You will wake up in the recovery unit with monitoring attached to you. You will have a cannula (drip) in your arm. Occasionally a drain (plastic tube connected to a container) will have been placed into your abdomen, and occasionally a urinary catheter (tube into the bladder) is used as well. The PCA pump can attach to your drip if required.
Further post-operative care
After 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 that are larger, older, or with medical problems that need closer monitoring will go to the HDU rather than the ward. Which ever 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 (DVT and PE). Early mobilisation is important, and your nurse and the physio 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 a blood thinning medication by injection.
You can start to suck on some ice chips or to take sips of water on your first night.
If not already in the ward, you will move there on day one. You will be encouraged to slowly sip your way slowly through one 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 this, your diet will progress to bariatric free fluids (see nutrition information section).
If you have a urinary catheter, this will be removed when you are moving independently. 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 well as 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.
Medications for pain and nausea will continue and will change to tablets or liquid forms so that the drip can be taken away. Do not hesitate to ask for a sleeping tablet if you require help to sleep at night.
Walking will continue to be encouraged. You will continue to wear 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.
Most 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.
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 3 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 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 the sleeve easily. This usually results in an uncomfortable, dull pain behind the breast bone. The best way to manage this circumstance to 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 sleeve 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.
- Analgesia for pain relief, usually for up to 2 weeks
- Anti emetic to help with nausea usually for up to 2 weeks
- Anti acid to reduce stomach acid usually for 6 weeks
- Perhaps a blood thinning medication for prevention of pulmonary embolism
Occasionally you may be prescribed a laxative 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 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 after your gastric sleeve operation. Smoking can slow the healing of the stapled edge of the stomach, and cause ulcers and bleeding. It is also important that you refrain from alcohol post surgery until you have got used to your new stomach. When you do want to start alcohol again, do so only in moderation: it can have a more potent effect, and contains a lot of calories.