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Department of Surgery
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 Obesity

Columbia University Center for Metabolic and Weight Loss Surgery
Patient Experience  Post-Operative Care


Discharge Instructions for Duodenal Switch Surgery Patients

Now that you are ready to go home here is some information you will need to care for yourself.

What medicines must I take and how do I take them?

So that the medicines can be absorbed and used by your body, you must:

  • Crush all non-chewable tablets and open all capsules. Mix powder with food.
  • Chew any chewable tablets completely then wash them down with liquid.
  • You may take liquid forms of your medicines, when available. Shake the bottle well before you pour the medicine dose.
  MedicineDoseComments
1 Prilosec® Take 20mg once a day for four weeks Open one 20mg prescription capsule OR two over-the-counter 10mg capsules into pureed food.
2 Lortab® Elixir (Hydrocodone/Acetaminophen) Take ½ - 2 teaspoons up to every 4-6 hours as needed. Once your discomfort lessens, change to Extra-Strength Tylenol® every six hours as needed. Take 2 tablespoons of liquid (equal to 1000mg) or two tablets (crushed).
3 Actigall® Take one 300mg tablet twice a day for six months. If you still have your gallbladder and do not have gallstones, we will start you on Actigall® at your first follow-up appointment.
4 Multivitamin with minerals Take 3 children's chewables every day.You can choose another form/type. Check your diet booklet.
5 Calcium   Check your diet booklet to choose a form/brand and to find the amount that you need to take every day.
6 Fat Soluble Vitamins Chew 1 tab 3X/day ADEK's order 800.472.2634 or www.axcan.com
7 Iron   Two to three weeks after discharge at your first follow up exam, your Dietitian will instruct you to start taking iron.

Medicines to avoid!

Do not take aspirin or aspirin-containing products. Do not take non-steroidal anti-inflammatories such as ibuprofen (Advil®, Motrin®, etc.) and naproxen (Naprosyn, Aleve®, etc.). They may cause ulcers in your pouch. Check with us if you are not sure which medicines you can take.
If you need to take any of these kinds of medicines, even once, call the Obesity Center. You may need a medication to protect your stomach, or a different prescription.


Can I shower or bathe?

Showering and using soap are OK. Pat the incision line dry after showering. Do not take a bath or soak the incision in water for one month.

If still in place, remove the outer bandage 3 days after surgery. Do not remove the steri-strips (i.e. adhesive strips) over the incision for one week or until they become loose. Some itching at the incision is normal during healing. Do not scratch the area.



How do I manage diarrhea?

  • Step one: reduce your consumption of high fat foods and beverages.
  • Step two: avoid milk and milk products.
  • Step three: if diarrhea persists, try 2 TBSP's of Pepto Bismol® every hour as needed, up to a maximum of 16 TBSP's in an 8 hour period or 2 TBSP's of Kaopectate® after each loose bowel movement. Remember to consume plenty of fluids to replace those you have lost in order to prevent dehydration.
  • Step four: If diarrhea persists call the Obesity Center.

What do I do if vomiting occurs?

  • If you vomit, you have probably eaten or drunk too quickly and/or too much.
  • Wait four hours and then try one ounce of a non-sugared liquid.
  • If this liquid does not make you nauseous or vomit, then continue with liquids until the next day. Then you can try soft/pureed foods again.
  • If vomiting persists, call the Obesity Center.

Diet Notes

  • For the first week after discharge, consume one ounce of pureed food OR one to two ounces of liquid no more frequently than every 20 minutes while you are awake.
  • For the next 2 weeks, all food must be in a pureed/soft consistency.
  • Starting the second week after discharge, consume 1 to 6 ozs. of food every 2-3 hours.
  • Consume 80-120 grams of protein everyday.
  • Make 1-2 choices from the milk group AND 8-15 choices from the protein group per day.
  • Consume at least one protein supplement daily.
  • Eat slowly! Stop eating when you are comfortably satisfied.
  • Do not eat foods that are high in fat.
  • No fluids for 30 minutes after a meal.
  • Drink as much fluid as possible throughout the day. Try to drink at least 48-64 ounces of non-caffeinated beverages every day.
  • Drink slowly and do not use a straw.
  • Drink no more than 2 cups of beverages that have caffeine per day.
  • Do not drink alcoholic or carbonated beverages for one month after surgery.

What kind of activity is allowed?

Do not drive until your pain is resolved and does not require medication. Pain can make it hard to move quickly. Stop any strenuous activity if it is uncomfortable during the first month. Walk as much as is comfortable for you. Your goal for the first 4 weeks after surgery is to walk 30 minutes per day, 7 days per week.


May I become pregnant?

You MUST avoid getting pregnant for 18 months after surgery. There may be a higher risk of birth defects while you are losing weight. Rapid weight loss increases fertility. Birth control must be used correctly and all the times to avoid pregnancy, even if you were not able to get pregnant in the past.


When do I follow-up after surgery?

You will meet with your Surgeon/Nurse Practitioner and Dietitian 2 to 3 weeks and 5-6 weeks after surgery. Subsequent follow-up visits with your Surgeon/Nurse Practitioner and Dietitian will be at 3 months and 6 months after surgery, then every 6 months till 2 years post-op and yearly thereafter.

You should have received dates and times for your first two follow-up visits with your preoperative instructions. If not, please call the Center to schedule them.


When should I call the Obesity Center?

Call us if you notice:

  • Increasing redness, swelling, heat or pain at an incision
  • Drainage from an incision
  • A fever greater than 101ºF
  • Abdominal pain
  • Frequent vomiting
  • Shortness of breath
  • Generally not feeling or doing well

EMERGENCY TELEPHONE NUMBERS

Call 212.305.4000 with any problems.
After 5PM, call your surgeon:

Dr. Marc Bessleron212.305.9506
Dr. Melissa Baglooon212.305.9506
Dr. Beth Schropeon212.305.9441

This information is brief and general. It should not be the only source of your information on this health care topic. It is not to be used or relied on for diagnosis or treatment. It does not take the place of instructions from your health care providers. For answers to your health related questions, talk to your health care providers for guidance before making a health care decision.


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