There are a number of ways by which the safety of this procedure can be improved by following these simple rules:--
Proper pre operative preparation- The work up before any Bariatric surgical procedure involves a visit to the doctor’s clinic with a thorough medical history and physical examination. This is followed by a number of tests which include blood work, radiology, hormonal analysis and check up of the cardiovascular and pulmonary systems. These tests would ensure the fitness of the individual to undergo the surgical procedure under general anaesthesia and help to detect any underlying disorder. If any disease is diagnosed, it is first treated and the patient’s medical condition is optimised before the surgery. Besides these tests, the patients are told to follow a liquid diet for 5-7 days before the Bariatric surgery to decrease the visceral fat especially the fat stored in the liver which helps ease the surgical procedure. Also, patients are instructed to strictly avoid smoking and alcohol intake for a week prior to surgery to decrease the risk posed by these substances on anaesthesia. If the patient is suffering from severe sleep apnea, they may be advised to use a CPAP machine to optimise their blood oxygen level prior to surgery. Similarly diabetes, hypertension, chronic respiratory diseases and thyroid status need to be adequately managed with medication to avoid any unnecessary complications during the operation.
Intra operative precautions- The patients should undergo surgery in a certified centre by a doctor having sufficient experience in Bariatric surgery. The surgery should be done following the proper protocol and using all gadgets and equipments which are certified for use during this procedure. The surgery makes use of a number of specialised gadgets like surgical staplers, ultrasonic energy devices, liver retractors and long laparoscopic instruments for smooth performance. Particularly, care should be taken about meticulous operative technique and hemostasis as well as avoidance of infection. The OT table is specially designed for supporting the bulky patient and the patient is secured properly by means of chest and thigh supports and foot rests at the end of the table. The surgeon may need to stand on a platform for ease of operation and the patient may be placed in split leg position. Care is also taken to avoid blood clotting by using a DVT pump during the operation which prevents blood stasis in veins of lower limbs. At the end of the procedure, a leakage test should also be conducted to confirm the proper application of staplers and stitches and avoid complications in the postoperative period.
Postoperative care-The patients should be observed in the surgical recovery room or HDU in the early postoperative period. This is followed by transfer to the ward once all vital parameters are normal. The patients are encouraged to maintain an upright posture and ambulated early after their surgery. They should be instructed to perform deep breathing exercises to prevent lung collapse and to move their legs yo prevent blood clot from forming. Once they have recovered fully from anaesthesia, they are encouraged to take a clear liquid diet slowly to allow bowels to start functioning. Any severe pain in abdomen, rising heart rate or fever at this stage should be treated seriously with aggressive tests and prompt diagnosis. CT scans or diagnostic laparoscopy are useful tools to find and treat any operative complication and may avoid serious damage later on.
Follow up- Patients are advised to maintain a regular follow up schedule to track weight loss and prevent the long term complications like nutritional deficiency. They are advised regarding the diet and nutritional supplements and also encouraged to exercise regularly and make positive lifestyle changes. A high protein diet along with plenty of fresh fruits and vegetables should be taken. Besides this, protein, multivitamin, calcium and iron should be supplemented especially in the initial few months to avoid deficiency. Blood tests should be performed quarterly to detect such at an early stage and some may require injections.