During and after surgery

Admission to hospital

When you receive your surgery date by post, it will tell you what day you need to come to hospital. Most people are asked to arrive the morning of surgery and are told the day before surgery which ward to go to (usually David Evans Ward). If you are diabetic, you may be admitted the day before surgery to stabilise your blood sugar levels while you are nil by mouth. You will be advised to stop taking aspirin or blood thinning medications 1 week prior to surgery.

You should bring with you toiletries, loose nightclothes/ tracksuits, slippers, any medications you are currently taking, and books/magazines/money to pay for TV and telephone services. If you use a CPAP or BiPAP machine for sleep apnoea at home it is essential that you bring this with you.

You will be asked to be nil by mouth from 2am on the day of surgery. You may take essential medications (such as cardiac drugs) with 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 theatres where you will have your anaesthetic.

What happens in hospital after surgery?

If you are having a gastric band inserted you will return to the ward after a short period in recovery. If you are having a gastric bypass or sleeve gastrectomy you will stay overnight in either our High Dependency Unit (HDU) or in Recovery where you will receive 1:1 nursing care.

You will be reviewed by the surgical team the day after surgery. If you had a gastric bypass you will need to remain nil by mouth until you have been to X-ray for a swallow test (gastrograffin study). Otherwise, the dietitian will visit you the day after surgery and advise you regarding starting fluids and your diet after discharge.

You will be encouraged to get out of bed and start walking as soon as possible. This will aid your recovery. You will be provided with painkillers and medication to stop you feeling sick. Please talk to the nursing staff if you do not feel they are working.

The average length of stay is:

• 1–2 days for a gastric band
• 3–5 days for a gastric bypass or sleeve gastrectomy

You will be given a supply of medication to take home with you and may be discharged with a 2-week supply of blood thinning injections. You will be taught how to inject yourself by the ward nurse. If you have stitches that need to be removed the ward staff will give you a letter for your practice nurse or district nurse to arrange their removal. If you need a sick certificate for your employer please make sure you ask the medical staff when they review you in the morning.

You will be sent follow-up appointments to see the surgeon 2–6 weeks after surgery, and the dietitian 4–6 weeks after your surgery. If you have not received appointments in the mail but feel you should have, please contact the dietitians or nurse and we will check if this has been arranged for you.

When can I start to be active after surgery?

You will be able to start getting up and walking the day after surgery. Most people are able to return to work a couple of weeks after surgery. We recommend no heavy lifting or strenuous activity for 6 weeks after the operation. We also recommend you do not drive until you can safely brake without any abdominal pain—usually 6 weeks. You will be able to start exercising about 6 weeks after the operation although gentle exercise such as walking can be done as soon as you feel it is appropriate.

Gastric band fills

Your first appointment will be 6–8 weeks following surgery. Further band fills can be arranged through the dietitian. We are guided by the list in the next section when deciding if more fluid is needed within the band. Sometimes we will recommend that some fluid be removed from the band. This is because sometimes when the band is too tight patients actually start to gain weight. This occurs because they start to take high calorie liquids.

Adjustment of your band

Band too loose

• Able to eat solid, crunchy foods
• Able to eat large meals
• Hungry between meals—snacking
• Gaining weight, not losing weight

Band just right

• Able to eat solid, crunchy foods
• Satisfied eating small meals
• Not hungry or snacking between meals
• Losing 1–2lb a week

Band too tight

• Only able to eat soft or sloppy diet
• Unable to eat food because it sticks and will not go through band
• Suffering from heartburn
• Not losing weight or losing too much weight