Preparation for Surgery
The first step for a successful bariatric surgery is the right patient selection and a careful preparation period. For this purpose, recommendations are included in many guides. As the AntBariatric family, patient health is our first priority. For this purpose, we attach importance to the preparation processes of the patients as much as their surgeries.
There are some rules that patients should pay attention to for a safe surgery and postoperative period after making the decision to have surgery.
Smoking and Alcohol
Tobacco smoking can cause serious postoperative complications, mainly by causing decreased tissue oxygenation (and consequent wound infections), pulmonary complications, and thromboembolism. Active alcohol or substance abuse is considered a contraindication for bariatric surgery. If you have alcohol and smoking habits before obesity surgery, you should definitely inform your doctor about this.
It is recommended to:
• Reduce smoking 4 weeks before the decision for surgery, and quitting it completely one week before,
• Cessation of alcohol use 10 days before the operation day.
Medication Use
- Anticoagulants (Blood Thinners)
- Anti-Diabetics / Oral Anti-Diabetic Drugs
- Parenteral Insulin Preparations
- Antidepressant Drugs
- Anti-Parkinsonian Drugs
- Diuretic Drugs
- Painkillers (Non-Steroidal Anti-Inflammatory Drugs) (NSAIDs)
- Antibiotics
- Herbal-Based Treatments
Anticoagulants should be discontinued before surgery to reduce the risk of postoperative bleeding. Depending on which branch and for what purpose they are started, it may be necessary to start low molecular weight heparin (enoxaparin) instead by the relevant branch physician.
• Acetyl salicylic acid (Aspirin®, Coraspin®, Dispril®) should be discontinued 1 week before the operation.
• Warfarin sodium (Coumadin®, Orfarin®) should be discontinued 4-5 days before the operation.
• Clopidogrel (Plavix®) should be discontinued 5-7 days before the operation.
• Ticlopidine HCI (Ticlid®, Agretik®, Ticlocard®) should be discontinued 5-7 days before the operation.
Due to the risk of hypoglycemia, it should be discontinued the evening before the surgery and switched to an i.v. buffered insulin solution.
• Glibenclamide (Diaben®, Gliben®)
• Glibornuride (Glutril®),
• Gliclazide (Betanorm®, Diamicron®, Glumikron®, Oramicron®)
• Glimeperid (Amaryl®)
• Glipizide (Glucotrol XL®, Minidiab®)
• Glycidon (Glurenorm®)
If fasting blood sugar (FGG) is normal, the dose to be taken on the morning of the surgery is not given. However, if FBC is high, half of the daily dose can be given on the morning of the surgery.
• Humulin®, Orgasulin®, Actrapid HM®, Humalog®
• Monoamine Oxidase inhibitors (MAOIs) Phenelzine, isocarboxazid, tranylcypromine, meclobemide (Aurorix®, Lobem®) should be discontinued 2 weeks before the operation
• Tricyclic antidepressant drugs: Amitriptyline HCl (Laroxyl®, Triptilin®), clomipramine HCl (Anafranil®), imipramine HCI (Tofranil®) Should be discontinued 1 week before the operation
• Lithium: Lithium carbonate (Lithiuril®), should be discontinued 1 week before the operation and serum lithium level should be checked.
• Levodopa+carbidopa (Sinemet®, Madopar®) should be discontinued 1 week before the operation.
• Chlorthalidone (Regrotan®), indapamide (Flubest®, Fludex®, Indapen®, Flupamid®, Fludin®), mefrucide (Baycaron®), furosemide (Desal®, Lasix®, Furomid®) amiloride HCl (Moduretic®), sprinolactone (Aldacton®, Aldactazide®, Triamteril®).
They can cause dehydration and hypovolemia therefore should be discontinued the evening before the surgery and the morning dose should not be given.
• Ibuprofen (Brufen®, Artril®), diclofenac sodium (Cataflam®, Diclomec®, Dichloron®, Dolorex®, Voltaren®), etodolac (Etol®, Lodine®), naproxen (Aprol®, Naprosyn®, Apranax®), tenoxicam (Tilcotil®, Tenox®, Tenoktil®), nimesulide (Mesulid®) should be discontinued 1 week before the operation and replaced with paracetamol and/or opioid analgesics
• Selective COX-2 inhibitors: Celocoxib (Cerebrex®, Rofecoxib (Vioxx®), Valdecoxib (Bextra®)) Minimal adverse effect on platelet functions, but can be stopped 1 week before major surgery.
• Aminoglycosides: Amikacin (Amikozil®, Amiklin®), gentamicin (Genta®, Garamycin®, Gentamycin®), tobramycin (Nedcin®, Tobel®), kanamycin, neomycin, may increase the effect of non-depolarizing muscle relaxants, therefore should be discontinued before surgery and/or switched with another antibiotic.
All herbal-based treatments should be discontinued 10-14 days before surgery.
Preoperative Nutrition
Preparing your body for surgery is important in accelerating your recovery and increasing your weight loss rate. Preoperative diet, especially in super obese patients, provides a significant (15-20%) reduction in liver volume. The reduction in the liver volume technically makes the surgery easier. This diet also makes it easier for you to adapt to the diet in the first weeks after surgery. The duration and intensity of the program you will apply before the surgery is arranged by a bariatric dietitian according to your current weight and biochemical values. Preoperative diet may not be required in every patient.
In general, the preoperative nutrition principle is in the form of high-protein, low-carbohydrate meals. In studies, a low-calorie diet (LCD, 1000–1200 kcal/day) or a very low-calorie diet (VLCD approximately 800 kcal/day) is recommended for 2-4 weeks, depending on the anthropometric characteristics of the person.
Pre-Operative Examinations
After the patients who are determined to be suitable for surgery are admitted to the hospital, some routine examinations are performed.
• Detailed blood analyzes
• Abdominal ultrasound
• Endoscopy
• Lung film
• ECG
• General Surgeon Examination
• Anesthesia Examination
• Cardiology Examination and Echocardiography
• Psychiatric Examination
• Internal diseases/endocrinology Examination
• Dietitian Examination