- Consultation with the bariatric surgeon.
- Dietary history and nutritional assessment.
- Psychological assessment.
- Complete investigation profile to rule out any latent diseases.
The preparation for a patient who has decided to undergo a bariatric surgery includes the following steps –
Consultation With the Bariatric Surgeon
The patient usually provides a full and detailed medical history to the bariatric surgeon before embarking upon any surgical procedure. Morbidly obese people usually have a number of associated health issues like diabetes, hypertension, sleep apnea, hormonal imbalances, infertility, etc. which need to be optimised before surgery. This is done after consulting the respective specialist doctors and review of the current medication. Besides the medical problems, the doctor needs to understand the diet and lifestyle of the patient to help him/her make the correct choice of procedure. A number of other factors including age, gender, motivation, level of physical activity and ability to comply with nutritional supplements and long term follow up will determine the surgical procedure which is ideally suited for a particular patient.
Dietary History And Nutritional Assessment
The patient needs to provide the dietary details like food preferences, volume of eating, timing and frequency, junk food and spicy food. Patients would generally be categorised into grazers (who take small quantities of food continuously) and volume eaters (who take 1-2 large meals in the day). Specific conditions such as craving for sweets, binge eating and depressive eating need to be ruled out as they will influence the outcome of the surgery. The dietician needs to take into account the presence of any existing nutritional deficiency and correct it accordingly. The pre as well as the postoperative diet plans are discussed with the patient to make them understand the changes which will be required which will ensure long term compliance.
Psychological Assessment
Morbidly obese patients may have underlying psychological disturbances which make them prone to excessive eating. Many times, the underlying factor may be some anxiety or a depressive illness. This by itself doesn’t contraindicate bariatric surgery, but the same should be found out and treated appropriately. Moreover, these people often face social discrimination and have a poor self esteem. They should have a realistic expectation from the surgery and understand all risks and long term consequences before embarking upon this decision.
Investigations
A battery of tests is prescribed before the surgery to ensure freedom from any latent disease. These include –
- Blood investigations
- Ultrasound of abdomen
- Chest X ray
- ECG and Echocardiography
- UGI endoscopy
- PFT, TMT and sleep studies may be required in select cases
All these tests ensure that the surgical procedure may be carried out safely without complications under general Anaesthesia.
Do’s and Don’ts before The Surgery
- Liquid diet for 1 week – especially for patients with BMI > 45-50 kg/m2 and fatty liver.
- Stop smoking 1 week prior.
- Avoid high calorie food and sweets.
- Optimization of blood pressure, blood sugar and thyroid status.
- Stop Aspirin 3 days prior.
- Treatment of any active infection.