What awaits you?
The decision to have bariatric surgery is a life change decision. In this direction, change should begin from the moment you make a decision. Before you have the surgery, you should start making changes in your lifestyle such as exercise, quitting smoking, changing diet and alcohol use. After surgery rules are esential if you want a best result about your surgery.
These are just a brief summary(Course) of what you will experience before and after surgery.
AT HOSPITAL
When you come to the general surgery outpatient clinic, your doctor will ask you for some tests and counseling from other departments in order to evaluate whether you are suitable for surgery. Departments such as dietitian, psychiatry, endocrinology, cardiology, gastroenterology will examine you about whether you can have surgery and will do the necessary tests. Then, the general surgeon decides that you can have bariatric surgery if there is no problem in your surgery, together with the tests and opinions of other doctors.
Surgery preparations begin. In this process, an appointment is made from the anesthesia polyclinic and the doctor evaluates whether you are ready for surgery with some tests such as blood tests, EKG, chest X-ray.
After the decision from the surgery;
• Quit smoking 2 months before the surgery. Smoking increases the possibility of health problems that may occur during and after surgery.
• Remind your doctor if you have sleep apnea before surgery.
• Before the operation, you must inform your doctor about the medications you use regularly. You may need to make medication adjustments before surgery.
• Start diet before surgery.
• Start with the level of exercise you can do before the surgery (such as walking). Try to increase gradually. Walk for 150-250 minutes a week.
• Pre-operative examinations should be completed during this process.
One day before surgery
• The night before the operation, your nurse will prepare you for the operation and give you information about it
• You should stop all eating and drinking (including water) from the night before the surgery until the morning of the surgery.
• Do not shave the surgical site with products such as razor blades or depilatory creams before the operation. Do not use products such as creams or perfumes.
• Be sure to have a relative with you.
• If you have complaints such as cold, cough, sore throat, be sure to inform your doctor.
• Sleep well at night.
On the morning of the surgery;
• Take your shower on the morning of the surgery. Wear clean clothes.
• Do not use products such as creams, perfumes, lotions.
• Remove your nail polish and make-up.
• Remove any jewelry, if any.
• Brush your teeth.
• Before going to the operation, your nurse will bring you a bonnet and apron.
• Take off your clothes completely and wear the apron with the closed part forward.
• Put on the cap so that it covers your hair.
• Make sure to deliver your valuables to your relatives during the operation.
• When the surgery time comes, you will be taken to the operating room accompanied by a staff member.
In the operating room
• When you come to the operating room, the nurse will take you to the operating room after doing some controls.
• When you lie on the operating table, some instruments will be attached to your body in order to follow you closely during the operation and to control your breathing and heartbeat.
• You will then be put to sleep quickly with anesthesia.
• You will not feel pain during the operation.
• The duration of the operation may change depending on the type of surgery.
In the recovery unit after surgery
• After your surgery is completed, you will be sent to the recovery unit.
• When you wake up, you will have an oxygen cannula/mask in your nose, serum in your arm, urinary catheter and the socks you wear to prevent clots on your feet.
• It will be important that you take care to breathe deeply.
• You will be warmed with a blanket to bring your body temperature back to normal/to prevent you from getting cold.
• If everything goes well when you wake up, your nurse will send you to the service with a staff member.
• Your relatives will be waiting for you at the door.
• In case of any problems during or after the operation or depending on your additional diseases, you can also stay in the intensive care unit for a while after the operation. Your doctor will decide whether you should be brought to the intensive care unit or service in accordance with your health condition.
When You Come to the Service / Clinic
• When you are brought to the service, you will have green surgical clothes, serum in vascular access, probe, and compression stockings.
• First of all, nurses and assistant staff will take you to bed, dress you in the clothes you brought before, and warm you up.
• The nurse will make some controls (such as blood pressure, pulse, temperature) and will inform you about what you need to do after the surgery.
• You will be able to convey all your problems to your nurse.
• If you experience nausea, pain or shortness of breath, inform your nurse.
What should I do when I have pain?
During the post-operative hospital period, you will be given medication to relieve your pain. If you feel pain despite the treatment, please inform your nurse.
When you have pain, you can evaluate your pain with a score between 0 and 10. “0” means you have no pain, “10” means you feel unbearable pain that you can’t even imagine.
