Your Surgery Plan

First Appointment

After the referral from your doctor for bariatric surgery, the first team member you are going to see is your surgeon, Dr. Werapitiya. When the practice staff at WA Weight Loss Centre contact you for your appointment they will send you further details including online links for further information. To get the most out of your first consultation it is best that you do your own research and have some idea first. It may also be a good idea for you to be accompanied by someone close to you for the first appointment.

During the first consultation your doctor will assess you for suitability for bariatric surgery. By the end of the first consultation you will be able to set goals for your weight and health in the long term. You will also be able to understand the best weight loss surgery suited to your personal needs and the reasons behind.

After your first consultation you may decide to book appointments to see other health professionals in the team for further assessment and preparation. These may include dietitian, physician, cardiologist, psychological assessment etc. depending on the need.

Dr. Werapitiya will see you for office consultations up to two to three times more before your surgery. It is important that you have all your questions answered and any doubts cleared before heading for a such important step in your life.

Bariatric Dietitian

There is a common misconception that the dietitian’s job is to teach people how to lose weight by diet based program which you may have tried already.
In contrast, experienced bariatric dietitian is there to assess you and to help you along the way to achieve the best out of your surgery.

Bariatric surgery involve significant change to the normal anatomy that leads to a predictable, procedure specific side effects. One common long term issue is the development of nutritional deficiency. Preventing such serous effects down the line is one of many benefits of dietetic education and counselling by an experience bariatric dietitian.

Pre-op Preparation

Stop smoking – smoking affects lung function and oxygen delivery and increase the risk of DVT. It also leads to delayed wound healing which increases the risk of most feared post bariatric surgery complication, staple line leak. Make sure that you stop smoking at least 6 weeks before the planned date of surgery.

Exercise – Start doing some regular exercise for 20 – 30 minutes a day.

Diet before Surgery

Some think people go on for a period of feasting (last supper) before having bariatric surgery. There is no need of this as modern bariatric surgery still allows you to be able to eat most of your favorite meals and you are not going to miss out on dining experience.

However it makes sense for you to start on a healthy diet before surgery as a preparation for what is required after. It is very important that you start eating a protein heavy healthy diet and having three meals and two snack diet pattern, and avoiding all calorie rich beverages (carbonated beverages, fruit juice and alcohol) and soft calories (lollies, chips, chocolate), and start drinking plenty of water.

A minority of patients will be required to have a prescribed very low calorie diet (VLCD) as meal replacements for a short period to achieve a weight target before been considered suitable for safe laparoscopic surgery. This is commonly required if your starting BMI is over 45 kg/m2. Your surgeon will inform you if it is necessary in your case and your dietitian will guide you through the process.

Stop drinking alcohol – it is not recommended for you to have alcohol for 3 months after bariatric surgery. Stop drinking alcohol starting from 4 weeks before surgery in preparation.

Gastroscopy

Gastroscopy also known as upper GI endoscopy is needed in most patients as a part of assessment and planning before bariatric surgery. It is a small procedure done at the hospital under sedation with no awareness pain or distress. Procedure involves using a thin flexible tube camera (endoscope) to examine the upper digestive tract. The tube is inserted into the mouth and travels down the food pipe (oesophagus), then into the stomach and first part of the small intestine (duodenum), to view these areas and to collect samples for further testing.

This gives your surgeon the opportunity to have an anatomical assessment including presence of hiatus hernia which may be repaired at the time of your surgery. Samples taken at the time of gastroscopy is tested for a bacterium called Helicobacter Pylori that can live in the stomach. If found you will have to have it treated with a course of antibiotics prior to surgery.

Normal Medication

Some of your current normal medication will need to be continued without interruption around your surgery. Please talk to your surgeon about the need and bring a supply of your normal medications to the hospital.

Blood thinners can lead to higher chance of severe bleeding after surgery and hence need to be discontinued for a period under medical supervision prior to surgery.

Uncontrolled high blood pressure after surgery is another factor that increase risk of bleeding and it is important taking your blood pressure medication as usual.

Diabetic medications need specialised management under a physician both before and after surgery. Be aware, some of your diabetic medications need to be discontinued before surgery. It is very likely that your diabetic medications will change after surgery.

Anaesthetic Assessment

Once you are scheduled for surgery you will have a pre surgery anaesthetic assessment. This appointment will introduce you to your anaesthetist and give you an opportunity to discuss special considerations and risks. He or she will educate you on the plan for after surgery pain and nausea management.

