Download Practical tips for bariatric patients following gastric banding surgery

Practical tips for bariatric patients
following gastric banding surgery
Information for patients, relatives and carers
Introduction
This leaflet is designed to give you practical information about what to do following your gastric banding
surgery. We hope this information will answer some of the questions that you or those who care for you
may have. The leaflet is not meant to replace the consultation between you and your medical team, but
aims to help you understand more about what is discussed. If you have concerns about any aspect of
your recovery, please speak to a member of the medical team.
What can I do when I first go home?
Your dressings can be removed and the wounds left exposed with the surgical clips left uncovered.
You will be seen in clinic approximately seven to ten days after your surgery to have your surgical clips
removed. Until then you can:




shower as normal
climb stairs
take walks (up to about 30 minutes each day)
resume sexual activity
You should avoid:



heavy lifting for at least two weeks (unless otherwise advised)
driving
going to work for the first week following surgery
Please note if you have a job that is physically demanding you may need to take more than one week
off. If this applies to you please discuss this further with the bariatric clinical nurse specialist (CNS) team
(contact details are listed at the end of this leaflet) or your GP.
What if I have abdominal pain?
It is normal to have some pain and discomfort for a few days after surgery. You may also have some
discharge from your wound that is clear or blood-stained. The discharge usually stops after a couple of
days but, if it persists and your wound becomes red and inflamed, please contact the bariatric CNS
team.
It is important to follow the post-operative diet provided in your diet sheet to prevent abdominal pain. We
advise that you only take the soluble pain relief that we give you. Non-soluble pain relief may get stuck in
your throat due to the size of the tablets. If you are unable to tolerate the pain relief we provide, please
check with us before trying an alternative.
Please note you should not take aspirin, ibuprofen (e.g. ‘Nurofen’) diclofenac (e.g. ‘Voltarol’) or
naproxen regularly unless this has already been discussed and agreed with your medical team.
Many people feel bloated or have wind pain. This is very common and can be due to swallowing too
much air whilst eating or drinking. One or more of the following may help:

taking five millilitres of simethicone (e.g. ‘Infacol’) four times a day – this can be bought over the
counter in most pharmacies and is very effective (you will be given a supply when you go home)

taking peppermint oil capsules or drinking peppermint tea

reducing your intake of wind-producing food such as beans, onions, cabbage, stone fruits, apples,
broccoli, sprouts, garlic, honey, sugar-free gum/mints and foods that contain cow’s milk

eliminating one food at a time from your diet (then reintroducing it if there is no improvement)

putting down your fork/spoon between bites whilst you are chewing – this will help you to eat
more slowly and stop you gulping down too much air

having probiotic yoghurts or drinks - these help put good bacteria back into the gut
If you have persistent abdominal pain that is associated with a temperature and vomiting and it is
becoming worse or is not relieved by painkillers, contact the bariatric CNS using the emergency number
listed at the end of this leaflet. If you are calling outside the hours of 08.00 to 16.00, call the Paterson
ward instead.
What medication will I need to take?
Before you leave hospital you will be given a list of medicines to take. Some of your usual medicines
may have been altered or stopped. If you are unsure about which medication to take please contact the
bariatric CNS team. We can only give one weeks’ supply of medication - you will need your GP to
continue prescribing it after this. You must continue to take a multivitamin and mineral supplement for
the rest of your life. Patients who are at risk of developing a blood clot may be given blood-thinning
injections.
If you are taking the antidepressant mirtazapine, you should stop unless specifically advised to continue
by the bariatric team. Taking mirtazapine can lead to weight gain after surgery. Your GP or the bariatric
psychiatrist can advise you on alternatives.
Do not stop taking antidepressant medication (apart from mirtazapine, as per the guidance above)
without prior discussion and supervision from your GP. Depression can resurface once the initial
happiness your weight loss brings has passed.
2
Nausea and vomiting
Vomiting is not normal after a gastric band. If you are vomiting it may be because:



you are rushing your food or not chewing it well
you are drinking when you eat
your band is too tight
If you are unable to tolerate the diet or fluids for more than 48 hours or you are vomiting, you should
contact a member of the bariatric team. If it is out of hours you should go to A&E at St Mary’s Hospital,
on the first floor of the Queen Elizabeth the Queen Mother (QEQM) building.
Stress and illness can cause the gastric band to become tighter so try to take time to relax. If you find
you have difficulties with eating and drinking, or you are vomiting after your meals, contact a member of
the bariatric team for advice.
The following suggestions may help you if you have difficulty eating and drinking:

ensure that you eat slowly, chewing well and taking a pause between bites (remember the ‘rule of
20’ - take nothing bigger than a 20p-sized piece of food in your mouth at a time, chew each
piece 20 times, take 20 minutes over your meals and always eat your protein first)

exclude foods known to be more difficult to digest such as bread, tough meats, pasta, rice and
fruit with skin on

leave a time gap of at least half an hour between eating and drinking

heartburn is common, but if it is severe and distressing your band may be too tight and you
should contact the bariatric team for advice
What if I have diabetes?
It is important that you keep monitoring your blood sugar after your surgery, as advised in your
discharge documentation. You will be given a chart to record your blood sugar reading before each meal
and at bedtime. You should complete this every day and bring it with you to your first appointment after
surgery. Your bariatric CNS will offer guidance on how often you should continue to test your blood
sugar at this appointment.
Diabetic medication may need to be adjusted as you lose weight. Please keep in touch with the bariatric
CNS for advice about this.
You should avoid sugary drinks (apart from when treating a ‘hypo’ by drinking Ribena as per the
guidance) and foods, as these will increase your blood sugar levels. Fruit is natural sugar; remember
that the riper the piece of fruit, the more sugar it will contain. Eat one piece of fruit at a time and spread
the portions you eat throughout the day.
If your blood sugar level is regularly above 12 mmol/L or regularly below 4 mmol/L you should call the
bariatric CNS. If it is out of hours please call the emergency bariatric telephone number, listen to the
message and call the number that is given to you (see contact details at the end of this leaflet).
3
Constipation
After surgery your bowel motions may change. Most patients find that they are quite constipated for the
first week after their operation. This can be improved by making sure you drink enough water and that
you are as mobile as possible. If you are constipated you should drink at least 1.5 litres of fluid a day to
ensure a good intake. You should not have fluids with your meals – have a drink one hour before or after
meals. Water is preferable, but you can also drink no-sugar squash, tea (or fruit tea) and coffee.
You will be discharged home with lactulose (a stool softener) which you should take as directed if you
have not opened your bowels for three days after surgery. Occasionally, laxatives such as macrogol
(e.g. ‘Movicol’), senna glycoside or glycerine suppositories may need to be given. If you have any
concerns or worries about this please contact us.
In the early stages following your operation, try the smoothie recipes in the diet booklet to provide
additional fibre. These should not be consumed regularly in the long term though, as they are high in
calories and can slow weight loss.
Any increase in dietary fibre intake should be gradual.
When can I exercise?
One of the greatest risks associated with bariatric surgery is getting a blood clot in either the calf or the
lung. To help avoid this we advise that you move around as much as possible and take a 30-minute walk
each day. To make sure that you do not become dehydrated you should drink at least 1.5 litres of fluid
per day.
Even whilst sitting down and resting it is important to keep moving your calves. You should move your
feet up and down and rotate your ankles, as if you were doing exercises when on an aeroplane. Other
exercise should be gentle for the first two weeks following your operation, such as walking or cycling.
You should not do any heavy lifting or weight training for at least two weeks.
For optimal and sustained weight loss after bariatric surgery, a long-term increase in activity levels is
essential, alongside a reduced food intake.
When can I drive?
You should not consider driving until after you have been seen in clinic approximately seven to ten days
after your surgery to have your surgical clips removed. Following this you should contact your insurance
company to find out their current guidelines before you drive. If you drive before the recommended time
following surgery has passed and you have an accident, it may result in non-payment by your insurance
company.
You need to be capable of performing an emergency stop before you consider driving again after
surgery (contact the DVLA and your insurance company for further guidance on this).
4
When can I travel?
We advise that you do not fly at all for two to three days following surgery. After this, short-haul flights
can be taken. You should not travel any longer distance until you have been seen for your first
appointment with the bariatric team. This usually takes place about seven to ten days after your surgery.
When can I work?
Generally we advise that you allow for one week off work, or until you are seen in the clinic (or by your
GP) to have your clips removed. If your job is physically demanding you may require more time away
from work. You should discuss this with the bariatric team or your GP.
What can I drink?
You should avoid fizzy drinks for life following your surgery as these can cause bloating and discomfort.
Your fluid intake is important and you should aim to drink 1.5 litres a day (taken one hour before or after
meals).
Avoid high-calorie fluids including hot drinks made with sugar - if needed, you should use sweetener
instead. You should have no more than 150 millilitres of fruit juice a day. If you wish to drink more than
this you should opt for the no-added sugar variety of squash instead.
Can I drink alcohol?
You should not drink alcohol for three months after surgery and, after this, only in moderation. The effect
of alcohol can be greater after surgery. We suggest that you exercise caution the first time that you try
alcohol after surgery.
What can I eat?
You will have seen a dietitian in the clinic before your operation who will have explained the postoperative diet to you. You will also have been given a diet sheet to follow. For the first seven days
following surgery you will only be allowed a liquid diet. Remember that in order to help stop you feeling
sick (or indeed vomiting), you must sip fluids. Using a straw can sometimes be helpful.
Once you start eating again, take your time. You will never be able to eat as before and you should
expect to feel full very quickly – remember this is the purpose of the operation. As soon as you feel full,
stop eating. If you try to hurry a meal or consume too much in one sitting then you will experience a lot
of pain and are likely to vomit.
If you are having problems with your diet or have any questions you should contact the dietitians using
the telephone/email listed at the end of this leaflet.
5
Pregnancy
We advise patients to avoid pregnancy for one year to 18 months following surgery. Oral contraception
can be restarted one month after surgery - please ensure that you use appropriate contraception during
this interim period.
If you are planning a pregnancy or you are pregnant you should ask your GP to change your ‘Centrum’
or ‘Forceval’ vitamins and start taking ‘Pregnacare’ vitamins, which are also available over the counter.
Can I smoke?
We advise patients to refrain from smoking after surgery.
What if I feel unwell?
If you feel an increasing amount of pain, are vomiting, have a fever or have any serious problem or
concern then you must contact us on the emergency phone number. Out of hours, please contact the
Paterson ward and a member of staff will be able to help you.
If you have a problem and are unable to wait for a member of the team to call you back please go to St
Mary’s Hospital’s A&E department on the first floor of the QEQM building.
What follow-up appointments will I have after my surgery?
Your follow-up appointments will be arranged as follows:

7-10 days after your surgery with the CNS at our outpatients clinic (you may be asked to go to
your GP to have your surgical clips removed before this appointment – if this is the case you will
be advised accordingly before you go home following your surgery)

5-6 weeks after your initial follow-up with the CNS for your first gastric band adjustment

regular appointments for the first six months with the CNS until you are fully adjusted
(appointments will be at St Mary’s Hospital or Brook Green Medical Centre satellite clinic in
Hammersmith)
You will be discharged from the service after two years and will need to ask your GP to refer you back if
you need to be seen again. We can see you as an emergency if you are having problems.
One year after your surgery we will arrange a barium swallow test. For this test, you drink a liquid which
shows up more clearly on x-rays, allowing us to see your gastric band and make sure that it is in the
correct position. Blood tests will be carried out six months and one year after your surgery initially. After
that you will be seen once a year, unless you are having problems.
It is very important that you attend all follow-up appointments. If you cannot attend please contact the
call centre to rearrange. Our clinics are very busy and we can usually offer appointment slots that are no
longer convenient for you to other patients.
6
If you feel you need further psychological support please contact the bariatric CNS team.
How can I tell if it might be necessary to adjust my gastric band?
If you are feeling hungry and eating big meals or you crave food and your weight is increasing or staying
the same, your band may need tightening. Fluid is added to achieve this.
If you are not generally hungry and have satisfactory weight loss (or your weight loss is maintained),
then no adjustment is needed.
If you are having difficulty swallowing and/or experiencing reflux, heartburn, night cough, regurgitation of
food, or you are developing poor eating patterns, your band may need loosening. Fluid is removed to
achieve this.
Contact details

Bariatric CNSs - for medical information, general enquiries and advice. The bariatric CNSs are
available Monday to Friday, 08.00-16.00. Telephone: 020 3312 5689
Email: [email protected]

Emergency telephone number (medical emergencies only): 07826 859 741

Dietitians - for information about the pre- and post-operative diet. Telephone: 020 3312 5688
Email: [email protected]

Administration - for information on dates for surgery and general enquiries. Telephone: 020 3312
6449

Call centre - to change appointment times. Telephone: 020 3312 6000

Paterson ward telephone: 020 3312 2400
How do I make a comment about my treatment?
Please speak to a member of staff or contact the patient advice and liaison service (PALS) on 020 3133
0088 (for Hammersmith and Charing Cross hospitals), or 020 3312 7777 (for St Mary’s Hospital). You
can also email PALS at [email protected]. Alternatively, you may wish to express your concerns in
writing to: Chief executive – complaints, Imperial College Healthcare NHS Trust, Trust Headquarters,
The Bays, South Wharf Road, London W2 1NY.
Alternative formats
This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative
languages. Please contact the communications team on 020 3312 5592.
Bariatric
Published: April 2015
Review date: April 2018
Reference no: 2547v1
© Imperial College Healthcare NHS Trust
7