Home Care After Endoscopic Sleeve Gastroplasty and Gastric Bypass Revision (TORe)

This Health Facts for You will tell you how to care for yourself at home before and after endoscopic sleeve gastroplasty.

Before Surgery

1 Week Before Surgery

• Start taking omeprazole 40 mg once a day, 30 minutes before breakfast.

• Stop aspirin

• If on other blood thinner, discuss with your doctor.

• If on diabetes medicines, discuss with your diabetic team and doctor.
  

12 Hours Before Arrival

• Stop all food and drink.
  

Night Before Surgery

• Take one Emend (aprepitant) 80 mg tablet by mouth.

• Place the scopolamine patch behind your ear.
  

After Surgery

Restrictions

• Do not drive or operate a motorized vehicle or dangerous equipment fo rone day.

• Do not make important decisions or sign any legal documents on the day of the procedure.

• Avoid lifting anything >20lbs for 4-6 weeks.
  

Redness/Swelling

If you have redness or swelling at sites where medicines were given, place a warm wet washcloth over the affected area for twenty minutes at a time until redness improves. If symptoms continue for more than 2-3 days, call Digestive Health Center during normal business hours.

Medicines

Ondansetron 8 mg:

• 8 hours after surgery: Take 1 tab under the tongue for nausea.

• For 4 days: Keep taking 1 tab every 8 hours.

• After 4 days: call Digestive Health Center if you still have nausea.
  

Hyoscyamine 0.125 mg (as needed):

• Take 1 tab under the tongue every 6 hours for cramping, as needed.
  

Lorazepam 0.5 mg (as needed):

• Take 1 tab by mouth every 12 hours for nausea only if symptoms are not controlled by ondansetron.

• Do not drive or operate a motorized vehicle or dangerous equipment while taking.
  

Hycet 15 ml (as needed):

• Take by mouth every 12 hours for pain, as needed.

• You may also take liquid Tylenol® (Children's Tylenol®) for pain control instead of Hycet.
  

Diet

• First 72 hours: Clear liquids only until nausea improves.

• After 72 hours: When nausea improves, advance to full liquids. Stay on this diet through day 30 (4weeks).

• After 30 days (4 weeks): Start smooth pureed foods.

• After 6 weeks: If you feel well, have tolerated smooth pureed foods and your symptoms have resolved, you can advance to a soft diet.

• You can return to a regular diet if you tolerate the soft diet

Clear Liquid Diet

A clear liquid diet consists of only clear liquids (liquids that you can see through when you hold up a glass of the liquid to light). You can't eat solid food while on a clear liquid diet. Clear liquids include:

• Water (plain or flavored)

• Fruit juices without pulp, such as apple or white grape

• Fruit-flavored sugar-free beverages, such as fruit punch or lemonade

• Jell-O (plain gelatin strained juice)

• Tea or coffee without milk or cream

• Strained tomato or vegetable juice

• Sports drinks

• Clear, fat-free broth (bouillon)

• Ice pops (no milk, bits of fruit, seeds or nuts)
  

Clear fluids are easy to digest and leave no residue in your intestinal tract. Because a clear liquid diet can't provide you with the calories and nutrients you need, only follow the diet for one to three days. You will also need a protein supplement called “Beneprotein.”

Full Liquid Diet

This diet includes all liquids that can pour off of a spoon. No lumps or bumps. The food should be able to pass through your pouch without causing pain or vomiting. Make sure your full liquids are sugar-free and low fat to prevent nausea.

You may not feel hungry and find it hard to eat even three times a day. Your servings should be about 2-4 tablespoons per meal. Use standard measuring spoons to measure portion sizes.

Eat your meals slowly. Allow 20-30 minutes per meal. Drink water or zero-calorie fluids throughout the day. Your goal is 48 fluid ounces a day, working up to 64 fluid ounces a day.

No straws. You can suck up too much air and cause discomfort. Sip, sip, sip.

Full Liquid Foods

These are foods that are liquid or semi-liquid at room temperature. Choose sugar-free and low-fat foods to help prevent nausea. Approved foods include:

• Any clear liquids from stage 1

• Fat free or 1% milk

• Light soy milk

• Canned creamed soups made with nonfat or 1% milk

• Canned broth-based soups run through the blender, no lumps or bumps

• Protein supplement drinks (limit 30 grams of protein per serving) \

• Thinned hot cereal such as cream of wheat, farina, cream of rice, or blenderized oatmeal \

• Thinned mashed potatoes (thin with chicken, vegetable, or beef broth)

• Packaged gravy mix

• Thinned sugar-free yogurt, plain nonfat yogurt

• Light drinkable yogurt

• Sugar-free popsicles
  

Flavor Options

• Sugar substitutes

• Vanilla, strawberry, almond, coconut, or butter extract

• Cinnamon, nutmeg, pumpkin pie spice, or apple pie spice

• Thyme, oregano, basil, garlic, onion powder
  

Between Meal Liquids

Choose low calorie options, less than 10 calories per 8 fluid ounces:

• Water

• Crystal Light® or other sugar-free flavored drink packets

• Broth

• Decaf coffee or tea – fat free creamer and sugar substitute are OK

• Tomato or vegetable juice (limit to 6 fluid ounces per day)

• Sugar-free gelatin (chew, chew, chew)
  

Sample Meal Plan: Full Liquids

Pureed Diet

A pureed diet is made up of foods that do not need chewing. They are ground, pressed, blended, or sieved (strained) to the consistency of a soft creamy paste or thick liquid. You must still avoid chunks to prevent food from getting stuck.

Keep drinking fluid between your meals. Stop drinking 30 minutes before your meal and start again 60 minutes after your meal.

Foods Allowed

• All foods from the clear and full liquid diets

• Yogurt blended without chunks

• Masked cottage cheese

• Scrambled eggs

• Pureed beef, chicken, or turkey

• Baby food meats

• White fish mashed with a fork

• Tuna mashed with a fork

• Mashed or pureed potatoes/sweet potatoes

• Pureed cooked butternut squash

• Pureed cooked spinach, carrots, green beans
  

Soft Diet

A soft diet is made up of foods that are easily chewed and swallowed. Avoid hard, stringy and tough foods and those that cause gas. You should still cook vegetables in this phase and chew all food well to avoid food from getting stuck.

Foods Allowed

• Liquid or pureed diet foods

• Moist and tender meats

• Cooked or canned fruits

• Banana

• Avocado

• Cooked vegetables

• Plain white rice, pasta

• Refined white or wheat bread
  

Foods to Avoid

• Nuts and seeds

• Dried fruit

• Smoked meats

• Broccoli,

• Brussel sprouts

• Cabbage

• Cauliflower

• Onions
  

Who to Call

You can send a MyChart message to Dr. Spiel or call the number listed below.

Digestive Health Center

Monday—Friday, 8 a.m. –5 p.m.

608-890-5090

For issues after hours, please call 608-890-5090 or 608-262-2112. Ask for the GI Fellow on-call,