Preparing for surgery

How can I start preparing for surgery?

In order for surgery to work, there are a number of ‘rules’ you will need to follow in order to lose the most amount of weight and minimise complications.

You can start preparing yourself for surgery by starting to practice the following:

  • Eating slowly - to avoid overfilling your small pouch. Overfilling can result in regurgitation (vomiting).
  • Chewing well - to avoid food pieces becoming lodged at the bottom of your pouch. This causes discomfort and can lead to regurgitation. Chewing well also helps you slow your meals down.
  • Not drinking fluids with meals - this can overfill your pouch and lead to regurgitation. If you have a band, it can also dilute your meals and push them through your band, which means you can eat more and not feel full. Aim to stop drinking 10 minutes before you are going to eat, and then wait 30 minutes after eating before you drink again.
  • Eating regularly - this stops you getting too hungry and eating too fast. Eating regularly also results in more weight loss than if you ate irregularly, or grazed and snacked all day.
  • Eating small portions - it takes a while for your brain to adjust to the small size of your pouch. Using a side plate, or toddler plates and cutlery helps you keep your portions under control.
  • Mentally preparing - start to analyse your eating behaviour and any triggers for comfort-eating or over-eating (eg particular situations, moods, times etc). Start finding alternative ways of coping or other things that you can do at these times.

Do I need to lose weight prior to surgery?

It may be necessary for you to achieve some weight loss prior to surgery. This makes surgery safer for you. Your dietitian or surgeon will advise you if they feel you need to lose some weight prior to surgery. Weight loss will be achieved using diet, activity, medication, or with the help of an intra-gastric balloon.

More information is available on this option from the team. If you do not achieve the weight loss asked of you, your surgeon may not be able to perform the operation.

It is also important that you use the time before the operation to plan ahead. You will need help at home for the first week or two as you will feel tired as the effects of the operation take time to wear off.

You also need to give yourself time to prepare mentally for the changes that will occur in your lifestyle after surgery. It is important to think about coping strategies and you should begin to plan ways to change your behaviour.

We can put you in touch with other people who have had surgery to talk to them about their experiences and to ask any questions. There are also patients who are happy to support you after your operation.

Appointments

Most of these consultations are held in the outpatients department on the first floor of the hospital, unless you have been specifically informed otherwise.

First appointment

  • During your initial appointment, you will be assessed by our Bariatric Nurse Specialist and one of our dietitians. They will ask you a number of questions about your medical history, weight loss history, and your eating habits.
  • They will also explain the surgeries in more detail, outlining the pros and cons of each, and answer any of your queries regarding surgery.
  • You will be asked to complete a questionnaire which will be discussed by the nurse.
  • Your dietitian will go through in detail the dietary changes that are necessary prior to and following surgery. They can also calculate for you your expected weight loss following the different surgery options. If you need to lose weight prior to surgery, they will also support you with this.

After this initial appointment, your case will be discussed at our multi-disciplinary team (MDT) meeting and you will be allocated a surgeon. You may then be referred to other members of our team according to your individual situation. These may include:

  • Psychologist
  • Endocrinologist
  • Chest physician
  • Anaesthetists

Attendance at these appointments is mandatory. You will not be considered for surgery until you have had all of these reviews conducted. This is to ensure you receive the best care and that surgery is safe for you.

  • After these reviews have taken place you will be booked to see your surgeon. The surgeon will answer any further questions you have, and if everything is in place, will put you on the waiting list for surgery.
  • Before your admission, you will be asked to attend a pre-operative assessment clinic. Any final checks to assess for fitness for surgery will be done here including blood tests, screening for MRSA, and ECGs.

Psychology appointment

Most people in the bariatric clinic are routinely referred to see a psychologist as part of the multi-disciplinary assessment before having surgery. It is recognition of the fact that bariatric surgery is a major step and requires radical behavioural change.

Many people being seen in the bariatric service may benefit from some psychological help and support before or after surgery. Surgery has a drastic impact on the way you eat, your weight and your health and can also have an impact on your self-esteem and body image.

