Pre-op instructions your Surgery Date, Time Place


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The products range from vitamin chews, protein shake mix, snack bars and so much more. You can sample or purchase many of these products in our clinic, then order online at your convenience.
The staff will provide ordering instructions from


1 Package Bariatric Advantage High Protein Meal Replacement

12 oz. water

1 serving fresh or frozen fruit

Pour all the above into a blender and mix with 8-12 oz. of water, ice and fruit. Serves 1.
More Bariatric Advantage High Protein Meal Replacement Shake Recipes:

  • Orange Sorbet: Mix vanilla flavor with orange crystal light

  • Almond Joy: Mix chocolate flavor with dash of almond and coconut extracts

  • Iced Latte: Mix vanilla flavor with 1 cup Hazelnut coffee, 1 cup water and ice

  • Cinnamon Roll: Mix vanilla flavor with 1 tbsp. cinnamon, 1 tsp vanilla and a dash of butter buds

  • Pina Colada: Mix vanilla flavor with pineapple orange crystal light, ¼ tsp rum extract, ¼ tsp coconut extract and 1 packet of Splenda

  • Cheesecake: Mix chocolate or vanilla flavor with 2 tbsp. FF/sugar free Jell-O pudding mix (dry) and cheesecake flavor

  • Banana or Coconut Cream Pie: Mix vanilla lean body with banana extract OR coconut extract and 2 tbsp. of vanilla FF/sugar free pudding mix. Crumble 2 graham crackers into blended shake
  • Chocolate Pudding: Mix any flavor lean body with 2 tbsp. of NutraSweet chocolate pudding mix (other flavors may also substitute) and ¼-1/2 cup water

Protein Sources


Serving Size

Gram of Protein

Lean Hamburger Patty

3 oz (1 patty)

21 grams

Lean cuts of beef

4 oz

28 grams

Chicken Breast

3.5 oz

30 grams

Chicken Thigh

3 oz

10 grams

Chicken Salad

½ cup

15 grams


3 oz

21 grams


3.5 oz

22 grams

Tuna in water

3 oz

22 grams

Salmon (canned)

¼ cup

13 grams


3 oz (10 shrimp)

18 grams

Pork Chops

4 oz

22 grams

Pork Tenderloin

4 oz

29 grams

Ground Pork

3 oz

22 grams


3 oz

19 grams


1 slice

5 grams

Canadian-style Bacon

1 slice

5 grams


3 oz (1 large egg)

6 grams

Skim milk

1 cup

8 grams

Soy milk

1 cup

6 grams

Cottage Cheese

½ cup

15 grams


1 oz

6 grams

Greek Yogurt

1 cup

11 grams


½ cup

9 grams

Veggie Burger

3 oz (1 patty)

13 grams


½ cup

9 grams

Soy beans

½ cup

14 grams

Kidney beans

½ cup

8 grams

Black beans

½ cup

7.5 grams

Pinto beans

½ cup

7 grams


½ cup

8 grams

Peanut butter

2 tbsp

8 grams

Raw almonds

¼ cup

8 grams

Dried peanuts

¼ cup

9 grams


¼ cup

5 grams

Pumpkin seeds

¼ cup

8 grams


¼ cup

5 grams

Flax seeds

¼ cup

8 grams

Sunflower seeds

¼ cup

6 grams


1/3 cup

6 grams


2 tbsp

4 grams


½ cup

3 grams

Protein intakes should be 60 to 80 grams daily. Focus on plant based protein (soy, lentils, and beans), lean meats, chicken and seafood


Immediate Post-Operative Period
Recovery Room: Patients will first go to the recovery room after the operation is over. There he/she will be closely monitored while waking up from anesthesia. Family members are usually not allowed because of Government rules concerning privacy of other patients.

2 Hours Post-op: With assistance from a nurse the patients’ needs to walk outside the room, in the hallway, at least 20 steps. After walking, the patient will be allowed to take low sugar liquids by mouth. Initially this is usually ice chips and sips of water. However, broth, sugar free popsicles and no calorie-non carbonated drinks are encouraged. Once the patient in ambulatory and able to drink water, the nurse will discharge the patient to a designated care giver. The hospital or surgery center will not release the patient without accompaniment.

