What to Expect After the LAP-BAND Operation

     AFTER THE OPERATION

When you wake up from the operation you will have some discomfort. There are two main sources of this discomfort. Firstly, the sites where we passed the tubes through the abdominal wall can be sore, especially the one where the access port is placed.

Secondly, it is common to have pain at the left shoulder area after the procedure. This pain is actually coming from the diaphragm, which is the largest sheet of muscle that separates the chest, with its heart and lungs, from the abdomen. It is called referred pain because, although it comes from the diaphragm, the brain interprets it as coming from the left shoulder and you feel sore there. It is common early after the operation but usually settles in a few days. Occasionally it can linger on for many weeks. We do not know exactly why it occurs and therefore we cannot predictably avoid it. Apart from letting time pass, various simple techniques have been found to help and are with trying:

• hot packs to the shoulder
• standing or sitting upright
• resting quite still for 10 minutes
• walking about
• peppermint tea
• simple pain relievers-acetaminophen (paracetamol) or soluble acetylsalicylic acid (aspirin).

Although placement of LAP-BAND is not totally painless it is not nearly as painful as if we made a large incision. The anesthetist will have given you pain relievers before you wake up to block some of the pain and we can give you whatever additional treatment you need for pain relief at any stage. However, we will be trying to avoid pain relievers, especially (pethidine), as they can make you feel nauseous and might include vomiting.
You will be able to start taking fluids such as water, tea or coffee as soon as you are fully awake from the anesthetic.

You will have an intravenous drip in one arm to give you additional fluids and we are happy to remove this as soon as you are drinking fluids without difficulty. Generally, we expect to remove the intravenous drip at about an hour after you come back to your bed from the operating room.
We will be encouraging you to get up out of bed and move around soon after the operation itself.

Normally, you will get out of bed and go for a brief walk within an hour of returning from the operating room.

If you do this, your recovery is likely to be smoother and easier and it is likely that you will have less problems with pain from then on. The nurses will encourage you and help you with this early mobilization initially.

Depending on where you are being treated, you may go home within 2-3 hours of the procedure or you may stay overnight. We usually do a limited barium swallow X-ray examination before you go to check that the band is in the correct position and that there is easy flow of liquid past the band. The barium swallow X-ray examination is not essential but does provide some helpful information and therefore we use it if the costs are low. In some settings it is quite expensive and then should only be used for selective patients. It involves taking just two or three mouthfuls of the barium. It does not taste great but, with the small volume, you will cope. The X-ray serves to reassure us that the band is in the correct position, shows that there is free passage of fluid past the band and provides a useful baseline and follow-up details. It enables us to compare this X-ray with future studies.
Before you go home we spend some time going over the rules regarding eating, particularly for the subsequent four weeks. We will make your initial follow-up appointments and we provide you with contact details should any questions arise once you are at home.

After you go home we would normally expect you to take 1 to 2 weeks to get back to normal activities. Even at this time however, you may be feeling more tired by the end of the day and you will still be trying to identify the best practices regarding eating. Nevertheless, by this time you will clearly see that you are almost fully recovered from the procedure and will already be seeing some weight reduction. You can return to work when you feel strong enough. Some will be back in a day or two but most off work for at least a week from the procedure. We are happy for you to drive your car once you feel that you can move easily without discomfort and you can rotate enough to see about you. Normally this would be day 3 or day 4 after the weight loss operation.

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