Laparoscopic adjustable gastric banding for morbid obesity - Home Study Program

AORN Journal, May, 2003 by Dorothy Roedel Ferraro

DISCHARGE INSTRUCTIONS

Nurses are instrumental in ensuring that patients are well informed about how to perform self-care when they arrive home by explaining the physician's discharge instructions. Activity, diet, and medication instruction are important pieces of information nurses provide patients before discharge.

Activity. Nurses advise patients to avoid driving for one week. Additionally, nurses instruct patients to avoid lifting anything heavy or participating in strenuous activity for two weeks postoperatively. Nurses encourage patients to perform other aerobic activities, such as walking, as soon as it is comfortable.

Diet. Table 6 describes the diet that the patient must follow immediately after surgery, during the following weeks, and thereafter for as long as the gastric band is in place. Dieticians explain that the patient must consume a full liquid diet for the first three weeks postoperatively, and that to ensure adequate protein intake, the patient may need to consume commercially prepared protein drinks. Avoiding regular foods during this time prevents distention of the small upper gastric pouch and dietary indiscretions that cause vomiting, both of which may predispose the patient to band slippage. Dieticians describe advancing the diet during the second month. Pureed foods are recommended, and by the third month, patients who have undergone laparoscopic adjustable gastric banding can progress to soft foods. At all times, foods must be eaten slowly, chewed thoroughly or pureed, and consumed in small portions. Fibrous and dry foods should be avoided. Dietary indiscretions may result in symptoms, such as epigastric discomfort and vomiting.

Dieticians instruct patients to

* avoid eating and drinking at the same time,

* keep portion size to less than 3/4 of a cup, and

* avoid drinking carbonated liquids and alcoholic beverages.

To ensure adequate hydration and prevent pouch distention, the patient should be instructed to consume adequate fluids 90 minutes after a meal until 15 minutes before the next meal.

Medications. A chewable multivitamin should be taken daily, and H2 antagonists often are prescribed prophylactically during the first month after surgery. Most patients require only mild analgesics, such as acetaminophen, for the first several days after surgery. It generally is good practice to avoid the use of anti-inflammatory medications following gastric restrictive surgery because of the potential for gastric ulcer formation. Patients are instructed to avoid large pills and substitute liquid preparations or smaller tablets when possible.

BAND ADJUSTMENTS

The percutaneous adjustability of the stoma size is one of the most important features of the gastric banding system, which allows for customization of the degree of restriction over time. The band is adjusted by injecting or removing saline via the self-sealing access port using a special noncoring needle (ie, Huber tip). In some cases, radiological assistance is used to locate the port for the adjustment. In other cases, it is possible to palpate and locate the access port without x-ray assistance. (40)