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Admission information for surgery

Posted Thursday, 10 February 2022

Issue date: February 2024

Review date: February 2026

Ref: C-470/CP/Dietetic/Admission information for surgery v2

PDF: Admission information for surgery final February 2024 v2.pdf [pdf] 261KB

Day of Admission

Nil by Mouth instructions

7am admission: Continue Liver reduction diet until 2.30am, you can have water up until 6.30am
11am admission: Continue Liver reduction diet until 6.30am, you can have water up until 10.30am.
Report to the ward stated on your admission letter.

Post-surgery

Following surgery, you will return to the ward. Depending on bed availability, the wards that specialises in Bariatric Surgery is Postbridge 23 hour Stay Unit and Wolf, if no beds are available then we may have to send you to another ward. This cannot be confirmed until the day of surgery.

Contact Numbers:

Wolf: 01752 439677 or 01752 439678

Postbridge: 23 hour stay unit 01752 432568

Items to bring into hospital: Please be mindful that there is limited storage on the wards.

All regular medication in their original boxes.
Overnight clothes
Personal hygiene items
Mobile phone
iPads/Tablets: (see note below)
Slim Fast®/Fortified Milk Powder /Sugar Free Squash (The ward is unable to provide this for you)

You must be advised that expensive items such as iPads/tablets and mobile phones are brought in at your own risk. The hospital cannot take responsible for your personal belongings.

Discharge Information

Driving: No driving for 2 weeks.
Work: You are advised to take up to 6 weeks off work.
Exercise: You are encouraged to go for short walks and walk around the house. This will help reduce the risks of clots in your legs and lungs. Exercise such as swimming /Gym need to be avoided for 6 weeks.
Blood Clots: To help prevent this, ensure you wear your stockings for 1 week and continue your blood thinning injections once or twice a day (weight dependent) for 7 days.
Constipation: If you are struggling with constipation post-surgery, please e-mail our generic inbox plh-tr.DerrifordBariatrics@nhs.net and we respond with a follow up telephone call.
Disposal of sharps bins: Please contact your local council who will have a sharps bins disposal service.
Wound care: keep clean and dry, observe for signs of infection, bleeding or wounds opening. If you have any concerns seek advice from your GP Surgery or send a photo to the generic e-mail address.
Medication: You will be discharged with 4 weeks supply of your lifelong vitamin and mineral supplements. Your GP will be informed that these will need to be added to your repeat prescription record.
Showering: you can have shower immediately post-surgery. Avoid having a bath for 1 week.

Lifelong supplements and post-surgery medication

Lifelong supplements
Medication	Dose	How often to take your medication and when	How long to take the medication for?
Inhixa (Enoxaparin)	40mg	Once or twice a day depending on weight Same time every day.	For 7 days
Omeprazole	40 mg	Once a day in the morning	3 months only
Multivitamin and Mineral A-Z Forceval Capsules	1 Capsule	Once a day lifelong In the morning	Lifelong
Iron Ferrous Sulphate	200 mg	Once a day: in the morning. Menstruating Women: you may be advised to take this twice a day. 08:00 hrs 18:00 hrs	Lifelong Must be taken 2 hrs before/ after Vitamin D and Calcium Must be taken 4 hrs after Levothyroxine
Vitamin D and Calcium: TheiCal D3	1 tablet	Lunch time	Lifelong
Paracetamol 1g	2 tablets	Up to 4 times a day. 4-6 hours apart	Until pain controlled post-surgery.
Ibuprofen (if you are able to take) 400mg	1 tablet	3 times a day. 8 hours apart	Up to 7 days only.
Ondansetron 4-8 mg	1-2 tablets	Up to 3 times a day. Each dose 8 hrs apart	Only if required.
Prochlorperazine 3 mg	1 Buccal tablet	1 tablet twice a day	Only if required

Your regular medication: Some medication must stop before and after surgery. Yow will be advised by the Bariatric Team or the pre-assessment nurse which medication will need to stop.

Post-operative diet plan

Following bariatric surgery, it is important to follow the texture stages as recommended by your Bariatric Centre to avoid complications such as pain, discomfort, regurgitation or vomiting and to allow your new stomach to heal.

Liquid stage (Day 1 to Day 14 following surgery)

For the first two weeks you must consume liquids only. Aim to have a nourishing drink at each meal and snack time. Liquids must be no thicker than a meal replacement shake such as Slimfast®.

