Other complications of gastric band procedure Unspecified procedure as the cause of abnormal reaction of patient or of later complication without mention of misadventure at time of procedure Other dysphagia
 
Name:  ___                    Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: SURGERY
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___.
 
Chief Complaint:
Dysphagia
 
Major Surgical or Invasive Procedure:
Gastric Band Removal

 
History of Present Illness:
The patient is a ___ woman who underwent
a laparoscopic adjustable gastric band in year ___, with
subsequent excellent weight loss.  She had actually been
doing very well, but developed acute onset of dysphagia and
vomiting.  Upper GI barium study demonstrated no passage of
contrast through the band consistent with a prolapse.  We
discussed at length the nature of prolapse as well as the
rationale for surgery.  We also discussed options including
band revision, band removal.  She understood the potential
risks as well as the expected outcomes and wished to have her
band removed.  We discussed possibly regain and she felt that
her lifestyle changes would achieve a durable weight loss.

 
Past Medical History:
 s/p lap band, GERD, seizure disorder ___ congenital 
malformation surgically corrected at ___. Last seizure ___, switched medication. 
 
Social History:
___
Family History:
non-contributory
 
Physical Exam:
98.3 97.4 58 122/68 16 98% RA
GEN: Well appearing, well nourished
CV: RRR ___
Resp: CTAB
Abd: Soft, obese, non-tender, non-distended
Ext: no evidence of edema, warm, well perfused
wound: Clean, dry and intact

 
Pertinent Results:
___ 03:05PM   GLUCOSE-53* UREA N-8 CREAT-0.8 SODIUM-141 
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-27 ANION GAP-13
___ 03:05PM   ALT(SGPT)-14 AST(SGOT)-20 ALK PHOS-48 TOT 
BILI-0.5
___ 03:05PM   ALBUMIN-4.3 CALCIUM-9.4 PHOSPHATE-3.5 
MAGNESIUM-2.0
___ 03:05PM   WBC-7.0 RBC-4.46 HGB-13.3 HCT-37.9 MCV-85# 
MCH-29.7 MCHC-35.0 RDW-13.6
___ 03:05PM   NEUTS-74.4* ___ MONOS-3.5 EOS-1.0 
BASOS-0.6
___ 03:05PM   PLT COUNT-232
 
Brief Hospital Course:
 
The patient presented on ___ with dysphagia. Pt was 
evaluated by anaesthesia and taken to the operating room on 
___ where a laparoscopic adjustable gastric band removal was 
performed. There were no adverse events in the operating room; 
please see the operative note for details. Pt was extubated, 
taken to the PACU until stable, then transferred to the ward for 
observation.
 
Neuro: The patient was alert and oriented throughout the 
hospitalization; pain was well controlled with acetaminophen and 
dilaudid.
CV: The patient remained stable from a cardiovascular 
standpoint; vital signs were routinely monitored.
Pulmonary: The patient remained stable from a pulmonary 
standpoint; vital signs were routinely monitored. Early 
ambulation and incentive spirometry were encouraged throughout 
hospitalization. 
GI/GU/FEN: He was initially NPO because of post prandial 
dysphagia. Then started on clears, which was advanced 
sequentially to stage 4, and well tolerated. Patient's intake 
and output were closely monitored.
ID: The patient's fever curves were closely watched for signs of 
infection, of which there were none.
Prophylaxis: The patient received subcutaneous heparin and ___ 
dyne boots were used during this stay; she was encouraged to get 
up and ambulate as early as possible.
 
At the time of discharge, the patient was doing well, afebrile 
with stable vital signs.  The patient was tolerating a stage 4 
diet, ambulating, voiding without assistance, and pain was well 
controlled.  The patient received discharge teaching and 
follow-up instructions with understanding verbalized and 
agreement with the discharge plan.

