13 January 2021


Section 7: Recovery


When you wake up after your procedure, you may feel groggy, so please seek assistance from a nurse if required. You will remain in bed for a few hours while the effects of the anaesthetic wear off, and we will advise you when it is appropriate to mobilise.

 

Immediate recovery from general anaesthetic

 

The following advice will help you to recover from your general anaesthetic:

Breathing exercises

Sit comfortably supported with pillows, with your knees bent. Take a low, slow breath in through your nose and hold for a count of two. Sigh the air completely 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 fully mobile.

 

When can I have something to drink?
 

You will undoubtedly feel ‘dry’ after your period of starvation. 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 feel unsure. Once you have tolerated a few sips, you then can gradually build up to a couple of drinks such as milk-based drinks, tea, coffee and thin soups (without ‘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, but you are very unlikely to be pain-free after your operation. The aim is to control your pain to a degree that you are generally comfortable with, and that you are able to move around. You will be prescribed pain killers whilst in hospital, as well as for your return home.

 

It is often best to take painkillers as prescribed regularly for the first few days, providing that they are in a liquid form or crushed/chewable, rather than waiting for any pain to develop. If you have taken your painkilling drugs and they haven’t worked after an hour, then you should let the nurse know so that we can try an alternative.

 

You may be advised to see your GP for further medication should your symptoms persist.

 

Remember, medication needs to be in liquid, crushable, soluble or chewable form for the first 8 weeks after surgery.

 

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 - this 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. Co-codamol, Solpadeine).

Sometimes a local heat pad over the area can help, along with a gentle shoulder massage. Mobilising slowly helps this gas disperse, as does drinking peppermint tea and/or gripe water. You can also purchase chewable medications such as Wind-eze or Deflatine to help ease wind pain.

Not all patients develop travelling or wind pain.

 

Medication
 

All medication in solid tablet/capsule form that is larger than an artificial sweetener tablet needs to be avoided during the below timeframes, if a solid diet is tolerated:

 

Operation type

Tablets less than 1cm in diameter

Tablets more than 1cm in diameter

Gastric bypass

4 weeks

6 weeks

Sleeve gastrectomy

4 weeks

12 weeks


 

Please see your GP to obtain medication 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)

 

NSAIDs such as ibuprofen, naproxen and diclofenac should be avoided permanently. This is because they can increase the risk of developing stenosis (see Section 5).

 

Diabetes medication

 

Patients with diabetes may note that their requirement for insulin and/or oral medication 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.

Lansoprazole
 

You will be prescribed a medication called lansoprazole after surgery. This reduces the amount of acid your stomach produces and helps it to heal after the operation.  The hospital will provide you with one month’s worth of a variety that dissolves on your tongue, but you will need to obtain a further two months’ worth from your GP (we will request this in the letter we send to your GP before surgery). You can swap to solid capsules after 6 weeks if you are back on solid food.

Blood thinning injection

You may be prescribed a blood thinner, heparin, (e.g. Clexane), depending on your surgeon’s recommendations. This will be provided by the hospital upon discharge; this is self-administered via injection for a specified number of days to reduce the risk of developing a deep vein thrombosis.
 

Do I need to take vitamin and mineral supplements?
 

It is essential that you take the recommended supplements. You will be consuming a greatly reduced volume of food and if you have had a gastric bypass, you will not be absorbing all the vitamins and minerals from your diet. However, it is still important you consume a varied diet and follow the advice of the dietitian to achieve a healthy balanced intake.

 

Advice on vitamin and mineral supplements is found in Section 14.

 

Wound care


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 the surgery. The nurse will discuss your wounds and any required review appointments during your post-operative telephone call (2-4 days post-operatively).

 

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; relevant numbers can be found at the back of this booklet.

 

When can I take a shower or have a bath?


Your surgical team will make a decision regarding when you can take a shower following your surgery. However, in most cases this will be approximately 4 to 5 days after your procedure. 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 them 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 of your surgery, unless there has been some reason that the healing has been delayed. People who may need additional time for their wounds to completely heal include those who:

 

o   Have medical problems such as diabetes.
o   Need to take daily steroids for other conditions.
o   Have immune systems that may be compromised.
o   Are malnourished.
o   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, and 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.

Scarring
 

If you have had your 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 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, providing that you are sensible and follow instructions. If you remain concerned about scarring after a few months, we can offer a consultation with a cosmetic surgeon (although any surgery agreed would be at separate cost).

 

What should I do when I am at home?
 

We recommend you take the first one to two weeks off work and rest as much as possible. During the first two weeks following surgery, there is a possibility of nausea, vomiting/regurgitation, pain and discomfort. If you have young children, consider asking a friend or family member to help during this time. Once the nausea and discomfort has started to settle, you can gradually increase your activity levels.

 

Remember, for the first four weeks after your operation you are to have a fluid-only diet (see Section 9). You may feel lacking in energy. You can start to eat pureed foods four weeks after the operation (see Section 10), followed by soft foods for two weeks (see Section 11), before progressing back onto solid foods (see Section 12).  You will have regular appointments with the dietitian to discuss each dietary stage after the surgery.

 

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, such as deep vein thrombosis.

 

Returning to work

 

When you return to work will depend 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 that required for normal healing or for reasons that are not absolutely in line with the surgery that has been carried out.

 

If you do not want your employer to know you have had a gastric bypass, your surgeon can provide you with a sick note that does not specify the type of surgery you have had. 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.

 

Remember not to rush the recovery process; the best results are achieved over time. It has taken time to put the weight on, and so it will also take time to take it off.

 

Smoking

 

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 or ‘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 you should do this as soon as you feel able. Most people feel ready to start increasing their activity two weeks after surgery. Ensure that your wounds are fully healed, and that you feel well in yourself, before doing so.

 

We recommend that you should carry out no heavy lifting or strenuous activity for six 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 three to four months. Speak to your GP if you are worried about increasing your levels of physical activity.

 

See Section 15 for further information on long-term exercise.

 

When can I drive?
 

You may resume driving seven to ten days after surgery if you feel 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 two to three weeks after surgery. By this point, most people who have had gastric bypass surgery will have recovered, healed and be back to normal mobility. Check with your insurance company before going overseas and always carry information about your procedure and our contact details (found at the back of this booklet) with you.

 

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 will also write to your GP before the operation to inform them of the vitamin and mineral supplementation, blood tests and medication you will need.
 

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