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Pathway

First consultation

The first step is a telephone Triage: a few questions are asked to exclude those who are definitely ineligible for surgery from consultation. The First Consultation collects the patient's clinical history: previous surgeries and illnesses, and therapies followed over the years. We investigate the presence of any comorbidities (type 2 diabetes, high blood pressure, sleep apnoea, gastroesophageal reflux, etc.). It is essential to have a few blood exams with you, to investigate sugar and lipid metabolism, kidney, and liver function. Then we move on to the Dietological Assessment, during which we examine the history of the patient's weight, his previous attempts at dieting, and past and current eating habits. It is then the time for the Psychological Assessment, which the patient may have performed on his own previously or which can take place at the same time as the First Consultation. The motivation for bariatric surgery is investigated, and great attention is paid to the presence of eating disorders. Finally, following all of the above Dr. Marinari makes a diagnosis and eventually suggests an operation. If Dr. Marinari’s decision is for a bariatric procedure, he will address several topics with the patient. In particular, he will explain the mechanism for weight loss, the compliance required by the patient, the lifestyle changes induced by surgery, the side effects, and the potential surgical complications. A Bariatric First Consultation by Dr. Marinari is different from a regular surgical visit as its duration is at least 60 minutes.

Preparation for surgery

Once it has been decided that the obesity therapy should be surgical, you may face two situations. In case 1, the patient has no comorbidities or if there are, the treatment is adequate (i.e., there is diabetes, but blood sugar is under control). The patient can go directly to the preparation for surgery. In case 2, during the First Consultation, we have identified comorbidities that have not yet been treated or that have been treated, but the values are still out of range (for example, too high values of blood pressure or blood sugar). In case 2, to minimize the risk of complication it will be necessary to optimize treatment of the comorbidities, setting a new therapy, or modifying the therapies in use. When treatment of the patient’s comorbidities has been optimized, he can go to the preparation for surgery. The preoperative assessment consists of exams and visits (blood tests, electrocardiogram, counselling, gastroscopy, anaesthesiologic examination, other specialist visits where necessary), all performed on the same day: after this assessment, the patient is ready for surgery.

woman with obesity
man with obesity
doctor and patient
lunch image

Surgery

Hospitalization is on the same day as the surgery. At the entrance to the operating block, the patient undresses and gets prepared for surgery. The operation takes place under general anaesthesia and, depending on the procedure chosen, can last from 40 to 120 minutes. At the end of the procedure, we transfer patients to the Recovery Room where they are monitored and observed. In our protocol, we do not use many of the devices of traditional surgery: when the patient wakes up, there won't be any nasogastric tubes, abdominal drain, urinary catheter, or central vein catheter. This policy allows the operated person to breathe and move better. Already 30 minutes after the end of the operation, the patient with help from medical staff, gets up, walks, and begins to drink small sips of water. After about an hour, the patient goes into the ward where he must keep on drinking and walking. The patient may have nausea, vomiting, and abdominal pain, symptoms for which treatment is planned and which are short-lived. Walking helps significantly in reduction of postoperative pain. The day after the surgery, you receive food instructions for the home management of diet in the first weeks; pain and vomiting are now negligible. Two nights after the surgery, vomiting and pain disappear and the patient is discharged.      

man patient with doctor
woman patient with doctor

First few days

Most people stay in the hospital for 2 nights after laparoscopic procedures and up to a week in case of open surgery. To reduce pain and recover early from surgery, about 30 minutes after waking up after the procedure, it is important to start walking and drinking in small sips. Once at home, you have to keep walking and drinking, following a strict liquid diet. You need to take extra care to stay hydrated. You must continue walking and drinking, even if you don't feel up to it. One week after the discharge, our Case Manager will phone you.

The first few weeks

Most people return to work 3-4 weeks after surgery. If your work does not involve any physical effort, you can return to work even after a week. For the first 2 weeks the diet is strictly liquid, and then pureed foods and shakes for the following 2 weeks. Only on the 5th week after surgery you can switch to solid foods. It will be essential to eat slowly and chew for a long time (make sure to follow the nutrition plan delivered at discharge by our dietitian). About 6 weeks after the surgery, there will be a follow-up consultation with different members of our team. You should be getting around 20 – 40 minutes of light exercise every day. Walking is perfect. 

6 months later

Your life should be getting back to normal now. You should be able to introduce other physical activities such as cycling, jogging, and swimming, as part of your new lifestyle. You should continue to eat slowly, chew for a long time, and drink separately from meals. Following these simple rules you will have a normal life. At the same time, the amount of food consumed will be reduced without the efforts of dieting. If you want you can join one of our group follow-up sessions where you will meet other bariatric surgery patients, and you will speak to our counsellor. From now on, it is natural for weight loss to slow down.

The rest of your life

To fully benefit from the treatment, establishing a healthy new lifestyle is vital. Follow a full diet - where you avoid high-sugar, high-fat, and high-calorie foods and beverages. Lead an active life, making the most of the possibilities offered by your new body. It is essential to keep on attending follow-up visits. If you want to have a baby, losing weight should make it much more manageable and safer. However, it is crucial to wait with pregnancy until around one year after the surgery in order to give the body plenty of time to recover and adjust to the new lifestyle.

walking man with obesity and dog
man on bicycle
man on bicycle
man with glass of water
woman in the swimming pool

Our team of qualified doctors is ready to help you get back to health,  contact us now!