Your Bariatric Surgery Journey
Below you will find details on the surgery journey from the assessments before being admitted to what will happen post-surgery. It is important that you inform yourself on the full process as there are many steps. Becoming aware of what will happen and what will be expected of you should help in making your decision.
Stage 1 - getting started
There are many steps involved in the six months before surgery. This is to ensure that you get the best care possible, appropriate to your needs. Your diet, nutrition and current health status will all be thoroughly reviewed at screening appointments.
At your first appointment, the team will discuss the surgery and explain in detail what is involved. You will complete a questionnaire in advance. This will be reviewed along with your medical history, weight loss history and eating habits.
After this initial appointment, you may be referred to other members of the team for review. Once these reviews take place you will see your surgeon again to decide whether to proceed.
Many patients benefit from some psychological support before and after surgery. At the initial assessment your expectations of surgery will be discussed, as well as the emotional factors that might affect your eating. The aim of this assessment is to think about whether surgery is the best option for you, and how you will cope with the necessary lifestyle changes.
You will meet the dietitian at your initial assessment. They ensure you are well informed for the dietary and lifestyle changes you will need to make. Your expected weight loss following surgery will be calculated.
You will see the dietitian at frequent intervals over a two year period to make sure you have adequate nutrition and are being consistent.
You will be given an appointment to attend a pre-operative assessment clinic in the hospital. This clinic includes final checks to assess your fitness for surgery including standard blood tests, screening for MRSA and ECG of the heart.
Patients with a pre-existing illness are at a higher risk of developing complications during or after surgery. The following may be required:
- Echo, ECG or stress test if you are at risk of developing heart failure, a heart attack or other heart disease.
- Endoscopy if you have a history of acid reflux or upper gastrointestinal tract disease.
- Anaesthesia assessment if you are assessed as high risk by the anaesthesia team.
- Respiratory/ sleep clinic if you have sleep apnoea.
Many patients needing bariatric surgery have a large, fatty liver which can cause difficulty for keyhole surgery. These patients will be required to follow a strict diet that is low in dietary carbohydrate and fat for two weeks prior to surgery, thus helping to shrink the size of the liver.
It is essential that you follow this diet. If you have not followed it prior to surgery, your surgery may be cancelled.
Stage 2 - preparing for admission
There are many steps involved in the six months before surgery. This is to ensure that you get the best care possible, appropriate to your needs. Your diet, nutrition and current health status will all be thoroughly reviewed at screening appointments.
You will be given a date for admission once your assessments have been completed and the team agree that you are fit for surgery. Once you have a date for surgery, you should make arrangements prior to being admitted to hospital.
Arrangements to make
- Transport to and from hospital
- Help at home for the first few weeks after surgery
- Prepare and freeze meals from your diet sheet to make the transition to your new diet easier
- Plan for coping strategies to deal with emotional eating
Stage 3 - The Surgery
It is best to be as prepared as possible for the day of the surgery. The details below explain what will happen once you are admitted to the hospital for your surgery.
- Most people are asked to arrive on the morning of their surgery. If you are diabetic, you may be admitted the day before surgery to stabilise your blood sugar levels while you are fasting.
- You will be advised to stop taking aspirin or blood thinning medications one week prior to surgery. You should bring toiletries, nightclothes/tracksuits, slippers and any medications you are currently taking.
- If you use a CPAP or Bilevel Positive Airway Pressure machine for sleep apnoea at home it is essential that you bring this with you.
- You will be asked to fast from food and drink from the night before your surgery - you may take essential medications (such as cardiac drugs) with small sips of water.
- You will be seen by the anaesthetist and the surgical team before you go to theatre—they will answer any further questions and confirm that it is safe to proceed with your surgery. You will be accompanied by a nurse from the ward to theatre where you will have your anaesthetic.
You will:
- Return to the ward after a short period in recovery
- Have a drip to provide hydration and you may have a patient controlled analgesia pump (PCA)
- Be allowed small sips of water the night after your surgery
- Have a swallow test the day after surgery in the x-ray department
- Be visited by a dietitian after surgery who will advise you regarding starting fluids and your diet after discharge
- Be encouraged to get out of bed and start walking as soon as possible, as this will aid your recovery
- Be provided with painkillers and medication to stop you feeling sick
Stage 4 - Post Surgery
On average patients stay in hospital for two to five days. The following outlines the advice and timelines you should follow to encourage a safe recovery.
- Wounds: the ward staff will advise you about wound care before you go home. If you have stitches that need to be removed, the ward staff will give you a letter for your GP or practice nurse to arrange their removal.
- Medication: your medication will be reviewed by the medical team before you go home. You may be given a supply of medication to take home with you. This could include pain relief, anti-sickness medication, or nutritional supplements. You may be given a two-week supply of blood thinning injections (heparin). You will be taught how to inject yourself by the ward nurse.
- Eating and drinking: follow the guidance provided by the surgeon and the dietitian.
- Washing: you can shower, but we do not recommend taking a bath for at least a week after surgery.
- Driving: we recommend you do not drive until you can safely brake without any abdominal pain (usually after six weeks). You should check with your insurance company for their specific advice about driving after keyhole surgery.
- Exercise: you will be able to start getting up and walking the day after surgery. You can exercising about six weeks after the operation, although gentle exercise such as walking can be done as soon as you feel it is appropriate.
- Returning to work: most people are able to return to work a couple of weeks after surgery. We recommend no heavy lifting or strenuous activity for six weeks after the operation. If you need a sick certificate for your employer please make sure you ask the medical staff prior to your discharge.
Two weeks after surgery you will be sent follow up appointments to see the surgeon and the dietitian.
You will then be seen regularly for 18 months by members of the multi-disciplinary team. If you have not received appointments in the post or by email, please contact the dietitian or nurse and they will check if this has been arranged for you.
You will see the dietitian regularly for the first year following surgery, and every 6–12 months thereafter. If you are having difficulties or want to see the dietitian more regularly, this can be arranged.
