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, the patient has plenty of time to go away think about it, talk to family and friends, and then make a final decision when they are ready. The surgeon refers on for appropriate tests, to see a physician if required and dietitian.
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.
Most patients having weight loss surgery on our programme will be seen by a physician. If you already have a physician 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 operative days in hospital to make sure everything is ok and adjust your medication and treatment as required.
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. You might like to involve a psychologist from the start. You could discuss this with your GP to help you find a suitable clinical psychologist. We do not have a psychologist that works in our 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. The hospital nurse will call you and do this with you over the phone, or sometimes might need to ask you to come to the hospital.
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 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
Better and easier recovery
Optifast, Optislim, BE Fit Food Be Rapid Programme, or Dietitian designed diet
People lose about 10 to 15% of excess weight or 5 to 20kg
For 2 to 6 weeks prior to surgery
Shrinks the liver and fat around the stomach
Very Low Calorie Diet (VLCD)
Preserves lean muscle mass
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
At your post op visit you will be given a list of the top tips from other patients to help you along.
We live in a an obesogenic society
Plate sizes, advertising, encouraged…
Take time out to eat
20 minutes per meal, 3 small meals
Please Contact Melbourne Bariatrics on 03 9770 7189 for more information or to make an appointment