Bariatric Surgery

The Trust's Bariatric (obesity) service is a regional centre for bariatric surgery providing surgical weight management services. We carry out gastric ballooning, gastric banding, gastric sleeves and gastric bypasses for patients who fulfil strict criteria.

Bariatic Surgery is part of the General Surgery department.

Your first appointment will be a group session (seminar) where you will meet the team, find out about the service and options.Your second appointment will be to see the Specialist nurse who will discuss your personal medical history with you, and you will also see the dietitian who will discuss your eating patterns and your lifestyle with you. At this point you will be given a weight loss target.

To help you achieve your weight loss target and additionally help you attain a healthy balanced diet patients will be required to attend a Healthy Eating Programme and work with a dietician. This program will be run in group sessions with a maximum of 10 patients per group. Patients are welcome to have 1 carer or family member to attend the group session with them. There will be 4 group sessions in total which will last for 2 hours and are run fortnightly in various locations.

These sessions will cover a variety of interesting and helpful topics that are fully aimed at supporting patients throughout their bariatric journey. On successful completion of this program patients will be given final review after one month where it will be determined if patients have achieved their weight loss target. If you have not achieved your weight loss then you may be given some extra time to do this.

If you have achieved your required weight loss you will be discussed at the MDT meeting. Some patients may not be suitable for surgery even if they achieve weight loss. They may have to have further tests and see other specialists before surgery would be considered.

Patients trying to lose weight will also be supported by the bariatric specialist nurses.

For more information prior to being accepted for surgery, and the different types of surgery, please read the information leaflet below.

A bariatric guide to methods of losing weight.pdf

Ward C31

Ward C31 (the Gastrointestinal Unit) is a 25 bedded ward which has been adapted in some areas in order to accommodate bariatric patients. We are a very busy ward with a rapid turnover of both elective and emergency patients. We deal with patients who come to hospital for a range of surgical interventions or procedures and also deal with emergency patients, not just those patients undergoing bariatric surgery or interventions.

Staff on C31 have worked as a team since 2007 when the dedicated bariatric ward was implemented.Having spent time on other areas we moved to C31 in November 2011 following a refurbishment of the ward. This refurbishment included widening of all toilet/ bathroom doors in order to accommodate specialist bariatric equipment.

Visiting times

Visiting times are 2 pm - 4 pm and 6 pm - 8 pm.

Visitors

In order to respect other patients on the ward we ask that no more than 3 people visit each patient at any one time.All visitors are asked to adhere to our hand washing policy, please wash hands on entry and departure to ward. No hot food or drinks should be brought on to the ward.

Ward C31 0191 5699731

Divisional General Manager Anna Hargrave

Directorate Manager Rebecca Elliott (0191 565 6256 extension 41961)

Clinical Director Mr Andrew Brown (0191 565 6256 extension 47260)

Consultant General Surgeon (Mr Peter Small 0191 565 6256)

Matron Denise Simpson

Bariatric Specialist Nurses Arun Sekhar and Lisa Wilde (0191 5656256 extension 42570/42708)

Specialist Dietitian Maureen Boyle (0191 5656256 extension 42832)

Your bariatric journey

On admission

Elective patients are received on to the ward on a daily basis. The ward is very busy and on occasions there may be a slight delay in you being allocated a bed. There is a day room in which you and those accompanying you will be asked to wait, please be assured that the ward staff and Patient Flow team will allocate you a bed as soon as possible. Once shown to your bed you will be orientated to the ward and its facilities.

A member of staff will carry out the following:

Checking of personal details
Recording of basic observations such as blood pressure, pulse and weight.
A named nurse will be identified on the board above your bed and an estimated date of discharge will also be identified and recorded as EDD.
Bloods may be taken.

You will be seen and assessed by a junior member of the medical staff and your consultant or his registrar will then discuss your case and procedure with you and explain the consent process. You may be seen by the anaesthetist on admission or the day of surgery.

All patients undergoing surgery will be commenced on a daily injection of Dalteparin which you will receive daily, in your tummy at tea time drug round, until your day of discharge. This medication helps to prevent blood clots. You can also help with this by ensuring you keep mobile in the ward, maintain regular leg exercises and the wearing of your anti- thrombolytic stockings. You will be advised of the time of your surgery by your admitting nurse and advice given on when to be nil by mouth.

Day of surgery

On the day of your operation you will be advised by nursing staff to take a shower.

Diabetic patients may have had a drip commenced overnight to stabilise blood sugars, and your BM recordings will be checked 2 hourly by nursing staff until you go to theatre.

You will be assisted into a gown and will be supplied with anti-thrombolytic stockings.

A checklist will be carried out by a registered nurse.

All Jewellery, make up and any nail varnish must be removed. If you do not wish to remove your wedding band this can be taped and secured by nursing staff.

