Complications during weight loss surgery or post surgery is a topic that very few people want to address or even think about.
Although complications are not common in our group ( less than 1%) or what is expected it is important to know
- What steps are being taken by your medical team before, during, and after surgery to reduce risks.
- What steps you as a patient can take to prevent complications or lower the risk of them.
It is important to note that the information provided is what our medical team at Mexicali Bariatric Center does as a protocol to assess risks and prevent complications. Each medical team will include or implement their own protocols depending on their years of experience with weight loss surgery, budget, facility where surgery is being performed, where recovery takes place, specialists available for your care, etc. Our protocol may serve as a guide so you can inquire about services provided by the medical team where you will have your surgery.
Medical Team Prevention Protocols
Protocol Before Scheduling Surgery:
Risk prevention starts with learning more about a patient’s medical history. It is very important to provide accurate information to your surgeon and medical team before surgery so that your case may be evaluated individually.
- Example 1: When filling out medical forms for surgery evaluation , sometimes patients fail to mention that they experience sleep apnea, this is a very common condition amongst bariatric patients. Why is this so important? Patients with sleep apnea fail to oxygenate properly after surgery. What may seem like just an inconvenience at home, not breathing properly after surgery when your entire system is depressed may lead to very serious complications if not addressed properly immediately post op. Patients who experience sleep apnea require a special protocol, for more information you may read the following blog Sleep Apnea and Weight Loss Surgery.
- Example 2: Another example may be failing to mention a particular medication or supplement you are taking. Before surgery certain medications or supplements need to be stopped for a period of time, this is especially true of those that may thin your blood. Providing all information to your doctor will help him issue proper pre-op instructions to get you ready for your surgery.
At Mexicali Bariatric Center the information you provide is evaluated by the Bariatric Doctor and Surgeon to ensure you are a good candidate for surgery and that we can properly address any and all medical conditions properly. In more complex cases a cardiologist and/or internal medicine doctor may be called to help assess the case properly.
Patients are given specific pre op instructions telling them how to prepare for surgery. We will explain how this affects their outcome in the next section of this blog.
Protocols Day Before Surgery
- Upon arrival it is important to have pre op tests done to see exactly how you arrive for surgery. Tests done at home may help to give the doctors an idea of your medical history but once you are at the hospital we need to know exactly what your medical situation is.
- Standard tests include: blood work, urine test, chest x ray, EKG and an evaluation by the internal medicine doctor. Extra tests that may be needed depending your medical history are an echocardiogram, stress test, barium swallow x ray, etc
- Pre op tests have oftentimes indicated conditions that patients were not aware of and that needed special attention before surgery, like providing nebulizations prior to surgery, antibiotics, iron, etc all to prevent a complication.
- All patients are started on antibiotics the night before surgery to ensure skin is clean of bacteria and prevent infections.
- All the information is evaluated by the surgical team and the internal medicine doctor, to ensure every patient is ready for surgery.
Protocols the Day of Surgery
Preparation for patients for surgery is key to help minimize risks.
- All patients at MBC are administered a blood thinner that is safe for surgery, to help prevent blood clots.
- Proper hydration is also started via an IV to prevent blood clots, ensuring patients have electrolytes and sugar to prevent a decompensation.
- Pneumatic stockings are placed on all patients to stimulate blood flow during surgery and prevent blood clots.
- Our Anesthesiologist evaluates each patient to assess risks and prepare the proper anesthesia protocol. An anesthesiologist with experience in dealing with obese patients is very important as risks are higher and parameters vary when compared to other patients.
Technical Surgical Protocols during surgery
- Since all are surgeries being done laparoscopically it is important to have high definition equipment with 4K technology to ensure optimal visualization.
- Single use Johnson and Johnson surgery kits ( staples and 100% titanium medical grade staplers) are used to ensure proper quality of materials used.
- The use of different staples according to the thickness of the tissue being worked on is key to prevent a leak. You may read more on this on our blog pertaining to staples.
- During a Gastric Sleeve urgery, Gastric Bypass Duodenal Switch surgery the surgeons suture over the staple line as added protection against leaks
- A leak test is performed during surgery to ensure stomach and/or anastomoses are properly sealed.
Post Surgery Protocols
- All patients remain in the recovery room for at least 2 hours until they are fully awake with adequate saturation levels and no residual effect of the anesthesia. During this time they are being monitored both by specialized personnel and equipment.
- All patients recover at the hospital for 2-3 days depending on the procedure they have had done. It is crucial for vitals to be monitored constantly, drainage to be evaluated by the doctor to know what is going on inside your body, urine output measured, pain levels assessed, etc.
- Patients with sleep apnea follow the sleep apnea protocol of a cpap machine and telemetry when needed. Where they are being monitored by the Intensive Care Unit (ICU) at the hospital 24 hrs.
- 2 more leak tests are done during recovery at the hospital. For more information on the leak tests done at Mexicali Bariatric surgery you may read this blog The importance of doing 3 different leak tests after bariatric surgery
- Pain is properly managed via an IV, with continuous flow of narcotics and rescue medication. This method keeps patients more stable during recovery.
- It is common for most patients to be nauseous after anesthesia so an anti nausea medication is administered to every patient which also ensures a more stable recovery.
- Patients are checked upon every 4 hours by medical staff.
Patient’s Prevention Protocols
Now let’s talk about what you as a patient can do to prevent complications during and after surgery.
Before Surgery
Before your arrival you will be given specific pre op instruction telling you how to get ready for surgery. Your compliance to the instructions is of utmost importance. These instructions may include following:
- Pre op diet: to help remove fat from your liver, to help clear out your intestines if you are having a malabsorptive procedure, to reduce visceral fat, improve apnea and reduce metabolic levels.
- Stop smoking and doing breathing exercises: to help get your lungs ready for surgery. Proper oxygenation is fundamental for proper healing of tissues.
- Reduce or discontinue taking certain medications or supplements which may cause bleeding, may prevent proper healing, etc.
- Discontinue the use of alcohol or drugs which may negatively interact with medication we administer.
Every instruction given for preparation has a specific reason for being given and should be followed to help reduce the risk of a complication.
At the hospital
During your hospital stay, the doctors will order early mobilization, our staff will help you to get up and walk the same day of surgery. This mobilization helps prevent complications including blood clots and it helps to get your intestines functioning properly.
You will also be asked to start performing breathing exercises at the hospital. These help you work your lungs properly to prevent pneumonia and help get oxygen to your tissues to aid in healing.
At home
You will be given specific post op instructions which again it is imperative to follow. These will include:
- Post op diet, this is a healing diet, it will introduce food slowly to ensure you do not disrupt the staple lines by eating too soon. The diet will also ensure you do not get dehydrated if you adhere to the guidelines.
- Breathing exercises, you will be asked to continue with these exercises at home for 2 weeks as mentioned above these help healing and prevent lung problems.
- Acid Inhibitors, you will be asked to take an acid inhibitor for 3 months post surgery. This will help protect your staple line against ulcers. Even if you do not feel the traditional symptoms of acid reflux it is important to take it.
At Mexicali Bariatric Center we want you to have a safe and successful surgery, if you have any questions about the risks and what we do to minimize them, contact us at (888) 344 3916 US Toll-Free or visit www.mexicalibariatric.com