Do I need a special diet before surgery?
Your surgeon may request that you take a special diet before surgery. This is usually Optifast which is a taken as three shakes plus vegetables as per dietitian instruction. This is a Ketogenic diet which means that after 2 days your hunger is switched off due to a state of fat burning. This feeling of hunger being switched off is similar to what you will experience after surgery. It is very important that you strictly adhere to the diet as even a small amount of carbohydrates will switch hunger back on. Our specialist dieticians will discuss and help you work through the diet. You can expect to lose 2 to 3 kg in weight per week. Your surgeon will recommend a 2 to 6 week diet depending on your starting weight.
The reason for following this diet is to make the surgery easier and safer. Importantly the diet shrinks the size of your liver by a third, in doing so it ensures that the operation can be carried out by laparoscopic (keyhole method) and means that the surgery as a whole is less complex.
Will I be seen by the anaesthetist, before the operation?
Yes, your anaesthetist who has been specially trained to treat obesity and the challenges it can pose to an anaesthetic, will meet with you prior to your surgery to carefully look at your past medical history, test results, and answer any questions that you might have.
What if I become unwell in the days before my operation?
If you develop any sort of cough or cold or become unwell in the week prior to your operation it is important to let us know immediately so that a decision can be made as to whether it is safe to go ahead or if the operation should be postponed until you are better.
Can you get blood clots from having this surgery?
Blood clots can occur uncommonly after surgery (one in 200 chances). Blood clots can occur in lungs called a PE (pulmonary embolism) or a blood clot in the legs called a DVT (deep vein thrombosis).
Lots of things are done around the time of surgery to reduce this risk as much as possible. Compression stockings (TED stockings) are put on prior to surgery and remain on until discharge from hospital. Special leg compression devices are also used during surgery. After surgery a blood thinning injection via a very small needle is given once daily until discharge form hospital.
What is also very important to prevent clots and speed your recovery is getting moving early after surgery. You will be encouraged by your ward nurse to be sitting in a chair on the day of surgery and mobilizing to the toilet. The day after surgery you will be encourage to take walks around the ward.
Do I need to stop smoking?
This is a time of change in your life, and a great opportunity to leave habits such as smoking well behind you. We encourage all smokers to stop six weeks before their surgery as they are more prone to experiencing problems with the anaesthetic, breathing, recovery and wound healing after the surgery than non smokers do. Stopping smoking six weeks prior to your surgery really does make a significant difference to how you recover after the surgery.
Who should I tell about my surgery?
For many the big question is who should be told about your surgery? This is a very personal decision and something for you to decide what is going work best for you. You may want your immediate family and close friends to know as they generally make up your normal support network and will want to support you through this very exciting time. This is without doubt a huge change and in many ways you are embarking on a new and very different chapter of your life. As with any life changing event, this can be a very emotional time. You are saying good bye to a past, and hello to a new and different future. It can be very beneficial to journal your journey or take photographs as a very visual way of documenting your weight loss journey over the coming weeks and months.
What happens during the hospital admission?
You can expect to stay in hospital for two nights. If your surgery is scheduled for the morning, you should not eat or drink anything from midnight the night before your operation. If your surgery is planned for the afternoon you may have an optifast for your breakfast at 8am at the latest, and then nothing but water until 10am. From 10am nothing further to eat or drink this also includes things such as chewing gum and sweets.
Whilst on the ward your surgeon and anaesthetist will both visit you to answer any remaining questions that you may have.
What happens when I go to the operating theatre?
You will be given a theatre gown to wear that opens at the back. You will have on leg compression stockings which are below knee in length. If they feel too tight below the knee it is important that you tell your nurse. All jewellery, make up and nail varnish must be removed prior to going down to the operating theatre, however wedding bands may be left on and taped. It will feel like there are a number of people around you busy talking and doing things to you, in order to get you ready and at times this may feel very confusing and overwhelming, but this is entirely normal, and you are safe hands.