At the time of booking a date for your surgery we will provide you the name and contact details of your anaesthetist. See the anesthetist team.

Hospital Pre-assessment

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Pre-admission Registration

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Recovery after bariatric surgery

Individual experience of recovering from bariatric surgery can be variable. However most patients have a better recovering experience than anticipated mainly because of the minimally invasive laparoscopic surgery. Dr Werapitiya keeps his bariatric patients in hospital for up to three nights after surgery to make sure that expert help is readily available during the hardest period.

Pain
A degree of pain is expected and usual after surgery. With laparoscopic surgery there is much less pain and hence expect to have a lot quicker recovery and easier return to work. You may experience some body wall pain at the sites of stab incisions which gets worse with active body movement. You may also experience referred pain usually felt at the left shoulder due to diaphragmatic irritation from leftover gas and a small amount of blood or fluid. You will have a patient controlled analgesia pump for pain control in the first 24 hours after surgery. This means you will be able to to give yourself a dose of strong injection painkiller when you need it with a press of a button at your control. After the first 24 hours you will have the access to strong painkillers as and when necessary. Most patients require no more than paracetamol for pain relief by the time they are discharged from the hospital.

Nausea
Anaesthetic medications, painkillers, surgery itself and even eating and drinking are factors that can lead to significant nausea in the first few days after surgery. You would need a variety of anti nausea medications during this period. They can be administered in tablet, injection or under the tongue wafer form. As a general guide, you should ask for more anti-nausea medication before coming to the point of dry reaching or vomiting.

Fluid
Before discharge from the hospital we make sure that you have adequate fluid intake to meet your hydration and nutritional demands. While adjusting to your new small stomach, meeting fluid demands may prove to be a challenge in the first few weeks. Try to have at least 1500 ml of low calorie base fluids a day. Drink off a bottle so that you have a measure. Often many find it difficult to drink just water. You can add some flavor using cold water infusion bags of various flavor. You can also use 500 ml of electrolyte solution a day which makes fluid absorption and retention better. If you feel dizzy when standing up, feels thirsty and not very well and if your urine is dark tea colour indicating concentrated urine, you are likely getting very dehydrated. If you are not able to drink plenty and rectify the issue quickly please contact us directly for further assessment to see if you need intravenous fluid therapy.

Diet
Detail counselling and printed information regarding post surgery diet should have been provided to you by your bariatric dietitian. As a principle you are gradually going from a thin liquid diet to a normal diet over the first 4 weeks allowing time for tissue healing. In the first week you are allowed to have only thin fluid diet similar to what you were served at the hospital. During the second week you are allowed to have thicker fluid (puree). This means you will have to use a blender to vitamise your food. By the third week you are ready to have soft diet and during the fourth week you trial on solids. It is also important that you eat slowly ( about 15 minutes for a meal) and stop when full.

Dressings
Stab incisions from laparoscopic port insertion sites are sealed with absorbable fine stitches under the skin and the surface covered with waterproof dressing patches. Please peel those dressings off 4 days after you go home. At this stage they are healed enough for you to have a shower with no wound protection. They need not be cleaned with and antiseptic solutions.

Activity / exercise
After bariatric surgery you will be able to gradually increase the level and amount of your physical activity. Listen to your body. If the level of activity is within your comfort zone, it is ok. For the first few days it is important for you to take a few deep breaths every hour to make the base of the lungs expand. It is also important that you spend time out of bed and take a few short walks when possible.

After discharge from the hospital you can start with short walks to the level of your comfort and build the level of activity. Most people are able to go for a brisk walk by the end of second post op week to a point your heart rate is up. You are ready to start on a supervised gym session by the end of fourth week. You can start swimming when you can comfortably go for a jog. It is not recommended to drive a car in the first 10 days.

Return to work
Everyone recovers at their own individual pace and have different personal expectations before return to work. As a general guide most will be comfortable doing a few hours of home based office duties at a computer by the end of first week after surgery. By the end of second week you will be able to return to office based job. People in a manual job with an option for light duties may return to work after 3 weeks and may need an extra week before resuming full duties. Before your surgery please talk to Dr Werapitiya about your situation and need for a medical certificate .

Supplements
Protein supplements are going to be necessary for the first 6 months to meet the daily demand. It is important that protein supplement is not considered a meal and fit in between meals. Vitamin and mineral supplements can be introduced when you get comfortable with oral intake, generally by the end of second post-operative week. For further details pleases refer to the information provided by your bariatric dietitian.