At Hote/Home – Week 1

Medications: All necessary previous medications should be taken at the prescribed intervals after returning from the hospital. Tablets will need to be crushed and capsules opened for the first week. Usually these are taken with water. Any medication that can be skipped should wait until 1 week post-op. Examples are: cholesterol medications, previous pain medications, muscle relaxants, special vitamins, etc. Absolutely necessary blood thinners such as aspirin, Plavix or Coumadin should be restarted 48 hours after surgery. If any signs of bleeding occur they should be discontinued and the patient should call the office immediately. Diabetes medications should be reduced to ½ dose, and blood sugar levels should be monitored every 6 hours if the patient is on any insulin. If you are on diabetes medication, make an appointment to see the prescribing physician within 2-3 weeks.

Activities: Patients can do their activities of daily living (ADL) such as going up steps, or taking care of themselves in the bathroom or shower.* The patient does not need special assistance from someone else.* He/she should not stay in bed; moving about and even light exercise are encouraged. The patient’s activity level should increase within 48 hours. All exercise is allowed after 2-3 days, including strenuous activity and lifting can. Normal sexual activity can occur as soon as the patient feels comfortable enough.

Driving: A typical patient will be able to drive his/her car approximately 1-2 days post-operatively. Driving should only be attempted if the patient feels that he/she can turn the wheel or apply the brakes in an emergency. If not, the patient should not attempt to drive.

Return to Work: Patients are able to return to work by day three post-op.

Diet: After the ESG procedure patient will be on a clear liquid, low sugar diet for 7 days. Please see the diet section for a description of the diet. Do not attempt to take soft or solid foods yet as these could breakdown the upper connection sutures. Also, avoid carbonated beverages until 1 month after surgery. Caffeine is allowed (with sugar substitutes and non-dairy, low fat creamer). Concentrated fruit juice and processed sugars should be avoided to avoid cramping, flushing and diarrhea which are the symptoms of the dumping syndrome.


You will have a post-op visit with Dr. Marvin in his office on Monday morning, following surgery. Once medically cleared for travel you will be able to begin your trip home.

Week 2-4

Medications: All previous medications should be resumed and can be taken normally (i.e. as whole pills or capsules. Diabetes medications should remain at ½ the previous dosage, and the patient should make an appointment to see the prescribing physician to alter the dose.

Diet: Warning: it is ABSOLUTELY ESSENTIAL NOT TO OVEREAT after the ESG procedure. The length of the suture line will be vulnerable to stretching and inhibiting the expected success. A revision may be required to tighten the stomach or move to the more invasive laparoscopic sleeve gastrectomy. At this point the patient can follow the regular prescribed diet provided.

Vitamins: A multivitamin with folic acid (folate) should be started one week after surgery. Although this can be chewable, it is not necessary. The patient should take some form of a multivitamin indefinitely.


At your 1 month mark, we will email you a questionnaire on your progress, much like an in clinic visit. Schedule appointments for 3, 6, and 12 months after surgery with your primary care physician. It will be necessary to have blood tests taken at this appointment and faxed to our office. This will include blood counts, electrolytes, protein levels, calcium, iron, vitamin B1, vitamin B12 and folic acid levels. The list is in this packet. Also, you will be emailed a follow up questionnaire from our staff. Please complete this as we would like to track your progress.

Activity after 1 month: Normal with increased exercise.

Diet: No change after week 4

Vitamins: Continue the multivitamin

APPOINTMENTS with your PCP, Lab Work and Follow Up questionnaire

3 Months

6 Months

12 Months


WARNING: Unpleasant symptoms occurring after Obesity Surgery can indicate a progressing and/or life threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.

In general the first week after surgery is an important period to monitor for problems, as the majority of complications will occur during this time.


This is the most common complication after Endoscopic Sleeve and usually occurs within the first 24 hours. Typically this is not fast bleeding at the time of surgery (although this can occur), rather it is usually from the suture line closure and managed at time of the procedure. Significant bleeding could lead to blood transfusion or extended hospital monitoring. Symptoms of blood loss are dizziness (especially on standing), shortness of breath, a rapid pulse (> 100 beats a minute), a pale appearance and minimal or no urine production. Of course, passing blood via vomiting after 24 hours or per rectum can be delayed 24-48 hours after the suture line bleeding ceases. Call 911 or go directly to urgent care and have Dr. Marvin paged.

