After Your Sleeve Operation
Take good care of yourself after your surgery. It’s essential you look after your wounds, listen to your body and understand what symptoms you may be experiencing.
- what pain to expect and how to alleviate it
- symptoms and reliefs for fatigue, bloating, constipation and diarrhoea.
- how to administer your Clexane (heparin) injections (if required)
- what medication you can have and should avoid
Wound Care – general advice
To minimise infection, please wash your hands thoroughly before caring for your wounds. Wherever possible avoid touching your wounds until they have fully healed.
During your operation the surgeon makes a number of incisions through which surgical instruments are inserted, the number will depend on your surgeon. When the procedure is completed, these wounds are stitched, stapled using clips or glued to bring the skin edges together. The skin edges usually form a seal within a day or two of the operation, though the rate of healing varies between individuals. Some early discomfort around the wound sites is inevitable and is a perfectly normal part of the healing process. It is also quite common to have a small amount of bruising of the skin immediately surrounding the wounds.
Stitches, Clips and Glue
The medical term for stitches is sutures. Most often the stitches used are dissolvable and don’t need to be removed. This usually takes around 10-14 days. Occasionally small stitch “ends” may be seen in the scar, if this is the case please contact your Bariatric Nurse. Special skin glue can also be used to close wounds and this usually peels off in 5-10 days. Surgical clips may also be used.
At the end of the operation, your surgeon may apply adhesive dressings to the single incision and/or other wounds. Some surgeons do not use any dressings post operatively. If applied the purpose of a dressing is to:
- absorb any leakage from the wound
- provide ideal conditions for healing
- protect the area until the wound is healed
Prior to discharge from the hospital the ward will provide you with a change of dressings. If you don’t have enough you can buy some from your local pharmacy. If glue has been applied to the wound, dressings are not supplied.
When can I shower or bathe?
We advise that you keep the wounds as dry as possible and avoid showering for 10-days, please also be careful when bathing. This is because if the wounds get wet, there is a significantly increased risk of developing a wound infection. When you start to shower or bathe, gently pat the wounds dry with a clean towel and avoid rubbing. However, if you have had glue applied to your wounds it is quite safe to shower immediately after your surgery.
How long will it take for the wounds to heal?
Usually your wounds will be healed in about two weeks following the procedure. However, some heal faster than others so please don’t be alarmed if yours take a few days longer.
Is it normal for the wound to itch?
Yes. This is a normal accompaniment to wound healing and is probably due to new skin and nerve endings growing into the area. However, it may also be due to a skin reaction to the dressings used to cover the wounds. If it becomes a problem, please contact your Bariatric Nurse for advice.
How do I know if the wound is infected?
If a wound becomes tender, looks inflamed, red or swollen, or if it weeps offensive smelling liquid, pus or blood, you should speak to your Bariatric Nurse. However, redness on its own is not necessarily a sign of infection.
What about antibiotics?
If your wound does become infected, it will be necessary for you to take a course of antibiotics. We recommend Augmentin for which you will need a prescription from your GP. Healthier Weight do not have the facility to issue prescriptions.
How to care for your wounds?
As mentioned in the previous section, how your wounds were closed and so how they are to be cared for, will depend on your operating surgeon. Please follow the instructions below that relate to your surgeon.
- You will be discharged with a wound care pack. Please follow the wound care regime below:
- Remove all dressings 5 days after your procedure and replace with new dressings.
- After another 5 days remove all the dressings and leave exposed to fresh air
- A wound care pack will not be required
- You will have surgical glue over your wounds which will simply peel off after time
- You can shower but please ensure that the glued wounds are totally dry afterwards by patting the skin gently with a clean towel
For the first two weeks after your operation you are likely to feel tired and although we would encourage you to walk daily, don’t overdo things. Remember, even when your wounds look healed on the outside, they are still healing on the inside.
For a few days after leaving hospital you may continue to experience pain from the wound sites. This is quite normal and you should be able to obtain some relief from the analgesics (pain killers) you were given when you left hospital (usually co-codamol or similar).
Pain in the left shoulder, which you may have experienced immediately after the operation, may also continue to bother you. We believe that this is ‘referred’ pain from the diaphragm, but it is not certain why the pain arises or why some have it and others do not. However, it will improve and there are a few things you may want to try:
- Hot water bottle on the left shoulder
- Walking about
- Peppermint tea
- Simple analgesics, e.g. paracetamol and co-codamol (Kapake, Tylex)
Even after a week or two at home, you may be aware of other aches and pains in your chest wall and abdomen especially when you are moving about and taking fewer painkillers. These are referred to as musculoskeletal pains and are a normal part of the keyhole cuts healing inside and forming scar tissue that is a bit less flexible than your tissues were before.
Your stomach may feel bloated for a few days after surgery as your body returns to normal. You may not be able to get rid of excess wind by belching and it will take longer for this wind to pass downwards.
You may experience gurgling or rumbling in the lower part of your stomach. It takes a while for your whole stomach to get in tune with the reduced food or drink that is delivered from your new stomach pouch. BUT notice that this does not mean that you are hungry!