Many people are likely to experience psychological difficulties at some point in their lives and this should not necessarily prevent them from having surgery—as psychologists we are here to provide you with any help and support you may need to make the best decision for you at the current time.

It is therefore helpful for you to be as open as you can about any concerns you have or previous difficulties you have experienced.

What happens in the assessment?

We will ask questions about your expectations of surgery, emotional factors that might affect your eating and think about ways to help you manage difficulties.

We will also ask about any other psychological difficulties that you are currently experiencing or have experienced in the past. The assessment is a chance to think about whether surgery is the best option for you and how you will cope with the lifestyle changes.

We can also decide together whether it would be helpful to arrange further psychology appointments in order to help you address issues (eg emotional eating, low mood, low self-esteem) and make changes.

Sometimes we decide that surgery should be postponed for a while so that the person can get some help to deal with psychological problems that could prevent surgery from working.

This decision would always be discussed with you. We can organise referrals to other support services, for example specialist services if further help is needed.

Other specialist appointments to assess fitness for surgery

Some patients are at a higher risk of developing complications during or after surgery due to a pre-existing illness. You may be referred to the following:

  • Respiratory physicians - sleep studies if you are at risk of stopping breathing when you are drowsy or respiratory function if you have breathing difficulty due to lung disease
  • ECHO, ECG or Stress Study - if you are at risk of developing a heart failure, a heart attack or other heart disease.
  • Endoscopy - if you have a history of acid reflux or upper gastrointestinal tract disease.
  • Anaesthetist - every patient’s notes will be reviewed by the anaesthetist. If the anaesthetist feels you are a high risk for anaesthetic they will book you into their specialist assessment clinic.
  • Stop Smoking Service - You will be advised to stop smoking for at least 2 weeks prior to your surgery. If you need support with this, we can refer you to the Stop Smoking Service at Chelsea and Westminster Hospital.

Appointments with the dietitian

You will meet the dietitian during your initial assessment. We may need to see you more than once prior to surgery to ensure you are well prepared for the dietary and lifestyle changes needed.

You will be working closely with the dietitians after surgery also, so it is a good opportunity to get to know them prior to surgery.

Pre-operative liver shrinkage diet

This needs to be followed strictly for 2 weeks prior to surgery. Many people needing obesity surgery have a large fatty liver, which can cause difficulty for keyhole surgery.

Therefore it is necessary to follow a diet that is low in dietary carbohydrate and fat. This encourages the body to use up glycogen stores (carbohydrate that is stored in the liver), thus helping to shrink the size of the liver.

It is essential that you follow this diet, otherwise your liver could bleed heavily during surgery or there could be injury to other organs. If this happens the surgeon may have to do open surgery instead of keyhole surgery. They may even stop your surgery.

Consider the liver shrinkage diet as an opportunity to kickstart your weight loss and get you into the habit of eating a healthy diet. The more weight you lose prior to surgery, the lower your risks related to having surgery.

When will I be put on the waiting list?

You will be put on the waiting list once you have completed all of your assessments listed above and you have made a final decision on which surgery you are opting for.

Preparation for surgery

  • You need to ensure you prepare for surgery by following the pre-operative liver shrinkage diet. If you have not received this diet from the dietitians, please contact them and arrange to see them again prior to surgery.
  • Ensure that you have made arrangements for transport to and from hospital unless you are eligible for patient transport. You may want to make sure you have someone to help out at home for the first couple of weeks after surgery, especially if you have children.
  • Look at your post-operative diet sheet and make some plans about what you need to buy prior to admission. You will need to buy or borrow a blender or liquidiser. Preparing some meals in advance and freezing them is a good way of making sure you can cope with the diet initially after surgery.
  • Start to think about your coping strategies. If you cope with stress or boredom by eating, you need to think about how you can divert your focus from food onto something else (exercise, reading, hobbies). Your appointment with the psychologist will help you with this.

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