Preparing for Surgery

Initial consultation with the Surgeon

The surgeon and patient discuss the patient’s weight and health history to assess the patient’s fitness for surgery, what operation might suit best, and any issues that need to be addressed. Patients will often have an idea of what operation that would suit them, and usually the surgeon will agree, but sometimes this needs to be discussed further until both are happy with the choice. If at the end of the initial consultation the right operation has not been decided upon, this doesn’t really matter because the patient has plenty of time to go away think about it, talk to family and friends, and can then make a final decision when they are ready. The surgeon refers on for appropriate tests, to see a physician, psychologist and dietitian.

Dietitian

Lamb Cutlets

All patients will see the dietitian at least 3 times. Firstly, just before starting the preoperative weight loss, secondly around the day of the surgery and thirdly around the time of an eating phase transition. Many people choose to see the dietitian more than this.

The dietitian will go through your current eating habits, likes and dislikes, food intolerances, medical history etc. And come up with an eating plan that suits you and your chosen operation They will also give you tips on healthy food choices and general food education.

Those patients who have bypass surgery will require long term nutritional monitoring with the dietitian

Physician

Every patient having weight loss surgery on our programme will be seen by a physician. If you have a physician that you already see that is involved with our programme they will be the physicians you see. This doctor will assess your fitness for surgery and plan how to mange your care in the peri-operative period. Eg what to do about your insulin, your asthma medication etc. They will also see you on the operation day and make sure everything is ok and adjust your medication and treatment as required.

Psychologist

Having a weight problem, trying to do something about it, succeeding with your weight problem, failing…these are all emotionally challenging times. Sometimes, the emotional side of a weight problem and weight loss surgery is quite overwhelming. It is best to involve a psychologist from the start. It will help with choosing the right operation, succeeding and then with getting on with your life. The psychologist may see you after the surgery as well, to help you along the way if you need this.

PreAdmission Clinic

This is where all the paperwork that the hospital requires and the various tests that have been done are collected together and the nursing side of the process is done. It is done to prevent there being any unexpected problems on the day of surgery. It is held at whichever hospital the patient is going to. For patients having surgery at Peninsula Private Hospital this is done in Mr Draper’s rooms at Peninsula Private Hospital in Frankston and is done by Sarah, the Bariatric Nurse Co-ordinator. For patients going to the Epworth Eastern and Richmond this is held at the Pre Admission Clinic at Epworth Eastern in Box Hill and Epworth Richmond respectively.

Final Consultation with the Surgeon

The surgeon and patient confirm which operation is most suitable, ask any questions, review the results of the tests etc and discuss the operation in detail including the risks and limitations of the surgery.

 

Three Eating Phases

 

1. Pre Operative Eating Phase

Obesity increases the risks of surgery

More dangerous
More difficult for the patient, surgeon, anaesthetist, nurses etc
Any obese person having surgery should consider weight loss beforehand.

Weight loss prior to surgery improves the body’s ability to cope with surgery

Especially for people with Sleep apnoea, diabetes, poor cardiac function, poor lung function
Makes surgery easier and safer
Less fat around the stomach and liver
Quicker
Less anaesthetic…
Less dangerous
Better and easier recovery

be prepared

People lose about 10 to 15% of excess weight or 5 to 20kg
For 2 to 6 weeks prior to surgery
Dietitian, Optifast, frequent monitoring, exercise programming and physician

Optifast

Shrinks the liver and fat around the stomach
Very Low Calorie Diet (VLCD)
Preserves lean muscle mass
Suppresses hunger
Range of products
Additional food allowed

 

2. Post Operative Eating Phase

Liquids for 2 weeks

Anything that could go up a straw is all you can have for the first 2 weeks after the surgery. This allows the stomach to heal and the sutures to get their full strength. If you need to vomit in these first 2 weeks it would be quite distressing if there was solid food involved especially if it got stuck. Weight loss surgery often results in most people not feeling hungry and so patients don’t mind this phase as much as they think they are going to. So the liquid phase is about safety, giving the stomach a chance to heal and making vomiting more bearable, and is not as bad as it sounds.

Transition back to solids over 4 weeks

Mushy foods are all that is allowed for another 4 weeks. This gives the stomach more time to heal. And food is reintroduced gradually, so by the time you are back to eating red meat you have chosen softer, easier to eat foods already and you know it is going to go down fine.

The dietitian will take you through what is involved with each of these. And you will be given written instructions including lists of foods and drinks that are allowed. You will also see the dietitian each time there is a eating phase changes over, just to make sure everything goes to plan.

 

3. The Rest of Your Life

Healthy eating and the rest of your life

Educate yourself about food
Make smarter food choices
Calorie dense vs nutrient dense

We live in a an obesogenic society

Plate sizes, advertising, encouraged…

Take time out to eat

20 minutes per meal, 3 small meals
Chew thoroughly
Eat slowly

Please Contact Melbourne Bariatrics on  03  9770  7189  for more information or to make an appointment
Royal Australasian College of SurgeonsAMA - Australian Medical AssociationFRACS - Fellow of the Royal Australasian College of Surgeonsmattu - Minimal Access Therapy Training Unit GuildfordIFSO - International Federation for the Surgery of Obesity and Metabolic DisordersMonash University
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