Recovering from Bariatric Surgery

Bariatric surgery is over! What next?

We understand that this journey can bring about a mix of excitement and anticipation, accompanied by some anxiety and perhaps even a little fear. It also leads to lots of questions about what happens after surgery. It is very important that you have clear expectations and the appropriate knowledge and tools to manage yourself in the early days and weeks after bariatric surgery.   In this section we will describe what to expect from the moment you wake up from surgery, to your time on the ward, and eventually your discharge from hospital.  We will walk you through each step, providing valuable insights and practical information to help you navigate this crucial phase with confidence.

What to expect immediately after bariatric surgery...

Recovery Room: After surgery, you are taken to the Post-Anaesthesia Care Unit (PACU) to recover and wake up properly. The PACU is a critical care unit where you are monitored closely by a team of nurses who ensure that your vital signs are stable and that you are waking up safely from anaesthesia.

Drowsiness and Disorientation: It’s normal to feel drowsy, groggy, and disoriented when waking up from anaesthesia. The effects of anaesthesia can take some time to wear off completely, and you may have difficulty focusing or remembering the immediate post-surgical period.

Pain and Discomfort: Bariatric surgery involves making approximately five small  incisions and manipulating tissues within the abdomen. As a result, you may experience pain and discomfort. The anaesthetist will administer strong pain killers to you through your drip during surgery, but you may still experience some discomfort when waking up.  If needed, the nurses in recovery will give you more pain-relieving medication until you feel comfortable.

Nausea and Vomiting: Some patients may experience nausea or vomiting immediately after surgery, and perhaps for the first 6-24 hours. This can be a side effect of anaesthesia, or the surgery itself. Medications will be given to you to alleviate these symptoms.

Intravenous Fluids: During, and Immediately after bariatric surgery, you will receive fluids and medications through an intravenous (IV) line. This helps maintain hydration and delivers necessary medications until you can tolerate oral intake.

Postoperative Monitoring: After surgery, patients are usually monitored closely for any signs of complications, such as bleeding, for example. Vital signs, including heart rate, blood pressure, and oxygen levels, will be regularly checked to ensure a smooth recovery.

Transfer to Ward: When you are fully awake, stable and comfortable, you will be transferred to your allocated room on the surgical ward.

What to expect on the surgical ward...

Postoperative Monitoring: You will continue to be closely monitored on the ward for any signs of complications. Your vital signs, including heart rate, blood pressure and oxygen levels will be regularly checked to ensure your continued smooth recovery. Your surgical wounds will also be monitored, and your dressings changed when necessary.

Pain Management: Your pain levels will continue to be monitored and managed.

Introduction of Oral Fluids: On the day of your surgery, you will be allowed iced chips and sips of water only.  The following day you will be commenced on the bariatric free-fluid diet and your drip will be removed if you are tolerating this.

Mobility and Ambulation: Getting out of bed and moving around as soon as possible after surgery is encouraged to prevent complications such as blood clots and to quicken recover. Most patients are up on their feet within 3 hours of waking up from surgery toileting themselves, and within 6-8 hours are having a shower under close nursing supervision. Walks around the ward will also be encouraged. The nursing staff will provide guidance and support to you at all times. 

Postoperative Education: Patients will receive instructions on postoperative care, including wound care, pain management, dietary guidelines, physical activity restrictions, and follow-up appointments. It is essential to follow these instructions carefully to promote proper healing and achieve optimal outcomes.

Discharge Planning: Dr Willingham and the ward nurses will assess your readiness for discharge.  This includes ensuring that you can tolerate oral intake, manage your pain adequately, and understand the postoperative instructions.  Most patients are in hospital for only 1-2 nights, with only a very small number of patients staying any longer than this.

What to expect after leaving hospital...

Pain and Discomfort

Mild to moderate discomfort or pain is not uncommon after surgery but should subside within 3 days and be quite maneagable after discharge. Pain that is accompanied by shortness of breath and/or chest pain needs to be addressed urgently and patients should Dial 000 for an ambulance

  • Abdominal Wounds: Your abdominal wounds have been infiltrated with local anaesthetic and this should numb the area for the first 12-24 hours.  This effect will wear off after this time, and then some mild pain, discomfort, tenderness and perhaps swelling is normal.  Please take paracetamol caplets as prescribed with sips of water. It is best to take paracetamol regularly for a few days, and then to taper them off. Cold packs may also be used. Do not use hot packs.
  • Shoulder Pain: Pain in the shoulder tips can occur after laparoscopic surgery. Treat with paracetamol, heat packs, and distraction.

