Follow-Up Schedule
Regular follow-up is essential for monitoring progress, identifying complications early, and supporting long-term weight management. The recommended visit schedule following bariatric surgery typically includes:
- 2 weeks post-op: Wound assessment, diet advancement review, hydration status
- 6 weeks post-op: Weight check, lab work initiation, activity clearance
- 3 months post-op: Nutritional labs, medication adjustments, behavioral health check-in
- 6 months post-op: Comprehensive metabolic panel, vitamin levels, weight trajectory evaluation
- 12 months post-op: Full annual labs, body composition assessment, comorbidity resolution review
- Annually thereafter: Ongoing nutritional monitoring, weight maintenance support, screening for late complications
Nutritional Monitoring
Micronutrient deficiencies are common after bariatric surgery, particularly following malabsorptive procedures such as Roux-en-Y gastric bypass. Routine laboratory monitoring should include:
Essential Labs
Complete blood count, comprehensive metabolic panel, iron studies (ferritin, TIBC), vitamin B12, folate, vitamin D (25-hydroxy), calcium, parathyroid hormone, thiamine (B1), zinc, and copper. Vitamin A and vitamin E levels should be checked in patients who have undergone biliopancreatic diversion with duodenal switch.
Supplementation Protocol
All bariatric surgery patients require lifelong vitamin and mineral supplementation. Standard recommendations include a high-potency multivitamin with minerals (twice daily), calcium citrate (1200–1500 mg daily in divided doses), vitamin D3 (3000 IU daily, titrated to labs), vitamin B12 (sublingual or injectable), and iron as indicated by lab results.
Protein Intake
Patients should consume 60–80 grams of protein daily to preserve lean muscle mass during rapid weight loss. Protein should be prioritized at each meal. Patients struggling to meet goals through food alone may benefit from protein shakes or supplements.
Medication Considerations
Several medication-related factors require attention in the post-operative period:
- NSAIDs: Strictly avoid non-steroidal anti-inflammatory drugs indefinitely after gastric bypass and sleeve gastrectomy due to risk of marginal ulceration and anastomotic complications
- Diabetes medications: Rapid improvement in glycemic control often necessitates prompt dose reductions or discontinuation of insulin and oral hypoglycemics to prevent hypoglycemia
- Antihypertensives: Blood pressure medications frequently require dose adjustments as weight decreases and metabolic parameters improve
- Extended-release formulations: Avoid in bypass patients due to altered absorption; convert to immediate-release equivalents
- Psychiatric medications: Monitor closely, as altered absorption may affect serum levels and therapeutic efficacy
Warning Signs Requiring Prompt Evaluation
Advise patients to seek immediate medical attention if they experience:
- Persistent vomiting or inability to tolerate any liquids
- Fever above 101.5°F (38.6°C)
- Severe or worsening abdominal pain
- Signs of dehydration (dark urine, dizziness, rapid heart rate)
- Wound redness, drainage, or dehiscence
- Chest pain or shortness of breath
- Rapid, unexplained weight loss beyond expected parameters