Pain from laparoscopic bariatric surgery is less than expected. However, the intensity of pain is different for everyone. After the surgery, some feel a lot of pain, some feel little pain. Do not let pain prevent you from breathing deeply, moving and sleeping comfortably.
Should I exercise after surgery?
From the day of the surgery, you should start moving by getting out of bed and taking steps, even if it is a short distance. You need to increase the duration of exercise day by day. Also, don’t forget to do deep breathing and coughing exercises regularly as your nurse will teach you.
Moving and exercising after the surgery will help your recovery process.
Changing positions in the bed while lying in the hospital, moving our arms and feet when we cannot get up, increases blood circulation and accelerates your recovery.
After surgery, your nurse will walk you first and tell you how to do it. Afterwards, you should take frequent walks until discharge.
Factors such as obesity, sleep apnea, anesthesia, surgeries increase the chance of clots. You are also in this risk group. This is why blood thinner injections are made. It is very important to start walking early after the surgery, not to sit or lie down for a long time, in order to prevent clot formation.
Before the surgery, you should start doing the deep breathing and coughing exercises taught by your nurse. Deep breathing will make you feel better, increase the oxygen level of your blood and speed up the healing of your wound. Deep breathing and coughing are very important in restoring your lungs after general anesthesia (narcosis), preventing infection and expelling sputum. For these reasons, you should repeat the breathing and coughing exercises hourly.
How should I eat after surgery?
You will start eating and drinking something at the time your doctor and nurse decide in accordance with your post-operative health condition and surgery. Your feeding process will be in four stages.
• In the first stage after the surgery, you will only consume clear liquids (such as water, tea) in the hospital.
• It is important that you do not eat anything other than what was given to you at the hospital.
• You should drink the drinks given to you very slowly, in at least 30 minutes.
• You should stop eating immediately when you feel fullness or discomfort.
Day after surgery
• Do the breathing exercise.
• Sit in a chair while eating or drinking.
• Walk every two hours or more often.
• Let your nurse know when you have pain.
What should you remember when you are discharged?
• Get your prescription for medications and vitamins you need to take before discharge.
• Make sure to make an appointment for the control 10-15 days after the operation.
• Get information about what you need to do at home from your doctor, dietitian, nurse.
AT HOME
What should you do when you have pain?
• If you still have pain despite taking pain medication while you are at home, please inform your doctor or nurse.
How should your surgical site be taken care of?
• It is important to keep it clean and dry for healing of your wound.
• Unless stated otherwise, a short shower should be taken after discharge from the hospital, washed with soap and rinsed and then dried completely.
• Never rub with a coarse bath-glove your wound during the shower.
• Make sure to dry your surgery area after a shower.
• Do not use any balm on your surgical areas, do not cover them with a bandage.
• Let it be open to your wound site.
• If the wound is draining or sticking to clothing, you can cover it with a very light medical bandage, but leaving the wound as open as possible can help prevent wound infection.
• It is normal to have itching at your wound site.
• Yellow-green, filthy smelling fluid leaking from the wound, swelling, redness and increasing pain are signs of wound infection. You may also have a fever if you have a wound infection. In this case, please consult your doctor.
How will I continue to eat after the surgery?
After the surgery, your nutrition process will be in five stages. The first phase will be completed in the hospital. After coming home;
• In the second stage, you will be able to consume liquid drinks. Your doctor or dietitian will tell you when to start liquid consumption. The most important point here is to consume an average of 1800 ml of fluid per day so that your body does not become dehydrated. The second stage will take about 10-14 days.
• If you have no problems with the second stage, you will move on to the third stage, also known as the “Pure period”. Here you can consume foods that can be eaten without chewing.
• In the fourth stage, you can consume foods that can be crushed and do not require excessive chewing. You will be fed this way for 1-2 weeks.
• In the final stage, you can now start consuming solid foods. When consuming solid foods, you should pay attention to the amount of solid foods you eat until your stomach adapts to its new shape and the stitches heal.
• You should continue with your dietitian’s support for your post-operative nutrition program.
IMPORTANT: You should pay attention to the following recommendations during all your meals.
What are the recommendations regarding nutrition/eating and drinking?
! Consume food/drinks in at least 30 minutes
! Do not use a straw.
! Drink slowly and sitting down.
! Do not consume liquids/beverages 30 minutes before and after meals.
! Do not consume liquids/beverages with meals.
