Surgery (First Day)
• Unless there is a special situation (past abdominal surgeries, recurrent revision surgeries, technical difficulties), all surgeries are performed closed. Average operation times are 25-30 minutes for sleeve gastrectomy and 1-1.5 hours for bypass surgeries. These periods do not include the time taken for the patient to be put to sleep and awakened. Although the operation times of the patient are as stated, it will take longer for the patient to return to the bed from the operating room.
• When the patient comes to bed after the surgery, there will be a drain and a urine bag in the abdomen. Drain, for the purpose of safety to detect possible bleeding early; Urine bag is attached for the purpose of monitoring body functions and patient comfort.
• There will be some pain in the first few hours after the surgery, strong painkillers are used during this period. After a few hours the pain subsides, after a day the patients feel almost no pain.
• Nausea, retching and vomiting may occur in patients immediately after the operation. These are common cases. For this, effective drugs are used, after the first few hours these complaints do not occur.
• Blood pressure is monitored frequently in the first hours after the surgery. This is a precaution taken for patient safety. In the following hours, the frequency of follow-up is reduced.
• Six to eight hours after the operation, the patient is mobilized in the company of a nurse. If there is no sign of bleeding and there is no problem in mobilization, the catheter is taken.
• On the day of surgery, patients do not take oral food.
Post-Operative Day 1
• Leak test is performed on the patients the day after the operation. This test consists of ingestion of contrast material by mouth. Patients who have no problems with the leak test can start to take liquid food. Abdominal drains are taken after the leak test in patients who do not have any signs of bleeding.
• Patients are given nutrition education by a bariatric dietitian on how to eat in hospital and after they leave the hospital.
• Patients are discharged on the 2nd or 3rd day after surgery, depending on how they feel.
Post-Operative Life
Changes in eating habits, exercise and lifestyle changes constitute the first step of obesity treatment. It is very important that changes in eating habits and exercise are included in the lifestyles of patients after bariatric surgery. Taking precautions by regulating the patient’s lifestyle after surgery is the key to the long-term success of any bariatric surgery.
Postoperative Gradual Dietary Approach
After the leak test in the first 24 hours after the surgery, the patients are started on a liquid diet. According to their tolerance, the patients start to eat liquid for 10 days, puree for 10 days, and solid nutrition after the 20th day. The gradual diet program is explained in detail by the bariatric dietitian and a post-bariatric information booklet is given to the patients.
Clear Liquid Diet
Clear liquid diet is often used as the first step in postoperative nutrition. Sugar-free or low-sugar clear liquids provide electrolyte and limited energy support and support the regeneration of bowel activity after surgery. Fluids in a clear liquid diet should be at body temperature and have minimal gastrointestinal residue.
Liquid Diet
Sugar-free or low-sugar liquid diets are frequently followed after clear diets. Liquid diets include lactose-free milk, dairy products, milk alternatives, and liquids containing other solutes. Liquid diets are more textured and have a higher gastrointestinal residue compared to clear liquid diets. The energy and nutrients provided by protein-enriched liquid diets approximately meet the needs of the patient. Liquid diet is applied for 10 days. The target in the diet is 60-80 grams of protein per day (at least 3 high protein supplements per day) and 1800 ml of fluid intake (including protein drinks).
Puree Diet
In bariatric surgery, puree diets consist of foods that have been blenderized with pudding and mashed potatoes or liquefied with sufficient liquid. Although protein-rich foods are emphasized at this nutritional stage, fruits and vegetables can be included in the puree. This diet contributes to gastric residue and intestinal fiber tolerance. Puree diet is applied in the 2nd postoperative week. Liquids should be avoided during the meal and should be waited for 30 minutes after eating for fluid consumption. Blenderized or crushed foods should be kept in liquid/baby food consistency. Spicy, very hot or very cold foods should be avoided. Only one new food should be tried at a meal to better understand which food can be tolerated.
Solid Diet
The target protein intake in this diet is 60-80 grams. As protein-based food consumption increases, protein support is reduced. Moist tender meats are better tolerated. The target fluid consumption is approximately 1800 ml per day. It is suggested to continue to avoid consuming liquids during meals, and to wait 30 minutes to continue consuming liquids after meals. In order to be well tolerated, foods should not be consumed quickly and should be chewed very well. Two months after the surgery, the diversity of the diet can be increased and foods from all food groups can be consumed.