Starting a new life and getting rid of habits is really not easy. During this period, you can mix everything, but fluid and protein intake should not be forgotten.
Balance fluid intake; Average daily fluid intake should be between 1500-1750 ml. Darkening of the urine color, dizziness when standing up, arm-leg pain and nausea may be the clues of low fluid intake and this situation should be aware of. During hospitalization, vitamin B1 should be added to intravenous fluids at a dose of 100mg per day.
Eat a protein-rich diet; It is very important to use protein concentrates in the process of rapid weight loss. Protein concentrate approved by your doctor should be started at the appropriate dose. The appropriate use of protein concentrate is to drink it little by little and spread throughout the day. This provides ease of intake and prevents liver function overload. By balancing the daily protein intake, muscle breakdown should be prevented.

All studies in the world have focused on how to prevent patients from regaining weight after bariatric surgery. Unfortunately, while there are many false statements such as “Eating Weight Loss Surgery-Stomach Bypass” imposed on patients in a way that I cannot understand by some media in Turkey, it is confusing that no one emphasizes how and how long the follow-up of patients who have undergone bariatric surgery should be.
It is already obvious that the patient who has undergone a successful operation will lose weight. “Eating Disorder Disease” is the basis of obesity and is a psychological disease. Long-term follow-up and psychological support should be given to prevent regaining the lost weight. On this subject, an article titled “The effect of psychological support on weight loss after obesity surgery” was published in the “Obes Surg” journal in April 2015. Psychological treatment was given to half of the 162 patients who had undergone “Stomach By-pass”, and the other half were not, and the patients were followed up for a long time. In the first year results, there was no difference in weight loss between the two groups and they reached their target weight. The importance of psychological treatment has emerged in the long term, and the weight regain has remained at a minimum in patients who are followed up and receive psychological support.
Diet; Generally, patients are discharged 4-6 days after the operation. Patients are discharged with a liquid diet, and it is recommended to monitor their fluid intake and urine output. After an average of 3 weeks, a gradual transition to soft and then solid food is made. While it is aimed for the patient to consume 400-800 calories for the first month, glucose intake should be reduced later on. Patients should be recommended a diet rich in salads, vegetables, fruits and protein in terms of nutrition in the future. To prevent stomach pain and vomiting, foods should be eaten slowly and food intake should be stopped when a feeling of fullness occurs. The simultaneous intake of liquids and solids should be avoided. Patients should not forget that surgeries change their bodies, do not make any changes in environmental factors, choose healthy foods, do not skip meals, and should be followed by a physician regularly, especially in the first year. Daily protein intake should be 1-1.5 g/kg per kilogram per day. Since the “duodenal switch” is an absorption-reducing operation, daily protein intake should be 1.5-2.0 g per kilogram. Alcohol is well tolerated after 6-12 months of operation.
Follow-up; Patients are in the first 4-6 months when weight loss is the fastest and then 8-12. Monthly weight and blood pressure should be followed weekly. Diabetic patients should take their measurements daily. The following tests should be performed at the 3rd, 6th, 9th, and 12th months; (1) complete blood count (2) Electrolytes (3) Fasting blood sugar (4) Iron tests (5) Vitamin B12 (6)AST,ALT,ALP,GGT (7)Total protein and Albumin (8) Lipid Profile (9 ) Vitamin D, Parathyroid Hormone (10)Tiamine (11)Folate (12)Zinc (13)Copper.
Complications that may occur after surgical treatment vary according to the type of operation performed. Low calcium, overworking of the parathyroid gland, bloating, stenosis in the stomach and intestinal connections, ulcers, gallstones, wound hernia, intestinal knotting after by-pass, short bowel syndrome, kidney failure, stomach narrowing, infection, reflux, vomiting, liver failure and dumping syndrome are late complications. Since by-pass surgery is an absorption-reducing procedure, the absorption of drugs is also reduced and their systemic bioavailability is reduced.

After the operation, the patients are followed up in the anesthesia advanced care room or intensive care unit. After the team who wrote this article performs the leak test with contrast, the patients with a nasogastric tube (nasogastric drain) are started to be treated on the 1st day in tablet, crushed tablet or liquid form. Blood tests were requested from the patients in the first 2 days. Nasal oxygen administration is the standard treatment. Lung problems are common early complications after bariatric surgery. Deep vein thrombosis (vascular occlusion in the calf muscles) is the most common cause of pulmonary embolism (clot). For this, precautions should be taken before and after the operation.

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Follow-up of patients in the late period; If leakage is not detected in patients after 24-72 hours, liquid diet is started. Post-operative follow-up team; Pain monitoring, wound care, blood pressure measurement, intravenous fluid therapy and respiratory function exercises should be applied in seriousness. Nausea-vomiting after bariatric surgery; It is more common in women, non-smokers, and patients with previous motion sickness. Initiation of anti-nausea medications before surgery reduces nausea.

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