Preparing For Surgery

Personal Preparation
Now that you have decided to proceed with surgery, there are certain steps to take before your operation to ensure that you are in the best possible readiness for the procedure.  Start taking multivitamins once daily to improve your general health. Further, take 500 mg of Calcium Citrate (CitraCal®) three times daily.  Vitamin and mineral intake is especially important after Bariatric surgery in order to maintain good nutrition and health.  We have found that if you start taking these supplements before surgery, it will be easier remembering them after surgery

Another important way to prepare for surgery is exercise.  The best time to begin your exercise program is before your surgery.  Walking on a daily basis improves your circulation and makes breathing easier during recovery.  Should you be unable to walk daily due to joint pain, then you may want to look into an aquatics program.  Water exercises still condition your breathing, but are not weight bearing and are therefore easier for people who have joint problems.  You will also benefit from having a plan in place, so you don’t have to figure out your routine during the recovery phase.

You should begin taking two showers per day for a few days before you enter the hospital.  Careful attention must be given to cleaning the entire trunk from the neck and armpits to the groin, making sure to clean between any folds of skin.  Use antibacterial soap such as Dial® or Hibiclens®.  Pat dry any reddened areas or use a blow dryer on low heat to dry difficult to reach places. 

Medicines
It is important to avoid aspirin and all aspirin-containing medicines for 7 to 10 days prior to surgery.  Remember to check the label, since certain over-the-counter medicines can contain aspirin, too.  If in doubt, please check with your pharmacist or your surgeon. Make sure that you keep your surgeon and other specialists informed of the complete list of medicines that you are taking.  Include herbal supplement and vitamins in this list.  Some herbal supplement must be discontinued before surgery, so be certain to check with your surgeon. 

Bowel Preparation before Surgery
For two days prior to surgery you may drink only liquids.  The day before surgery, you may drink only clear liquids.  Clear liquids include water, coffee, tea, apple juice, grape juice, cranberry juice, bouillon, broth, clear Popsicles, soda and gelatin.  Further instructions will be given to you at your pre-operative appointment.  It is important that you follow these instructions completely.  After midnight you must take nothing by mouth except medicines that have been approved by your anesthesiologist and your surgeon.  Your stomach must be empty at the start of the procedure to avoid the risk of food particles going in to your windpipe. 

Alcohol and Tobacco
Smokers who undergo anesthesia are at increased risk for complications.  Patients are required to stop smoking eight weeks before surgery. Patients must agree to permanently refrain from smoking after surgery.  Ask your Primary Care Physician to write you a prescription for a smoking cessation aide.

Alcohol causes gastric irritation and can cause liver damage.  During periods of rapid weight loss the liver becomes especially vulnerable to toxins such as alcohol.  You may find that only a couple of sips of wine can give you unusually quick and strong effects of alcohol intolerance.  In addition, alcoholic beverages are high in empty calories and may cause “dumping syndrome”.  For these reasons, we recommend complete abstinence from alcohol for one year after surgery and avoiding frequent consumption thereafter.

Work and Disability
Expected return to work time is about two to six weeks.  This varies from person to person depending on the kind of work you do, your general state of health, how badly your work needs you, how badly you need your work (i.e. the money), your general state of motivation, and your energy level.  Some patients do not wish to tell the people with whom they work what kind of surgery they are having, and this is perfectly appropriate.  Although you do not need to tell your employer that you are having weight loss surgery, it is recommended to reveal that you are having major abdominal surgery.  Do not tell your employer that you are having gall bladder surgery, since you would be expected to return to work within two weeks.  Explain that you will need four or more weeks to recover.  Your employer should have the relevant forms for you to complete if you would like to have some form of financial compensation during your absence. You may want to indicate that you will not be able to do any heavy lifting for several months after surgery. 

Pre-op Evaluation Procedures
Before you can have your surgery, you will need a consultation with your surgeon.  This is a good time to have questions reviewed with your medical team.  Remember, your team consists of many participants, the most important of which is you.  In addition your surgeon, a physician assistant, an anesthesiologist, nurses, physical therapists, respiratory therapists, lab technicians, social workers, pharmacists and dietary consultants will all take part in your care.  You will also have the required pre-op specialists appointments with a cardiologist, pulmonologist, nutritionist, and a behavioral health specialist.  In some cases appointments with an endocrinologist and a vascular specialist are also necessary.   You will need to have the following tests prior to surgery: a pulmonary function test, an arterial blood gas test, pre-op blood work, an Ultrasound of your gallbladder, a chest x ray, an EKG, and an Echo cardiogram.  If you have previously had any of these tests performed in the last 6 months please notify our office, as you may not need to have them repeated.  We will also need a letter of medical necessity from your Primary Care Provider.

Please bring with you insurance cards, a detailed list of your medications, including herbal supplements and vitamins, which you may be taking.  You can discuss advance directives and living wills with the pre-admitting nurse. 

If you are ill before Surgery
Should you develop a cold, persistent cough, fever or any changes in your condition during the days before your surgery, please notify the physician who medically cleared you for surgery immediately.  You will need to be re-evaluated for surgical readiness.  You need to be in the best possible shape for anesthesia.  Scheduling can be adjusted to your condition if necessary.