Sleeve Gastrectomy Guidelines For First 2 Weeks & Discharge Instructions

Wound Care

• Your wounds should heal nicely without special care. The skin has been stiched from the inside with a clear disolving suture. You also have steristrips (paper tapes) then a wound dressing. The wounds will feel lumpy for the first few months then they will soften and become smooth.
• The wounds do not need dressings for healing purposes. However, it is more comforatble to leave the dressings on for 5 days after going home. After that remove he dressings but leave the paper tapes if they remain attached until they start to come off by themselves.
• It is ok for the incisions to get wet in the shower. Simply dap the wound dry with a towel. Do not soak the wounds in a bath or a swimming pool until two weeks after your surgery.
• You may feel a pricking sensation at the corners of the wound. This is a end of the disolving suture sticking through the wound. It will disolve with time.
• Some patients notice a clear orange odourless drainage from one of the wounds within the first coupe of weeks. In the majority of patients this is normal and represent liquified fat if you are concerned then come and see Dr Zarrouk
• Some patients like to apply vitmain E ointment or apply silicon tapes on the wounds to reduce the scaring. There is no evidence that these make any differnece on scarring but they cause no harm either so you can use them if you like.

Medications

Discharge medications

• You will be give a script for Nexium 40 mg once daily for three months. This is a drug that stops the stomach from producing acid. This is important to help the staple line heal. It will also help stop heartburn caused by acid reflux which is common in the first few weeks. You need to take Nexium for at least 6 weeks and we encourage you to use if for full tree months.
• In the first few days you will find that dissolving the Nexium in water is easier to drink but once you are drinking well you can take the tablet.
• Most patients will have minimal pain by the time they leave the hospital. You can take panadol (liquid or tablet) if you have pain. Some patients will be given script for Oxynorm or Endone (an opiod) on discharge.
• Some patients may have nausea in the first few days and may be given tablets or wafers under the tongue for that.
• Take your TEDS stockings (white hospital stockings) and Triflow device home and continue wearing the stockings and doing the breathing excercises for the first two weeks at home. This is important to reduce the risk of blood clots (DVT).

Your usual medications

Most medications that you were taken should be resumed after surgery with few exceptions:
Diabetes:
You need to measure your blood sugar regularly to help guide the dose of you diabetes medications.
Insulin dose will need to be reduced otherwise you will have hypoglycaemia attacks. Please liaise with your GP or endocrinologist about that.
Diabetes tablets should not be restarted until your blood sugar starts to rise again after surgery.
Blood Pressure Medications:
ACE inhibitors angiotensin receptor antagonists and diuretics (water pills) should be stopped the day of the surgery and not restarted until blood pressure starts to rise again and you are drinking well. The combination of reduced fluid intake, these medications, and low blood pressure can cause kidney damage. Please see your GP a week after your surgery to help adjust you blood pressure medications.
Beta blockers should not be stopped before of after surgery. Doing so may put stress on the heart and result in a heart attack.
Anti-inflammatories (NSAIDs):
You should not take NSAIDs for 3 months after surgery. These drugs can cause stomach ulcers and can interfere with the healing of the staple line. Panadol, Panadeine and Panadol Osteo are not NSAIDs and are safe on the stomach.
Drugs that thin the blood (aspirin, clopedogril, warfarin ..etc:
Let Dr Zarrouk know if you take medications that thin the blood. When to restart these medications depends on the reason you are taking blood thinners and the risk of bleeding of you particular operation. Dr Zarrouk will guide you with that.

Swallowing tablets

You can swallow tablets once you are able to drink well, however, you should take one tablet at a time. Large tablets may need to be broken, however, some tablets labeled as controlled release should not be broken.

Multivitamins

Start multivitamin supplements within a week after your surgery. By that stage you should be able to drink well and start the puree diet. Soluble or chewable tablets are easier to take in the first few weeks. If you find your mutlivitamins to upset your stomach it is ok to leave off the supplements for a couple of days then restart again. We recommend Nutrichew or BN Multi chewable tablets twice a day. Some patients may also require extra B12 or vitamin D or calcium tablets.