Stomach Leak

This is potentially a life threatening complication. Fortunately, peri-gastric leak after Endoscopic Sleeve Gastroplasty is rare to about 1.1%. (Sharaiha, et al.) It occurs when a hole or gap develops somewhere along the suture line closure allowing stomach juice to escape into the abdominal cavity. A severe infection develops that can lead to adverse symptoms involving all body systems. In the two year research study of 91 patients, 1 patient developed a peri-gastric leak. A drain was applied and antibiotics were administered and no additional surgery was required. (Sharaiha, et. Al.) Should Dr. Marvin deem additional measures must be taken, open surgery and hospital stay will be mandatory.

Stomach Obstruction

A stomach obstruction is a blockage which leads to both vomiting and moderate to severe abdominal pain. This problem is thought to be very rare, and has not been reported, as to Dr. Marvin’s knowledge, from the ESG procedure. If this cannot be corrected with conservative therapy then an operation to untwist the stomach may be necessary.

Tightness Concerns

Theoretically, the placement of the sutures could lead to over tightening. This has not been reported to our knowledge and little evidence exist to warrant a concern with a trained skilled surgeon.

Esophageal Damage

The placement of an esophageal tube is done very carefully to avoid any damage to the esophagus and avoid any aspiration. You may experience a sore throat for a few days following the procedure and that is common. There are standard risk with any therapeutic endoscopy such as bleeding, infection and perforation (tear in the lining of the esophagus).

Failure to Lose Weight

As with any weight loss program procedure or surgery the patients choices after are of the greatest impact. We include detailed nutritional information in this packet and exercise recommendations. Although the data provides weight loss statistics, there is no guarantee of how much or for how long it can be maintained. The fact is, there only exist two years a research data on the Endoscopic Sleeve Gastroplasty. We look forward to following our patients’ progress.


A stenosis is a narrowed area somewhere along the tapered tube of stomach. A stenosis is thought to be from over-scarring at the site of involvement with subsequent contraction of the scar. This can lead to a very small channel only a few millimeters wide. The classic story is that the patient was initially able to tolerated solid foods, but a few weeks later started to vomit solids but could handle liquids. Later there might be progression of intolerance to soft food and later liquids. The treatment of a stenosis is to assess the area with upper endoscopy. If necessary a balloon can be passed into the channel and used to dilate it to a larger size. This treatment is usually effective; however, an occasional patient might require serial dilatations. Although dilatations are relatively safe there is a small risk of perforation of the bowel which would require emergency Open Surgery to correct.

IMPORTANT: The problems above are a partial list of all possible complications that can occur after this procedure. Some complications are rare and may be beyond the experience of the surgeon or even the surgical literature. Complications are usually not foreseeable.


Sharaiha, Reem Z., et al. “Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients.” Clinical Gastroenterology and Hepatology, vol. 15, no. 4, 22 Dec. 2016, pp. 504–510., doi:10.1016/j.cgh.2016.12.012.



Congratulations! You have reached new beginning!

Diet Changes:

Your meal plan will be high in protein, which is essential for optimal healing and weight loss. Your diet will always be low fat and low sugar. Certain solid foods may not be well tolerated. Food intolerances are individual and often temporary. It is a good idea to keep track of the food that causes discomfort and wait two weeks before trying that food again. Patients often report that they do not feel hungry or have a loss of appetite after surgery. In turn, this often causes patients to skip meals, depriving themselves of their nutritional needs. Many also believe that skipping meals will help with speedy weight loss, however, this is not true nor is it healthy. You should eat a minimum of 3 high protein, low fat and low sugar meals per day. Do not force yourself to finish meals, and stop eating as soon as you feel full.

IMPT: Drink Fluids only between meals! It is essential for you to consume the optimal amount of nutrients during your meals, thus drink your fluids at least 45 minutes after you eat.


Eat at least 3 to 6 small portions per day

Chew, chew, chew!

