Before bariatric surgery, tests will be done to check your health during the months you and your surgeon have worked together to prepare you for surgery. When it's time for surgery, you will be watched and kept as comfortable as possible throughout surgery and recovery. After surgery, you may stay in the hospital for one or more days. How long depends on which type of surgery was done and how well you progress.

Your doctor will see you months before surgery and will request blood tests and other studies. You may be referred to a cardiologist or a pulmonary specialist. These tests help to prepare you for surgery. Chest X-rays may be ordered to check your lungs. An electrocardiogram (ECG) may be done to check your heart rhythm. Your surgeon and dietitian may also ask you to lose some weight before surgery to make the surgery safer. You may also meet with a mental health counselor or professional to help cope with the stresses before and after surgery. In some cases, you may have a sleep study to check for sleep apnea or other disorders.

To prepare for surgery, you may be asked to:

• Stop smoking, vaping, or using other tobacco or nicotine products.
• Lose weight by following a special diet.
• Stop taking certain medicines, including aspirin and anti-inflammatories for about a week before surgery. Ask your surgeon what medicines to continue taking, and when to stop the other medicines. Be sure to mention any over-the-counter medicines, herbs, or supplements you take.
• Not binge on food before surgery.
• Follow any directions you are given for not eating or drinking before surgery.

On or before the day of surgery, you will need to sign any consent forms both for surgery and anesthesia.

An anesthesiologist will talk with you. You will be told about medicines to block pain (anesthetics). These will keep you asleep through surgery. The anesthesiologist will also talk to you about your health history, your medicines, and any allergies you have. They will tell you which medicines to take on the day of surgery. If you have a CPAP or BiPAP machine for sleep apnea, bring it with you to the hospital.

Your surgeon begins the surgery by making one or more cuts (incisions) in your stomach. For a laparoscopic procedure, the surgeon makes several small incisions (port sites). During the procedure, the surgeon puts special tools and a tiny camera through small tubes placed in these small incisions. The surgeon operates by looking at the organs on a video monitor. For open surgery (laparotomy), the surgeon makes one large incision. Before surgery, your surgeon will explain what type of procedure you are likely to have. In some cases, your surgeon may do your procedure with the aid of a robotic system.

You will wake up in the PACU (post anesthesia care unit). Or you may be in an ICU (intensive care unit). One or more I.V. (intravenous) lines may be in place. I.V. lines deliver fluids and medicines. One I.V. line may be attached to a PCA (patient-controlled analgesia) pump. You can use this pump to give yourself pain medicines safely as needed. Tubes may also be in place to drain or suction body fluids. In some cases, a tube may be in your throat overnight to help you breathe. You may also have special leg stockings to help improve blood flow, and help to prevent a blood clot in your legs. You may have a urinary catheter that was placed after you went to sleep.

As you recover from surgery, you will be moved to a hospital room. You will be asked to be active as soon as you can, and the nurses can help you get out of bed to move around. This helps speed your recovery, and helps to prevent complications like blood clots in your legs. You will start with liquid nutrition as your body recovers from surgery. You will also be asked to do breathing exercises, using an incentive spirometer to help take deep breaths and cough. This helps to prevent pneumonia and keep your lungs healthy. X-ray tests may be done to check your progress. Your team will tell you when you're ready to go home.

• American Society for Metabolic and Bariatric Surgery,https://asmbs.org/
• National Heart, Lung, and Blood Institute Obesity Education Initiative, www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt