Wound Infections after weight loss surgery

There is always a risk of infection in the wound. We surgeons always worry about wound infections, but no matter what we do, they will happen to some patients. A wound infection typically happens about five to ten days after surgery. Usually the patient notices that the wound is getting red, the redness starts to spread a bit—and then some pus comes out of the wound.

Wound infections are easily treated. First, they need to drain. If the skin is closed over an infected wound it isn’t allowed it to heal from the bottom up, the wound will “pus out” Wound infections are typically caused by the patient’s own bacteria. again. Second, you will need some antibiotics. You might also need to learn “wound care,” like how to “dress” the wound. If you have a deep wound, it can take weeks and weeks to close—and become a major nuisance. Sometimes the surgeon places drains in the wound or wicks—sometimes special wound vacs are used. However, most wounds heal up nicely when simply treated with some wound care and antibiotics.

Wound infections are typically caused by the patient’s own bacteria. This is why we “prep” your abdomen with a special antibacterial solution before we cut into the skin. Various surgeons use different antibacterial preparations, and again this is a matter of choice. I use something called Duraprep™ because it kills most bacteria on contact, and can last for hours after the surgery is complete. This is also why surgeons give you antibiotics before cutting your skin. It is very rare that a wound infection is caused by the surgeon, some member of the surgical staff, or by “dirty” instruments.

After surgery, taking antibiotics will not prevent a wound infection, but it might make your body resistant to that antibiotic. That is why surgeons typically do not send patients home on antibiotics.

Bleeding after Gastric Bypass or Lap-band weight loss surgery

— or, “it was dry when we left”

Rarely do we have to take someone back to the operating room for bleeding internally. It does happen on occasion, and typically it is a small bleeder that opens up after we leave the operating room. After we finish any intra abdominal surgery, we look around and make certain that the abdomen is “dry.” A small bleeder can cause a major re-operation, so we surgeons are careful before closing the wound that it is dry as dust.

Internal bleeding can cause dramatic reactions in patients. Their heart rates rise and their blood pressure drops, and before you know it we are whisking them away to the operating room. When we open the abdomen we might find a lot of blood, but sometimes we cannot find the source of the bleeding. This is frustrating, but not uncommon.

Typical blood loss in surgery is anywhere from a cupful to more, so we expect the blood count to go down a bit after surgery. It will go down because of blood loss, and it will also go down because, after surgery, we give patients a lot of intra venous fluid. Sometimes there is a lot of bleeding or a lot of bloody fluid draining from the abdomen. If you have this, please call your surgeon.

Abscess and fluid collections

An abscess is a pocket of pus, and pus needs to be drained. Developing an abscess in the abdomen means that something needs to be drained. Typically, these collections are drained in the radiology suite, which is great, because it means you don’t have to go to surgery. Sometimes, unfortunately, these abscesses have to be drained in the operating room. There are a lot of reasons abscesses develop. It is a known complication of surgery. This will mean spending more time in the hospital, probably going home with the drain, and learning how to take care of it.

Evisceration after gastric bypass weight loss surgery

—or, “Hey doc, are these my guts?”

When we close the abdomen, we close the fascia, or gristle, with suture that is about like a 30-pound test fishing line. Sometimes the suture is flawed and breaks, and sometimes a patient coughs or vomits so violently that the suture breaks. When this happens, the fascia opens and the contents of the abdomen, guts and all, bursts out. This is quite dramatic—because it breaks out through the skin and everything that was inside is now outside.

First, put your guts back inside of you, and then call the nurse. Second, if you are at home or there is no nurse nearby, put some pads of warm salt water on your guts to keep them moist.

Then call your surgeon. He will take you back to the operating room and sew you up again. This rarely happens, but when it does it is dramatic and frightening. It is also the cause of a lot of jokes—but it is only funny two weeks later when you are healed.

If the fascia is torn or weakened and you don’t have an evisceration, you can develop a hernia (see Long term complications).

Atelectasis

—or, don't forget to breathe

Atelectasis is the most common post-operative problem after weight loss surgery. It is the source of fever during the first forty eight hours. When you have surgery you tend to take shallow breaths. Also, narcotics blunt your respiratory drive so your brain doesn’t feel the need to breathe deeply. This can cause the small air sacs in your lungs to fill with fluid, and if your lungs become infected, then you develop pneumonia. Walking can prevent this problem, so walk the day of surgery and every day increase your walking—you will feel better and do better.

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