The theatre porters will come to the ward to collect and transfer you to theatre on your bed. You will be accompanied to theatre by a member of nursing staff and handed over to the care of theatre staff where another checklist will be carried out.

On return to the ward you will be made comfortable, your observations will be recorded and a full check carried out of your wounds, drip site etc. Your observations will be undertaken hourly for 4 hours and then 2 hourly for a further 4 hours and then subsequently every 4 hours.

You will be kept nil by mouth with a drip in place for hydration.

If you are able you will be mobilised at the earliest opportunity by nursing staff. You will also have a flowtron machine attached to your legs which compresses the veins and pushes the blood back towards the heart. This then deflates again after a controlled time. This action copies how the veins are squeezed by the muscles when you walk. Intermittent compression also helps to break down some of the proteins in the blood that can cause blood clots. You will be reviewed by the surgical team and closely monitored by nursing staff.

First day after surgery

If no problems overnight you will be allowed to commence on 1 litre of water today. Your drip will be maintained in order to ensure you are hydrated.

Your wounds will be checked and redressed by nursing staff.

Observations will continue to be monitored 4 hourly or more frequently if required.

You will be encouraged to mobilise and walk to toilet/bathroom with supervision and assistance.

Your pain and nausea score will be monitored and actioned by nursing staff.

You will be reviewed by surgical team on ward rounds.

Nursing staff will take a routine blood test from you.

Second and third day after surgery

If you have tolerated your fluid well and observations / pain score are satisfactory you will be allowed to commence puree diet today.

You will be reviewed by the surgical team on ward rounds.

If you are well and your blood results from the day prior are satisfactory you may be discharged home today or tomorrow.

You must be reviewed by the dietitian prior to discharge. You will also be seen by pharmacist and take home medications arranged.

Diabetic patients may be reviewed by a member of the diabetic team prior to discharge.

Your wounds will be checked and you will be given wound care advice.

You will be asked to attend your practice nurse for wound check or if you unable to attend your GP's practice a district nurse may be arranged.

Discharge

You will be given wound care advice prior to discharge by nursing staff and will be given a small supply of dressings to take home. You will also be given a letter for your district or practice nurse advising that a wound check will be required. A discharge checklist will be completed.

Your GP will receive a letter electronically.

You are expected to continue to wear your anti-thrombolytic stockings for 4 weeks post operatively (you may remove at night) and a spare pair of these should be provided.

Please make nursing staff aware if you require assistance with transport as soon as possible.

Medical staff will be able to provide a Fit (sick) note for you if required, please ask.

You will have been provided with literature from the dietitian and specialist nurses, please ensure you take this home with you.

The nursing staff may ask you to transfer to the Discharge Lounge in order for the bed space to be prepared for another patient.

If you have any problems or questions following discharge then please contact the ward on 0191 5699731

Bariatric Specialist Nurses

Introduction

You will be introduced to the Specialist Nurses at the introductory seminar (this will be the first time you meet some of our team). You will be given a presentation by one of our consultants and have a chance to ask some questions at the end.

New patient assessment

The new patient assessment is a medical/psycho-social assessment to help us know more about you. You may be referred to our psychologist at this point depending on the outcome of the assessment; it is not uncommon to be referred to psychology so don't be disheartened or upset. There may be some things that need to be dealt with prior to surgery that the surgery itself cannot fix.

Multi-disciplinary Team (MDT) meeting

MDT meetings comprise of Consultants, Specialist Nurses and Dieticians where each patient will be discussed individually. In some cases we might request more information from your GP or other healthcare professional regarding previous surgery or tests you may have had. This will allow us to decide the suitability and safest type of surgery most appropriate to you.

Ward visit

The next time you will see the nurses is when you are admitted to hospital to have your surgery. This is an opportunity to answer any questions you may still have and to provide you with contact details for the bariatric team and nurse led support group.

Post-operation telephone review

This is carried out usually within 7 days of your discharge from hospital. It provides an opportunity to check you are OK, provide post op advice and for you to ask questions you may have. While in hospital it is important to make sure you give ward staff your most up to date telephone numbers. N.B calls will appear on your phone as 'withheld number' - please answer as it is only us.

Nurse led urgent review clinic

This clinic is held twice per week and can be used for anything from checking to see if you have met your weight loss target, to health promotion advice and motivation and even problems or concerns following your operation - simply call and make your appointment.

Nurse led support group

This support group was established in April 2013 and allows us to bring some professionalism and guest speakers to an exciting group. Feel free to come along and share your experiences, ask other members advice, tips or just listen. This service is for you and if you have any suggestions or ideas then let us know and we will try to arrange it.

The specialist nurses are always available to support you with the above so if you do have a problem or need advice please doesn't hesitate to contact them.

Bariatric Specialist Nurses Arun Sekhar and Lisa Wilde (0191 5656256 extension 42570/42708)