Bypass
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The Roux-en-Y gastric bypass is considered by most to be the gold standard of weight loss surgery and is the most commonly performed weight loss surgery in the United States.
The Roux-en-Y gastric bypass can be performed either “open” or “laparoscopic.” The “open” incision varies in size from six inches to 12 inches running lengthwise in the center of the abdomen. “Laparoscopic” procedures require five 1⁄2 inch incisions. Patients who have the procedure laparoscopically will have less pain, better cosmetic results, and less chance of incisional hernias or infections. Dr. Valentine is one of few surgeons who is trained to perform this surgery laparoscopically.
The Roux-en-Y gastric bypass is both a restrictive and malabsorptive procedure. Dr. Valentine will create a small pouch at the top of your stomach using staples. The remaining part of your stomach is stapled off and cut away from the pouch but is otherwise left intact and will still produce gastric juices and secrete them into the small intestines to aid in digestion. The small pouch is attached to the jejunum (second portion of the small intestine), thus bypassing the stomach and duodenum (first portion of the small intestine).
For most patients (95%) this surgery produces a feeling of being full when eating a very small amount of food and a sense of being satisfied.
This operation takes approximately 2 hours. Using the laparoscopes, Dr. Valentine will create your 2 ounce stomach pouch and bypass 100 to 150 cm of your small intestine.
A drain tube may be temporarily placed in the abdomen. Once this procedure is completed, you will be moved out of the operating room into recovery.
Lap Band
The "Lap Band" is another weight loss procedure performed by Dr. Valentine. This procedure is performed laparoscopically. Five 1/2 inch incisions are made through which long cameras, and laparoscopic tools are inserted to perform the procedure. A band is placed around the top of the stomach to divide the stomach into two parts. The band has an inflatable balloon on the inside next to the stomach that is attached to a port. That balloon can be inflated and deflated with saline to either tighten or loosen the band.
Once the device has been placed, the tubing is attached to the port. The port is attached underneath the patient's skin and after healing is where the needles inject the saline or remove the saline to adjust the band's constriction around the stomach.
The lap band is a restrictive procedure it works by overall decreasing caloric consumption. The top portion of the stomach fills up faster with less food than the patient could eat normally. Then the food slowly passes through the constricted portion where the band is located. Most patients also report decreased sensations of hunger.
Over the course of the following years, patients follow-up approximately every 4-6 weeks for band adjustments.
When you are ready to leave the recovery room, you will be transferred to either a hospital room or the ICU. A patient may be transferred to the ICU for approximately 24 hours to be monitored more closely. Later that day you will be asked to get up and start moving around. This will help prevent blood clots, pneumonia, and will also alleviate pressure from the gases that are used during surgery. You also may be connected to a PCA machine (Patient Controlled Analgesic) that will dispense pain medication under your control. You cannot overdose with this machine. If you experience nausea, the nurse will give you additional medication.
The first day after surgery selected patients will have a test called an upper gastro-intenstinal series with gastrographin swallow (a type of contrast). This test will make sure there are no leaks between your new pouch and your old stomach and will make sure there is not a leak from your new pouch into the rest of your abdomen if you have had the gastric bypass. If you have had the lap band this test will make sure the band is in the proper position. You will be taken to radiology and given approximately 30 ml of a liquid water soluble contrast gastrographin to drink. You will drink the contrast while the x-ray pictures are being taken. After the test is completed, and there are no signs of a leak, you will be able to begin drinking small amounts of clear liquids.
Most patients are discharged from the hospital 1 to 3 days after surgery. You will be discharged only when Dr. Valentine feels it is safe for you to go home.
Follow-up appointments will be sceduled based on which type of weight loss surgery you have.