Transcription:

Bill Klaproth (Host): If you are scheduled or thinking about a bariatric weightloss procedure, you probably have questions about the hospital experience. Here to talk with us about that is Jenifer Stein, Program Navigator for the Bariatric and Colorectal Surgery Programs at Saint Barnabas Medical Center supporting Garden State Bariatrics and Wellness Center. Jenifer, thank you so much for your time. We appreciate it. So, take us through this. What happens 30 days out from the procedure?

Jenifer Stein, MS, RDN, CDE, CSSGB (Guest): Thank you for having me today. Yes, that’s a very good question. We find that our patients have a lot of questions about what to expect in the hospital. Thirty days before surgery, we like our patients to come to the hospital to our preadmission testing area. In the preadmission testing area, our patients will talk to the multidisciplinary team about what to expect the day of surgery. In the preadmission testing appointment, they will meet with the anesthesiologist, the nurse practitioner, the patient educator. The preadmission testing technician will take bloodwork and bring them to any other testing that their surgeon would like them to have before surgery.

Host: Okay that’s good to know. So, there’s a lot of involvement, a lot of testing beforehand. So, as the big day comes, it’s time for bariatric weightloss surgery; can you take us through that from the time the patient gets to the hospital up until surgery time? Can you paint that picture for us and what happens?

Jenifer: Sure. The patient will receive a phone call the day before surgery from the nurse in the surgical area which will tell them what time to report to the hospital. Typically, the patient can expect to report to the hospital two hours before their surgery time. When they come to the hospital on the day of surgery, they’ll go to the registration area where they will register to be in the hospital. Most of the information that they will be asking will already be in the medical record as they’ve already gathered that information at their preadmission testing appointment.

From the registration area, the patients will report to the surgical welcome desk. At the surgical welcome desk, the greeter will let the surgeon know that the patient has arrived, and the patient and they can have as many loved ones as they want with them in the surgical waiting area, however, just one visitor will stay with them into the preparation area. So, from the registration area to the welcome desk and then into the preparation area.

The nurse will call back the patient into the surgical prep area and get them ready for surgery. Again, the patient can have a loved one with them in that area. The nurse will instruct the patient on how to cleanse their body to get ready for surgery, change them into a hospital gown and start running some IV fluids. From the preparation area, the patient will be rolled on a stretcher into the operating room holding area. We call that the OR holding area and then from the OR holding area into the operating room.

The loved one can wait with the other family members in the surgical waiting area and then will be called when the surgery has been completed and meet – one visitor can meet the patient in the recovery room.

Host: Really detailed Jenifer, thank you so much. So, you really painted that picture. First registration, then the welcome area, then preparation for surgery, into the holding area and then into the operating room. So, do you get questions about anesthesia? When will the person be put out then in this timeline?

Jenifer: Yes, I get questions on how long is the waiting time before they can meet their loved one in the recovery room. It depends upon the procedure. I would suggest that the patients talk to their surgeon about how long they think the procedure might be. We do standard procedure for maybe the sleeve gastrectomy may be an hour or two of surgical time, however, each patient may be having different procedures so they should really check with their surgeon at their preop visit to see how long they think the surgery would be.

Host: All right Jenifer, so after the surgery is done; what happens then?

Jenifer: The patient will wake up in the recovery room, we call it PACU, post anesthesia care unit. The nurses will assess the patient for nausea and vomiting and then the anesthesiologist will perform a procedure called a TAP block in the recovery room. A TAP block is a nerve block that allows our patients to be pain-free for about 12-18 hours. Our hospital is very unique in that we use these TAP blocks for many abdominal surgeries as a way to manage pain without reliance on stronger pain medications like opioids that could have side effects.

Host: So, Jenifer, I know this is a general question, but can you home in on the general lengths of stay per procedure?

Jenifer: Sure. At Garden State Bariatric and Wellness Center they perform different weightloss procedures. One of the procedures they perform is a gastric band removal. Some of our patients had a gastric band many years and need to have it removed. The gastric band removal is a same day procedure, so the patient will not spend the night in general.

Another procedure that the team performs is a sleeve gastrectomy. Typically, with a sleeve gastrectomy, the length of stay in the hospital is overnight, just one day. And then another procedure that the surgeons are performing is called a loop duodenal switch. Typically, those patients spend one to two days in the hospital.

Host: So, then what is the discharge criteria?

Jenifer: The discharge criteria for our patients is we want them up and walking. We want them ambulating. We want them tolerating their fluids. We want them to have their pain managed to an acceptable level. That’s typically the discharge criteria.

Host: And after discharge, can you tell us about the follow up afterwards?

Jenifer: The patients can expect to visit their surgeons for a follow up visit one week after surgery, meet with their surgeons and the physicians assistant and the dietician. After that, at Garden State Bariatrics and Wellness Center, they typically like their patients to have a follow up visit a month after surgery, three months after surgery, six months, 12 months, 18 months, 24 months after surgery and then yearly after that. In addition to meeting with their surgeon – following that appointment schedule, the patients should meet with their primary care physician and we highly recommend that our patients attend monthly support groups.

Host: So, you are with this person every step of the way after the procedure. Can you briefly tell us a little bit more about support groups?

Jenifer: Support groups are run by myself as a clinical nutritionist and a clinical psychologist. We meet once a month. It’s open to the community. The patients don’t necessarily need to have had their surgery done with Garden State Bariatrics or at Saint Barnabas Medical Center. We open up to the community, so it is open up to anyone who has had a previous weightloss surgery. We run it once a month. We meet for about an hour to an hour and a half. We typically have a topic picked out that revolves around nutrition, physical activity, behavior, support after surgery.

Host: Very good information and if you want more detailed information on support groups listen to our podcast on support groups that Jenifer and I have done. Well Jenifer, thank you so much for this great information today. We appreciate it. And for more information please visit the Garden State Bariatrics and Wellness website at www.gsbwc.com, that’s www.gsbwc.com. This is Winning Through Losing a weightloss surgery podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.