50-60 grams of protein a day, thus 10-15 grams of protein per meal

Eat protein first

Healthy snacks only between meals

Sit while eating

Bake, broil or steam…don’t fry

Read labels

Use non-fat dressings, spreads and condiments

Avoid sweet and sugary foods

Avoid snacks with low nutritional value

Alcohol in moderation

Keep a daily food journal

Drink 64 oz. of low calorie liquids per day

Sip, don’t gulp

Drink fluids between meals!!
Introduction to Macronutrients

MACRONUTRIENTS are chemical elements and compounds that provide the energy we need to grow and survive. Macronutrients need to be consumed in sufficient amounts to stay healthy, and they include protein, carbohydrates, and fat.

PROTEIN: Key nutrient that is needed by the body to build and repair cells and tissue. It also helps the body resist disease and wound healing. If the body does not get enough protein from food, it cannot properly grow and aide in healing. The body would become more susceptible to infection, resulting in the individual becoming very sick.

For you: Extra protein is needed BOTH before and after surgery to improve the healing process and prevent infection

CARBOHYDRATES: Prime source of energy for all living things. The two main forms of carbohydrates are sugars (such as fructose, glucose, and lactose) and starches, which are found in foods such as starchy vegetables, grains, rice, breads, and cereals. The body breaks down (or converts) most carbohydrates into the sugar glucose, which is absorbed into the bloodstream. As the glucose level rises in the body, the pancreas releases a hormone called insulin. Insulin is needed to move sugar from the blood into the cells, where it can be used as a source of energy.

For you: The right type for carbohydrates should be consumed to stay healthy. The Lap-Band diet must be low in sweet and sugary foods.

FATS: (lipids) The body uses fat as a fuel source after it uses the available carbohydrates, thus fats are the major storage form of energy in the body. Fat also has many other important functions in the body, and a moderate amount is needed in the diet for good health. Fats in food come in several forms, including saturated, monounsaturated, and polyunsaturated. Consuming the right kind of fats is essential for staying healthy.

Healthy fat: helps decrease the risks of cardiovascular disease

Monounsaturated fat- helps lower LDL cholesterol (bad type of cholesterol) and increase HDL cholesterol (good type of cholesterol)

Foods: nuts, avocado, olive oil, whole grain wheat, cereal, oatmeal

Polyunsaturated fat- helps lower LDL cholesterol Foods: fish, cereal, whole grain wheat, peanuts

Unhealthy fat: promotes onset and continuation of cardiovascular disease

Saturated fat- increase the risk of heart disease and stroke. Foods: butter, lard, coconut oil

Trans fat: most trans fats are in the form of partially hydrogenated plant oils, which is neither required nor beneficial for health. Foods: butter, lard, any product that has “partially hydrogenated oil” listed on the ingredients.

For you: Fat may be difficult to digest after surgery. Too much fat delays emptying of the stomach and may cause reflux, a back up of stomach acid and food into the esophagus that could cause heartburn. Fat may also cause diarrhea, nausea or stomach discomfort, thus reading nutritional labels is essential.
All About Carbs and Sugar


It is important to understand that carbohydrates are essential in one’s everyday diet. Although the body can obtain energy from protein and storage fat, these two macronutrients are primarily used for other homeostatic purposes in the body. The main purpose of carbs is to provide the body with energy, but it is important to know the differences between complex carbs and simple carbs.
Complex carbs vs. simple carbs: What’s the difference?


Simple carbohydrates. These are just what they sound like: simple sugars. Simple sugars are quickly converted to glucose in your body. Simple carbohydrates include naturally occurring sugars and are most usually found in refined and processed foods, including white breads, sugary beverages and candy.

Complex carbohydrates. Complex carbs are more slowly digested and almost always found in foods more healthful than their simple counterparts. You find complex carbohydrates in:

Fruits & Vegetables

Whole grain foods (cereal, bread, pasta)

Health benefits of complex carbohydrates

There are numerous health-related reasons why you should increase your complex carbs, while decreasing the amount of simple sugars in your diet.

  • Weight management

    • Foods that are high in complex carbohydrates are often lower in calories. It generally takes more time to eat 100 calories of a banana than it does to consume 100 calories of soda. Calorie for calorie, complex carbohydrates are more satisfying and the calories add up more slowly when compared to simple carbs.