Diet

Free Fluid Phase (The first week after surgery)

• You should aim to dink 1.5 to 2 liters of fluid per day. This is not going to be easy in the first few days and it means that you have to drink almost constantly. Have a bottle of your preferred fluid with you all the time and sip, sip and sip.
• The stomach is now reduced to a narrow tube and this tube is stiff and swollen in the first few days. This together with the effect of removal of the hunger hormone can make you not feel thirsty. So do not wait until you feel thirsty to drink. You need to conciously drink a minimum of 1.5-2 liters per day.
• Take a small sip at a time and if it hurts to drink then slow down and try again.
• Often you feel there is an air bubble that you need to burp before fluid goes down. This is normal as there is no space for air and fluid at the same time.
• Do not use a straw as you end up swallowing more air.
• Do not use carbonated drinks as this will fill the limited space in the stomach with gas.
• Do not drink coffee in the first few days as coffee acts as a diuretic (water pill) and make you more dehydrated.
• Do not drink with food and do not drink within 30 minutes after eating. There is no room for both fluid and food.
• It is hard to get enough proteins when you are on the fluid phase. Have one of the optifast drinks a day to get more protein.
• Stay on the free fluid phase for one week then start the puree diet after that.
• Keep an eye of the color of your urine. If the colour is light then you probably well hydrated if the urine colour is deep yellow the nyou need to drink more.

Puree Diet Phase (Second and Third Weeks)

Start the puree diet seven days after surgery.

Bowel Movement

Changes in bowel habits are normal. Some patients experience constipation while others experience diarrhoea in the first few days.

Constipation:
Be sure you are drinking enough
Take Benefibre or Metamucil twice daily
Walking will help bowel movements
If no bowel movements after 4 days the we recommend you take coloxyl and senna tablets or Movicol sachets

Diarrhoea:
Some patients experiece runny diarrhoea while on the fluid phase of their diet. Sometimes this is caused by lactose intolerence or sorbitol present in sugar-free drinks. If changing the type of fluid does not make a difference then progressing to puree and soft diet often fixes the problem. If not come and see Dr Zarrouk.

Activities

• Walking help the healing process. It improves circulation, burns calories, prevents muscle loss and, most importantly, prevents respiratory complications and blood clots.
• Start slow and build up gradulally increasing your distance and time as you are able. Aim for 30-60 min per day or more.
• You may walk up and down stairs.
• Do not lift more than 10 kg for the first 4 weeks after surgery.
• Do not drive as long as you are taking pain killers. Most patients can start driving within 5-7 days after surgery.
• You may return to work as soon as you think you are ready. This depends on the type of work that you do. Most patients need 2 weeks off work after sleeve gastrectomy.
• You can resume sexual activity after 2 weeks. Use your judgement.

Your Weight

You will very likely weigh more when you get home than when you came into hospital. This is normal and it is caused by the normal fluid retention that happens in response to any major surgery. The body will shed this fluid via urine after 7 days. 

Remember: Your focus in the first 6 weeks should be about healing rather than about weight loss. 

Photo

We encourage you to take photos every month in addition to checking your weight. This will be a good way to see the changes your body goes throuh after the surgery.

Follow up

See Dr Zarrouk and the dietitian 2-3 weeks after the operation. Remember, there is no charge for all you follow-ups with Dr Zarrouk for three years after surgery.

Critical Signs

Call us early if you have any of the following problems

1. Fever of 38.5 or greater
2. Chills
3. Worsening pain
4. Smelly or pus like discharge from the wounds
5. Redness, swelling or pain over one of the wounds
6. Vomiting or not able to drink enough fluid
7. Shortness of breath
8. Calf pain or swelling
9. If you are worried or not sure about anything