The Hospital stay and treatment after insertion of a gastric band
The general notes in the following two chapters are valid for all operations involving adiposity surgery. Due to the frequency of operations, the developments following the insertion of a stomach band will be given special attention.
Hospitalisation (hospital stay)
Patients are generally hospitalised the day before the operation, the exception being patients of high risk who require therapy with hospitalisation for stabilisation. The patient stays in the hospital for 4 to 7 days including the time for the operation.
After clarifying the essentials and performing key examinations required for ascertaining indications as an outpatient, there are still some obligatory examinations to be completed before the operation. To improve breathing, all patients in the "pre-group" are taught breathing techniques by a physiotherapist and must do breathing exercises.
In addition to the intake exam done by the nursing staff, the final preparations for the operation include a physical, a definitive declaration of consent regarding the scheduled operation, a conversation with the head surgeon and a visit by the anaesthesiologist. In addition to this, the usual preparations for an operation are to be observed (preparation of the intestines by emptying them, the thromboprophylaxis, etc.).
The operation is performed under general anaesthesia (see Surgical Techniques, Chap. 4.7.4.3)
After being monitored for a short time in an anaesthetic recovery room, the patient is generally brought to a normal care station. Intensive medical monitoring and treatment is only necessary in circumstances involving commensurate risk due to manifest concomitant illnesses with serious disturbances in the functioning of the lungs or heart. This is seldom the case and is decided by the anaesthetist and the surgeon immediately after the operation. The stay in intensive care generally lasts until the first night. In general, patients’ post-operative development is uncomplicated and they can be released three to four days after the operation.
In the first phase after the operation, the active involvement of the patient is indispensable. The goal is to leave the hospital bed as quickly as possible, at the beginning for a short time with a nurse’s assistance, while afterwards, the length of time and degree of mobility rise rapidly. Standing up and, consequently, the bodily activity involved has a decisive influence on the improvement of the functioning of the heart and lungs, while minimising thromboembolic risks. In this way, the diaphragm sinks as a result of the body’s upright position, which benefits the required "abdominal breathing" (diaphragmatic breathing) and reduces the breathing muscles’ workload due to the reduced burden placed on the thorax. The expansiveness of the lungs, the coughing up of phlegm into the air passages and finally the functioning of the lungs are improved by the increased repletion of oxygen and the expulsion of carbon dioxide. The emergence of agglutination in the lungs due to a lack of expansion (atelectasis) and, consequently, emerging lung infections are minimised.
Due to the high risk of thromboembolic events, much emphasis is placed on prevention:
- Standing up (mobilisation) on the day of operation to accelerate the backward flow of blood from the veins in the lower legs and pelvic area.
- Wearing of compression socks; binding the legs with special elastic bandages has not been proven effective due to the building up of wrinkles with a lace effect with patients who are severely overweight.
- Medical high-risk thromboembolic prophylaxis with a high quantity of (low-molecular) heparin. Outpatients will continue this for a total of three weeks after the operation, along with self-administration of the necessary injections twice a day. It is only in rare instances that a doctor must make a house call to do this.
Breathing therapy consists of mobilisation, the continuation of the breathing exercises begun before the operation, and the continuation of regular inhalation to open up the air passages. In this way, the functioning of the lungs is improved significantly. On the first day after the operation, an x-ray of the gastric band is taken to confirm the exact position of the band. Any rare early complications can thus be recognised at a favourable point in time and corrected through a new laparoscopy. An early complication almost always emerges with concomitant symptoms that demand clarification so that the time of the x-ray check should be put into perspective. At the latest, however, this takes place before the patient is released. It also documents the final situation and is significant for comparative assessments.
Diet and nutrition after the operation
The patient can begin drinking fluids on the day of the operation and can generally eat mushy food (blended food) on the first day. For the first six weeks after the operation, the patient can only eat blended food. The prerequisites for the consuming of food are a high degree of alertness and the ability to hold the upper-body erect. Patients should not begin drinking fluids while lying down. At first, he or she should take small sips carefully. The patient must learn to consume only small portions of food. Vomiting after the operation is prevented using all available means. The emergence of queasiness is handled with medication immediately and this queasiness generally disappears quickly. Vomiting is supposed to be avoided due to the danger of aspiration (cf. Lung Risks) as is a premature, inordinate strain on the gastric band.
The patient is allowed to go home after building up the ability to eat, improving the functioning of the intestines as witnessed by normal bowel movements, increasing his or her familiarity with blended food, and after receiving nutritional advice from leaflets. The patient must be in good general condition, without serious pains and with a social network of family or friends.