Day Zero
Recovery Unit
You will wake up in the recovery unit with monitoring attached to you. You will have a drip. Occasionally a urinary catheter (tube into the bladder) and/or a drain (tube into the abdomen) is used as well. The PCA pump will be attached to your drip, if required.
Further post-operative care
When you are awake and comfortable you will be transferred to the ward. Occasionally we keep patients in the high dependency unit (HDU) initially. Typically, patients who are larger, older, or with medical problems that need closer monitoring will go to the HDU rather than the ward. Whichever location you are in, your nurse will record your vital signs regularly and give medications to control pain or nausea. You will be encouraged to do deep breathing exercises to keep your lungs healthy, and to move into a chair.
We use several means to prevent clots forming in the legs and lungs. Early mobilisation is important, and your nurse practitioner and the physio therapist will help you with this over your stay. You will also have TED stockings on and a FlowTron machine (inflatable stockings). You may be given injections of heparin, which is a blood thinner.
You can start to suck on some ice or to take sips of water on your first night.
Day One
Ward
If not already on the ward, you will move there on day one. You will be encouraged to slowly sip your way through 1 litre of water over the day. When you are able to manage this amount of water, your IV can be removed. Do not try to hurry this: have a cup or water bottle to hand and sip slowly and steadily. If you appear to be managing fluids well, your diet will progress to bariatric free fluids (see nutrition information section).
Usually your PCA will be stopped at this time too, and oral medication used for pain relief if required. Your catheter will be removed when you can move independently to the toilet. If you have a drain, this will be cut short with a bag fixed over it or removed to allow you more freedom to move. You will continue with measures to prevent blood clots (as described above). Your surgeon and anaesthetist will see you, as will your dietitian and physiotherapist.
It is important that you get up and move around as soon as you are able, so you will be encouraged to walk around the ward. This allows your lungs to fully expand and the circulation to your legs to return to normal. Moving gently and regularly around your room and the ward is extremely important for a rapid and uncomplicated recovery.
Day Two
Walking will continue to be encouraged. You will continue to be given heparin injections and wear the TED stockings all the time. The FlowTron device will be used when you are not moving around.
All your medications should now be taken orally, perhaps crushed or in liquid form. You should be managing bariatric free fluids by this stage, and you can proceed to a bariatric pureed diet as you are able. (Advice on bariatric pureed diet is provided in the nutrition information section.)
Many patients, if they are progressing well, will be able to go home on this day. If you have a drain, it will usually be removed before discharge.
Day Three
If you did not leave hospital the previous day, preparations will take place for this today. Your diet should be a bariatric pureed diet (see nutrition information section). Walking as much as possible and deep breathing exercises will be encouraged.
Advice on discharge
You will be reminded to eat three meals a day. This must be by the clock, as often you will not feel any hunger. Remember to take small bites and chew, chew, chew. When you feel full, STOP eating.
In the early days after surgery, you will need to re-learn what your new stomach can manage. Almost every patient will at some stage inadvertently swallow a mouthful of food that is too large or too solid to pass through easily. This usually results in an uncomfortable, dull pain behind the breast bone. The best way to manage this circumstance is to simply wait and stay upright. Gravity will eventually help the food to pass. Sometimes the food will be regurgitated. Do not try to push or flush the food down with more food or fluid. This will only worsen the situation. Do not panic: it is almost impossible to do harm to the operation by swallowing something that does not go down easily.
Swallowing will become progressively easier over the first week or so after surgery. Most patients can easily tolerate small amounts of puree regularly after a few days.
You will be given a prescription for medications to be taken after discharge.
These include:
- analgesia for pain relief, usually for up to two weeks
- anti emetic to help with nausea usually for up to two weeks
- anti acid to reduce stomach acid usually for six weeks
- occasionally heparin for prevention of pulmonary embolism
- Occasionally you may be prescribed a laxative, such as lactulose, for help with bowel movements.
You should carry on taking your normal medications that you were on before surgery, unless specifically told to stop. Some medications will need to be monitored closely after surgery and sometimes the dose should be adjusted. This is particularly important with medications for diabetes, blood pressure, depression or epilepsy. Your GP can help you with this. Some tablets taken in the first six weeks after your operation may need to be crushed. We advise you continue wearing your TED stockings for 10 days post operation. This is to reduce the chance of blood clots that can form in the legs and can go to the lungs. If you have successfully managed to stop smoking prior to your surgery, then you should maintain this post-operatively. Smoking can cause ulceration and narrowing at the surgical joins that have been created. It is important that you refrain from alcohol post surgery until you have got used to your new stomach, and then drink only in moderation as it will have a much more potent effect. Driving should be avoided until you are completely comfortable and able to move freely. For most people this is in one to two weeks.