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Get the Facts on Duodenal Switch.

Leading to Your Surgery and Hospital Stay

Different hospitals and practices have their own processes. For the most part, the overall process is the same. This will require patients to register in the hospitals system before the day of surgery. For most hospitals this is done after an appointment has been made and prior to surgery the surgeon will see the patient.

The day of surgery will usually start early in the morning. The patient needs to get to the office early to start signing paperwork, then the nursing staff in the preoperative holding area will start an IV access and administer the medications that may have been ordered by his/her surgeon and the anesthesiologist. These medications will include antibiotics, antacids, blood pressure and diabetic, if indicated, also something to “calm” the nerves down after consents have been signed.

A family/friend can join the patient when they’re in a surgical gown waiting to be taken to the operative room. By this time, most patients will be given some medication to relax them, and then they will be taken to the operating room and will be placed onto the operating table. The anesthesiologist and the nursing staff will connect the monitoring devices to measure blood pressure, heart rate and saturation of the oxygen in the blood. This is when patients drift to sleep due to the medication that was given to them.

Most patients’ first recollection is in the recovery room. The nurses in the recovery will assure the patient that they have adequate pain medication. This variable depends on the surgeon and the type of the procedure the patient has had. The patient may or may not have a nasogastric tube a Foley catheter, feeding tube or JP drains.

Throughout recovery in the hospital, some or all of these tubes and drains will be removed prior to being discharged home.

Pain management has also changed significantly over the last few years. Most patients will have a patient-controlled analgesia (PCA) machine that controls the amount of narcotic medication being delivered into the system; these include morphine, dilaudid, fentanyl, and Demerol. Patients may also have IV Tylenol and Toradol in addition to the PCA above. The idea is that the synergistic effect of the medication works better than individual ones, some surgeons and anesthesiologist also use epidurals. Also, some surgeons will utilize a local anesthesia infusion pressure bag. Then catheters are placed under the skin and connected to a self-contained reservoir, which continuously pumps local anesthesia into the wound.

It is important that the patient is able to distinguish between the postoperative incisional pain and intra-abdominal gas pain. Surgical postoperative pain should be treated with pain medication. Pain associated with bloating, intra-abdominal gas, and back pain associated with the uncomfortable hospital beds, should be controlled with early ambulation and pain medication. It is very important that the patient's realize the significance of getting out of bed within hours of the surgery and spend some time sitting up in a chair or walking up and down the hallway. This not only helps with reducing the chance of blood clots in the legs, but it can also helps with reducing the intensity of the nonsurgical pain.

Some surgeons allow the patient to start a liquid diet immediately after surgery, while others would want the patient to pass gas prior to resuming diet. Most surgeons and hospitals have clearly outlined protocols for resumption of diet; the frequency, the volume and the types of the food/fluids the patients are expected to have. It is important to understand that if the patient does the surgery during the same stage, at different hospitals, operated by two different surgeons, may be instructed to follow completely different diets.

Bowel function will return, and any drains that were placed in the operating room will be removed. If a feeding jejunostomy tube was placed it will stay in and be removed later on. Do not worry about this- unlike the JP (drains that may not be comfortable coming out), the feeding Jejunostomy tubes slide out with most patients not even realizing it.

Car rides after discharge may be uncomfortable, but a patient may be provided and with an abdominal binder which will that helps. Some patients also find it very comforting to hold onto a pillow as an external support.

It is also very important for the patient to not let the pain get out of hand. This means a patient must take the pain medication for the first few days on a regular basis. As to when a patient is to resume their medications the hospital staff will discuss this after discharge. A surgeon or hospital staff will want the patient to begin their multivitamins, calcium, and other supplements; a discussion of change to their diet and care to the would or related issues will have specific instructions from the surgeon.

Furthermore, patients’ must not forget that part of the recovery includes walking in regular intervals and patients’ should increase the distance they walk continuously. This not only reduces long related consultations of atelectasis (blocked small airways of the lung), which may be due to pneumonia, but also reduces the chance of blood clot formation as mentioned before. Patients’ may also be given an incentive spirometry machine; this is a breathing exercise tool that is supposed to help expand their lungs. This should be continued being used at home.

At some point, usually the day before discharge, and a few days after being home, most patients will find themselves asking the question, “ what did I do to myself?” This reaction is normal and expected. It is important that patients keep reminding themselves as to why they decided to have the surgery and that this is a passing phase. These feelings are increased by the inability to get totally comfortable; lack of sleep, episodes of nausea, pain associated with the incision, having lost “control”, which worsens the feelings of regret. This would be a good time to reach out to the network of support that is available to the patient since they have become a part of the DS community.

The patients “job” at home, after being discharged from the hospital, is to stay hydrated, walk and slowly increase their diet. Different patients will progress at different paces. Patients must keep in mind not to compare notes and progress to other patients. Patients, while at home, won't feel like eating or drinking; not much will taste the least bit pleasant either. Having said all of this, it is important to aim for 64 ounces of water a day; experiment with flavors and temperatures to find something that can be tolerated. Most patients tolerate room temperature much better than ice-cold water and over hot tea. Adding a few drops of lemon or limejuice also helps to break the plain taste of water, also, patients should not be discouraged if it appears impossible for them to drink the water. Because of the reduction of a small stomach associated with the surgery, patients have to resort to continuously sip, versus drinking a glass of water at a time. Patients are encouraged to take a sip before doing anything; water is also tolerated much better while in a standing position. It is a good idea to make a habit of walking with a bottle of water in hand and sipping on it while walking continuously. Note that there is more consumption of water while walking then when sitting.

Eating is not going to be any easier; protein drinks that were reasonably pleasant before surgery may taste horrible after surgery. For some patients, absolutely nothing will taste acceptable for some time. It is important to take this phase one bite at a time; focus on having the next sip of water, protein drink, and the next bite of your a meal.

Most patients also reported a significant change in their taste palate. Foods that were their favorite may not be as desired. Also, cravings will develop for things that were not desired before surgery. The sense of smell may also be significantly heightened.

Patients have reported that over time things get easier. Slowly but surely water will be easily tolerated, a toleration of a broader spectrum of food will occur, and stamina as well as activity levels will improve.

Almost all patients have commented that their recovery was better than expected and that if they had known about the surgery, they would have done it sooner.