Wound Care

  • Your wounds will be covered with a waterproof dressing, and below this will be steri-strip tapes. 
  • You may shower over the waterproof dressings, but swimming should be avoided for 2 weeks.
  • After 4-5 days you may remove the waterproof dressing – but leave the steri-strips in place. 
  • You may shower over the steri-strips – gently pat dry.  Allow these to fall off on their own.
  • The stitches sit just under the skin and may be felt as a slight bump. The stitches are absorbable and will not need to be removed.
  • Please contact us if your wounds become red, raised, hot, swollen and painful – or if there is any discharge from the wound site.

Medications

  • Your regular medications: please continue to take all your regular medications unless instructed to stop by Dr Willingham.
  • Blood thinners: for example Warfarin, Pavix, Xarelto, Brilinta, Aspirin, Fish Oil – discuss with Dr Willingham before recommencing.
  • Panadol (paracetamol): take regularly for the first  1-3 days at home until you have minimal to no discomfort.
  • Pariet (rabeprazole): take one 20mg tablet every day for 1 month if you have had a sleeve, and for 3 months if you have had a bypass.  This is a tablet usually prescribed for reflux and works to reduce the amount of acid made by the stomach.  This is an advantage to a healing wound, so please take it consistently for either one, or three months depending on the procedure you have had.
  • Maxalon: this is for nausea, and should be taken only if your are struggling with nausea – otherwise, don’t take it.
  • Benefibre, Movicol, Dulcolax, Osmolax -take as required if constipated, but ensure your fluid intake is also high.
  • Non Steroidal Anti-Inflammatory Drugs (NSAIDs) – for example Nurofen/Advil (ibuprofen), meloxicam, celebrex, voltaren (and others). These medications cause stomach irritation and even ulceration if used regularly. Gastric bypass patients need to be especially careful with NSAIDs as the top join where the gastric pouch is made is particularly susceptible to ulcers. Ulcers can cause pain or bleeding – and in extreme circumstances, can result in perforation of the bowel. NSAIDs are to be avoided in most instances and only taken if approved by Dr. Willingham.   

Fluids and Nutrition

Adapting to eating and drinking after surgery is commonly the most difficult aspect of bariatric surgery!

Fluids:

  • Sip, Sip, Sip all day long to avoid dehydration! 
  • High water intake of 1.5 litres to 2 litres is beneficial, but you should sip liquids slowly and in small amounts, starting from the moment you wake up.
  • Drink only non-carbonated liquids that are low in sugar – add something to the water to break water tension, ie protein powder, a few drops of diet cordial, sliced lemon/lime, etc.  Icy Poles are a good option if you’re struggling.
  • Avoid using straws, or sucking through pop-top bottles – this can cause you to swallow excess air.
  • Do NOT drink half hour before eating, or half hour after eating.
  • Signs of dehydration include: dry mouth, dark urine, dizziness, headache.
  • Please contact the Dietician, Practice Nurse or Dr Willingham’s rooms if you are unable to tolerate at least one litre of fluid per day.
Nutrition:
 
  • Follow the fortnightly dietary guidelines as set by the dietician.
  • Take your time when eating! Keep your mouthfuls small.  Chew well.  
  • Eating too much, too quickly or not chewing well will cause pain, nausea or vomiting.
  • No NOT drink half hour before eating, or half hour after eating.

Bariatric Multivitamins, Minerals and Protein Powder

  • Because bariatric surgery changes the digestive process, lifelong bariatric multivitamin and mineral supplements are essential to support your immune system, cognitive function, and cardiovascular health. Commence these when you get home, as instructed by the dietician. 
  • Protein powder helps you to heal, stay fuller for longer, and maintain lean muscle mass. Commence when you get home, as instructed by the dietician.
  • Regular follow up with your surgical team and/or GP for monitoring and blood tests will prevent most nutritional deficiencies. 

Bowel Habits

  • Mild constipation is common after surgery. Prevent it by drinking enough liquids and increasing your fibre intake.
  • Regular Benefibre is helpful after surgery.
  • Otherwise, Movical, Osmolax or Dulcolax can help you if you feel constipated, but please be mindful to keep your fluid intake as high as possible.
  • If you continue to be constipated please speak to the Dietician or the Practice Nurse.

