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General Surgery Mr R Ackroyd MB ChB MD FRCS Consultant Surgeon Mr KA Patel Consultant Surgeon Secretary : Northern General Hospital Herries Road Sheffield S5 7AU Tel: 0114 2434343 Della Oldham 0114 3052411 Sheffield Bariatric Surgery Service Your patient has been added to the waiting list for bariatric surgery and will undergo this in the near future. The nature of the surgery is such that medicines are advised to be taken in liquid, dissolvable or crushed form. There is no national guidance on when patients undergoing bariatric surgery should resume solid medicines and therefore practice varies. Sheffield Teaching Hospitals Foundation Trust advise that these patients will need to crush their tablets or have chewable or liquid forms for four weeks post-surgery or until they are on solid food. Restrictive operations (e.g. gastric bypass, sleeve gastrectomy and gastric banding) reduce the ease by which some drugs enter the stomach- large tablets or capsules in particular can become stuck. Prior to admission for bariatric surgery it is advised that the GP reviews patient’s medicines to ensure that all medicines are still indicated and essential. . Practice pharmacists who are attached to GP surgeries can advise on the most cost effective formulations. It should be noted that sometimes these are unlicensed Specials which can incur significant costs to the NHS. However, this is just for the first four weeks post -surgery whilst they are on the liquid/pureed stage of the post- operative diet. Patients are advised to take a chewable multi vitamin and mineral supplement during this time which can be purchased over the counter. Once they have progressed onto the soft, mushy, crispy stage of the diet they should be able to tolerate their tablets in usual form. We therefore advise that where possible, patients bring their medications with them, in an alternate form, when they are admitted to hospital for surgery. All bariatric surgery patients require a complete A- Z multivitamin and mineral supplement once daily orally lifelong. Forceval is available on prescription in soluble/tablet form; however, at Sheffield Teaching Hospitals NHS Foundation Trust patients are encouraged to buy their own over the counter equivalent. Those undergoing gastric bypass or sleeve gastrectomy (but not gastric band) surgery, also need routine 3 monthly Vitamin B12 (1 mg) injections lifelong. (Loading doses are not necessary unless a deficiency has been identified) We do strongly recommend that all patients undergoing either gastric bypass or sleeve gastrectomy are given a PPI for at least three months post-op. We would recommend Lansoprazole FasTab 30 mg OD as this does not need to be swallowed (or dispersible equivalent). As there is an increased risk of GI adverse effects following bariatric surgery, NonSteroidal Anti Inflammatory Drugs should be avoided. Surgery may impact on the absorption of some medications so patients should be carefully monitored for decreased/ increased efficacy or decreased requirement. The ongoing need and side effect profile of some medicines, e.g. anti- hypertensives, anti- diabetic medications, some mental health and chronic pain medications should be frequently reviewed. Many thanks for your co-operation in this matter. Kind regards.