Preparation for Bariatric Surgery

Preoperative evaluation (free in-person consultation)

Conducted before hospitalization. At the consultation we assess: indications and contraindications for surgery, medical history, comorbidities, current medications; if necessary, we order additional tests or consultations with other specialists. Surgery is not suitable for everyone — we inform the patient of our decision at the consultation; if there are contraindications, we discuss alternative treatment options.

Day 1 — Admission to hospital

Complete preoperative examination by the surgeon and anesthesiologist; collection of necessary tests (blood, urine, coagulation profile), ECG, and other tests if indicated; instructions on preoperative preparation and signing of informed consent.

Day 2 — Surgery day

Surgery under general anesthesia.

Days 3–5 — Inpatient monitoring (3 more days)

Monitoring of vital functions, pain control, early mobilization, gradual restoration of nutrition step by step; prevention of thromboembolism and infections. Discharge if stable and criteria for readiness are met (pain managed with oral medications, tolerance of prescribed diet/fluids, adequate mobility).

Follow-up and control tests

• First visit: 2–3 weeks after discharge — evaluation of condition, adjustment of treatment if needed.
• 3 months: patient completes recommended lab tests at their local laboratory and sends results to the clinic. If abnormalities are found — additional in-person consultation.
• 6 months: repeat set of control lab tests and in-person clinic visit for progress evaluation and planning further follow-up.
• Afterwards, monitoring schedule is tailored individually.

What to do in advance (do not delay)

• Start a preoperative diet to reduce liver size — usually 1–2 weeks before admission.
• Quit smoking — the earlier, the better; at least 4–6 weeks before if possible.
• Stabilize comorbidities (diabetes, hypertension, etc.) — follow your cardiologist’s/endocrinologist’s prescriptions.
• Coordinate stopping/adjusting medications (anticoagulants, antiplatelets, some antidiabetics, NSAIDs) — per doctor’s instructions.
• Prepare documents/items: ID/insurance, list of medications, CPAP (if you use it), comfortable loose clothing for discharge.

On admission day (Day 1) — what to expect

• Clinical examination by surgeon and anesthesiologist.
• Collection of all required tests and studies.
• Instructions on preoperative diet, hygiene (antiseptic shower), fasting times as directed by anesthesiologist.
• Signing informed consent (if not yet signed).

On surgery day (Day 2) — what to expect

• Meeting anesthesiologist before anesthesia.
• Laparoscopic surgery (usually through 4–6 small incisions). Duration depends on the procedure, typically 1–3 hours.
• Intraoperative antibiotic prophylaxis if needed and thrombosis prevention measures.
• After surgery — transfer to ward/ICU for monitoring.

Inpatient monitoring (3 more days)

• Early mobilization: start standing/walking as early as possible (same day or next).
• Breathing exercises (incentive spirometer, deep breathing) — pneumonia prevention.
• Pain management: multimodal approach (minimizing opioids).
• Thromboembolism prevention: compression stockings/devices, low molecular weight heparin if indicated.
• Diet progression: clear liquids → protein shakes → semi-liquid/pureed food. Goal — adequate protein and hydration.
• Monitoring: temperature, heart rate, blood pressure; additional tests if condition worsens.
• Discharge criteria: pain controlled with oral meds, tolerance of prescribed fluids/food, adequate mobility, stable vitals.

Post-discharge nutrition rules — see brochure:https://bariatr.com.ua/rek.pdf

Weekly diet progression (approximate)

• Week 1 — clear liquids and protein shakes.
• Weeks 2–3 — thick liquids/pureed food.
• Weeks 4–5 — soft food (fish/meat mashed with fork) in pureed/soft consistency.
• From weeks 5–6 — gradual introduction of solid foods (as tolerated).

Portion size: max ~150 ml food per meal. Drinks — small sips (~30 ml at a time).Frequency: small meals every 3–4 hours, no skipping.Protein: priority nutrient. Goal ~80–90 g/day (use protein shakes if needed).Fluids: sip frequently — total daily target 1.5–2 L.Food & drinks separation: wait at least 30 min between eating and drinking (do not “wash down” food).Forbidden: alcohol, carbonated/sweet drinks, sugary high-calorie liquids; no straws.Introducing foods: one new item per day, monitoring tolerance.

Medications & supplements

• Multivitamins — lifelong.
• B12, calcium (citrate) + vitamin D, iron — as indicated and guided by lab results; many patients require lifelong support.
• If anticoagulants are prescribed after discharge — follow physician’s instructions.

Physical activity & work — what and when allowed

• Walking: start immediately, aim to increase daily.
• Return to office (sedentary) work: usually after 6–7 days if feeling well, with doctor’s approval.
• Heavy physical work/lifting: avoid lifting >5–10 kg for 6–8 weeks (longer if advised).
• Driving: not allowed while taking opioids or until reaction/reflexes are normal — usually minimum 1–2 weeks.

(Timelines are individual — final decision is made by your treating physician depending on condition.)