! Sip your water all along the day.
! Always carry water with you.
! Don’t forget to drink water. Drink at least 1.5 liters of water per day.
! Eat small bites and slowly.
! Chew your bites until they have a puree consistency before swallowing them
! Listen to your body and learn when to stop eating/drinking.
! Eat enough, not until you are full.
! Think about whether I feel full after every bite.
! Saturation can make you feel pressure in the middle of your stomach.
! When you feel full or uncomfortable, stop eating immediately. In your recovery process, you will notice foods that cause nausea and vomiting that are not good for you. If you do not follow the recommendations, your feeling of nausea, indigestion and discomfort will increase.
! Do not lie down after a meal.
! Do not forget to take your vitamin and mineral supplements recommended by your doctor.
! Avoid high-calorie foods and drinks.
! Consume quality protein. Consume as much protein (like meat and dairy products) as possible.
! Eat foods having 60–80 grams of protein every day.
! While you eat, consume the protein on your plate.
! Eat at least 5 servings of fruit and vegetables every day.
! Consume fruits and vegetables of different colors.
! Be sure to read food labels. Avoid foods having sugar.
! Track your urine color to see if you’re drinking enough fluids. If your urine is dark yellow, you are not drinking enough water.
! Avoid smoking and alcohol during this period.
Will I take supplements like vitamins after the surgery?
With the surgery, your stomach has shrunk and you may not be able to meet the vitamins and minerals your body needs with food. For this reason, you will need to take vitamin and mineral supplements in addition to your diet.
If you do not take daily vitamin and mineral supplements, there may be various health problems. When you have a vitamin and mineral deficiency, there are symptoms such as delayed healing of your surgery site, weakness, hair loss, muscle weakness and tremors. To avoid these, you should take the recommended supplements.
Liquid or chewable supplements are recommended for the first 2 months after the surgery. Afterwards, you can use tablets. Use your vitamin and mineral supplements in line with your doctor’s recommendation.
Take your vitamins every 4 hours to increase your absorption.
Take your vitamins every day as recommended by your doctor.
How will I do the exercises after surgery?
exercises after surgery;
• Protecting and improving your overall health
• Increasing your weight loss,
• To prevent weight gain again,
• To maintain your weight in the following years,
• It is very important to improve your quality of life
Light-intensity exercise: Simple activities of daily living such as walking at a slow pace, using a computer at a desk, using light hand tools, washing dishes, ironing, and preparing meals.
Moderate-intensity exercises: Activities such as brisk walking, vacuuming, cleaning the house, washing the car.
High-intensity exercises: These are activities such as very brisk walking, running, cycling, swimming.
1-4 weeks after surgery: For the first two weeks after surgery, your goal should be 30-60 minutes of exercise daily. Light exercises such as walking are recommended as your surgery site begins to heal. Walk around the house, take the stairs as high as you can, do not force yourself. Do not sit at home for more than 30 minutes if you are not sleeping. Get up and move around at least every 30 minutes.
5-6 weeks after surgery: If you have had a closed surgery (laparoscopic), you should not lift more than 6-7 kg for 6 weeks after the surgery. You should avoid abdominal exercises for the first three months. You can do moderate-intensity exercises. You can do exercises such as riding a stationary bike, walking on a treadmill, and housework. Be sure to inform your doctor about your exercises during this process.
7-12 weeks after surgery: Do not do high-intensity exercises for the first few months. During this period, you can do exercises that will increase your heartbeat. You can walk for 30 minutes 5-6 days a week, walk 150 minutes a week or take 10 thousand steps a day.
• Set yourself realistic goals.
• While exercising, be sure to consider the healing process of your surgery site.
• To lose weight, you must spend more calories than you take in.
Will I use medication after surgery?
After the surgery, some pills may need to be crushed and some drugs may need to be avoided for a while. Please ask your doctor or nurse for information about which medicines to crush and which to use.
Will I be able to get pregnant?
You should not get pregnant for 12-18 months after the operation.
What should you do when you are nervous/stressed?
When our body feels any danger and in stressful situations, it reacts against them. These may include work-related problems, commuting, chores, take care of the kids, bring home the bacon, or health problems. As soon as the body realizes the stress, a response occurs in our body and mind to overcome with the stress. This is a normal process. However, our response to stress is very important. Incorrect responses to stress affect our health negatively.
