Laparoscopic Sleeve Gastrectomy
Sleeve Gastrectomy :: Procedure Guide :: Risks and Complications :: Post Operative Instructions
Preparing for Surgery
Now that you have decided to proceed with surgery, there are certain steps to take before your operation to ensure that you are as prepared as possible for the procedure.
Goals and Objectives
Making the decision to undergo weight loss surgery is a complex, personal and life-altering decision. As you know, many changes in lifestyle and dietary habits are required in order to make the surgery a success. Since some old habits are hard to break and some new habits are difficult to establish, it is wise to begin now undergoing these changes that will continue for the rest of your life. By doing so, not only will you find it easier to accept and adopt the changes immediately following surgery, but also you will decrease the possibility of complications and improve your opportunity for overall success.
If you begin now to practice some of the dietary and lifestyle changes required of you, you will likely find that you are quite familiar with them immediately following surgery. These include:
- Take your vitamins. Start taking multivitamins daily to improve your general health. Also take 500 mg of Calcium Citrate three times daily. Vitamin and mineral intake is especially important after bariatric surgery in order to maintain good nutrition and health. We have found that if you start taking these supplements before surgery it will be easier remembering them after surgery. Set up a schedule
- Eat sensibly. Now is not the time to "binge" eat or perceive each meal as your "last" meal. Rather, begin practicing good nutrition, complete with eating slowly and deliberately, while chewing food thoroughly. By doing so you will avoid the temptation to eat uncontrollably, possibly gaining weight and putting yourself at increased risk for surgery.
- Exercise. Do some investigating and choose the exercise program that is right for you, as exercise contributes significantly to overall success. Some recommended exercise plans to choose from include: daily walking, water aerobics, swimming, biking and light weight lifting. Taking an interest in one or several of these and undergoing a trial prior to surgery is very beneficial. Once you have recovered from surgery, you may find it comfortable as well as motivational to resume an exercise routine you are already familiar with.
- Lose weight. Losing even a few pounds before surgery may improve your risk for surgery. Not only is the scale moving in the right direction, but also weight is preferentially lost from the abdominal organs first. This enhances visibility for your surgeon that improves chances of having your procedure successfully performed laparoscopically.
- Drink plenty of water. Water is a key component in promoting weight loss, since it is needed to metabolize fat adequately. Water also aids in digestion and distribution of the nutrients in food. The minimum amount of water for a healthy individual is 64 ounces (2 liters) a day. Although you are not to drink water with meals or drink too much water at any single time following surgery, it will be very important that you take frequent sips of water throughout the day. You will likely become accustomed to carrying a water bottle with you at all times. So, the sooner you begin enjoying the benefits of water, the better. You may also find that water replaces many other calorie-containing beverages like sodas, power drinks or coffee-beverages, which is a healthy habit to promote.
- Practice good nutrition. While the quantity of food you are to consume after surgery is greatly reduced, it is important that what you eat is of good nutritional value. Foods that are high in protein, as well as a fruit or vegetable, are to be eaten at each meal. There is no time like the present to begin making some healthy selections.
- Limit sweets. Following surgery, you probably will not be able to eat foods containing simple sugar, such as cookies, candy, cake, etc. as this will likely cause dumping syndrome. This is characterized by feeling of lightheadedness, shakiness, palpitations, cold sweats and possibly uncontrolled diarrhea. Although dumping syndrome is an unpleasant experience, many patients view it rather positively, as the thought of such an adverse experience helps them avoid sugar in order to avoid the consequences. By limiting sweets now, you will not feel as deprived following surgery.
- Maintain good hygiene. Good skin integrity is essential for the operative site. Keep your skin clean and dry, especially in the days before surgery. Skin breakdown could possibly cause your surgery to be delayed.
- It is important to avoid aspirin (and all aspirin-containing medicines) for at least 10 days prior to surgery.
- Please discontinue all Non-steroidal Anti-inflammatory Drugs (NSAIDs -ie: Aleve®, motrin, ibuprofen, etc.) for at least 2 weeks prior to surgery.
- Coumadin (warfarin) and any other blood thinner medications must be discontinued at least five days prior to surgery. Please check with your doctor for specific instructions.
- Please discontinue all oral birth control pills and/or estrogen hormone supplements you may be taking one month prior to surgery, if possible. These medications increase the risk of blood clots. You must use a different method of birth control during this period. You may resume oral birth control pills one month after surgery.
