1. BARIATRIC SURGERY UT Health | McGovern Medical School
UT Minimally Invasive Surgeons of Texas

2. University level personalized care in your neighborhood

3. MSWL and clinical clearances
Initial Visit
MSWL and clinical clearances
Pre-op visit
Surgery
Post-op Visits
Support Groups
The Process

4. Before Your First Appointment
Establish a relationship with a primary care physician if you don’t already have one
Ensure that your routine health maintenance testing is current, i.e. mammography, pap smear, prostate specific antigen
If you need a screening colonoscopy, we can perform this
Make a list of all the diets and medications you have tried
Bring any pertinent medical data including reports of special tests
- echocardiogram, sleep study, upper or lower endoscopy, etc.
Bring a list of your medications with dose and schedule
STOP smoking

5. Initial Visit
We will review your medical and surgical history and perform a physical exam. We will discuss the best surgical option for you.

6. Standard Pre-Operative Evaluation
Nutritionist/Dietician
Mental health evaluation
Pulmonary and/or Cardiac clearances
Nutrition/Bariatric bloodwork
EGD (upper endoscopy)
Medically supervised weight management sessions per insurance requirements

7. Mental Health Evaluation
Everyone is required to see a mental health specialist
Identify and make a plan to deal with food triggers
- Stress eating? Boredom? Food addiction?
Support is key
Develop long term plan specific to you

8. Preparing for Surgery
Develop a healthy eating routine Become active now Stop tobacco and alcohol use

9. You completed all preoperative requirements and received insurance precertification!
Once the date of surgery has been secured, you will be scheduled for a preoperative visit.

10. Final Preoperative Visit
Review all required clearances
Answer questions and address concerns
Discuss preparation for surgery
- Anesthesia Clinic
- Review medications
- Time of arrival to day surgery, time of surgery
- Preoperative Liquid diet

11. Preoperative Liquid Diet
Begins 1-2 weeks prior to date of surgery in order to help reduce the size of the liver
Meal-replacement shakes for breakfast, lunch, and dinner
Snacks: calorie-free liquids, sugar-free Jello, sugar-free ice pops, and broth

12. If you gain weight during this process your surgery will be CANCELLED.
NO SMOKING.

13. The Surgery Surgery Length Band = 30-60 min Sleeve = 45-90 min
Bypass = hours
Duodenal Switch = hours

14. Hospital Stay
1-2 nights
Minimize risk of deep vein thrombosis (DVT) or pulmonary embolism (PE)
- Compression boots, blood thinners, ambulation
Pain Expectations
- Anesthetize the nerves supplying the abdominal wall
- Minimize narcotic pain medications
Activity
- In the afternoon after surgery, the nursing staff will assist you to get up and walk
Diet
- You will be started on a clear liquid diet 4 hours following your surgery
- 1 ounce = 2 tbsp. = 30 cc of liquid intake is needed every 15 minutes to maintain hydration

15. Postoperative Diet Stage One Day 1- Day 3 Clear Liquid Diet Stage Two
Full Liquid Diet
Pourable liquids without chunks only
Protein shakes (60g daily)
Start daily MVI and calcium/Vit D
Stage Three
Week 3-6
Puree Diet
Stage Four
Maintenance
High protein, low carbohydrate diet

16. Closely follow the dietary guidelines as discussed Allowing time for proper healing of your new stomach pouch is necessary and important to avoid complications

17. Rules for Success: Hydration
Drink ounces of fluid a day
Take small sips – no gulps
Do not drink 30 minutes before or after a meal once on solid foods
All fluids should be sugar-free
Avoid carbonated drinks, alcohol, and excessive caffeine

18. Rules for Success: Meal Pattern and Preparation
After your recovery, your diet will consist of 2-4 small sized meals a day
Eat slowly and chew food thoroughly
- 1 minute per bite, min per meal
Protein in the form of lean meats (chicken, turkey, beef, fish) and other low-fat sources (cottage cheese, eggs, tofu, milk, and cheese) should be eaten first
- Minimum of 60 grams daily

19. Rules for Success: Meal Pattern and Preparation
Avoid high fat, high sugar foods (sauces, gravies, butter, margarine, and junk foods)
STOP eating when you feel satisfied
Try not to skip meals, especially early in the day

20. Rules for Success: Exercise
Aerobic exercise may begin once surgical pain has resolved
- Every day for at least 20 min
One-mile brisk walk, bike riding, stair climbing, swimming etc.
Weight/resistance exercise can be added 4 weeks after surgery
- 3-4x a week

21. Rules for Success: Vitamins
Adult multivitamin daily
- Does not need to be liquid/chewable once on solid food
Calcium citrate with Vitamin D
mg calcium daily, best absorbed in mg dose
- At least 3,000 IU of Vitamin D
Vitamin B12
mcg daily
Iron
Probiotic

22. It is strongly recommended that women wait at least one year after surgery before a pregnancy

23. Comprehensive Follow-up
Routine follow-up visits are scheduled at 1 week, 6 weeks, 3 months, 6 months, 9 months, 1 year, 1.5 year, and then yearly
During these exams, we will review personalized health, diet, exercise, medication, and vitamin/mineral requirements and track progress
This is a good time to discuss any post-operative problems or concerns
Long-term weight may fluctuate 10-20% from lowest weight, this is normal
We want to see you even if you are feeling great!

24. Support groups are available on an ongoing basis.
We are committed to providing comprehensive, compassionate care and want to help you achieve a healthier and happier life.
Support groups are available on an ongoing basis.

25. Minimally Invasive Surgeons of Texas
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Minimally Invasive Surgeons of Texas
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