  • Fiber
    • Most Americans don’t get the recommended amount of fiber per day: 25 grams for women and 38 grams for men. Increasing your complex carbohydrate foods always means an associated rise in fiber intake. And fiber helps you feel fuller for longer, meaning you’ll feel the need to eat less often.

  • Nutrients

    • There is no limit to the amount of nutritional benefits you get from switching to complex carbohydrates. These foods contain vitamins, minerals, phytochemicals and other nutrients that are rarely present in simple-sugar food items.

Be a smart consumer: Choose complex carbs over simple carbs

With the recent focus on the detriments of low-carb diets has had a positive effect—there’s a renewed interest in the benefits of complex carbohydrates and whole grains. But beware; food manufacturers are exploiting this interest with numerous ways to confuse complex-carb seekers. A good whole grain food choice should be made primarily from whole grains. It sounds intuitive, but it’s easy to get misled:

• Be wary of label lingo. Regulation surrounding labeling claims on whole grain foods is weak. Any food with a modicum of whole grain in it can be labeled “whole grain”. Check the ingredient list: if “enriched” is in the first ingredient, put it back on the shelf. Look for the word “whole” in the first ingredient to assure it is indeed a good whole grain food.

• If sugar appears as the 1st, 2nd or 3rd item in the ingredient list, AVOID IT! Sugar can be listed as: sugar, maple syrup, honey, molasses, corn syrup, and corn sweeteners. Beverages that contain sugar should be avoided always. Sweeteners like Equal, Splenda, and Sweet n’ Low may be used as they have no caloric value.

• Keep an eye out for the fiber content. The truth is in the label, and particularly the “fiber” section of the label. A good serving of whole grains will have 3 grams of fiber or more per serving. Only choose breads, pastas, cereals and grains that meet this requirement.

• You can’t go wrong with fresh fruit and vegetables. These are your best low-calorie sources of complex carbohydrates. They are packed with nutrients and fiber and make great snacks throughout the day.

Grains and Starches: Bread, Cereal, Rice, Pasta and Starchy Vegetables

• Select whole grain products to maximize fiber and nutrient intake. Read food labels and ingredient lists to look for products with 100% whole wheat flour, stone ground whole wheat flour and other whole grains.

Examples of Serving Sizes

1 slice of bread

½ English Muffin

½ Lender’s Original Bagel

½ pita pocket

5 small crackers

1 ounce ready-to-eat cereal

½ cup pasta or rice (cooked)

½ cup starchy vegetable

Serving sizes will change as your activity and lifestyle changes. Long-term, post-op diet goal is for 4 grain/starch servings per day. Discuss this with your dietician before advancing.


100% whole wheat bread or toast, English muffins, tortilla, seedless rye, pumpernickel, pita. Crackers such as low-fat Saltines or whole wheat crackers, and baked chips Cereal with low or no sugar such as oatmeal, bran flakes, high protein Special K, high protein Total or Kashi cereals. Any type of rice or pasta, but 100% whole wheat pasta and brown rice provides more fiber. Starchy vegetables such as corn, peas, potatoes, sweet potatoes, yams, winter squash, and plantains.


High fat or sugary baked goods such as pastries, croissants, muffins, donuts, cookies, cakes, biscuits and fried dough. Crackers such as butter crackers, Ritz, Triscuits, Goldfish or Wheat Thins. Any sweetened cereal, granola or fruity cereals. Pasta in cream sauce or macaroni and cheese. High fat foods such as French-fries, tator-tots, hash browns, cheese curls, microwave popcorn, and non-baked chips made of potato, corn or tortilla.

All About Vegetables

Remember to introduce new vegetables slowly and start with soft consistencies

Examples of Serving Sizes

1 cup raw leafy vegetables

½ cup raw vegetables

½ cup cooked vegetables

Early post-operative goal is to reach 2 servings per day. It may help to separate into 4 smaller servings throughout the day. Long term, post-op goal is 4 vegetables servings a day.


Raw or cooked vegetables such as carrots, broccoli, green beans, summer squash, brussel sprouts, asparagus, spinach, green or yellow or red peppers, cucumbers, tomatoes, radishes, mushrooms, cauliflower, cabbage, lettuce and many more. Use olives and avocados sparingly.


