Your hospital stay after the sleeve gastrectomy operation will last two to three days, depending on how quickly you recover from the anaesthesia and the surgical procedure. Initially, you will be connected to monitoring equipment and calf compressors to encourage blood flow from the legs. Most patients will not have a urinary catheter, drain or a stomach tube in the nose. After recovering from anaesthesia you will be transfered to the High Dependency Unit (HDU) or to the regular surigcal ward.
Triflow Incentive Spirometer
After surgery, your nurse will give you a triflow incentive spirometer device. Immediately after surgery, some of the samll air spaces in your lungs will be collapsed or blocked by mucus. The triflow device teaches you to breath deeply to open these small spaces and clear any secretions. This is important to prevent chest infection.
How to use the triflow incentive spirometer?
- Sit on the edge of the bed or sit up as far as you can.
- Hold the triflow device upright.
- Exhale and place your lips tightly around the mouth piece.
- Breathe in as deeply as possiible and at a sufficient rate to move the three balls. Your aim is to lift the three balls and to hold them up as long as possible.
- Rest then repeat 5-10 times every hour. It is normal to cough after your breathing exercise.
You may find the video below useful
Diet in Hospital
After your operation you will be allowed to have sips of clear fluids and iceblocks to suck. It is normal to have nausea for the first few days and you will have regular medications for that. You will have intravenous fluids so do not worry, you will not get dehydrated.
Day 1 After Surgery - Clear fluids
You will be started on clear fluids diet. Intravneous fluids will be continued until we are sure you are able to drink enough. Most patients will leave the HDU and go the general ward.
Day 2 After Surgery - Free fluids
You will commence a free fluid diet. On average half of our patients will be able to go home on that day, the other half benefit from another day in the hospital.
Your stomach is much smaller, so take it easy
Remember, the whole purpose of the sleeve gastrectomy operation is to reduce the size of your stomach and thus the amount of liquids and foods that it can hold. Its volume has been reduced from an average of 2 litres to a tube that can hold no more than 100 to 200 millilitres. As a result, our general advice during this post-operative recovery period is to start slowly. You will be encouraged to slowly sip water and other clear fluids for the first day. You may still be experiencing some nausea, and you will not yet be accustomed to the new size of your stomach, so don't rush things.
During these first post-operative days, your stomach will still be swollen and tender from the surgery, and so you may not be able to meet the goals established by your surgeon for how much liquid you should consume. Don't worry about this; the amount varies from patient to patient. Start with small sips and then stop drinking after taking them. Your habit will be to try to take larger gulps or drink a whole glass of water or other liquids very quickly, as you have been used to doing in the past, but this may not be possible and may result in feelings of nausea or reflux.
So start slowly, and take your time
It took a lifetime to develop the BMI level that became a problem for you, and it will take some time to get used to your stomach's new size and limitations. During these first few days, you may be given liquids other than water to sip, including clear soups, jellies, milk, custard, diet cordials, tea, and coffee. Sip them all slowly, and do not force yourself to consume all of the liquids provided to you in one sitting. Just sip easily, while trying to be aware of when you start to feel full, at which point you should stop drinking. You can always sip more later. If you feel dehydrated, you can also suck on ice cubes to alleviate any feelings of thirst, while still taking it easy on your new stomach. Any medications that you regularly take for medical conditions associated with your high BMI will be provided in liquid form, and you should continue taking them unless specifically advised not to by your surgeon or anaesthetist.
During your hospital stay you are encouraged to get up and move around as much as is comfortable for you. This is important because it allows your lungs to expand and helps to restore circulation to your legs and other extremities. You will be wearing compression stockings before the surgery and you need to continue to wear them throughout your hospital stay. This is to reduce the chance of developing clots in the veins of the legs. We encourage you to take the stockings home with you and to continue to wear them for the first two weeks.
Prevention of blood clots (DVT & PE)
Obesity is a risk factor for the development of blood clots in the veins of the legs and pelvis. We take the prevention of blood clots seriously. You will receive an injection of a blood thinner called heparin the morning of the operation and wear elastic compression stockings. You will also have pneumatic (air powered) calf compressors during the operation and this is continued till the day after surgery. The heparin injections and the elastic stockings are continued while you are in the hospital. You should take the elastic stockings home to wear for the first two weeks after surgery. Breathing exercises, well hydration and early mobilization are also important to reduce the chance of blood clots.
If you are at a higher risk, you will be given Clexane injections to use once a day for two weeks. These injections come as single use preloaded syringes and are easy to use. Your nurse will teach you how to use the injections during your stay in hospital.
You can watch the following video to learn more about how to use the Clexane injections