Nourishing drinks include

Meal replacement shakes, make up as directed on tin with skimmed milk. Drink as tolerated.
Fortified Milk: Make up 1 x pint per day by adding 4 x dessert spoons of skimmed milk powder to 1 pint of skimmed milk.
Smooth soups, you can add fortified milk to increase your protein intake.
You can use Horlicks Light® / Ovaltine Light® / Sugar free Crusha® / Options® / Highlights® hot chocolate with fortified milk for more variety.
Yogurt

Liquid stage example day

Breakfast: ½ Meal replacement shake (made up as per manufacturers’ instructions (7.5 g protein)

Mid-morning: 150 mls Fortified milk (11g protein)

Lunch time: Fortified smooth soup (100 mls soup & 100 mls fortified milk = 10g protein)

Mid-afternoon: ½ meal replacement shake (7.5g protein)

Evening: Fortified smooth soup (100mls soups & 100mls fortified milk = 10g protein)

Supper: Ovaltine® light with 150 mls fortified milk (15g protein)

Overall aim: to drink at least 1pint fortified milk per day and 1 meal replacement shake per day to provide (630 kcals & 55g protein).

Pureed stage (Week 2 to Week 4 following surgery)

This stage needs to be followed for two weeks. Puree must be the same consistency and texture of smooth yogurt with no bits or lumps.

Getting started

Invest in a handheld blender if you do not already own a food processor.
Plan ahead and cook in bulk. Use ice cube trays and small containers to freeze meals and defrost as needed.
Add extra liquid e.g., gravy, stock, tinned tomatoes / passata, milk or low-fat white sauce to blend food to the desired consistency.
Add extra vegetables into sauce then blend to increase fibre content.
Use a ramekin dish to help control portions
Use a teaspoon. You may find 4 to 5 spoonfuls will fill you up.
Stop eating before you feel uncomfortable or pain in your chest. This is a sign your pouch is full.
Soups, stews and casseroles containing meat and / or beans, pulses and lentils tend to blend down very well, are a good source of protein and very nutritious.

Puree stage example day

Breakfast: ½ Weetabix® or 15g Ready brek® made with semi skimmed milk

Mid-morning: High protein or natural strained Greek yogurt & stewed apple

Lunch: Scrambled egg (made with one egg and milk)

Mid-afternoon: Pureed tinned peaches and low fat, low sugar custard

Evening meal: Pureed chicken casserole

Overall Aim: Use a ramekin dish for each meal / snack. Eat five times a day. Only eat what you can comfortably manage.

Pureed meal ideas

Pureed breakfast ideas: Weetabix®, Ready brek®, scrambled egg / poached egg with pureed tinned tomatoes, pureed tinned mackerel in tomato sauce, pureed baked beans and grated cheese.

Pureed main meal ideas: Pureed chicken with gravy, pureed cod in parsley sauce, smooth mashed potato with grated cheese and gravy mixed well, pureed sweet potato with salmon with half fat crème fraiche and mint sauce, pureed cottage pie with gravy, pureed fish pie with extra milk, pureed beef, pork or lamb casserole, pureed chicken & vegetable stew, pureed bolognese with extra tinned tomatoes (no pasta), pureed vegetable & bean hotpot, pureed macaroni & cauliflower cheese with extra milk.

Pureed snack ideas: Tinned fruit in juice such as apricots, peaches, or prunes pureed with natural strained Greek yogurt / high protein yogurt, stewed apple with low fat, low sugar custard, pureed banana with high protein natural yoghurt. Flavoured Quark, pureed cottage cheese.

Four weeks onwards

You can now start a soft diet. This includes minced meat, soft fish, well cooked beans / pulses / lentils / vegetables & soft fruits (no skin initially). You can gradually introduce normal textures over the next two to three weeks. You should aim to eat a normal textured diet by around 8 weeks after your operation date.

Remember your eating techniques!

Eat mindfully & follow the 20-20-20 rule
Leave a 30-minute gap between eating and drinking
Ramekin dish sized portions will still be normal at this point and for several / months / years thereafter
If portions remain small, aim to eat three meals a day plus one to two healthy snacks in between
Ensure that you drink plenty of fluid, aiming for at least 1500 mls per day. If you are struggling to achieve this, try drinking 100mls fluid per hour.

If you have any queries, please contact the Bariatric Teams generic email address.

plh-tr.DerrifordBariatrics@nhs.net