 
Medications on Admission:
Citalopram 30 mg PO DAILY 
FoLIC Acid 1 mg PO DAILY 

 
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H:PRN Headache 
2. Citalopram 30 mg PO DAILY 
3. FoLIC Acid 1 mg PO DAILY 
4. LaMOTrigine 50 mg PO BID 

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Dysphagia
Gastric Band Prolapse

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

 
Discharge Instructions:
Your band was removed, but that does not mean you have to 
abandon your efforts to improve your health.  Take this 
opportunity and incorporate what you have learned from your 
health care team.  Continue being active on a regular basis and 
follow these healthful guidelines (not diet!) for life long 
benefits.

In the hospital, you will be on a stage 3 diet for healing.  
This diet includes all liquid, high protein, low sugar and low 
fat supplements.  When you are discharged home, you may advance 
your diet as tolerated.  Below are some helpful tips to continue 
your journey of eating well and healthy living.

 

1.Keep an eye on calories.

2.Always eat at a table.  Avoid eating while driving, standing, 
sitting on the sofa, or lying in bed.  

3.Eat slowly.  Continue to take 30 minutes to eat a meal and 
chew your foods thoroughly. 

4.Surround yourself with healthy foods. Clean out your cabinets 
of any trigger or unsafe foods.

5.Keep a food journal or track your intake on-line.  Record 
what you eat, portion sizes, and the time you eat.  You may want 
to include your mood and hunger level, as well.

6.Avoid skipping meals.  Always eat at regular times to avoid 
overeating later in the day.

7.Listen to your body.  Eat when you are physically hungry and 
stop when you are full.

8.Be active.  Engage in at least ___ minutes of physical 
activity most (if not all) days of the week. 

9.Regularly check your weight.  Give yourself an acceptable 
range (i.e. 5 pounds).  This prevents slip ups from becoming 
bigger problems down the road.

10. Make small changes.  Set small, reasonable goals to keep on 
track. 

11. Reward yourself.  Treat yourself when you reach goals with 
a non-food treat (i.e. pedicure, movie). 

12. Ask for support. Call the ___ nutrition clinic for 
follow-up at ___. Join Weight Watchers, talk to friends 
and family or contact a local dietitian. 

13. Drink plenty of fluids. Stay hydrated.

Fluids & Diet
Fluid intake is extremely important the first month of your 
recovery. You must also take in enough liquids
to prevent dehydration. Dehydration can cause nausea, fatigue, 
lightheadedness and dark urine.  We recommend you track what you 
drink and eat each day. 
Most Frequent Problems

Discomfort
Abdominal soreness below your ribs on the left side is the most 
common site of tenderness after waking up. Despite this 
discomfort, it is very important that you get out of bed and 
take short walks.

Dehydration
Your most important job after surgery is drinking enough fluid. 
Dehydration is the most common reason to return to the hospital 
after surgery. Your goal is to drink 8 cups (64 oz) of fluid a 
day. You may not be able to drink this much fluid at first, but 
come as close as you can. Refer to your nutrition
packet for more details.

Wound Drainage & Infection
It is important to care for your incisions to prevent infection. 
You will have small fiber tapes on your wounds. This should keep 
your wound dry and closed. Leave them on until they fall off by 
themselves. Do not put band aids, ointments, lotions or powder 
on your incisions. You may get your incisions wet but
avoid scrubbing them. Pat them dry. It is not unusual for an 
incision to drain a little bloody fluid after you
go home. If you have some drainage, dab the wounds with diluted 
hydrogen peroxide (hydrogen
peroxide mixed half and half with water) and then cover with a 
dry gauze. Doing this twice a day will
speed your recovery.
Infections are uncommon and rarely serious after a laparoscopic 
operation. An infection will be red, warm,
firm, and tender. The infected fluid will look more like pus 
than like blood. If you notice this please call the
nurse at the Bariatric ___ Program to discuss your symptoms.
 
Followup Instructions:
___

{'dysphagia': ['Other dysphagia'], 'vomiting': ['Other complications of gastric band procedure'], 'fever': ['Other complications of gastric band procedure'], 'pain': ['Other complications of gastric band procedure']}