Preparation for Surgery & Pre-Surgery

Home / Preparation for Surgery & Pre-Surgery

Preparation for Surgery

The first step to a successful obesity surgery is the right patient selection and a careful preparation period. For this purpose, recommendations are included in many guides. As the AntBariatric family, patient health is our first priority. For this purpose, we attach importance to the preparation processes of the patients as much as to their surgeries.

After deciding on surgery, there are some rules that patients should pay attention to for a safe surgery and post-operative period.

Cigarettes and Alcohol

Tobacco smoking can lead to serious postoperative complications, mainly by causing decreased tissue oxygenation (and resulting wound infections), pulmonary complications, and thromboembolism. Active alcohol or substance abuse is considered a contraindication for bariatric surgery. If you have alcohol and smoking habits before obesity surgery, you should definitely inform your doctor about this.

Reduce smoking 4 weeks before the decision for surgery and quit smoking completely one week before.
It is recommended to stop using alcohol 10 days before the surgery day.

Drug Use

Blood thinners should be discontinued before surgery to reduce the risk of postoperative bleeding. Depending on which branch and for what purpose they are started, low molecular weight heparin (enoxaparin) may need to be started instead by the relevant branch physician.

  • Acetyl salicylic acid (Aspirin®, Coraspin®, Dispril®) should be discontinued 1 week before the operation.
  • Warfarin sodium (Coumadin®, Orfarin®) should be discontinued 4-5 days before the operation.
  • Clopidogrel (Plavix®) should be discontinued 5-7 days before the operation.
  • Ticlopidine HCl (Ticlid®, Agretik®, Ticlocard®) should be discontinued 5-7 days before the operation.

Due to the risk of hypoglycemia, it should be discontinued the evening before surgery and switched to i.v buffered insulin solution.

  • Glibenclamide (Diyaben®, Gliben®)
  • Glibornuride (Glutril®),
  • Gliclazide (Betanorm®, Diamicron®, Glumikron®, Oramikron®)
  • Glimeperide (Amaryl®)
  • Glipizide (Glucotrol XL®, Minidiab®)
  • Glycodone (Glurenorm®)

If fasting blood sugar (FBG) is normal, the dose to be taken on the morning of surgery is not given. However, if FBG is high, half of the daily dose can be given on the morning of surgery.

  • Humulin®, Orgasulin®, Actrapid HM®, Humalog®
  • Monoamine Oxidase inhibitors (MAOIs) Phenelzine, isocarboxazid, tranylcypromine, meclobemide (Aurorix®, Lobem®) Should be discontinued 2 weeks before the operation,
    Tricyclic antidepressant drugs: Amitriptyline HCl (Laroxyl®, Triptilin®), clomipramine HCl (Anafranil®), imipramine HCl (Tofranil®) should be discontinued 1 week before the operation,
    Lithium: Lithium carbonate (Lithiuril®) should be discontinued 1 week before the operation and serum lithium level should be checked.
    • Levodopa+carbidopa (Sinemet®, Madopar®) should be discontinued 1 week before the operation.
    • Chlorthalidone (Regrotan®), indapamide (Flubest®, Fludex®, Indapen®, Flupamid®, Fludin®), mefrusid (Baycaron®), furosemide (Desal®, Lasix®, Furomid®) amiloride HCl (Moduretic®), sprinolactone ( Aldacton®, Aldactazide®, Triamteril®). They may cause dehydration and hypovolemia. They should be discontinued the evening before surgery and the morning dose should not be given.
    • Ibuprofen (Brufen®, Artril®), diclofenac sodium (Cataflam®, Diclomec®, Dikloron®, Dolorex®, Voltaren®), etodolac (Etol®, Lodine®), naproxen (Aprol®, Naprosyn®, Apranax®), tenoxicam (Tilcotil®, Tenox®, Tenoktil®), nimesulide (Mesulid®) should be discontinued 1 week before the operation and replaced with paracetamol and/or opioid analgesics,
      Selective COX-2 inhibitors: Celocoxib (Cerebrex®, Rofecoxib (Vioxx®), Valdecoxib (Bextra®) It has minimal negative effects on platelet functions, but can be discontinued 1 week before major surgeries.
    • Aminoglycosides: Amikacin (Amikozil®, Amiklin®), gentamicin (Genta®, Garamysin®, Gentamicin®), tobramycin (Nedcin®, Tobel®), kanamycin, neomycin may enhance the effect of non-depolarizing muscle relaxants.  It should be discontinued and switched to another antibiotic before surgery.

    • Bitkisel kaynaklı tedavilerin tümü ameliyattan 10-14 gün önce kesilmelidir.

Preoperative Nutrition

Preparing your body for surgery is important to speed up your recovery and increase your weight loss rate. Especially in super obese patients, the diet applied before surgery provides a significant (15-20%) reduction in liver volume. The reduction in liver volume technically makes surgery easier. This diet also makes it easier for you to adapt to the diet in the first weeks after surgery. The duration and intensity of the program you will follow before the surgery is arranged by the bariatric dietitian according to your current weight and biochemical values. Preoperative diet may not be required for every patient.

In general, the preoperative nutrition principle is high protein, low carbohydrate meals. In studies, a low-calorie diet (LCD, 1000–1200 kcal/day) or a very low-calorie diet (VLCD, approximately 800 kcal/day) is generally recommended before surgery for 2-4 weeks, depending on the person’s anthropometric characteristics.

Preoperative Examinations

Some routine examinations are performed after patients who are determined to be suitable for surgery are admitted to the hospital. 

– Detailed blood tests

– Abdominal ultrasound

– Endoscopy 

– Lung film

– ECG

– General Surgeon Examination

– Anesthesia Examination

– Cardiology Examination and Echocardiography

– Psychiatric Examination

– Internal Medicine / Endocrinology Examination

– Dietitian Examination