Some of the most common questions that arise after bariatric surgery are listed below with answers that usually hold true for just about everyone. Post-operative questions tend to differ from pre-operative questions because now the surgery has already taken place, and certain things may not be fully in line with pre-operative expectations. In other cases, new concerns arise that were just never covered or addressed in the preoperative education. Here are four of the most common post-operative questions after metabolic surgery.
1. Is This Amount of Pain Normal?
In almost all cases, the short answer is… Yes. One important thing to remember is that every person is quite unique with respect to their pain experience. Observing thousands and thousands of people undergo surgery, it is quite striking how different the level of reported pain can be from person to person. It is exceedingly common for someone to undergo a major operation and report very little pain and use very little pain medication. It is also equally common that individuals undergo minor or non-invasive surgery and report a great deal of pain and seek a high amount of pain medication. These are not judgments; they just reflect that everybody is different. I like to say that everybody is wired up differently and we experience pain very differently.
Another helpful thing to remember is that pain is very rarely a helpful indicator of a serious problem. That is completely counterintuitive, but just think about things that hurt like crazy, such as stubbing your toe, and things that do not hurt at all, like cancer. It gives you a good idea that pain is not a very useful indicator of the seriousness of the problem.
It is best to communicate the pain you are experiencing and if it seems to be worsening as opposed to improving, then it may warrant some further investigation with things like vital signs, an office examination, laboratory test, and possibly imaging. But if everything else is going well, there are no fevers, you are tolerating the diet successfully, walking, and generally improving overall, then the amount and duration of pain can be extremely variable and usually does not carry much additional meaning. It is also important to report the pain that you are experiencing as accurately as you can and keep track of how you are doing on other milestones. Usually after laparoscopic sleeve gastrectomy, the first three or four days are pretty darn sore, especially at the site of the single larger incision required to remove the tissue. After that, things tend to improve significantly but gradually.
2. Can I Safely go Back to Work?
There is not a great deal of risk associated with resuming work, so for the most part, doctors and practitioners offer advice that is meant to gauge how a person is likely to feel and when they are likely to feel comfortable enough and capable enough to resume work. The most common things that people experience are fatigue, lack of energy and possibly lingering postoperative pain. Lack of energy comes into play when a person is expected to work an eight-hour shift but after three or four hours they feel exhausted and want to go home and lie down. This is very common after even very minor surgery and anesthesia in the first week or two.
With physically demanding jobs that involve lifting items that weigh over 30 pounds, there is a small risk of splitting the muscle closure of the larger incision site and developing a hernia, which could require a future surgical repair. This risk is thought to be in the single digits’ percent chance, but it can be mitigated by pursuing a “light duty” strategy for the first four to six weeks. We generally recommend a six-week period of light duty after open abdominal surgery for this exact reason. The laparoscopic technique makes the hernia risk a lot lower, but it is not quite 0%. Advising people to keep the weight limit under 30 pounds really minimizes that risk. If you choose a four-week timeframe, keep in mind that the additional last two weeks might be a good time to try to limit the amount of weight being lifted and perhaps wear the kind of belt or support that a weightlifter would use.
There are individuals who go back to work within 24 or 48 hours, usually because they have tremendous flexibility, and they can work for a few hours on their computer and then come home or take a break or take a nap. There are other people who need two or three weeks completely off followed by two or three more weeks of light duty. The best strategy is to gauge your own job requirements and your own constitution and find a meeting of the minds with your provider. In most cases, it is quite safe and quite normal to resume office-level work within two weeks.
3. Do I Have to Follow the Post-Operative Diet Strictly?
Most programs and practices in the United States provide some detailed guidance about post-operative diet. I try to ask every single patient to “buy in” to a strategy that involves a 12-week structured post-operative diet that is somewhat intensive but very useful to kickstart major weight loss in those first three months. So, my best advice is to read the diet, stock up on the items you will need, and do your best to follow the diet to the best of your ability.
Having said that, there are all kinds of reasons why it might not work to follow the diet to the letter of the law. I tell people to feel free to substitute similar ingredients, flavors, recipes, etc. Do your best to stick with the general outlines in terms of grams of protein intake per day, vitamins consumed, overall calorie target concept, reduced carbohydrate intake, and fluids. The truth is that people have their own thoughts, and millions of people undergoing metabolic surgery still get great results with a lot of different kinds of postoperative diets. I suggest taking the proven route and following the dietary advice given to you by your surgeon as best you can, while knowing also that it is not the end of the world if you must veer off the path a bit here and there.
4. Should I Worry about Loose Skin?
The short answer to this question is no, at least not yet. The most important thing after metabolic surgery is to do your very best to lose all the pounds you can. This means creating a seven-days-a-week habit of daily walking or equivalent exercise and gradually devoting yourself to the plan, increasing the daily minutes so that it becomes a lifelong habit of 60 minutes per day, for example. In addition, following a lifelong diet plan that continues to reduce the carbohydrates in the diet and emphasizes a healthy mix of protein, vegetables, and vitamins. Do not let concerns such as loose skin or fitting in amongst a friend group that also battles with obesity, wardrobe concerns, etc., lessen your commitment to following your diet and exercise plan and losing as much weight as your body will let you.
If you are successful, then hooray, you have embarked upon a better life in which you are going to have more energy, feel better about yourself, enjoy better health and longevity. It is also true, that depending on how your body is built, you may have melted a whole bunch of the subcutaneous fat underneath some skin and now you have loose skin that just will not retract or tighten up on its own. For the vast majority of people, this is either a nonexistent problem or a minor nuisance. But that is not to say that there are not some people who are really bothered by loose skin and who eventually proceed with surgical removal of loose skin. Keep in mind that you will want to save money for this potential skin removal because the insurance plans do not generally cover it, and that you do not want to proceed with skin removal until at least a year after your surgery when you have reached your lowest weight.
A lot of cosmetic surgeons do a fantastic job with package deals addressing loose skin of the upper arms, abdominal pannus, and thighs, along with potentially other areas such as face, neck, breasts, etc. The most common single area of concern is the abdominal pannus after a person loses a large amount of weight in the abdomen. Often men are built this way such that every pound gained seems to go right in the beer belly, and likewise, all the pounds lost seem to come right from the same area, leaving loose abdominal skin. A fair number of bariatric surgeons, like myself, were trained in procedures to remove this skin and tighten the abdominal wall muscles and tissues and can do a very good job with this one area. But if the loose skin concerns involve other areas mentioned above, then seeking out an excellent cosmetic surgeon is the way to go.
Your bariatric surgeon and center should be on hand to answer all of your questions, so don’t hesitate to reach out. If you’re considering metabolic surgery, learn more about whether you’re a candidate – contact the team at Sasse Surgical in northern Nevada today.