Some people develop quite severe diarrhoea in the first few weeks after surgery. This can be due to a change to a liquid diet or an increase in your milk consumption. Make sure that you drink sufficient fluid to replace what you are losing. If the diarrhoea is particularly troublesome, you should ask your GP to check that there is not some other cause, e.g. an infection. The sleeve is unlikely to be the direct cause.
There may be some reduction in the volume of your stools. This is normal because the volume of food you are now eating is much less then before surgery, especially in the liquid phase of the diet (see later). Make sure you are drinking plenty of water and you can also try vegetable juice or dulcoease or senokot. If this doesn’t do the trick, you may want to try a liquid laxative such as lactulose (Duphulac) or Senokot Syrup.
Administering your Clexane (heparin) injections
You may be required to administer a series of subcutaneous injections in the days following your surgery. You have been prescribed heparin (under the brand name Clexane®) to prevent the formation of blood clots and to protect against complications that may arise following surgery or a period of hospitalisation. It is essential that you do not miss an injection and that you complete the course as directed by the bariatric team.
If you have any queries or concerns, call to speak to a nurse on 0121 693 4488
What is a subcutaneous injection?
A subcutaneous injection is given in the fatty layer of tissue just under the skin. It is required because there is little blood flow to fatty tissues and the injected medication is generally absorbed more slowly, sometimes over 24 hours.
Choosing an injection site
- Subcutaneous injections can be given in the legs or abdomen but we recommend the abdomen (see right)
- To locate a suitable injection site on the abdomen, place your hands on the lower ribs and draw an imaginary line below them. Use the area below your hands for injections, as far around as you can pinch up fatty tissue. Do not use a 1-inch area around the navel
- It is extremely important to rotate injection sites to keep the skin healthy. Repeated injections in the same spot can cause scarring and hardening of the fatty tissue that will interfere with absorption of medication
- Subcutaneous injections should not be administered into a skin site which is burned, hardened, inflamed, swollen, or damaged by a previous injection
Administering the injection
- The skin is the body’s first defence against infection so it must be cleansed thoroughly with soap and warm water before the needle is inserted
- Wash your hands thoroughly with soap and water. Dry on a clean towel
- Check the label for the correct medication. It should state heparin under the brand name Clexane®
- Take the cap off the needle. Be careful not to contaminate the needle. Place the cap on its side
- Hold the syringe in one hand like a pencil
- With your other hand, pinch a fold of skin where the injection will be made
- Hold the syringe at a 90° angle, about 2 inches from the skin surface
- Insert the needle with a quick jab. The needle should go all of the way into the fold of skin
- After the needle is completely inserted into the skin, push down the plunger into the skin that you are grasping
- With skin fold still grasped, pull needle out and discard of the empty syringe and needle into the yellow sharps container provided by the hospital. The syringe has a safety lock mechanism system to ensure safety from the needle
- Once your course of injections is completed, please seal the rigid sharps container, by sliding the movable part of the cover across the lid until you hear a “click”. You should not be able to slide the lid once this action is successfully completed
- Return the sealed sharps container to your nearest clinic for safe disposal when you come to the clinic for future appointments
- Sanofi Aventis the manufacturers of Clexane® / Tinzaparin (heparin) have produced a short video on Youtube called ‘How to Inject Clexane at Home: A Patient Guide’’ which demonstrates how to administer the injection
Usually, you will be able to continue with your regular medication. However, if your tablets are very large, it may be necessary to break them up (most good chemists can provide a small device that will allow you to do this quite easily). If, when you first try to take your tablets as normal, you feel they are sticking, you can crush them up and take them with a spoonful of yoghurt to disguise the taste. Before doing this, however, you should check with your pharmacist that this is OK. Some tablets are specially formulated to be released slowly or coated to protect the stomach and these properties may be destroyed if you crush them. Capsules should not cause any problem because they are soft and designed to melt inside the stomach.
Non-steroidal anti-inflammatory drugs (NSAIDs)
You should avoid aspirin or other non-steroidal anti-inflammatory pain relievers such as Brufen, Diclofenac, Sulindac, Celecoxib, Oxicam etc. That’s because if you take these drugs long term, they may irritate the lining of the stomach, causing inflammation or ulceration. If you have arthritis and need these forms of medication, you may be able to continue as normal if you take an additional tablet to protect the stomach lining. Speak to your doctor and, if you are still unsure, ask the Healthier Weight team for advice. Following surgery, you will need to follow a specific nutritional plan for the first five weeks.
We will write to your GP to explain the blood tests that are required to maintain your well being for the long term. Your gastric sleeve package also includes private blood testing and we will be in touch with you to arrange this. The first private blood test is scheduled 6 months after your surgery with the standard package.
Medication on discharge from the hospital
The hospital will discharge you with a 5 day supply of medication postoperatively. This may consist of pain relief, anti-sickness medication and anti-reflux medication. You may be discharged with all or just some of the medication depending on the surgeon preferences. Your discharge letter from the hospital will inform you if you need to continue with any of the medication on a regular basis. The most frequent medication that patients are required to take regularly postoperatively is an anti-reflux tablet a PPI (proton pump inhibitor) for example Zoton fas tab (all surgeons have their own preference). Injections prescribed to prevent blood clots have been described ina the previous section. Again not all surgeons prescribe this regime postoperatively.