- Herbal medications such as St. John's Wort, Gingko Biloba, Garlic, etc, should be discontinued 2 weeks prior to surgery, as these have blood-thinning properties.
- Other herbal supplements such as Kava and Valerian Root are known to interact with anesthesia and should also be stopped at least 10 days before surgery. Again, remember to tell your surgeon all the medicines and herbal supplements you are taking.
- Do not forget to check the label of your multivitamin; many times they can contain herbal supplements as well.
- Remember to check all labels of over-the-counter medicines, since certain over-the-counter medicines can contain aspirin, too.
- If in doubt, please check with your pharmacist or your surgeon.
Alcohol and Tobacco
- Patients are required to stop smoking eight weeks before surgery.
- Since smoking hinders proper lung function, it can increase the possibility of anesthetic complications.
- Smoking can increase your risk of complications such as deep vein thrombosis (blood clots in the legs).
- Smoking also reduces circulation to the skin and impedes healing.
- Smokers who undergo anesthesia are at increased risk for developing cardiopulmonary complications (pulmonary embolism, pneumonia and the collapsing of the tiny air sacs in the lungs) and infection.
- Besides the well-known risks to the heart and lungs, smoking stimulates stomach acid production, leading to possible ulcer formation.
- Patients must agree to permanently refrain from smoking after surgery.
- Ask your Primary Care Physician to write you a prescription for a smoking cessation aide, if necessary.
- Alcohol causes gastric irritation and can cause liver damage.
- During periods of rapid weight loss the liver becomes especially vulnerable to toxins such as alcohol. You may find that only a couple of sips of wine can give you unusually quick and strong effects of alcohol intolerance.
- In addition, alcoholic beverages are high in empty calories and may cause "dumping syndrome". (Please refer to page 38.)
For these reasons, we recommend complete abstinence from alcohol for one year after surgery and avoiding frequent consumption thereafter.
Work and Disability
Expected return to work time is about two to four weeks. This may vary greatly. The time you take off from work depends on many things:
- The kind of work you do
- Your general state of health
- How badly your work needs you
- How badly you need your work (i.e. the money)
- Your general state of motivation
- The surgical approach (laparoscopic versus open)
- Your energy level
Note: It is important to remember that you are not just recovering from surgery, but you are eating very little and losing weight rapidly. You may have heard that someone went back to work full-time in just two weeks. We would, however, caution you not to rush back to full time work too quickly. The first few weeks are a precious time to get to know your new digestive system, rest, exercise and meet with other post-operative patients in support group meetings. If financially feasible, take this time to focus on your recovery.
Some patients do not wish to tell the people with whom they work what kind of surgery they are having.
- It is perfectly appropriate to tell as much or as little to your employer as you would like. Although you do not need to tell your employer that you are having weight loss surgery, it is recommended to reveal that you are having major abdominal surgery.
- Explain that you will need two or more weeks to recover, especially if you would like to have some form of financial compensation during your absence.
- You may want to indicate that you will not be able to do any heavy lifting for several months after surgery.
- Your employer should have the relevant forms for you to complete.
Diet Before Surgery
It is expected that you will follow a high protein, low calorie/low fat liquid diet for one to two weeks before your surgery. One of the common side effects of obesity is fatty infiltration of the liver. This fatty liver makes surgery more difficult and may mean the difference between the surgery being performed through a laparoscope or done by a laparotomy approach (an incision that extends from the breastbone to the navel). The liver fat will be burned up quickly by this prescribed diet. Shrinkage of the liver makes the operation less difficult and safer.
On the day before surgery:
- Switch to only clear liquids, which include water, decaffeinated coffee or tea, apple juice, grape juice, cranberry juice, bouillon, broth, clear popsicles and gelatin.
- After midnight you must take nothing by mouth except medicines that have been approved by anesthesiologist and surgeon.
- Your stomach must be empty at the start of the procedure to avoid the risk of aspiration.
If you are ill before surgery
- Should you develop a cold, persistent cough, a temperature of 101 F degrees, skin breakdown or any changes in your condition during the days before your surgery, please notify the surgeon immediately.
- You will need to be re-evaluated for surgical readiness. You need to be in the best possible shape for anesthesia.
- Scheduling can be adjusted to your condition if necessary.