Guidelines for patients

Pre operative preparation

Persons are evaluated with investigations regarding fitness and to detect any factors which can hamper outcome. Associated medical conditions are treated to make patients with optimum health. Persons are kept under high protein liquid diet for 2 – 10 days depending on weight and taken for procedure.

Post operative follow up:

Kept nil orally for 24 hours
Initially with liquids in small quantity but frequently, later shifted to thick liquids to soft diet. After 4 weeks allowed taking normal diet.
Food consists of small meals with high protein, less fat and less carbohydrate diet.
Requires multivitamin, iron and calcium supplementation

Broad guidelines are given for the people who wish to undergo procedure. However exact instructions are given after consultation and on individual basis.

Primary consultations:

All patients are seen and evaluated by surgeon. They are explained about the procedures available and guide them what is best suited for them. The primary information can be obtained through mail consultations also. The primary consultation is done to evaluate weight, BMI, associated medical problems and nutritional assessment etc. After a decision is made by person to undergo weight loss or diabetic surgery primary evaluation is done.

Investigations:

Basic investigations consists of

Investigations (BASIC)
CBP	X ray chest PA View	TMT
CUE	ECG	Sleep studies
Bl. Urea, S. Creatine,	Echocardiogram	Cortisol, PTH, other hormones
Blood sugar F & PP	PFT	Others tests as per requirement
Blood grouping	U/S abdomen	Fasting insulin levels
Viral Serology	Special	C protein
BT,CT,PT,APTT	UGI endoscopy	others
Lipid profile, LFT, TSH	Doppler study of legs
HbA1c	S protein

All patients undergo clinical evaluation, pulmonalogy, cardiology, nutritionist, anaesthesia evaluation before surgery. Psychologist and other consultations are sought as per need. Dietary counselling is done in all persons.
Depending on BMI all patients are kept on liquid diet from 2days to 2 weeks with high protein content.
Patients are admitted night before surgery and kept on DVT prophylaxis and otherwise healthy people same day admissions are made. Informed consent is taken detailing procedure and its implications. All patients require at least one attendant who is allowed to stay with patient.
Procedures are done laparoscopically under general anaesthesia and patients are kept in surgical ICU for observation for 4 – 6 hours after which shifted to room. High risk patients are kept overnight or as per necessity in SICU.
Most patients are ambulated in evening and kept nil orally and on IV fluids for 24 hours
Patients are allowed on clear liquids after 24 hours and those patients who are otherwise fit are allowed to go home on 2 day. Stay in hospital is around 2 days unless required otherwise.
All patients are given dietary and medication instructions at the time of discharge. They are allowed sponge bath for 4 days, followed by regular bath.
Those who are in station called to review after 1 week and outstation patients can plan follow up as per requirement.
No suture removal is required.
Diet restrictions are generally for one month followed by high protein, low carb, low fat diet
Most of people can get back to normal activities in one week
All patients are advised to keep an account of diet intake daily and weight chart on monthly basis
Regular exercises are allowed after one month.

“These are broad guidelines only and may vary from patient to patient or person to person.”

Guidelines for patients