Nausea/Vomiting: This is the most common problem after GBP, and is almost an expected outcome in the first few weeks. In this early post-operative period the new stomach pouch and the attached small bowel don't function very well, and this causes symptoms of poor function. In some patients this occurs because they are trying to eat too much at once, and the resulting "stuffing" of the gastric pouch causes pain and nausea.
On days when patients have N/V, they should be instructed to "fall back" to clear liquids only, and the problem will usually pass in 12-36 hours. If the N/V persist to an extent that the patient is becoming dehydrated, arrangements should be made to be evaluated.
Keeping a food diary will help you figure out if vomiting is caused by food.
Bowel Changes: Liquid stools for the first 3 weeks after surgery. If they become too frequent, you may take the anti-diarrheal products that are liquid or chewable, such as Imodium AD.
Pain: Incisional pain is usually nearly resolved by the time the patient is discharged from the hospital. Patients commonly have persistent discomfort at the left rib margin, secondary to intra-operative retraction- this is benign but can require 1-3 months to resolve.
Ventral Hernia : Approximately 20% of patients will develop an incisional hernia after open GBP, and is much more rare after laparoscopic GBP. This is usually manifested three months or more after the surgery, with patient complaints of midline abdominal pain and a bulge under the incision.
Hair Loss: Many patients report that in the 2-4 month time period their hair brush begins to fill up with huge clumps of hair. This hair loss is very common, and is due to a relative protein deficiency. As long as you maintain your protein intake the hair loss will resolve-no patients have yet gone bald due to GBP.
Flabby Skin: Unfortunately, skin does not always shrink as fast as you lose weight. This frequently results in bothersome and unsightly folds of skin on the abdomen, thighs, and upper arms. This extra skin can be removed by plastic surgical procedures. Arranging to have this done by military plastic surgeons is only sometimes possible. The copayment for this surgery at BAMC or WHMC is approximately $3,800.00 for the abdominoplasty alone.
Lactose Intolerance: Dairy products frequently cause cramping and diarrhea after GBP, because the surgery has bypassed the part of the bowel that has most of the enzyme (lactase) necessary for digestion of mild sugar. On the other hand, dairy products are desirable because of their protein content. Patients generally appreciate a substantial improvement in their ability to consume dairy products with the addition of Lactaid, which can be purchased over the counter in drug stores and supermarkets. Patients can also anticipate improvement in milk tolerance over a period of months following surgery, as the bowel adapts to the new nutritional flow. This may be short or long term. Only time will tell.
Dehydration: Watch your urine for a dark color or strong odor, or watch for bad taste in your mouth, with nausea. These are signs of dehydration that tell you to drink more. As a gastric bypass patient, you can become easily dehydrated. Your goal the first day home is to drink a minimum of 42 ounces of fluids. Then increase your fluid intake you intake daily until you are drinking closer to 72 ounces of fluids.
Constipation: In the long term you may have difficulty with constipation. This is usually due to relative dehydration and the patient should remember frequent small volume fluid intake. Another option is to purchase over-the-counter products such as Milk of Magnesia, Colace, or Dulcolax, taken as directed. You may also opt for a stool bulking agent such as Metamucil or Benefiber daily.
Metabolic Changes: Two to four weeks after surgery, your body reacts to the smaller amount of food. You feel tired, lethargic, and often depressed. Your body wants to slow down until the old food supplies returns. The best way to deal with this is to recognize the symptoms and know they are normal. Start exercising so your body gets used to using body fat as source of energy. As your body adjusts, the hibernation syndrome will end.
Hypoglycemia: You may feel lightheaded, shaky, faint, or have a headache. This could be caused by hypoglycemia
(low blood sugar) and can be helped by drinking milk or orange juice, or by eating a graham cracker, a granola bar or a piece of hard candy. It is a good idea to carry one of these products with you at all times. You may experience this if you have skipped a meal, or did not eat before exercising. You can also suffer from what is called rebound hypoglycemia, if your diet is high in carbohydrates. If this condition continues contact your bariatric surgeon.
(To prevent hypoglycemia eat a well balanced meal that includes proteins, whole grains, fruits and vegetables).
Dumping Syndrome: This is the result of an intolerance to foods that are high in sugar (sweets), fats or grease. When you eat these foods, they now enter your intestines without being partially digested by the gastric juices of your old stomach. You may then become lightheaded or dizzy and have cramps, diarrhea, flushing, or sweating. Some patients may even suffer from nausea and vomiting. This reaction can last for 30 minutes or a day. Once a patient experiences this very unpleasant reaction, they will want to avoid foods that caused the dumping syndrome.
Possible complications of lesser frequency
Gastroenterostomy stenosis:
The anastomosis of the stomach to the bowel is made a certain size to restrict the rapid emptying of your new stomach. In some patients, excessive scarring can occur at this site and will shrink this opening further. The patient usually complains of inability to tolerate solid foods and may have retching or vomiting. This complication is managed by performing an endoscopic dilation (enlarging the opening via an upper GI endoscopy). It may require multiple dilatations at different times to manage the problem.
Marginal ulcers:
Erosion occurring at the anastomosis between the small intestine and stomach pouch. Patients usually complain of pain, nausea and occasional vomiting of blood. Treatment is usually consists of antacid medications, however, refractory cases may require re-operation and reconstruction of the connection between the stomach and small intestine.