Once in the theatre an intravenous drip will be inserted into your arm or on the back of your hand and various items to monitor you throughout your surgery will be attached including a peg on your finger which monitors your oxygen saturation level, a blood pressure cuff and three stickers that go on your chest to help monitor your heart, all very standard and very normal for anyone having any type of surgery.
When everything is in place an oxygen mask will be placed on your face and you will be ask to breath in deeply, filling your lungs with oxygen, whilst there may be a strange smell there is nothing but oxygen in the air that you are breathing in. You will slowly fall asleep as the anaesthetist inserts medications into your intravenous drip.
What will happen immediately after the operation?
You will wake up either in the recovery room or back up on the ward, once awake you will notice that you are still connected to a number of things, including a drip, oxygen mask and blood pressure cuff. This is entirely normal, and for the first few hours after your surgery you will be closely monitored and blood pressure and pulse will be checked frequently. You may also notice that you are wearing foot pumps that might feel like they are pulsating, we use these to help reduce the risks of blood clots.
You may also have a PCA (patient controlled analgesia) which you are able to press if you need pain relief; it is preset so it will only deliver what you are allowed so there is no danger of overdose. If you feel nauseated or have pain it is important to tell your nurse so that she is able to give the medication that has been prescribed for you. Being comfortable means that you breathe better, move better and drink better, all the things that really do help to ensure you have a positive and rapid recovery.
Once you are awake you will be allowed to start taking small sips of water and your nurse will encourage you to stand up, move around and walk to the toilet as soon as you are able. This early movement is very important and plays a large role in the prevention of complications such as blood clots and chest infections. The use of blood thinning drugs and compression stockings are used to further help reduce the risk of blood clots. You will also be encouraged to take deep breaths, cough and do breathing exercises, all things that will help with your recovery.
The key to reducing the risk is movement and the more you are able to sit out in the chair and walk around the ward the better it is for you. You might find it more comfortable to sit up than to lie down and you may even prefer to sleep sitting in your chair.
Your drip is usually taken down in the evening and the cannula removed the following day.
Will I have pain following my operation?
Most people find that the operation is not as painful as they expect it to be. In fact most find that the pain settles with simple paracetamol, which is given either as a liquid or in gel capsules.
Once home, if you need to take anything for your discomfort or pain, then paracetamol will be recommended.
Your stomach is inflated with gas to perform the operation laparascopically (via keyhole surgery), and some small amounts of gas may sometimes remain and will slowly be absorbed during the week after surgery. Some people experience a discomfort from this gas as a pain in their shoulder, moving around and a warmed wheat bag will help to relieve this discomfort which should gradually disappear over the coming days.
When will I start eating and drinking again?
The introduction of food and fluids after the operation is a slow and gradual process. You will be able to sip water after the operation.
What will happen when I am discharged from hospital?
When you are discharged from hospital you will be given medications to take home with you, including:
Omeprazole tablet once per day– this medication works to reduce the amount of stomach acid that you produce. Even if you have had no symptoms of reflux you will need to continue taking these tablets for one month following your surgery, this helps to create the optimum environment within the stomach for wound healing to occur.
Should you have pain, paracetamol and codeine should be taken as prescribed.
Lactulose 20 mls daily, if you should have symptoms of constipation.
You will commence taking a multivitamin 14 days following your surgery.
Any other medications that you normally take will need to be crushed or taken in liquid form whilst you are on the post operative eating plan. You should speak to you GP about any medication that you are taking that can be substituted for one that is in dissolvable or liquid form.
It is very important to remember that medications such as ibuprofen, voltaren, sulindac and naprosyn should not be used post operatively unless discussed with your surgeon.
Is it normal to become constipated?
Many people will have constipation after surgery particularly in the first month. This is because in the first month food consumption is significantly reduced. The key to treating this is to be pre-emptive. In the first instance, use addition fiber with Benefibre 2 teaspoons twice daily. If no success, use Lactulose 20mls once to twice daily until bowels functioning.
What Should I do with my dressings?
