Dr.Weight // BEFORE and AFTER bariatric operation - practical guidelines // The operation and days after

The operation and days after

Bariatric Surgery - DoctorWeight.com – 2008

The day of the operation

Please arrive by 09-00 and bring:

1. Your passport.
2. The results of all laboratory tests, EKG, x-ray of your chest, upper GI endoscopy (or x-ray study of the oesophagus, stomach and duodenum). If any of these documents are missing, your surgeon must be informed in advance so that the necessary tests can be taken.
3. A list of regularly taken medication, including vitamins and food supplements.
4. Pyjamas or other comfortable light cotton clothing.
5. Slippers.
6. Deodorant, tooth-paste, toothbrush, razor etc.
7. Women of reproductive age must bring appropriate hygienic accessories regardless of expected date of menstruation, as the stress of an operation can cause this prematurely.

N.B. Please do not bring jewellery.

One-bed or two-bed rooms are available according to preference (to be arranged in advance).

At the appointed time you will be taken to the operating theatre (your relatives and friends can see you off only as far as the theatre entrance), and there the nurse anaesthetist will place the intravenous catheter in your arm vein. The anaesthesiologist will ask you a few questions, give you an oxygen mask and inject anaesthetic intravenously. You will fall asleep and will wake up only after the operation.

Surgery can last from 30 minutes (laparoscopic gastric banding) to 3-4 hours (laparoscopic gastric bypass). Sometimes, in difficult cases, it can last 5-6 hours. You will then be placed in a special post-operation room until waking. When fully conscious, you will be returned to your room.

Evening and night after the operation

Pain

Normally pain is only moderate and easily cured by analgetic injections, and some patients do not even request this.

Urinary bladder function

Usually the patient gets up and goes to the toilet in the evening. If you have problems with urination, inform the nurse. If a urinary catheter was installed during the operation, it must be removed before you stand.

Physical activity

It is important to get up at least once during the evening, but with the assistance of your relatives, friends or hospital personnel as you may feel dizzy. Sit up in bed for 5 minutes first, inform your nurse, then stand. If you feel no discomfort or disorientation once vertical, you may walk without restriction. This active regimen, as well as constituting good breathing exercise, is a safeguard against thrombosis of the leg veins.

Leg exercises

Simple leg exercises, such as bending and unbending your feet, also help to prevent vein thrombosis.

Drinking and eating

Do not eat after the operation. If you underwent laparoscopic gastric banding, you may drink after 5-6 hours. Try to swallow a small amount of water. Unless you vomit you may then drink as much as you wish (except sparkling water). The next morning you may have a light breakfast.

If you underwent gastric bypass or gastroplasty, do not drink or eat until your doctor gives permission.

Breathing exercise

It is important to take a deep breath 10 times per hour. Cough if you wish. If you have any medical problems with your respiratory system, e.g. asthma or chronic bronchitis, please bring your drugs and inhalators with you and continue to use them.

Nausea and vomiting

Nausea and vomiting are undesirable after surgery. If you feel nauseous, please inform medical personnel immediately so that necessary drugs may be given.

First post-operative day

On the following day you should not only get up but walk actively, as this has a very positive effect on your whole body.

If you underwent gastric banding you may drink without limitation, in which case intravenous fluid infusions will not be required. Acceptable non-carbonated liquids include:

• Still water
• Weak warm (not hot) tea
• Weak warm coffee
• Diluted fruit juice.

If you wish, you can add some sugar or sugar substitute. If you wish to eat, then the best options are yoghurt, banana, clear soup or puree.

As a rule, laparoscopic gastric banding patients can go home the day after the operation. The intravenous catheter is removed, the dressings changed and the patient discharged.

After gastric bypass or gastroplasty, a special upper GI test is necessary before the patient is allowed to drink and eat. The patient is taken to X-ray room and given one swallow of a liquid contrast substance. The doctor inspects the passage of this contrast through the new small stomach and through the gastroenteroanastomosis (connection between the small stomach and the intestine). If the passage is satisfactory and no leakage is revealed, the patient is allowed to drink 500ml of water a day. In addition, the patient is usually given a special blue dye to swallow to test the water-tightness of the anastomosis.

Intravenous fluid infusion continues, as does administering of antibiotics, analgetics and any other drugs necessary. Dressings are changed, but the drain in the abdominal cavity is not yet removed. (When you walk, put the plastic bag of the drain into the pocket of your pyjamas or your coat.)

Second post-operative day

After gastric banding

We do not recommend returning to work (though it is theoretically possible if your work does not involve significant physical effort). Stay at home and rest, and perhaps take a walk in the fresh air. Do not lift anything heavier than 5-6 kg. Drink a minimum of 1.5 litres of water. Liquid and semi-liquid food is recommended for a period of 2-3 weeks (banana, yoghurt, soup, puree). If you eat more solid food, take small bites and chew thoroughly. If as regular medication you need to take a tablet or capsule, grind it.

If you have a dressing like Tegaderm on your stomach, you may shower. This kind of dressing stays on your skin for about a week.

After gastric bypass and gastroplasty

After gastric bypass and gastroplasty, the patient can drink up to 1 litre of water. The intravenous infusion of fluids continues (as well as of other drugs, including antibiotics and analgetics). Your surgeon may decide to remove the drain from your abdomen. Eating is not yet permitted. Continue to walk actively.

Third post-operative day

If the patient can drink 1.5 litres of water in the course of the day, intravenous fluid infusion can be stopped. The drain from the abdomen is removed.

The patient then tries a small amount of semi-liquid food. If no problems occur, the patient can continue eating.

Fourth post-operative day

In most cases this is the day of discharge for bypass and gastroplasty patients. The dressings are changed, and the catheter from the cubital vein is removed.

Be careful at home, and avoid lifting more than 5-6 kg.

• After gastric bypass
• After adjustable gastric banding
• After other restrictive operations
• Preparation for bariatric operation
• The operation and days after
• General recommendations for rehabilitation period
• Grand questions after gastric banding
• Grand questions after gastric bypass
• Potential problems following all types of bariatric surgery
• Rules for a new life after bariatric operations
• Some groups of food products that could be eaten after the operation