Iowa Bariatrics, Inc.

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What is the significance of the drainage tube? With regards to the drain: The amount of drainage is not of much significance. If the drainage begins to look like oral intake that is of concern and should be confirmed by drinking something blue or purple (food coloring or grape juice) and seeing if the color appears in the drainage. If it does it should occasion a call to the physician. Drainage or wetness outside and around the drain tubing is usual and does not signifiy that anything is wrong, in particular it is not a sign of infection. Redness extending more than two inches from the drain site should be seen by the surgeon. The drain is protection against a wound infection at the drain site and against the life threatening consequences of a leak. Leaks are very rare after two weeks. Removal of the drain before two weeks after surgery entails some extra risk. Patients who want the drain removed early should consider the risk. About 2% of patients will develop a leak. It is ok to shower and get incision sites or drain sites wet and soapy after surgery. The area should be dried off afterwards and dressed if wetness at the site might stain clothing. A temperature greater than 101 degrees is reason to call the doctor. Lower temperatures are not usually of much significance. Patients often complain that the drain site hurts and that relates to two considerations: First, the drain is brought out the largest and therefore tenderest port site. Second, the drain is sutured to the skin so that it will not be accidentally pulled out and if it is not taped so that pulling on the drain does not pull on the suture a good deal of discomfort can result from normal activity. What if I'm having constipation? Constipation after gastric bypass surgery is a common complaint. It is caused by decreased food and water intake and, in some people, supplemental iron, or narcotic pain killers, tranquilizers, and antidepressants. It is often aggravated by weak abdominal muscles or busy schedules wherein people defer having a bowel movement when the urge exists. Our approach is to provide the following advice: Do exercises that strengthen the abdominal muscles and assist in bearing down. Most people experience the need for a bowel movement after breakfast and that is the natural and easiest time to have a bowel movement and should not be ignored. Increase water intake. An increased intake of any vitamin except B12and vitamin A tends to produce diarrhea and has not significant other side effects and is helpful in eliminating constipation. Especially useful in this regard is Vitamin C or ascorbic acid since in addition to preventing constipation it enhances the absorption of iron in Trinsicon or other forms. Next add fiber to the diet: Eat high fiber breakfast (bran-based cereals, oatmeal) add vegetables to other meals. Miller's unprocessed bran found in the cereal section of the grocery store can be taken with juice, or sprinkled into salad, meatloaf, cereal, etc. The same thing can be done with Metamucil, or psyllium seed. These are more expensive forms of non-digestible cellulose or fiber. The water content of stool can also be increased with a stool softener, docusate sodium, marketed as Colace, or Peri-Colace or P-Col-Rite. If the above measures are still not correcting the problem the electrolyte laxatives such as Fleet Phospho-Soda, Magnesium citrate, Milk of Magnesia, or Colyte, to name a few, should be tried. Avoid laxatives that directly stimulate the bowel smooth muscle eg. Senecot, as tolerance develops and more and more is required over time. What if I'm having gas? Excessive air swallowing is probably the commonest cause and may result from deliberately belching to relieve a sense of fullness or from swallowing frequently as sometimes occurs with anxiety and nervousness. A deliberate change in behavior is usually effective. Simethicone, marketed as Gas X, helps reduce large bubbles of gas to small ones and may relieve the cramping sensations. Nullo which is a chlorophyll derivative also may be helpful. After gastric bypass, excessive dietary intake of fat increases intestinal transit time and delivers undigested food to the colon. Food in the colon is broken down by resident bacteria and results in a very malodorous gas. A restriction of dietary fat intake may be sufficient to eliminate the problem. Bismuth subgallate marketed as Devrom (1-800 453 8898) is also helpful. If the problem occurs soon after a distal gastric bypass, Pancrease

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