When you wake up after your operation you may feel groggy, so seek assistance from a nurse if required. You will remain in bed for a few hours while the effects of the anaesthetic wear off. You will be advised when it is appropriate to mobilise.
Immediate recovery from general anaesthetic
The following advice will help you to recover from your general anaesthetic:
Sit comfortably, supported with pillows and with your knees bent. Take a low, slow breath in through your nose and hold for a count of two. Sigh the air right out slowly. Repeat 3 times. These exercises should be repeated every hour until you are walking well and have no phlegm.
Moving in bed
With your legs straight, briskly circle or bend and stretch your feet up and down from the ankles for 30 seconds. Repeat this exercise every hour until you are up and about and fully mobile.
When can I have something to drink?
You will undoubtedly feel ‘dry’ after your period of starvation, and once you are fully awake and not feeling sick you can take a few sips of water. Seek the advice of your nurse if you are unsure. Once you have tolerated a few sips, you then can gradually build up to a couple of drinks such as milk based drinks, smooth thin yogurts, sugar-free jelly and thin, smooth soups (without any solid pieces of food present) bits over the next few hours until you are ready to leave the hospital the following day.
Will I have any pain?
Everyone is different in terms of how they respond to surgery. You are very unlikely to be pain free. The aim is to control your pain to such a degree that you are generally comfortable and able to move around. You will be prescribed painkillers whilst in hospital, as well as for when you go home.
For the first few days, it is often best to take painkillers regularly as prescribed, providing they are in a liquid, dissolvable or chewable form, rather than waiting for the pain to develop. If you have taken your painkilling drugs and they haven’t worked after an hour, then let the nurse know so that an alternative can be tried.
You may be advised to see your GP for further medication should your symptoms persist.
Remember, any solid tablet/capsule medication needs to avoided for the first 4 weeks after surgery. See your GP and/or pharmacist to obtain in an alternative form.
Travelling pain / wind pain
During surgery, some gas is pumped into the abdomen to increase the area inside and allow the surgeon to see clearly. This inflation of the abdomen can stretch the diaphragm. Whilst most of the gas is removed at the end of the operation, some can remain which can produce ‘referred’ (travelling) pain, which radiates to your left shoulder because of the way that the nerves are connected at the diaphragm. This can be very painful; the pain medication you will be prescribed (usually soluble paracetamol) should help to reduce this. If required, you can obtain stronger soluble pain relief over-the-counter (e.g. cocodamol - Solpadeine).
Sometimes a local heat pad over the area can help, along with a gentle shoulder massage. Mobilising slowly, as well as drinking peppermint tea and/or gripe water, helps this gas disperse. You can also purchase chewable medications such as Wind-eze or Deflatine to help ease wind pain.
However, not all patients develop travelling pain or wind pain.
All medication in solid tablet/capsule form that is larger in size than an artificial sweetener tablet needs to be avoided until a solid diet is tolerated (4 weeks after surgery). Please see your GP and/or pharmacist to obtain in an alternative form during this time; we will also request this in the letter we send to them before surgery.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If you need to take NSAIDs such as ibuprofen, naproxen and diclofenac, you should only take them in liquid or soluble form. This is the case permanently. This is because if tablets or capsules of NSAIDs get stuck at the site of the band, they can cause irritation and eventual ulceration. This can increase the risk of band erosion (See Risks of surgery, potential complications).
Patients with diabetes may note that their requirement for insulin or tablets falls after surgery. It is advisable to monitor your blood sugar levels closely and arrange regular checks with your GP or diabetes clinic after leaving hospital.
Blood pressure medication
Patients with high blood pressure (hypertension) may, over time, note that their requirement for medication falls after the surgery. You will need to arrange for regular blood pressure checks with your GP or hypertension clinic after leaving hospital.
Do I need to take any other medication?
You may be prescribed an anticoagulant, heparin (e.g. Clexane), depending on your surgeon’s recommendations. This will be provided by the hospital upon discharge; it is self administered via injection for 5 days or more to reduce the risk of developing a DVT.