What happens when you’re nervous and stressed?
• Desire to eat excessively
• Eating high-calorie foods
• Drinking too much alcohol
• Avoidance of movement
• Insomnia/inability to sleep
• Thinking negatively
• Feeling depressed.
Here are some suggestions you can do when you are stressed.
• Take 3 slow and deep breaths.
• Hug your partner, children, loved ones
• Take a walk outdoors
• Go outside, walk
• Read a book
• Pray
• Have a friendly/friend chat with someone you trust
• Listen to music
When should I go to Hospital Controls?
• You should come for a check-up at the second week and at 1,3,6 and 12 months after discharge, and then once a year.
• If you encounter one of the following situations, immediately apply to the emergency service.
When should I go to the Emergency?
• Fever higher than 38.5ºC, chills
• Increasing shortness of breath
• Significant bleeding in your surgical sutures
• Redness and increasing pain around the surgical sites
• Severe abdominal pain
• Chest pain lasting longer than five minutes
• Blurring of consciousness
• Pain or swelling and redness in your calf area
When should you contact your doctor/nurse?
• Dizziness
• Not getting enough fluids
• Fast heartbeat
• Pain that is not relieved by painkillers
• Nausea-vomiting
What problems may I encounter after surgery and what should I do?
Dumping Syndrome
Dumping is often caused by malnutrition. It occurs when you consume sugary foods. It can also occur when you eat milky products, some kind of oils, fried foods. There are two types of dumping.
1. Early dumping: It occurs 30-60 minutes after meals. Symptoms such as abdominal pain, sweating, flushing, increased heart rate, palpitations, desire to lie down, nausea, diarrhea, cramps are seen.
2. Late dumping: It occurs 1-3 hours after a meal. Symptoms such as sweating, trembling, feeling of hunger, fainting, drop in blood sugar are seen.
• Avoid ready meals with high sugar content.
• Be sure to read food labels.
• Avoid foods that have sugar in the first three lines on the label.
• Avoid artificial sweeteners.
• You should consume liquid at least 30 minutes after meals.
• Avoid foods that raise blood sugar quickly.
• Eat foods that are rich in fiber and protein, eaten slowly and chewed well.
Constipation
• You should consume plenty of fluids. You should consume 1500-2000cc of fluid per day.
• Eat fibrous foods.
• If you are on a full liquid diet, mix 50 ml of prune juice and 50 ml of regular water and drink it.
• If you’re into puree, try kefir, prune puree or pea puree alongside prune juice.
• If you are in the later period, you can also use prunes, fruits and vegetables in addition to all of the above.
• If all these procedures do not work, please call your doctor or nurse.
Diarrhea
• Diarrhea may occur to gallbladder removal during surgery, lactose intolerance or some medications.
• Do not consume foods high in sugar and/or fat.
• Avoid spicy foods.
• Avoid drinks containing caffeine or alcohol.
• If you are sensitive to lactose, use products such as soy milk and almond milk.
• Eat fibrous foods.
• If your diarrhea continues, please call your doctor or nurse.
Nausea-vomiting
• Nausea is usually caused by malnutrition. It can be caused by insufficient chewing, not waiting long enough between bites, smells, overeating or not eating enough, medications, or dehydration.
• Consider what is causing the nausea. You need to take action against it.
• Wait 1-2 minutes between bites/sips.
• Do not drink liquids for at least 30 minutes before and after meals.
• Do not eat very large portions.
• Chew each bite completely.
• If your nausea/vomiting continues, please call your doctor or nurse.
Gas
• Do not use a straw.
• Drink liquids slowly.
• Do not drink carbonated drinks.
• Eat slowly, waiting 1-2 minutes between bites/sips.
• Remember that foods such as beans, broccoli, brussels sprouts, cauliflower, onions and peas cause gas.
Hair loss
• Hair loss usually starts about 3-6 months after surgery and is usually temporary.
• Insufficient protein consumption is seen due to the decrease in biotin and zinc values.
• Always consume 60-80 grams of protein per day.
• You can take zinc and biotin as supplements by talking to your dietitian.
Dehydration – Dehydration
• It occurs when not enough fluid is taken. Symptoms such as fatigue, dark urine, fainting, nausea are seen.
• Consume at least 1.5 – 2 liters of water per day.
• Avoid drinks containing caffeine.
