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Date issued:  October 2020

For review: October 2022

Ref: A-400/CW/Dietetics/Admission for bariatric surgery v2

PDF: Day of Admission for Bariatic Surgery [pdf] 598KB

Nil by mouth instructions:

• 7 am admission: Continue liver reduction diet until 2:30 am, you can have water up until 6:30 am.
• 11 am admission: Continue liver reduction diet until 6.30 am, you can have water up until 10.30 am.
• Report to the ward stated on your admission letter.

Post-surgery:

Following Surgery you will return to the ward. Depending on bed availability, the ward that specialises in Bariatric Surgery is Wolf ward level 7, if there are no beds available then we may have to send you to another ward. This cannot be confirmed until the day of surgery.

Contact Numbers for Wolf: 01752 439677/ 01752 439678

Items to bring into hospital:

• All regular medication (although your medication will be converted to liquids for 4 weeks, some of your medication may be crushable)
• Overnight clothes
• Personal hygiene items
• Mobile phone
• I pads/Tablets: (see note below)
• Slim Fast®/Fortified Milk Powder /Sugar Free Squash (The ward is unable to provide this for you)

  Please do not bring valuables into hospital you must be advised that expensive items such as tablets and mobile phones are brought in at your own risk.  Please give them to your nurse for safe keeping, if this is not possible, remember, the hospital does not accept responsibility for loss or damage to any personal property you choose to keep with you.

Discharge information:

• Driving: Do not drive 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 injects once or twice a day (weight dependent) for 7 days.
• Constipation: If you are struggling with constipation post-surgery please contact the Bariatric Nurse Specialist for advice on 01752 431724.
• 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 up. If you have any concerns seek advice from your GP surgery.
• Medication: This will be in liquid or crushable form for 4 weeks. You can then go back to having tablets. You will be discharged with the following medication alongside your own regular medication:

Lifelong Supplements and Post Surgery Medication

Medication	Dose	How often to take your medication and when	How long to take the medication for:
Clexane (Enoxaparin)	40mg	Once or Twice a day depending on weight Same time every day	For 7 days
Lansoprazole (orodispersable)	30mg	Once a day in the morning	3 months only, can convert to tablets at 4 weeks
Multivitamin and Mineral A-Z Forceval	1 Soluble tablet  for 4 weeks then 1 tablet	Once a day lifelong In the morning	Life Long
Iron : 1st 4 weeks: Sodium Feredetate Liquid   After 4 weeks: Ferrous Sulphate or Ferrous Gluconate or Ferrous Fumarate	10mls         200mg 300mg 210mg	Once a day: in the morning   Menstruating Women: you may be advised to take this twice a day. 08:00 hrs 18:00 hrs	Life Long
TheiCal D3	1 tablet	Lunch time	Life Long
Paracetamol  1g Adult suspension	10 mls	Up to 4 times a day 4-6 hours apart	Until pain controlled post-surgery
Ibuprofen (if you are able to take) 400mg	20 mls	3 times a day 8 hours apart	Up to 7 days only
Ondansetron Liquid 4-8 mg	5-10 mls	Up to 3 times a day Each dose 8 hrs apart	Only if required

 

Please refer to PDF file for Your Regular Medication Chart.

 

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 – 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.
• Make smooth soups thinner by adding some of your fortified milk and this will increase the protein content.
• You can use Horlicks Light® / Ovaltine Light® / Sugar free Crusha® / Options® / Highlights® hot chocolate with fortified milk for more variety. 

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 thin, smooth soup (100 mls soup & 100 mls fortified milk = 10g protein)

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

Evening: Fortified thin, 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 1 pint fortified milk per day and 1 meal replacement shake per day to provide (630 kcals & 55g protein).

Pureed stage (week 2 – 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 hand held 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 – 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 Dietitian or Nurse on 01752 431724

E-mail: plh-tr.DerrifordBariatrics@nhs.net