Before Surgery

Goals of the Preparation Process

The main objectives of pre-operative preparation are:

• Evaluating the patient's general health for surgical suitability
• Identifying and managing potential risks in advance
• Reducing liver volume to facilitate the surgery
• Preparing the patient physically and psychologically for the post-operative period
• Laying the foundation for transforming eating habits

Medical Evaluation and Tests

A comprehensive evaluation is conducted before surgery by a specialized bariatric surgeon and a supporting medical team. The main tests performed during this process include:

General Health Checks

• Detailed medical history and physical examination
• Body Mass Index (BMI) measurement
• Blood pressure and pulse evaluation
• Body fat percentage analysis

Blood Tests

• Complete blood count
• Liver function tests (AST, ALT, ALP)
• Kidney function tests (urea, creatinine)
• Blood sugar and HbA1c
• Lipid panel (cholesterol, triglycerides)
• Thyroid hormones (TSH, T3, T4)
• Vitamin and mineral levels (B12, vitamin D, iron, ferritin, zinc)
• Blood type and coagulation tests

Imaging and Endoscopic Tests

• Upper gastrointestinal endoscopy: evaluation of the stomach and esophagus
• Abdominal ultrasound: examination of the liver and gallbladder
• Chest X-ray
• CT or MRI when needed

Cardiac Evaluation

• Electrocardiography (ECG)
• Echocardiography
• Stress test when needed
• Cardiology consultation for high-risk patients

Pulmonary Evaluation

• Pulmonary function tests
• Polysomnography (sleep test) for patients suspected of sleep apnea
• Pulmonologist consultation when needed

Other Consultations

• Anesthesiologist evaluation
• Endocrinology (in case of hormonal disorders)
• Gastroenterology
• Psychologist or psychiatrist consultation
• Dietitian consultation

Psychological Evaluation

The long-term success of bariatric surgery is closely related to the patient's psychological preparedness. Pre-operative psychological evaluation includes:

• Screening for eating disorders (binge eating, emotional eating)
• Depression and anxiety assessment
• Examination of expectation realism
• Motivation level evaluation
• Analysis of social support system

Any identified psychological issues are managed appropriately before surgery. This significantly supports the patient's adaptation to post-operative lifestyle changes.

Nutritional Preparation

The pre-operative nutrition plan is designed both to reduce surgical risks and to facilitate the patient's adaptation to new eating habits.

2-4 Weeks Before Surgery: Liver-Shrinking Diet

In overweight patients, the liver may be enlarged, making laparoscopic surgery more challenging. To reduce liver volume, a low-calorie, low-carbohydrate, and high-protein nutrition program is followed. Key features of this diet:

• Daily intake of 800-1200 calories
• Emphasis on protein-rich foods (eggs, chicken, fish, low-fat dairy)
• Avoidance of sugar, white flour, and processed foods
• Limitation of fatty foods
• Adequate water intake (at least 2-2.5 liters per day)
• Increased vegetable consumption

This program is individually tailored by a dietitian.

One Week Before Surgery: Liquid Transition

As the surgery date approaches, the nutrition program becomes even lighter. Typically, in the last few days:

• Clear soups
• Sugar-free tea and herbal teas
• Low-fat dairy products
• High-protein beverages
• Small amounts of puréed foods

8-12 Hours Before Surgery: Complete Fasting

The stomach must be completely empty before general anesthesia. Therefore, all food and liquid intake is stopped 8-12 hours before the surgery.

Medication Adjustment

Pre-operative medication use is carefully reviewed. Some medications may need to be temporarily discontinued or have their dosage adjusted.

Medications That May Need to Be Temporarily Stopped

• Blood thinners (aspirin, warfarin, clopidogrel): Usually discontinued 5-10 days before surgery
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Stopped at least 1 week before surgery due to increased risk of stomach bleeding
• Herbal supplements: Garlic, ginkgo, fish oil, and ginseng may increase bleeding; stopped at least 2 weeks before
• Birth control pills: May be stopped 4 weeks before surgery to reduce the risk of thrombosis

Medications That May Need Adjustment

• Diabetes medications: Dose adjustment is required before and after surgery. Patients using insulin require especially careful monitoring.
• Blood pressure medications: Usually can be taken at half dose on the morning of surgery; this decision is made by the physician.
• Thyroid medications: Generally continued as normal even on the day of surgery.
• Reflux medications: May be initiated before surgery.

Supplements That May Need to Be Added

Based on identified deficiencies:

• Vitamin B12 supplement
• Vitamin D supplement
• Iron supplement
• Multivitamin

It is essential to strictly follow the medication list provided by the physician. No medication should be started or stopped without the physician's approval.

Smoking and Alcohol Use

Smoking significantly increases the risk of complications during and after surgery. It delays wound healing, increases the risk of infection, and may cause respiratory problems. Therefore:

• Smoking should be stopped at least 4 weeks before surgery
• Alcohol consumption should be stopped at least 2 weeks before surgery
• Smoking and alcohol should be avoided for at least 6 weeks after the operation

Physical Activity

Regular physical activity before surgery accelerates the patient's recovery and reduces surgical risks. Activities planned based on the patient's condition include:

• 20-30 minutes of daily walking
• Light-pace swimming
• Stretching exercises
• Breathing exercises

Excessively strenuous activities should be avoided, and movements should be gradually increased.

The Evening Before and the Day of Surgery

Final preparations before surgery include:

• Showering the night before
• Removing nail polish, makeup, and jewelry
• No food or drink after 10 PM the previous evening
• Taking recommended medications with a small amount of water (if any)
• Preferring comfortable and loose clothing
• Bringing important documents and reports
• Having a companion accompany you

Importance of the Pre-Operative Process

The preparation process is critically important not only for the safety of the surgery but also for long-term success. During this period, the patient:

• Begins learning new eating habits
• Develops body awareness
• Mentally prepares for change
• Manages health conditions through early intervention

The more disciplined the approach to the preparation process, the more successful the surgery and post-operative lifestyle change will be.