What to expect after surgery

What to expect after surgery

In the Hospital

1. Hospital Stay:

Bariatric Surgery is done laparoscopically and almost like a day-care procedure at LOC. It can be made a key-hole procedure, stitch-less and painless. The patient can generally get discharged a day after the surgery. Generally, by then the patient is pain-free, tolerating liquids and ambulatory and fit to travel.

2. What should I carry to the hospital?

• Loose, comfortable clothes (gown, track pant, t-shirt)
• Basic Toiletries (comb, toothbrush, paste etc)
• All medical reports done in the last 1-2 months
• Medication (if you are on any)
• You will be given a light meal the night prior to surgery and bowel cleansing medication when required.
• A physician/anaesthetist will evaluate your reports and clinical status on admission
• After the surgery the patient’s diet will be taken care of by the hospital till discharge.
• On admission please use this opportunity to know everything about why you have taken the decision and how the new life would be after surgery. This may be the best opportunity to get introduced to all the specialists involved and have all your queries answered satisfactorily.

3. Pain:

There may be slight discomfort or pain after surgery. But we make sure that this pain is kept to the minimum. The discomfort could be around the chest, back abdomen and neck. It is normal to experience some discomfort in these areas but keeping the patient comfortable is of utmost importance to us. Within a few hours of surgery, the patient is made to walk, take deep breaths and cough, all of which are essential for quick recovery. Pain threshold is a subjective phenomenon and different medications are available for pain relief. However, majority of patients are pain-free on discharge.

4. Ambulation:

Ideally all patients at our centre walk into the operation theatre and walk back to their rooms after the surgery. Post that once in the room that patient is made to walk every 1-2 hours as it is essential for quick recovery and prevention of deep venous thrombosis.

5. Liquid Intake :

Generally, the patient starts sipping water a few hours after surgery and by the next morning the patient starts sipping clear liquids (eg., Lime water, coconut water etc) which they continue after going home. During this period at the hospital the patients are taught how to drink clear fluids in sips and small amounts up to half a cup at a time and frequently, ensuring adequate hydration.

At home

6. Daily Activities:

Ideally, the earlier one gets back to a normal routine, faster is the recovery. It will also enhance recovery and healing and give energy. Patients are advised to keep themselves active by walking every 2 hours for about 10-15 minutes and keep themselves hydrated.

7. Follow-up:

We care about how the patients are doing even after they are home. Keeping in contact with the team will help in smooth recovery and progress. Patients could contact the team through calls or messages.

The first follow-up if all goes well can be planned 10-15 days after surgery only for those who stay nearby.

Patients would continue to follow-up with the team, either telephonically or on video call or in a personal visit once a month for the first 6 months and then once in a couple of months post 6 months. Post that annual follow-ups could be planned.

In between if need be, the patient must get in touch with the team whenever required.

8. Work:

Usually the patient is up and about, able to do all routine activities by the time they are home. They could start work-from-home immediately after going home but you could start going to work in about 3-5days after surgery.

9. Diet at Home:

Diet at home post the surgery will range from clear liquids to thick liquids to soft diet. The dietary advice with detailed instructions of what to do and how to go about with the diet will be given by the healthcare team before discharge. During each follow-up these dietary changes will be further explained and taught to the patient and family.

10. Activities that can be and cannot be done:

Generally, the first instruction that is given to all patients after surgery is to get back to their regular routine at the earliest and the patient should stop behaving like a patient and family members too need to stop treating the patient like a patient.

• Keep yourself hydrated with different types of liquids as advised so as to avoid dehydration and keep you energetic.
• Avoid lifting any heavy weights (>5-8kgs) for the first 6 weeks.
• Being active and walking frequently, even though for a minute or two is advisable after surgery for better recovery.
• The dressings are tiny and water-proof hence taking a shower and maintaining personal hygiene immediately after surgery almost without any assistance is easy and possible.
• The wound requires minimum care, you may not require frequent dressing and if needed it can be done at home or from a local doctor with similar bandages advised after discharge.
• Blood Pressure and Blood Sugars must be monitored.
• Additional instructions as per the patient’s health and co-morbidities are given individually at the time of discharge

11. How to avoid dehydration?

A lot of times one may feel that they are on liquids and not taking any solid food that has led to weakness. And most of the time it is the family members who feel this more than the patient themselves.

But it should be noted that weakness after surgery is generally due to dehydration and electrolyte imbalance. Symptoms include tiredness, dark coloured urine, fainting, dizziness on changing position, nausea, low back pain (a constant dull ache across the back) and a whitish coating on the tongue. During such situations hydrating oneself and adding salt to the fluids helps replenish the lost electrolytes. If you have difficulties drinking due to nausea, suck on ice chips. Despite this if the complaints persist then consulting the healthcare team is essential.

12. Bowel Habits:

Even if on liquids immediately after surgery, regular bowel movements start once the hydration increases. It is normal to pass motions alternate days or even one to three times. Most of these will resolve once your fluid intake increases and you shift towards a normalz diet. If constipation or loose motions persist then consulting the surgeon is important.

13. Exercise:

To begin with, walking is the best form of exercise especially during the early recovery phases. In fact, it is advisable to walk as much as possible immediately after surgery. The physiotherapist will also be teaching limb exercises and breathing exercises that can be done initially on discharge at home. Slowly as the healing progresses, the healthcare team will guide you about the types of exercises one can do after surgery. But generally depending on the weight loss and progress cardio and water exercises can be started 3 weeks after surgery. Initially the exercises should be less weight bearing and over a period progress the intensity can increase and weight training and strenuous exercises can be started.

14. How will my weight loss progress be?

Typically, a person will lose about 50-70 percent of excess weight. But the amount of weight one loses will differ from patient to patient. Generally, a significant chunk of the weight is lost in the first 3-6 months after which the weight-loss slows down but still continues till the end of 1 year.

The weight loss varies for each patient depending on the age, comorbidities, weight loss attempts etc.

15. What can I do to ensure reduction in skin laxity after weight loss?

When one starts gaining weight, the skin starts expanding to make place for the growth. One such example is pregnancy where the skin expands slowly over the nine months period and once the baby is delivered the skin slowly contracts over time.

In case of people who start gaining weight and become overweight or obese the skin starts expanding and remains stretched for long periods of time thus damaging the skin. After weight loss surgery the skin remains expanded.

There are certain contributing factors for loose skin after bariatric surgery:

• a) Age: Skin of younger people has more ability to contract than that of older people
• b) Duration for which one has been overweight or obese: The longer a person has remained overweight or obese, the more the skin will be lax after surgery
• c) Amount of weight loss: More the excess weight more will be the weight loss and hence more will be the loose skin.
• d) Weight loss attempts: More the weight loss attempts one has, more the skin has stretched and contracted, in such patients the skin laxity will be more after the weight loss surgery.