Preparing for your Biliopancreatic diversion surgery

This is exactly the same as for the gastric bypass and the sleeve gastrectomy. In other words it is exactly the same approach as with these procedures.

You will have an honest and yet comprehensive discussion with your surgeon. This will also involve his/her multidisciplinary team: this team will comprise a psychologist, dietician and specialist nurses. They and your surgeon are there to talk you through the procedure, check that you are fit enough to undergo surgery and will formulate a diet and exercise plan for your use after surgery. This type of surgery means that you will also have to take a daily nutritional supplement on a regular basis for the rest of your life.

That last part is VERY important: there are risks with this surgery, in particular the risk of malabsorption due to the work undertaken on the small intestine. The small intestine will be cut and then redirected which will dramatically affect the digestion and passage of food through your system. This risk means malnutrition: that can lead to vitamin and mineral deficiencies which can result in anaemia, osteoporosis (a high risk for women) and night blindness.

They will encourage you to be in the very best shape you can be before surgery. This means starting on a healthy diet and undertaking some exercise. For the exercise part gentle walking is probably best to start with. Once you start to lose weight and get that bit fitter then you can increase the intensity of this, or walk a bit further. The idea behind this is to get you used to a healthy lifestyle and to reduce your risk for surgery by loosing some weight. Obesity surgery is safe but like all types of surgery there are risks and these tend to increase if you are carrying excessive weight. So, any weight that you can lose beforehand will help here.

Also, you will have to follow an exercise routine after surgery so it is a good idea to start now. The best way with the diet and exercise is to include in your normal everyday activities so that it becomes a routine. If you do this then it will be much easier to stay with it after your surgery.

You will get advice about this and other obesity related issues from your surgeon and his/her team. This team will provide support after surgery which will include regular follow up sessions to check on your progress.

They will discuss the procedure thoroughly with you with the aim of ensuring that you know exactly what it entails and the consequences. This includes an explanation of the benefits, and the risks as well as things that you will need to do after the operation.

This is a life changing decision and one that you cannot enter into lightly so make sure that you have all the information that you need before making a decision. Be aware that this surgery means that your lifestyle will have to change and on a permanent basis. So, if you find it difficult to stick to a routine then ask yourself if this is a suitable route for you to take. You will have to follow a set routine every day as regards your diet and nutritional supplementation. If you decide to miss a day or forget then there can be problems.

If you are clear about all of this and decide to go ahead then it is a good idea to have your family and friends on board. This is an emotionally and physically demanding time and you will need plenty of help and support. This is important in the period before your operation, as well as during and afterwards.

Another good source of help is a local or national support group. There is a very useful organisation called BOSPA – British Obesity Surgery Patient Association, which provides information and advice about obesity matters. This also includes a section on local support groups.

Your overall health will be assessed which will include checking your blood pressure and taking blood and urine samples. If you smoke then you will be asked to stop at least a month before your surgery. Ideally, it would be better for you in the long run if you gave up permanently though it can be quite difficult to do so. If you do decide to resume smoking after your operation then leave it for a minimum of a month before doing so. Smoking can cause slower healing of surgical wounds and can increase the sensitivity of the lungs – which could be problematic during anaesthesia.

They will also take a full medical history. If you have any allergies or have had surgery in the past then let them know. There are a set of criteria for suitability for surgery and these include certain health problems. If, for example, you have ulcerative colitis then this may exclude you from surgery. If you are currently on or have been on any medication then this is something they will need to know.

A few days before surgery arrange for someone to drive you to and from the hospital. It is also a good idea to arrange for the same person, if possible, to be on hand if you need anything. For at a few days after surgery you will be confined to the house whilst you are recovering. So, have someone who can take over any day to day tasks such as grocery shopping.

For the first two weeks you will be on a liquid diet. This means thin soups, low sugar drinks, milk etc. Make sure you have ample supplies of these. And, that you have an adequate of any prescribed medication. You will be taking painkillers for a few days but these will be given to you at the hospital.

The surgical team will have given you a set of information about what to do before your operation, and afterwards. This will include information about when to have your last meal before surgery, what to do on the day and so on.

The day before surgery is a time when you will be doing any last minute jobs. If you have a family then this will mean asking them to help out; even more so when you arrive home afterwards. You will be tired and groggy when you arrive back home which means plenty of rest. Do not try to do any household tasks. Your stomach will be sore and probably swollen as well so bending over or stretching for something will be very uncomfortable. What you don’t want to do is to put any pressure on your surgical wounds so avoid any unnecessary movements.

You will need to pack a case with the following items:

  • Pair of light, slip on shoes. If not a pair of trainers are fine.
  • Loose, comfortable clothing. A jogging suit of a soft material or something which is loose and baggy. You do not want anything which is tight fitting.
  • A cushion. This is to be placed over your stomach when you are in the car (after surgery). It will stop the seatbelt rubbing against your tender stomach.
  • A couple of books.
  • Medication. If you are taking any medication make sure you bring those with you.
  • Instructions about the surgery. You will have been given a set of instructions about what to do before, and after surgery.

If you are wearing any make up and/or jewellery then remove this beforehand. One exception to this is a wedding ring: if you wear a wedding ring then you can cover this with sticky tape.

And, do not eat or drink anything after midnight.

On the day of your surgery have a bath or shower. Then, after a last minute check, set off to the hospital (or clinic). When you arrive at the clinic you will have to go through their standard admissions process. This is a straightforward process and will not take very long.

Once you are on the ward, or in your room, a nurse will visit you to perform some pre-surgery checks. These include checking your blood pressure and taking samples of both your blood and urine. He/she will also give you a pair of compression stockings to wear and you may also be given an injection of a blood thinning drug called Heparin. The reason behind this is to prevent the risk of deep vein thrombosis or blood clots which can be dangerous.

Following this you will have a visit from your surgeon. He/she will go through any last minute issues before asking you to sign a consent form. Before you do so, make sure you are satisfied with all the information you have been given. The consent form is a document which states that you are giving your permission for the surgery to be carried out. You are full aware of all the risks and benefits of the procedure and agree to this going ahead. As with any legal document read it very carefully (including any small print) before signing.

Biliopancreatic diversions guide sections

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