Pre-op instructions your Surgery Date, Time Place

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For Out-of-Town Patients

Endoscopic Sleeve Gastroplasty

Table of Contents

Table of Contents 1

Vision Statement 2

PRE-OP INSTRUCTIONS Your Surgery Date, Time Place 3

Important Hospital Information 4

Important Travel Instruction 5

Pre and Post-Op Lab Test Orders 6

What to bring to the hospital 7

What medications do I take at home? 8

Prescriptions 9

Stage One Diet 10

Stage Two Diet 11

Vitamin Supplementation 12

Protein Shake Recipes 13

Protein Sources 14


Post-operative Problems after ESG 17-18

Nutrition Guidelines for Life 19-32

Exercise Regimen 33


Houston Surgical Specialists is a multi-physician practice, headed by an experienced surgeon with a track record of consistently excellent results. We strive to provide a global approach to the complex problem of morbid Obesity with a wide range of treatment plans, from medically supervised diets, nutrition and vitamin plans, to all the proven effective surgical procedures. Our goals are to identify patients who will benefit from bariatric surgery, provide consistent error free application of surgical technique, and effective postoperative care with subsequent clinical outcomes that far exceed recognized standards. By fulfilling these goals, we anticipate that Houston Surgical Specialists will provide consistent, quality care to the obese patient, continue to be recognized by the pre-eminent society of obesity surgeons in the United States and become the premiere practice for the care of Obesity in our region.

Dr. Marvin will free you from the burden of obesity.

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Patient Pre-OP Instructions
Dr. Robert Marvin

4120 Southwest Freeway Ste. 230

Houston, TX 77027
Office: 713-993-7124

Fax: 713-963-0476

Your Surgery Date is: ______________________________
Location: ________________________________________
Arrival Time: _____________________________________
Important Hospital Information:

Please call for directions or any additional information

Park Plaza Hospital: 1313 Hermann Drive

Houston, TX 77004

Herman Drive Surgical Hospital: 2001 Hermann Drive

Houston, TX 77004

First Street Hospital: 4801 Bissonet Street

Houston, TX 77401

Southwest Freeway Surgical Center: 4120 Southwest Freeway Ste. 200

Houston, TX 77027


**If you are running late, get caught in traffic or any other unforeseen delay…PLEASE call our office (713-993-7124) and let us know! If it is before or after normal business hours, please call the listed numbers above.

**Let the hospital know that you are scheduled for surgery at the time listed above and what time you will be arriving!

Important Travel Instructions

No matter where you live, the ESG weight loss procedure is available with Dr. Marvin. We quite often treat patients traveling to Houston for the ESG. Located in Greenway Plaza/Upper Kirby district, we are minutes from most attractions in town. The facilities used for the ESG are within 5 miles of Dr. Marvin’s clinic. With two airports, a plethora of hotels, shopping, restaurants and popular options for transport such as Uber, Houston is the perfect location for starting your weight loss journey.


Consultations are scheduled with the patient and Dr. Marvin over the telephone. To minimize the length of time off from work and regular life, the schedule is a 5 day/4 nights stay in Houston. This is one of the highly appreciated perks of the ESG, very quick recovery!

    • Thursday morning arrive in Houston by 11 am. Pre-op appoint with Dr. Marvin that afternoon. Labs are required and only billable through insurance in house. *

    • Friday morning will be the ESG procedure, recovery 2-4 hours, then released only when it is clear there are no adverse reactions to anesthesia. The surgery center determines cost.

    • Saturday and Sunday are free days to relax.

    • Monday morning is the post-op visit with Dr. Marvin and then released to fly home.

Post-Op visits can be managed by a local physician.

The following page is a list of labs needed throughout the process.


If you are choosing not to bill insurance for lab work, you will be required to visit a local lab for the pre-op testing. This would need to be completed before or after your post-op appointment with Dr. Marvin on Thursday. Two closest are: Quest Diagnostics (713) 432-0220 or Any Lab Test Now (713) 266-7900.

Hospital Discharge When Traveling Alone – Requires 24 hour care to a companion over 18 years old.

