Surgery and Post-Surgery Life
Surgery (First Day)
– Unless there is a special situation (previous abdominal surgeries, repeated revision surgeries, technical difficulties), all surgeries are performed closed. Average surgery times are 25-30 minutes for sleeve gastrectomy and 1-1.5 hours for bypass surgery. These periods do not include the time it takes to put the patient to sleep and wake him up. Even if the patient’s surgery times are as stated, it will take longer for the patient to return to bed from the operating room.
– When the patient comes to bed after the surgery, there will be a drain and a bladder in the abdomen. Drain, for safety purposes, to detect possible bleeding early; The urinary bladder is worn for monitoring body functions and patient comfort.
– There will be some pain for the first few hours after the surgery, strong painkillers are used during this period. After a few hours, the pain subsides, and after a day, patients feel almost no pain.
– Immediately after the surgery, patients may experience nausea, retching, and vomiting. These are common situations. Effective medications are used for this, and these complaints do not occur after the first few hours.
– Blood pressure is monitored frequently in the first hours after surgery. This is a precaution taken for patient safety. The frequency of follow-up is reduced in the following hours.
– Six to eight hours after the surgery, the patient is mobilized under the supervision of a nurse. If there is no evidence of bleeding and there are no problems with mobilization, the catheter is removed.
– On the day of surgery, patients do not take oral food.
Post-Operative Day 1
– The day after surgery, patients are given a leak test. This test consists of drinking contrast material orally. Patients who have no problems with the leakage test can start taking liquid food. In patients with no signs of bleeding, an abdominal drain is removed after the leak test.
– Patients are given nutritional training by the bariatric dietitian on how to eat in the hospital and after leaving the hospital.
– Patients are discharged on the 2nd or 3rd postoperative day, depending on how they feel.
Life After Surgery
Change in eating habits, exercise and lifestyle changes constitute the first step of obesity treatment. It is very important to include changes in eating habits and exercise in patients’ lifestyles after bariatric surgery. The key to the long-term success of any bariatric surgery is that the patient takes precautions by adjusting his/her lifestyle after surgery.
Postoperative Phased Diet Approach
After the leak test in the first 24 hours after surgery, patients are started on a liquid diet. Depending on their tolerance, patients start on liquid nutrition for an average of 10 days, puree for 10 days, and solid nutrition after the 20th day. The gradual diet program is explained to the patients in detail by the bariatric dietician and a post-bariatric information booklet is given.
A clear liquid diet is often used as the first step in postoperative nutrition. Sugar-free or low-sugar clear liquids provide electrolyte and limited energy support and support the restoration of intestinal activity after surgery. Liquids in a clear liquid diet should be at body temperature and have minimal gastrointestinal residue.
Sugar-free or low-sugar liquid diets are often followed by clear diets. Liquid diets include lactose-free milk, dairy products, milk alternatives, and liquids containing other solubles. Liquid diets are more textured and have higher gastrointestinal residues than clear liquid diets. The energy and nutrients provided by protein-enriched liquid diets approximately meet the patient’s needs. Liquid diet is applied for up to 10 days. The target in the diet is to ensure 60-80 grams of protein per day (at least 3 high protein supplements per day) and 1800 ml of fluid intake (including protein drinks).
Puree diets in bariatric surgery consist of foods blended to the density of pudding and mashed potatoes or liquefied with sufficient liquid. Although protein-rich foods are emphasized in this nutrition phase, fruits and vegetables can be included in the puree. This diet contributes to gastric residue and the intestinal tolerance to fiber. Puree diet is applied in the second postoperative week. Liquids should be avoided during meals and one should wait 30 minutes after eating to consume liquids. Foods that are blended or crushed should be kept at a liquid/baby food consistency. Spicy, very hot or very cold foods should be avoided. Only one new food should be tried at a meal to better understand which food is tolerable.
The target protein intake in this diet is 60-80 grams. As protein-based food consumption increases, protein supplementation is reduced. Moist tender meats are better tolerated. Target fluid consumption is approximately 1800 ml per day. Continue to avoid consuming liquids with meals and wait 30 minutes before resuming liquid consumption after meals. Foods should not be consumed quickly and should be chewed very well in order to be well tolerated. Two months after the surgery, the diversity of the diet can be increased and foods from all food groups can be consumed.