There is very little care that needs to be given to your surgical wounds. The most important aspect for the first 72 to 96 hours will be to keep them dry and clean. They should be kept covered with dressings for the first 48 hours post surgery.
Depending on how your wound has been closed, you may require an appointment with the nurse 1-2 weeks after your surgery. The nurse will discuss your wounds and any required review appointments during your post-operative telephone call (2-4 days post-op).
However, if at any stage the wounds appear red or swollen, feel hot to the touch or discharge fluid/pus, and/or if you develop a temperature, contact us without delay to speak with one of our nurses as these are signs of infection.
When can I take a shower or have a bath?
Your surgical team will determine when you can take a shower. In most cases, this will be approximately 4 to 5 days after your surgery. Ask your surgeon or nurse about when you may first shower. Baths are discouraged until your wounds are completely healed in order to avoid soaking the wound in bath water; you may also find it difficult to get in and out of the bath initially after the operation.
Does it take a long time for the wounds to heal?
Your wounds should be healed within two weeks from your surgery, unless there has been some reason delaying that healing. People who may need additional time for their wounds to completely heal include those who:
- Have medical problems such as diabetes.
- Need to take daily steroids for other conditions.
- Have immune systems that may be compromised.
- Are malnourished.
- Have poor blood supply.
If you have questions about the time it will take for your wound to heal, discuss this with your surgeon at your consultation.
Should I apply an antiseptic solution/cream to my wound?
No. Antiseptic solutions merely disperse bacteria, they do not eliminate them. Antiseptic creams could make the wound become “boggy” and break down. Some antiseptic solutions can delay the healing process. If your wound demonstrates any signs of infection (heat, redness, swelling, oozing) and/or if you have a high temperature, contact us as soon as possible for advice, as you may need to see your GP. In this instance, you may be given specialised antiseptic dressings to help reduce the infection.
If you have had the surgery performed laparoscopically (keyhole), you will have a series (usually about 4-5) of small one-inch scars, as well as a slightly larger scar for the port placement. These small scars tend to heal well and after a few months should be barely visible. It is important to remember that everyone heals at a different rate, and that all scars are red and raised to begin with. It takes 6-12 months for scars to mature or fade. If you have an ‘open’ procedure, the scar will be larger and take longer to heal, but it should still cause no long term problems as long as you are sensible and follow instructions.
Silicone products have been shown to provide some improvement to the appearance of raised scars
If you remain concerned about scarring after a few months, The Hospital Group can offer a consultation with a cosmetic surgeon (any surgery agreed would be at separate cost).
What should I do at home?
We recommend you take the first 1-2 weeks off work and rest as much as possible whilst there is a possibility of nausea, vomiting/regurgitation, pain and discomfort. If you have young children, consider some help from a friend or family member. Once the nausea and discomfort has started to settle, you can gradually increase your activity levels.
Remember, for the first two weeks after your operation you are on fluids only (see Dietary advice for weeks 1 & 2), so you will probably feel lacking in energy. You can start to eat soft, sloppy foods 2 weeks after the operation (see Dietary advice for weeks 3 & 4). You will have appointments with the dietitian around 3 weeks and 5 weeks after the operation to discuss future stages, but some detailed information can be found in Dietary Advice for weeks 5 onwards.
It is important to do as much as you feel able. You must move around/walk at regular intervals in order to reduce the chance of any post-operative complications e.g. deep vein thrombosis (DVT).
Returning to work
Returning to work depends upon the type of job you have, and this can be discussed with your surgeon. Sick notes are only required after the seventh day - for the first seven days, self-certification is all that is legally required by your employer. A sick note is a legal document and carries serious consequences for signatories who misuse them. Accordingly, the hospital cannot issue notes for periods of time that exceed those required for normal healing, or for reasons that are not absolutely in line with the surgery that has been carried out.
Confidentiality requires that we do not discuss our patients with their employers. If proof of your hospitalisation is required, please request a sick note when you are admitted so that the surgeon has time to sign it.