For the out-of-town patients who are traveling without a companion there are two options:

Plan on one night in the hospital or hire the nurse companion to stay with you from discharge until 9 am the following morning. The facility will not release you unless you have 24 hour care.

Pulse Staffing offers Certified Nurses Aid for hire. This CNA will act at the accompaniment required by the hospital or surgery center. It is a 4 hour minimum and $25 an hour for a CNA or $58 an hour for an RN. See the travel guide for details or ask a member of our staff.

Pre and Post Procedure Testing Orders

This is a list of the required lab work by Dr. Marvin. This will be discussed during your phone consultation and relayed to you by the clinic staff.

Please have this page available or a pen and paper to make note.

Fax to (713) 963-0476 Attn: Clinic Coordinator

Lab orders are provided upon request. These labs will send direct:

Quest Diagnostics Account # 27746 Lab Corp Account # 42214405
Patient Name: __________________ DOB: __/__/___ Diagnosis: _____ Surgery Date: __/__/___


  • CBC

  • PT, PTT

  • BMP

  • LFTS

  • HgA1C


  • TSH

  • T3 FREE

  • T4 FREE


  • PTH

  • FE (IRON)

  • FE SAT

  • TIBC











OTHER: ____________________


  • CBC

  • BMP


  • HgA1C


  • TSH

  • T4 FREE


  • PTH

  • FE (IRON)

  • FE SAT

  • TIBC






OTHER: __________________________

Taken at 3, 6 & 12 months.

Forward to the fax above.

Additional Instructions: ____________________________________________________

What to bring to the hospital:

  • Wear comfortable clothes – Elastic waist pants are best so that your abdomen is not pinched or compressed by tighter clothing. Yoga Pants.

  • If you use a CPAP or BIPAP machine when sleeping, please bring this with you to the hospital. You will need to use your home machine while you are waking up from anesthesia and when you are sleeping in recovery.

  • If you use a walker, cane or other walking assistance device please bring this with you to the hospital. We want you up walking within a few hours after surgery!

  • Do NOT bring anything valuable to the hospital – leave all your jewelry, cell phone, laptop, iPod, etc. with family or AT HOME!

  • You DO NOT need to bring any of your home medications to the hospital with you. The hospital will dispense all medications from their pharmacy to you.

  • Some patients prefer to bring some of their favorite beverages with them to the hospital (crystal light, Propel, Fruit H2O, etc.). You will have a diet tray supplied to you, however, you are welcome to bring any of the low sugar clear liquid items.

  • Comfort items – some patients prefer to bring a blanket and pillow from home to make them more comfortable. Personal pajamas are not needed as you will have IV tubing that will need to be accessed by nurses and PJ’s can be difficult to work around. Robes are a bit easier to manipulate if you prefer to wear something of your own.

After Surgery: What medications do I take?

For the first week after surgery you will need to CRUSH all pills to swallow any medications, to make this as easy as possible. Follow the guidelines below to help with your home medications and if you have any questions make sure to call the office!

Medications for high blood pressure:

  • Resume these meds at home the morning after you are discharged

  • Make sure to crush medication

  • If the medication contains the terms “XR, CR, SR or XL” you will need to have an alternate dose of medications as these are time release pills and cannot be crushed

Medications for diabetes:

  • Resume your home meds at half the normal dose

  • Be sure to check your blood sugar often and call if you start to notice either extreme high levels (>250) or extreme low levels (<60)

  • If you are on insulin, resume half the normal dose – make sure to keep a log of your blood sugar readings, the time of day, and how much insulin you administered

Medications for high cholesterol:

  • You may wait until week 2 of your diet (soft solids) to resume these meds

  • If you decided to continue these medications at home during the first week after surgery, they will need to be crushed

Blood thinners and aspirin containing products:

  • If you are taking Coumadin, Plavix or other blood thinning medications or a regular basis you should have received specific instructions regarding resuming these meds. DO NOT RESUME THESE MEDICATIONS UNLES THE MD/PA HAS INSTRUCTED YOU TO DO SO

  • A daily aspirin for “heart health” may be re-started at home 48 hours after surgery


  • Supplements are not mandatory during the first week after surgery and may be held until week 2

  • Any specific questions about supplements should be asked before leaving the hospital

Thyroid medication:

  • Resume your normal dose of thyroid medication the morning after leaving the hospital

Heartburn/reflux medication:
  • These medications should not be needed after surgery, if you begin to have symptoms, call the office for further direction

Prescriptions Prior to Arrival:

You will be given prescriptions to manage any pain or nausea you may experience and one for vitamin B12 supplement.

