Patients are kept nil by mouth for the first 24 hours of surgery. After this, a clear liquid diet is started. Initially, they are instructed to take only 30-50 ml of fluids every hour which should be taken in small sips. Use of straw and gulping the fluids should be avoided as it leads to aerophagy which can cause discomfort and vomiting. A clear liquid diet is followed for 3-5 days after which all liquids are started and continued for a period of 15 days. This is followed by pureed and soft diet which is taken for one week each. Patients resume a normal diet 4-6 weeks after the surgery but the quantity of food intake is drastically reduced.
Post operative care after Bariatric Surgery
Bariatric Surgery is performed under general anaesthesia which means that the patient remains fully unconscious during the procedure. The duration of surgery varies according to the procedure performed and is generally between 1-3 hours. After the procedure, the patient remains in the recovery ward for 2-6 hours and is shifted back to his/her room as soon as the condition is stable. The total duration of hospital stay varies between 2-4 days.
There is no awareness of pain during the surgery. Immediately afterwards, there is pain but which is controlled by giving certain injections. This pain gradually decreases over the next few hours and patients normally report little or no pain 24 hours after the procedure. The patients receive tablets at the time of discharge from the hospital which help them cope with any discomfort which they might experience at home.
Recovery and work
Patients can resume their normal household activities as soon as they are discharged from the hospital. Most people are able to go back to work within a week of surgery. Walking and light exercise is recommended soon after the operation. Weight training and strenuous exercise is usually deferred for a month.
Patients usually require some dietary supplements for protein and multivitamins in the initial period of rapid weight loss i.e. 1-3 months after the procedure. Protein supplements are usually in powder form to be taken with water or milk 2-3 times a day. Multivitamins can be taken either as syrups or capsules depending upon personal preferences. Restrictive procedures like gastric band and gastric sleeve do not require long term supplements. However, patients who have undergone malabsorptive procedures like gastric bypass may require supplements in the long run with periodic monitoring.
The weight loss after bariatric surgery is divided into two phases- initial short period of rapid weight loss lasting 2-3 months followed by more prolonged period of gradual weight loss of 6-8 months. The amount of weight lost will depend upon the initial weight of the person before the surgery. Generally, restrictive procedures result in 60-80% of excess weight loss whereas the malabsorptive /combined procedures may result in 70-90% excess weight loss. The weight is maintained over the long term and numerous studies have shown good results even 10-15 years after the procedure.
In the present era, bariatric surgery is extremely safe and the complication rate is the same or less than any other major elective surgery. The risk factors are often patient dependent. Patients who are extremely obese with multiple other medical conditions have a higher than average risk during the procedure and require appropriate care.
Most of the immediate complications can be managed by medical/surgical intervention. Long term side effects include a risk of malnutrition or vitamin deficiency especially in patients who have undergone a malabsorptive or combined procedure. These patients require regular follow up with periodic review of diet and nutrition and may require supplements. Usually there is no weakness experienced after the procedure, and in fact, patients experience lightness and sense of renewed energy which is long lasting.
The patients are usually discharged within 2-4 days of the procedure and are called after a week for the removal of skin sutures. They are then told to follow up at 1 month and then periodically every 3 months thereafter for the first two years. A review of the weight loss, diet plan, exercise routine and lifestyle is done and any changes required are told to the patients.