You should refrain from smoking, as this can delay healing.
When can I start to exercise?
It is important to start getting up and moving around as soon as possible after surgery. This will help reduce the risk of blood clots in your legs (deep vein thrombosis - DVT) and will encourage the build-up of strength in your muscles. Keeping yourself mobile can also help alleviate trapped wind, which is common after surgery.
Gentle walking is encouraged and should be done as soon as you feel appropriate. Most people feel ready to start increasing their activity 2 weeks after surgery, but ensure your wounds are fully healed and that you feel well in yourself before doing so.
We recommend no heavy lifting or strenuous activity for 6 weeks after the operation. Most people are able to return to work a couple of weeks after surgery. If you have had a hiatus hernia repair, you will need to avoid lifting heavy weights for 3-4 months. Speak to your GP if you are worried about increasing your levels of physical activity.
See Physical Activity for further information on long-term exercise.
When can I drive?
You may resume driving 7-10 days after surgery if you are comfortable enough to do so. If in doubt, contact your insurance company.
What about sexual activity?
You may resume sexual activities as soon as you feel comfortable to do so.
Can I travel?
If you have flown in for your surgery, you may take a flight for your journey home.
You may go on holiday 2 to 3 weeks after surgery, as most people who have had the surgery will have recovered, healed and be back to normal mobility at this stage. Check with your insurance company before going overseas and always carry with you information about your procedure and our contact details, found at the back of this booklet.
Some patients have reported that the band can feel tighter in certain climates and during long haul flights – see Risks, C.
Will my GP be informed of the operation?
When you are discharged from hospital, you will usually be given a letter to take to your GP to inform them of the procedure. If you have consented, the dietitian may also write to your GP after the operation to inform them of your progress.
What if I had a hiatus hernia repair during the operation?
What is a hiatus hernia?
A hiatus hernia is where part of the stomach pushes up into the lower chest through a defect in the diaphragm. The diaphragm is the large flat muscle that separates the lungs from the abdomen that helps us to breathe.
The cause is unknown, but hiatus hernias may be the result of a weakening of the supportive tissue. Increasing age, obesity and smoking are known risk factors in adults.
Most people with a hiatus hernia do not have any symptoms or problems. However, the hernia makes you more prone to reflux acid into your oesophagus (gullet), which can cause heartburn and other symptoms.
A hiatus hernia can result in the gastric band slipping and as such, repair is necessary. Small hernias can be repaired at the same time as insertion of a gastric band.
Normally, a hiatus hernia can be repaired by minimal stitching to the diaphragm, following which no different aftercare is required. However, if the hiatus hernia is slightly bigger, 5-6 stitches may be required and sometimes for large hernias, biological mesh is used to reinforce the repair. In these cases, it is sometimes not recommended to fill the band until at least 8 weeks post-surgery. Your surgeon will advise you if this is the case and make a note on your file.
Following repair of a hiatus hernia, you might experience some pain, swelling and bruising in the abdomen area. These side effects usually disappear during the first week after your operation without further treatment. Pre-operative symptoms of heartburn and acid will also improve during the post-operative weeks.
Post-operative instructions for your gastric band should be followed in line with the contents of this booklet, but in addition, to aid recovery of the hernia repair you are advised to pay particular attention to the following:
- Avoid straining when moving bowels. You can avoid constipation by drinking plenty of fluids, and ensure a good intake of fibre by including:
- During the first 2 weeks - meal replacement drinks (e.g. Slimfast) and soups including vegetables.
- During the second 2 weeks - soft high fibre foods (e.g. soft vegetables, soft mashed fruit (but no skins), soft wholemeal pasta
- From 4 weeks post-op onwards –solid high fibre foods e.g. al dente wholemeal pasta, wholemeal wraps, wholemeal bread/toast/pitta, rye crispbreads or other high fibre crackers, fruit and vegetables/salad.
- Sleep with an extra pillow.
- Take gentle walks.
- Avoid lifting heavy weights for 3-4 months.
- Avoid smoking.
- Avoid running up the stairs.