Bariatric Surgery

Bariatric Guide Transcript

Hello there, it is my pleasure to provide you some practical information to help you through your bariatric surgical procedure!      

It is completely normal to feel nervous about the unknown. Together, we will explore how to best prepare, what to expect, as well as the best way to become involved in your recovery from your upcoming surgery.

All information presented is recommended and supported by a critical review of the medical literature, including the recently developed Enhanced Recovery After Surgery pathway or ERAS.

Compared to traditional operative care, the use of ERAS has been associated with decreased pain, length of stay, use of nursing time, while simultaneously improving patient satisfaction and quality of life, thus enabling you to recover more quickly and resume routine activities in a more timely fashion. These benefits have been reported for patients undergoing bariatric procedures.

Planning for your procedure and going in as healthy as you can will have a positive influence on your recovery. Pre-operation information and guides for bariatric surgery have been shown to reduce fear, fatigue, and pain while speeding up the recovery process.

A surgery is something that is best approached when one is prepared and takes the appropriate measures to recover from such a physically and mentally draining day. You should spend the time before the procedure being as active as you can (whether that involves going for short walks or exercising), having a well-balanced diet, and getting an appropriate amount of sleep. Your doctor will recommend you to follow a specific diet as weight loss prior to bariatric surgery is associated with less complications. This diet will also make your liver smaller, which is extremely important for the success of your surgery. If you smoke or drink alcohol, you would benefit to stop as soon as possible, because smoking can cause problems with breathing and recovery from surgery, and stopping alcohol consumption reduces post-operative complication rates. It should be noted that for females planning to undergo bariatric surgery, pregnancy should be avoided one year before and one year after the surgery to decrease risks to you and your baby. If you plan to get pregnant soon, the appropriate timing of your surgery should be discussed with your surgeon.

 

While certain health care teams have their own practice, ERAS recommends:

  • Consumption of solid foods up to six hours prior to surgery and clear liquids up to three hours prior.
  • Clear liquids include water, black tea, black coffee or apple juice but not milk or orange juice.
  • To improve recovery, as your last drink, it is recommended to have an energy drink 3 hours prior to surgery, as this has been found to be significantly correlated with improved recovery and a reduction in length of hospital stay by about 1 day in patients undergoing major abdominal surgery.
  • before surgery, patients should shower or bathe their full body with 4% chlorhexidine gluconate soap at least the night before and ideally the morning of their surgery as it has been associated with a lower risk of surgical site infection (from 6% to 1.1% ) for patients undergoing gynecological procedures
  • Hair in the operative field should be clipped, not shaved, while skin is cleaned to avoid any cuts or irritation.

  

THE DAY OF SURGERY,

  • Try to Bring a family member, friend or someone to assist you. You won’t be allowed to drive after outpatient surgery, or even after a few days in the hospital, primarily if you’re taking pain medication. Plan to have someone take you home.
  • Wear comfortable clothing. Wear or bring loose-fitting clothing. Your body might be sore or swollen from surgery, or you may have bulky bandages over your incisions. Leave jewelry and valuables at home. Toothpaste/brush, pajamas, denture cup if necessary, and any medications that you take regularly in a labeled pharmacy container approved by your healthcare provider. You may also choose to bring compression stockings to wear on your journey home.

On the day of the surgery, the health care provider who will admit you, will likely check your temperature, blood pressure, pulse and breathing, review your medication and help you get ready. You will receive some medications before and after surgery to improve pain control. Frequently an intravenous tube, called an IV, will be placed into a vein in your arm, to allow you to get fluids and medication. When you are ready, someone will help you onto a stretcher and take you to the holding area, and then to the operating room.

 

Immediately after your operation (Day 0)

 

Postoperative ERAS elements typically focus on pain management, bowel function, diet, and patient mobilization. Criteria for discharge for any patient undergoing bariatric surgery include tolerance of their diet, ambulation, ability to go to the bathroom, and appropriate pain control.

When you wake up after surgery, you may feel cold and experience pain in your abdomen. If you had laparoscopic surgery, you may also feel transitory pain in your shoulder. This pain is from the carbon dioxide gas that is used to expand your abdomen during this type of surgery. The sensitivity to pain is different for each person. If you are having pain or nausea, tell your nurse, who will help you get more comfortable and give you medication.

If your surgery is more than 3-4 hours long, you may wake up with a urinary catheter in place until the time you are able to mobilize out of bed and make your way to the bathroom.

 

Your throat may feel sore from the tube used to help you breathe during surgery. If your mouth is dry, you may have some ice chips when you are fully awake. Feeling stiff or achy is also normal at this time. These feelings will go away when you can move around more. Some patients feel sad or “blue” after surgery. These feelings are normal. As your body heals and you are able to resume your activities, these feelings will lessen. Please talk about these feelings with your nurse, a friend or someone in your family. If you feel overwhelmed by these feelings or they do not lessen over time, please get help from a health care provider.

 

Following your operation, when you wake up, it is important that you perform deep breathing

exercises. Breathe in deeply through your nose and relax the air out through your mouth, undertake this at least five times an hour. You will receive an incentive spirometer, which is a device used to help you open up your airways after surgery. When you feel like coughing, don’t hold back but try holding a pillow to your abdomen to control the pain. You should be able to cough and clear your airway, otherwise ask your nurse for more pain medication.

