Preparing for Sleeve Gastrectomy surgery

This surgical procedure forms part of an overall anti-obesity programme: this programme is designed to help you lose weight and when you have done so, to maintain a healthy weight and lifestyle.

This means a permanent change to your current lifestyle and a commitment to following a healthy diet, exercise and nutritional supplements

A word about nutritional supplements: please be aware that if this procedure is performed as a two stage procedure – by that we mean this procedure followed by either a gastric bypass or duodenal switch; you are looking at daily nutritional supplements for the rest of your life.

If it is performed as a single technique then this is not a problem as food absorption is not affected.

But, if you undergo the single technique and then opt for the bypass or switch at a later date then make sure that you fully understand what this entails. This means that for every day for the rest of your life you will have to take a daily vitamin/mineral supplement, and follow a high protein diet.

There is no ‘day off’ with this: if you miss a day or so then you are looking at the very real possibility of malnutrition or a range of vitamin deficiencies. So, be very, very sure that you want this procedure.

It may be the case that the single sleeve technique works so well and that you lose your excess weight. If so, then this is nothing to worry about but if after having the first stage, weight loss is not as you hoped for then consider your options very carefully.

This will be explained to you when you have your initial consultation with your surgeon. He/she will run through the various options open to you, explaining the risks and benefits of each before deciding upon your suitability. You can choose your procedure but before you have surgery your surgeon will use a set of criteria to assess your suitability for a procedure. If the risks of the procedure are greater than the risks of not having surgery then he/she will be reluctant to go ahead with the surgery.

This may sound draconian but it is designed to protect you against any unscrupulous surgeons or clinics who would recommend you for surgery even though it would be dangerous for your health.

What this comes down to is this: you will need to balance the benefits and risks of the surgery against the risks of not having surgery. This will depend upon your BMI and your overall state of health. If you are suffering from an obesity-related illness or co-morbidity then this could exclude you from surgery but again, this will be discussed between you and your surgeon.

Your surgeon will have a multidisciplinary team which will include a dietician, psychologist/counsellor and senior obesity or bariatric nurse. They are there to help you make the right decision based upon all the information that you have to hand. They can advise you about diet, taking exercise, finding a patients support group, dietary supplements and so on.

They will be with you from the first consultation right through to the aftercare.

Apart from the surgery they will encourage you to start on a healthy lifestyle in the weeks leading up to your operation. This is to get you used to a change in lifestyle; and, to ensure that you have lost weight in the time leading up to the surgery. This will also help to reduce the risks. Risks of obesity surgery are uncommon but they do happen: the risks associated with surgery are greater for obese patients than many other types of patients.

If you are a smoker you will be advised to stop as smoking can increase your risk of chest infections such as pneumonia, and can slow down the healing process. Ideally, if you can, try and stop altogether but for the purposes of this surgery then stop smoking a month before, and a month afterwards.

These are all things that will be talked through with you in the weeks leading up to your surgery. This can be a stressful time and one that they are fully aware of and are sympathetic to. They will help you with this and can recommend other useful sources of support. The British Obesity Surgery Patient Organisation (www.bospa.org) has some very useful information on their site about local support groups.

The aim is to make sure that you have all the information you need, and if you decide to go ahead, what lies ahead of you. This does mean a lifelong commitment so make sure that you are satisfied with this information: are aware of the risks as well as the benefits and are fully prepared to change your lifestyle for ever.

As the date of your operation draws nearer you will need to make some preparations at home. For the first few days after the surgery you will have to rest and so you need to make sure that someone is available to help you at home. This means doing your shopping, cooking, tidying up and any other such jobs. You will have to avoid putting any strain on your operation wound which means even the smallest task will be too much. This even includes such tasks as opening a tin. Ensure that you have a good friend or partner who can do these things for you.

He/she will ideally, be on hand to drive you to the hospital and back, will stay with you and generally, be there if you need anything.

If you are on any prescribed medication then ensure that you have enough supplies to tide you over. For the first few days you will be confined to the house so the last thing you want is to run out of a vital medicine.

Mention your medical history to the team. If you have any allergies or history of previous surgery then let them know. If you are on medication then again, let them what type, what it is for and how often. They will check your blood pressure and will probably perform blood and urine tests. Don’t worry, this is just standard procedure.

They will provide you with a guide to what to do (and not do) before your operation. This will include instructions on fasting (which includes no liquids) before surgery, stopping smoking, ensuring someone can drive you home etc.

The day before surgery is likely to be a busy time as you will be getting things ready before the big day. This will mean ensuring that someone can keep an eye on things at home. If you have children, this means either your partner or someone else taking care of them whilst you are in hospital.

If it is your child or teenager undergoing surgery then they will understandably be nervous so it is a case of reassuring them beforehand. Ensure that they have packed everything that they need which includes medications (if any). They are likely to be off school or college for a week after surgery but will be back after then. Teenagers tend to recover very quickly from surgery so this shouldn’t be a problem.

For yourself, you will have arranged for someone to take you to the hospital and drive you home afterwards. He/she will also be on hand if you need anything. You can expect to feel tired, groggy and sore afterwards so their help will be invaluable.

You will be on a liquid diet to start with and certainly for the first two weeks after your surgery. So ensure that you have a ready supply of drinks, thin soups, purees etc but try to avoid anything with plenty of sugar. Also make sure that you have all your medications to hand and enough painkillers for the duration. The painkillers will be given to you at the hospital.

On a more practical level, remove any make up (if applicable) and take off your jewellery. Jewellery can go missing and it is better to leave it at home than run the risk. If you wear a wedding ring you can keep this but cover it up with sticky tape. If you wear contact lenses or glasses then remember to bring your container for these.

Pack a small case or bag with the following items: pair of flat shoes or comfy trainers, soft, loose clothing such as a tracksuit, prescribed medication (if appropriate) and your favourite book. Also include the set of instructions given to you beforehand by your surgeon.

Ideally, you should aim to have your last meal at around 8pm but no later. Do NOT eat or drink anything after midnight. You will not be allowed on the day of your surgery although some surgeons will allow you to have tiny sips of water a couple of hours beforehand.

On the day of the surgery itself have a bath or shower first thing in the morning. On arriving at the hospital have someone stay with you whilst you go through the admission process. This is relatively straightforward and involves a member of staff recording your personal details. Once on the ward or in a room a nurse will check your blood pressure and will take blood and urine samples. This is routine practice and nothing to be worried about. You will be given an injection of a drug to prevent the formation of blood clots. This drug called Heparin will also be administered after surgery. And, as a further aid to reducing the risk of blood clots or DVT (deep vein thrombosis) you will be asked to wear a pair of compression stockings.

Once you are settled in you will be visited by your surgeon and anaesthetist. They will be able to answer any questions you have no matter how many you may have. They will go through with you what will happen when you are taken down to the theatre and afterwards. This is meant to reassure you.

You will then be asked to sign a consent form. This means that you are signing a declaimer to the effect that you understand about the risks and benefits of the procedure and have given your permission for the surgery to take place.

Make sure you full understand what this form is about and that you are satisfied with the information from this and your surgeon before proceeding. If you don’t understand something then ask. Do not feel pressurised to sign until you are ready.

Preparing for Sleeve Gastrectomy surgery

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