Exactly how
the operation is done for an individual patient depends on their
individual anatomy, their general health status, whatever changes they may
have from prior surgeries, and what they hope to be achieve from the
operation. The stomach compartments can be completely divided from each
other or simply partitioned, the small stomach pouch and the intestinal
limbs may be connected to each other with either staples or sutures, a
small band may be placed around the stomach pouch, and the two intestinal
limbs may be made longer or shorter.
Patients will be on a clear liquid diet for the first few days immediately
following surgery, and then advance to a pureed diet. These foods will be
very soft, so as to pass through the small, newly formed pouch and stoma.
One of the main issues during this period will be adequate fluid intake,
and dehydration can be a problem for patients recovering from this
surgery. We will ask patients to take in at least 32 ounces of liquid a
day before leaving the hospital.
Approximately one month after surgery the patients can expect to advance
to a transitional diet. They begin to take more regular table foods, but
will often still go back to eating the pureed foods that they have
tolerated well. They will still be learning how to eat right, including
chewing food carefully, learning to drink most of their liquids between
rather than with meals, and learning that eating the wrong foods, such as
sweets or fatty foods, can make them ill.
Patients experience the most rapid weight loss during this period. They
are often thrilled to see the weight coming off, sometimes at the rate of
20 pounds a month, but it is not an easy time. Patients feel the loss of
calories taken in, and are sometimes low in energy. Their small pouch will
make them uncomfortable when they eat too much or too fast. They may have
diarrhea, which can usually be controlled by avoiding certain foods or by
taking medication. They may experience hair loss, though the hair usually
begins to grow back within a few months.
At 6
months the patients will probably be on their long-term maintenance diet,
which is more or less what and how they will eat for the rest of their
lives. The maintenance diet for the most part consists of regular table
foods, but in small portions. Most patients describe their meals as child
sized, and they often do not finish what they are served. The patients
generally become comfortable eating these small meals, and almost always
say the loss of the ability to enjoy large meals or certain foods is more
than compensated for by being able to successfully control their weight.
Patients may expect to lose approximately 70% of their excessive body
weight during the first 2 years following surgery. An approximately 10%
weight regain is sometimes seen between years 2 and 5, perhaps because the
small pouch increases several ounces in size, and perhaps because the
patients learn how to take in extra calories without making themselves
sick.
