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.)