Avoid added fats in vegetables such as butter and margarine, cream, regular mayonnaise, sour cream, butter sauce, au gratin, Hollandaise sauce, Béarnaise sauce or cheese sauce. Avoid all deep fried vegetables.

All About Fruit

Remember to introduce new fruits slowly and start with soft consistencies

Example of Serving Sizes

½ cup unsweetened fruit

1 melon wedge

1 medium apple, orange or peach

1 small banana
Early post-operative goal is to reach 1 serving a day. Long term, post-op goal is 2-3 servings a day.


Fresh fruit such as banana, berries, kiwi, orange, peach, plums, melons, mango and many more. Canned fruit like unsweetened apple sauce or any fruit packed in fruit juice or water (not sugar) is acceptable.

All fruits canned in light syrup or heavy syrup. Candied apples, coconut and fruit juices (even the ones that say “light”).

All about Sweets

Limit: 1-3 times per week

Examples of Serving Size

¼ cup sherbet

¼ cup fat free, sugar free pudding

Fat free and sugar free: Sherbet, popsicles, fudgesicles, pudding or custard made with skim milk. Blue Bunny no sugar added reduced fat products.


Candy, ice cream, iced milk, pies, pastries, cakes and cookies.

All About High Protein Foods

Goals are at least 3 servings of protein per day. Protein can come from animal or vegetable sources.

Example of Serving Size

3 oz. cooked lean meat, poultry or fish

1 egg

½ cup cooked beans, legumes

2 tablespoons of peanut butter


Fish- low fat: cod, flounder, haddock, catfish, redfish, halibut, perch, red snapper, sea trout, tuna canned in water. Fish- moderate fat: Bluefish, herring, mackerel, salmon, trout, swordfish

Shellfish: clams, crab, lobster, oyster, scallops, shrimp

Poultry: Skinless chicken and turkey breasts, ground chicken or turkey

Beef: Lean select or choice cuts trimmed of visible fat such as loin, T-bone, porterhouse, filet mignon, sirloin, round steak, tenderloin, rump roast, 90% or more lean ground beef.

Lamb, Pork, Veal: Lean select or choice cuts trimmed of visible fat

Cold cuts: 95% fat free, 3 grams of fat per ounce is acceptable

Eggs: whole eggs limited to 3 per week. Egg whites unlimited. Egg substitutes unlimited.


Avoid fried fish, fish canned in oil or commercial breaded fish products. Fried shellfish, stuffed shrimp or lobster. Avoid fried chicken, turkey or other meats, wings, legs and thighs or any poultry. No regular hot dogs, only 70-89% lean hot dogs. Bacon sausage, kielbasa, knockwurst, pepperoni, Slim Jims. No salami, bologna, corned beef, pastrami or liverwurst. No fried or scrambled eggs with butter (may use small amount of I Can’t Believe It’s Not Butter Light).

All About Dairy

Long term, post op goal is 2 servings per day

Examples of Serving Size

1 cup milk or yogurt

1 ounce fat free or low fat cheese

½ cup cottage cheese


Skim, fat free or 1% milk. Carnation Instant Breakfast, no sugar added, made with skim milk. Yogurt that is nonfat, fat free, or 1% low fat plain or with artificial sweetener. Nonfat, fat free, low fat cheeses such as Alpine Lace, Healthy Choice or part skim Mozzarella. Nonfat cottage cheese or cream cheese.


Avoid whole or 2% low fat milk, cream, half and half, regular hot chocolate, milkshakes, frappes, chocolate drinks, eggnog, chowders made with cream, regular and 2% yogurt. Avoid cheese sauces, regular cottage cheese and sour cream.

All About Fat

Refer to page 2 of this packet for greater detail

Example of Serving Size

1 tablespoon fat free or low fat products

1 teaspoon oil (preferably olive)

1 tablespoon peanut butter


Fat free or low fat salad dressing, fat free and low fat mayonnaise, Butter Buds, Molly McButter, non-stick cooking spray, fat free cream cheese or sour cream. Limited amounts of canola, olive and peanut oils as well as peanut butter.


Regular salad dressing, mayonnaise, reduced fat mayonnaise, butter, margarine, cream cheese and sour cream. Read the labels!

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