The medical staff may help you out of bed after your operation. You should try to spend up to two hours out of bed on the day of your operation. If you feel faint or dizzy, call the nurse to help you get back to bed.

You may feel gas pains in your stomach or abdomen. This is normal as your bowels start to work again. Walking, rocking, or using hot packs, can relieve gas pains. Passing gas, or having a bowel movement will often take away gas pains. Walking around and gum chewing can help make bowel movements come more quickly. However, it is normal to not pass gas or have a bowel movement for several days following bariatric surgery, and you may not experience these prior to your discharge home.

 

THE FOLLOWING DAYS

Diet:

From the time you wake up after your surgery, you will be encouraged to drink very small amounts (15ml) of clear fluids frequently (every 15 minutes). This is because it will take you time to get used to your new and smaller stomach. On the second day the amount you drink will double to 30ml every 15 minutes. Do not worry about dehydration as you will be receiving all the hydration you need through your intravenous tube. You should avoid any carbonated or sugary drinks, as these may upset your stomach.  You will likely continue on a liquid diet for a few weeks, followed by a thicker pureed diet for an additional few weeks. Prior to surgery (or shortly thereafter) you will meet with a nutritionist who will outline the type of diet you should follow in the weeks before your surgery and in the weeks, months and years after. You may require supplements like calcium, vitamin D, vitamin B12 and other vitamins. Remember that bariatric surgery does not guarantee weight loss and that you must follow a healthy diet outlined by your nutritionist for the rest of your life.

 

Mobilization:

On each day after your surgery, it is advised that you sit in the chair for a total of six hours, with intermittent rests on the bed as needed. Your medical team will place compression stockings and give you medication in order to decrease the chance of blood clots in your legs while you are lying in bed.

You should also aim to do some lower extremity exercises, such as bending your knees, rotating your ankles, and pointing your feet up and down. Once you are capable, you should aim to walk along the ward corridor as much as possible. Being in an upright position, getting out of bed, and walking will help improve breathing, increase muscle strength, and decrease the chance of clots in your chest and legs.

It is worthwhile to plan in advance for your discharge. You may require someone to help for a few weeks. Although it is not indispensable, some people feel more confident to go home if a friend or family member can stay with them for a short period of time.

 

POST HOSPITAL RECOVERY  

 

Abdominal pain

It is not unusual to suffer abdominal pains during the first week following surgery. The pain usually lasts for a few minutes and goes away between the spasms. If you have severe pain in the abdomen or chest, fever, shortness of breath or non-improving nausea and vomiting you should immediately contact a health care provider.

 

Your Wound

It is not unusual for your wounds to be slightly red and uncomfortable during the couple weeks. You may start to take showers two days after your surgery. Let the water run over your wounds and do not rub them, only pat them dry. If you have staples or clips on your incisions, you will get an appointment to remove them 10-14 days after your surgery. Please contact a health care provider if your wounds become red, inflamed, painful, swollen, or start to discharge fluid.

 

Diet

You will receive a specific diet plan by your nutritionist before leaving the hospital. A balanced, low calorie, varied diet is recommended. You may find that some foods upset you and cause loose bowel motions. If that is the case you should avoid those foods for the first few weeks following your surgery. If you are finding it difficult to eat it is still important to obtain an adequate amount of protein to help your body heal. If you are suffering from diarrhea it is important to replace the fluid loss and to drink extra fluid.

 

Exercise

Walking is usually encouraged starting the day following your operation. You should plan to undertake regular exercise several times a day and gradually increase this during the four weeks following your operation until you are back to your normal level of activity. The main restriction on exercise is usually not to undertake heavy lifting (generally not more than 5 – 10 lbs) and contact sports until six weeks following your surgery. In addition, if you are planning to restart a routine exercise such as jogging or swimming you should usually wait until at least two weeks after your operation and start gradually. Common sense will guide your exercise and rehabilitation. In general, if the wound is still uncomfortable, modify your exercise. Once the wounds have completely healed you can normally undertake most activities.

 

Driving

You should not drive until you are confident that you can drive safely. A good yardstick for this is when you have got back to most of your normal activities and not on strong pain killers. Usually this will be within two to four weeks of surgery. It is important that any pain has resolved sufficiently and that you are not taking any medication that would interfere with your ability to react appropriately in the event of an emergency on the road.

 

Hobbies/Activities

You should consider taking up your hobbies and activities as soon as possible again after surgery. It enables you to maintain your activity and will benefit your recovery. You should not need to restrict these unless they cause significant pain or involve heavy lifting.

 

Tiredness

It is common to feel low energy levels following surgery and anesthesia. It is important to mix activities with some rest as needed, but to get out of bed each day and get dressed if possible.

 

Summary

To enhance your recovery you will benefit to return gradually to normal as quickly as possible. This means that you need to actively participate in your recovery by walking, eating and drinking. Each day you should feel some improvement but do ask your healthcare provider if you are worried about something. You can refer to the list of products on Precare.ca for your specific surgery as an example on what you need for your surgical preparation and recovery. It is our hope that this video makes you feel more confident about what’s ahead. On behalf of the Precare team, we wish you the best on your journey.