Pre-surgery Planning

Examinations

Before weight loss surgery, you will need to undergo certain baseline investigations and assessments to ensure that the procedure is safe and suitable for you. These assessments include:

• Physical assessment: The physical assessment is intended to identify factors that can complicate your weight loss surgery.
• Baseline investigations: Blood tests and endoscopy (and sometimes radiological imaging) to exclude or confirm undiagnosed nutritional and medical issues.
• Nutritional assessment: The nutritional assessment is carried out in detail by our dietitian to assess the history of your diet, eating patterns and their effect on your weight. The aim is to increase your awareness on the changes to your dietary/nutritional requirements after surgery. It helps us to formulate the pre- and post-surgery dietary plan for you.
• Psychological assessment: On occasion, a psychological assessment may be recommended to assess any psychological barriers or emotional problems that could contribute to problematic eating behaviour. Your psychologist may be able to help you in developing strategies in dealing with certain patterns of habitual eating that may hinder the success of your surgery.

Recommendations

Your surgeon will obtain detailed information about you including your past medical and surgical history. Your surgeon will perform a physical examination and will order certain diagnostic tests such as blood tests and endoscopy (and sometimes radiological imaging) as part of your pre-operative assessment. After reviewing these results, your surgeon will then recommend the most appropriate treatment.

It is not uncommon to have questions or doubts. We encourage you to clarify your doubts during the appointment. Your surgeon will take time to explain the options for treatment and our administrative staff will go through the details of costs and logistics with you. Our aim is to provide you with all the information that you would need to make informed decisions about managing your health. If you still have questions when you leave the office, please do not hesitate to contact us - we are here to help.

Diet and Medication

Your surgeon and dietitian will recommend a strict, individually-tailored, very low-caloried diet (VLCD) for a designated period of time before weight loss surgery. The diet helps in shrinking the liver so that your surgeon can safely perform surgery to your stomach. This is particularly important for operations on the extremely obese (BMI>50) and those with fatty liver disease. Reducing a moderate amount of weight before surgery decreases the risk of surgical complications. The pre-operative diet includes:

• The use of Optifast replacement diet
• Protein supplements
• Avoiding or reducing alcohol intake
• Taking mineral and multivitamin supplements (if found to be deficient in your blood tests)

If you are diabetic, you need to reduce your medication when you go on your pre-operative diet as guided by your diabetes nurse educator, GP or endocrinologist. Your surgeon and anaesthetist will also give you clear instructions as to the medications that you can/should take and those you should avoid prior to surgery.

Day Before Surgery

Once you and your doctor decide that surgery is required, you will need to prepare mentally and physically for surgery. Understanding the process and your role in it will help you recover more quickly and achieve your goals of surgery.

Working with your doctor

If you smoke, you should aim to stop smoking 6 weeks prior to surgery to reduce your surgery risks and improve your recovery.

If you are taking anti-inflammatory medication or any other blood thinning medication, you may need to stop taking them a week prior to surgery, to minimize bleeding, but you should first speak to your surgeon about this.

Discuss any other medications you are taking with your surgeon, anaesthetist and/or your general practitioner to see which ones you should stop taking before surgery.

Discuss with your doctor the options for preparing for potential blood replacement prior to the surgery.

Report any infections to your doctor. Surgery should not be performed until all infections have cleared.

Home Planning

• Arrange for someone to help out with everyday tasks like cooking, shopping, laundry and cleaning.
• Put items that you use often within easy reach before surgery, so you won’t have to reach and bend as often.
• Remove all loose carpets and tape down electrical cords to avoid falls.
• Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.
  

Preparing for Procedure

If you are having a day procedure (such as a intragastric balloon), remember the following:

• Have someone available to take you home as you will not be able to drive for at least 24 hours.
• The combination of anaesthesia, food and car motion may cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours.

Take your pain medicine as directed. Take the pain medicine as you start feeling uncomfortable, and not when you are in severe pain. If you wait to take your pain medication when the pain is severe, you will have more difficulty controlling the pain. Be aware, if you are taking some stronger pain medications, you should not drive.

Pre-operative Diet

Following a strict pre-operative diet is very essential for patients undergoing weight-loss surgery in order to decrease the size of the liver and facilitate minimally invasive (laparoscopic) surgery safely, which is associated with less post-operative pain and faster recovery.

Your surgeon and dietitian will provide information on a pre-operative diet specifically for you based on your weight and your medical history. Your pre-op diet for weight-loss surgery will generally start at 2 to 3 weeks prior to your surgery.

If you are diabetic, your diabetic medication will need to be adjusted by your diabetes nurse educator, GP or endocrinologist.