There will be six small wounds on your abdomen; they will be covered by tape dressings. The dressings should be left in place for 14 days and only changed if the wound is oozing or the dressing has lifted off. After showering pat the incisions dry gently. There are no stitches to be removed. The skin stitches are under the skin and in time will spontaneously dissolved and disappeared. It is important to remember not to scratch your wounds, and it is normal for them to feel itchy. There is no need to use creams, lotions or gels on your wounds they will heal better on their own.
Do I need to follow a special diet after my surgery?
After surgery you will need the following post-operative diet:
Two weeks : Fluids which can include optifast, Kate Morgan or bariatric advantage, water, tea, coffee, drinking yoghurt, milk, soup (that has been sieved, no lumps), miso soup, weight watchers jelly, diet cordial and concentrate, milky Milo, thin pumpkin soup. Aim for 1.5 litres total fluid intake per day so that dehydration is avoided
Two weeks: Pureed – consistency of baby food
Four weeks: Soft diet leading to a normal diet.
It is recommended you stick to this diet, as it helps place the stomach in the best position for healing. It is also important to remember to drink regularly throughout the day to ensure that you remain adequately hydrated. Remember following your operation you will only able to take sips of fluids rather than been able to drink a whole glass of water as you can prior to the surgery.
Should I be taking vitamins and supplements after my surgery?
On day 14 post operatively you should commence taking:
One multivitamin daily (must contain folic acid, selenium and zinc)
B12 drops under the tongue (1000mcg per day)
Calcium with cholecalciferol (Vitamin D)
Iron ( for menstruating women) – don’t take at the same time as calcium
Follow up appointments
You will be seen at the rooms for a wound check at 1-2 weeks post-op. You will have appointments with the surgeon then at about 3-6 months, 1 year and 2 years post operatively. You will also have follow up appointments with the rest of the team including dietitians and the exercise consultant. You will also have blood tests done at 6 months and then they should be checked annually.
When can I return to work?
Most patients are back at work 2 weeks following their surgery. If your job involves heavy lifting, or stretching discuss with your surgeon how long you should be expected to be off from work.
When can I get back to normal exercise?
Following your return home, you are able to start going out for walks one week post operatively, start with short walks several times each day. After two weeks you can get back into the swimming pool as long as all your wounds are clean and healing well. Gym activity can be commenced at four weeks after surgery. No abdominal exercises for four weeks and avoid lifting more than 15 kg for the first four weeks. In the first month you will feel tired, this is common, but don’t worry it will resolve.
When can I start to drive again?
You should be able to start driving 5 days after your surgery. You should only be back in the driver’s seat when you are confident that you will be able to undertake an emergency stop and find having the seat belt comfortable around your stomach.
What should I do about being socially active?
Being socially active is very important and plays a large role in positive emotional well being, but do be careful not to overdo it initially, do not under estimate just how quickly you will tire during those early few weeks. Remember to, that because you are eating only small amounts, you may be more prone to the intoxicating effects of alcohol than you used to be. Remember too that alcohol contains a large amount of liquid calories and this could slow down your weight loss.
What should I do about contraception?
It is strongly recommended that women do not become pregnant in the first year following their weight loss surgery. The reason for this is that the growing baby is unable to obtain enough nutrients while the mother is undergoing substantial weight loss. We advise that women of childbearing age should be using some form of barrier contraception during this time. This includes women who might have previously had issues relating to infertility.
Surgery is a tool, and the more you engage with it the better the result. Engaging with it means that you are implementing portion control, making good food choices and the lifestyle changes, including exercise that will help support and maintain your weight loss long term.
CONTACT YOUR SURGEON IF YOU ARE
Unable to drink fluids
Have abdominal pain
If you have a problem that occurs during the evening, or over the weekend and are unable to contact your surgeon, then got to the Emergency Department of your nearest hospital immediately.
Contact your surgeon via
Christchurch Weight Loss Surgery office phone number
An after hour’s emergency phone service is available on this phone number
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