We recommend filing these prior to your flight to Houston at least one week in advance.

Provide the clinic coordinator, Kris, with the pharmacy of your choice and an order will be sent.

Note: the B12 spray is the most effective, yet may not be fully covered by your insurance. The sub-lingual (under the tongue) can be substituted.
Antibiotics are given to you through your IV prior to surgery.

Stage One: Low Sugar, Clear Liquids

  • Your clear liquid diet will last for one week. If you have surgery on Monday, you will be on clear liquids through the following Monday.

  • All clear liquids should be sugar free. Labeled “no sugar added”
    does NOT mean sugar free. There should not be more than 10 calories per serving of liquid.

  • A clear liquid is defined as a substance that you should be able to see light through. The color of the liquid is not important. Any liquid that has milk or a cream base to it is NOT considered a clear liquid.

  • Avoid straws, sports top bottles or chewing on ice as this causes excessive intake of air and can worsen gas bubbles and gas pains.

Clear Liquid Shopping List – The Staples

  • Crystal Light – all flavors

  • Diet Snapple products
  • Fruit H2 flavored water

  • PowerAde ZERO

  • Sugar Free popsicles

  • Sugar Free Jell-O

  • Iced tea – unsweetened

  • Beef, Chicken, Vegetable broth

  • Miso Soup (strain off any solids, Miso & Easy soup base)

  • Sugar Free Tang, Kool-Aide or Hawaiian Punch

  • Hot tea


  • Use artificial sweetener such as Splenda, Equal, Truvia, Sweet n Low, NutraSweet

-You can use fresh lemon and limes to flavor plain water

-AVOID all carbonation
-Your goal is 60-80 oz. of liquids DAILY!


  • A soft solid is a food that can be cut through easily with a fork, resembling the consistency of baby food.

  • A soft solid does NOT mean chewed until soft and mushy before swallowing.

  • Your soft solids should all be low fat and low sugar.

  • During this stage of your diet, you need to remember to NOT DRINK liquid while eating your solid meals.

  • You still need to concentrate on adequate hydration so remember to drink between your meals to reach your goal of 60-80 oz. of fluid.

Soft Solid Shopping List: The Staples

  • Eggs – scrambled, hard boiled, egg salad (low fat Mayo or Miracle Whip)

  • Cream of Wheat, Malt-o-Meal, oatmeal; avoid high sugar “flavored” varieties

  • Mashed sweet potatoes

  • Low Fat Cottage cheese, Laughing Cow Soft Cheese
  • Low sugar, low carb yogurt

  • Sugar free, fat free pudding

  • Beans – black beans, pinto beans, refried beans

  • Tuna, Tofu

  • Baked fish – all types, but remember, NOT breaded or fried

  • Bananas

  • Cooked Carrots, steamed zucchini and squash, cooked peas

  • Soups - Low fat cream based soups, in a carton (Butternut Squash, Tomato Basil Bisque) and Campbell’s Healthy Choice (made with skim milk)


  • You may use spices, Pam cooking spray or I Can’t Believe It’s Not Butter Spray

  • Focus on eating high protein foods – your goal is 50 grams of protein daily

  • READ YOUR NUTRITION LABELS – get to know which foods are low in fat and sugars…Remember your limits per serving. (4g sugar/6g fat)



The following vitamins/supplements are MANDATORY for all post-op patients, starting week 2:

**Twice a day Bariatric Advantage Multivitamin
**1500mg of Calcium Citrate daily with Vitamin D
Many great products are sold in the clinic for your initial purchase.
Replacements can be found on our Bariatric Advantage web site, customized specifically for Dr. Marvin’s patients.

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