Activities and Restrictions

  • It is recommended that you have a minimum of 14 days off work to recover from surgery – and longer if your work activity is very strenuous.
  • Remain active after discharge from hospital – walk around your home every 1-2 hours  to help to avoid blood clots. Blood clots, which can form after surgery and prolonged rest, are known as deep vein thrombosis (DVT).  DVTs can travel to the lungs, causing a pulmonary embolism (PE).  The best way to prevent these is to mobilise early and regularly after surgery.
  • Start walking around your neighbourhood – increase your pace and distance each day. When you feel tired or start hurting, stop and rest.
  • No heavy lifting (5kg) for the first 2 weeks  post operatively. Limit your strenuous activities for 3-4 weeks after surgery. 
  • After 6 weeks you can do most things – but please use common sense! If it hurts, STOP what you are doing.
  • Consider your choices over time. Gym activities ? Sports ? 

Driving

  • Do NOT drive for at least one week after surgery as your reflexes and response time may initially be affected by your surgery. You need to be able to take strong evasive action (wrench the wheel), or perform an emergency stop (slam foot on the brake) in the event of an emergency. 

Follow-up Appointments

  • Your routine follow-up appointment will commence about 2 weeks after surgery.
  • These appointment will have been made for you, prior to your surgery – please ensure you have them diarised!

In Case of Emergency

Please present to an Emergency Department or dial 000 if you experience any of the following:

  • Chest pain
  • Sudden shortness of breath
  • Fast heart rate – more than 120 beats per minute
  • High temperature of more than 38 degrees celcius
  • Severe nausea and vomiting and an inability to keep down fluids
  • Increasing abdominal pain
  • Pain in one or the other leg

Letoya, please leave this Accordion here .... I will be adding FAQs relevant to 'Recovering from Surgery' to it soon. Thanks. Tia

Yes. A referral is a requirement under Medicare. This can be obtained from your GP and will last for 12 months. You can also obtain a referral from a Specialist but this will be valid for only three months. We would also like to keep your treating doctors informed about your management plan and subsequent progress.

  • There are many health risks associated with obesity, here are just some…
  • Diabetes (type 2)
  • Joint problems (e.g., arthritis)
  • High blood pressure
  • Heart disease
  • Gallbladder problems
  • Certain types of cancer (breast, uterine, colon)
  • Digestive disorders (e.g., gastroesophageal reflux disease, or GORD)
  • Breathing difficulties (e.g., sleep apnoea, asthma)
  • Psychological problems such as depression
  • Problems with fertility and pregnancy
  • Urinary incontinence

If you are obese, severely obese, or morbidly obese, you may have:

  • Major health risks
  • Shorter life expectancy
  • Compared to people of normal weight, obese people have a 50% to 100% higher risk of dying prematurely

Some of the social and mental health challenges that can be associated with obesity include:

  • Negative self-image
  • Social isolation
  • Unhealthy attitudes to eating
  • Depression
  • Anxiety
  • Discrimination

Normal tasks become harder when you are obese, as movement is more difficult You tend to tire more quickly and you find yourself short of breath Public transport seats, telephone booths, and cars may be too small for you You may find it difficult to maintain personal hygiene

Overweight and obesity refer to excess body weight, which is a risk factor for many diseases and chronic conditions, and is associated with higher rates of death. It mainly occurs because of an imbalance between energy intake (from the diet) and energy expenditure (through physical activities and bodily functions)

Body Mass Index (BMI)
BMI is an internationally recognised standard for classifying overweight and obesity in adults. While BMI does not necessarily reflect body fat distribution or describe the same degree of fatness in different individuals, at a population level BMI is a practical and useful measure for monitoring overweight and obesity.
BMI is calculated by dividing a person’s weight in kilograms by the square of their height in metres. A BMI of 25.0–29.9 is classified as overweight but not obese, while a BMI of 30.0 or over is classified as obese. A BMI of greater than 35.0 is classified as severely obese.
To calculate your BMI and see how it compares with other Australian adults, enter your height and weight into the AIHW BMI calculator.
Height and body composition are continually changing for children and adolescents, so a separate classification of overweight and obesity (based on age and sex) is used for young people aged under 18 (Cole et al. 2000).