Current research suggests that one in three Americans is obese. In this country alone, about 300,000 deaths per year can be linked to obesity. Obesity is associated with serious health conditions, including high blood pressure, heart disease, sleep apnea (serious sleep disorder), heartburn or reflux, cerebral artery disease (stroke), diabetes mellitus (sugar diabetes), asthma, osteoarthritis, infertility, and cancer of the breast, colon, prostate, and uterus. Usually, within the first six months after weight-loss surgery, patients will no longer need to take medications for these conditions.

Medical conditions that may be greatly improved after bariatric surgery include:

• High blood pressure. At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure typically two to three months after surgery. When medications are still required, their dosage can often be lowered, with reduction of medication side effects.
• High cholesterol. More than 80 percent of patients will develop normal cholesterol levels two to three months after the operation.
• Heart disease. Although it can’t be said definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol and diabetes certainly suggests that improvement in risk is very likely. In one recent study, the risk of death from cardiovascular disease was profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.
• Diabetes. More than 90 percent of Type II diabetics obtain excellent results, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as bariatric surgery — which has led some physicians to suggest that bariatric surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or “borderline diabetes,” is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well.
• Asthma. Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.
• Respiratory insufficiency. Improvement of exercise tolerance and breathing ability usually occur within the first few months after gastric bypass surgery. Often, patients who have barely been able to walk find that they are able to participate in family activities — even sports.
• Sleep apnea syndrome. Dramatic relief of sleep apnea occurs as patients lose weight. Many report that within a year of bariatric surgery, their symptoms were completely gone, and they had even stopped snoring completely — even their spouses agreed. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after a surgical weight-loss procedure.
• Gastroesophageal reflux disease. Relief of all symptoms of reflux usually occurs within a few days of gastric bypass surgery for nearly all patients.
• Gallbladder disease. When gallbladder disease is present at the time of the surgery, it is “cured” by removing the gallbladder during the surgical weight-loss procedure. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.
• Stress urinary incontinence. This condition responds dramatically to surgical weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.
• Low back pain, degenerative disk disease and degenerative joint disease. Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after bariatric surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.

1. How long will I stay at the hospital or facility?
1. The procedure for most open hernia repairs is between 30-90 minutes and is done on an outpatient basis, meaning you will go home the same day. While patients recover differently from anesthesia, most get discharged after a few hours.
2. When can I shower after surgery?
1. Patients who have an incision after an open repair should not shower until the bandage is removed (around 3-5 days). You should aim to keep the dressing dry and clean. In addition, patients should not visit a swimming pool or jacuzzi until the incision is healed.
3. How should I care for the incision?
1. The dressing should be left on for 3-5 days, but should be changed earlier if the dressing gets soiled, wet or dirty. 
4. What activity restrictions do I have?
1. Light walking is acceptable and encouraged after surgery.  You should NOT lift anything heavier than 20 lbs for 6 weeks after surgery and avoid strenuous exercise for at least 6 weeks following surgery as well. 
5. When can I exercise again?
1. Most patients are able to resume exercise 6 weeks after surgery.
6. Will I get pain medication?
1. Yes, we will send a prescription to your preferred pharmacy. Please let our office know which pharmacy you prefer, prior to your surgery.
7. When can I drive after surgery?
1. Patients should not drive while taking prescription pain medication. Once patients have stopped taking prescription pain medications, driving is acceptable as tolerated. 

1. How long will I stay at the hospital or facility?
1. Most inguinal, ventral, sports or umbilical hernia repairs will be done on an outpatient basis, meaning you will be discharged the same day. The procedure generally takes 60-90 minutes. While patients recover differently from anesthesia, most get discharged after a few hours.
2. Hiatal hernia repairs will usually require the patient to spend the night at the hospital, for what is considered a “23 hour stay”. If you are recovering normally, you should be discharged the morning following the procedure.
2. When can I shower after surgery?
1. For a laparoscopic procedure the incisions are closed with a special type of glue. It is fine to shower or take a bath the following day after surgery. Swimming pools and jacuzzis should be avoided for at least 2 weeks after surgery. 
3. How should I care for the incision?
1. For small incisions closed with surgical glue, wash the incisions lightly with soap and water. Please do not vigorously scrub the incision. 
4. What activity restrictions do I have?
1. Light walking is acceptable and encouraged after surgery. You should NOT lift anything heavier than 20 lbs for 6 weeks after surgery and avoid strenuous exercise for at least 6 weeks following surgery as well. 
5. When can I exercise again?
1. Most patients are able to resume exercise 6 weeks after surgery.
6. Will I be on pain medication?
1. Yes, you will be prescribed pain medication after the procedure. This will be sent to your preferred pharmacy electronically after surgery. For this reason, it is important to ensure you give the hospital facility the correct pharmacy where you want your medication to be sent, as we cannot change the pharmacy once the prescription has been sent in.
7. When can I drive after surgery?
1. Patients should not drive while taking prescription pain medication. Once patients have stopped taking prescription pain medications, driving is acceptable as tolerated. 
8. Can I have an MRI done if I have mesh?
1. Yes, the mesh used in hernia repair does not interfere with MRI imaging.
9. What is Phasix dissolvable mesh?
1. Phasix mesh will dissolve after about 12-18 months, and is made of a special synthetic material. More information be found here https://www.bd.com/en-us/products-and-solutions/products/product-families/phasix-mesh
10. What to do about constipation after surgery. 
1. Surgery and pain medication can often cause constipation after surgery. You can consider supplementing with Metamucil after surgery. This is a fiber supplement mixed with water and can be purchased at your local drugstore or most grocery stores. We recommend giving this a try along with ensuring to drink plenty of water and light walking. If that does not help resolve the issue, please give our office a call. 
11. Do I need to follow a special diet after surgery?
1. For patients undergoing hiatal hernia repair, a liquid diet will be consumed for 1-2 days after surgery. After 1-2 days, the diet can be advanced as tolerated. We recommend advancing to soft foods first and if tolerated, advancing to solid foods. 

1. Patients who have an incision after an open repair should not shower until the bandage is removed (around 3-5 days). You should aim to keep the dressing dry and clean. In addition, patients should not visit a swimming pool or jacuzzi until the incision is healed.

1. How should I care for the incision?
1. The dressing should be left on for 3-5 days, but should be changed earlier if the dressing gets soiled, wet or dirty. 

Every surgical procedure and patient have pre-operative instructions tailored to the individual case. Be sure to review your full medication list with Dr. Nguyen at your consultation appointment. General guidelines are as follows:

– No eating, drinking or smoking 8 hours prior to your surgery check-in time
– No over the counter blood thinner (Aspirin, Ibuprofen, Aleve) for 7 days prior to surgery.
– 81mg Aspirin is ok during this time if prescribed by a physician.
– Prescription blood thinners such as Xarelto, Plavix or Coumadin must be stopped 5 full days prior to your procedure unless otherwise instructed by prescribing physician.
– Tylenol is okay to take during this timeframe for any aches or pains you may experience
– Plan to continue all non-blood thinning medications.
– You must have a responsible adult check you out of the facility and drive you home after the procedure

If any questions arise, please call our office staff at 408-358-1855 for additional instructions.