Prior to bariatric surgery, each patient will need to complete a pre-assessment appointment to review their continued fitness for anaesthesia to proceed to have weight loss surgery. If the pre-assessment team assess that it is safe for you to proceed to surgery, you will then be offered a surgery date. Sometimes you are offered a surgery date before pre-assessment.
Everyone will be required to complete a liver reduction diet before weight loss surgery.
Your surgeon may also ask you to complete a liver reduction diet before other operations, such as hernia repair or gallbladder surgery, to increase the safety of the operation and to prevent organ injury during the operation.
When you are overweight and suffer from the disease of obesity, your liver becomes fatty and large and it covers other organs. This makes it difficult for the surgeons to see clearly when they operate. In addition to obscuring the surgeon's visual field, a large liver is also more likely to get injured and bleed during surgery. Therefore, to make your surgery safer, all patients must complete at least 2 weeks of liver reduction diet. This helps reduce the volume of your liver. If it is clinically necessary or if your BMI is over 50kg/m2, your surgeon may ask you to follow a liver reduction diet for 6 weeks and sometimes even longer.
You may have encountered a variety of liver reduction diets used by other hospitals, however our trust has a specific policy around the diets we recommend, and we advise you to follow our policy to improve your safety.
We offer a choice of 6 different diet options - you will learn about these options in your second mandatory education session or you may be given a copy of this diet by the preassessment team.
All 6 options are liquid, commercial meal replacement shakes or milks, which will replace all meals and food for the full 2 weeks or longer.
Each option provides fewer than 1000kcal daily, contains 100 � 120 grams of carbohydrates, and minimal fat, while providing on average 60 grams of protein.
Each option provides fewer than 1000kcal daily, contains 100 � 120 grams of carbohydrates, and minimal fat, while providing on average 60 grams of protein.
Each option is nutritionally complete, when followed exactly as directed, meaning it provides all your daily micronutrients (vitamins and minerals).
It is very important not to eat anything else during the diet and only consume the following additional fluids: water, sugar-free squash, black tea, black coffee, oxo stock cubes or Bovril. You should aim for at least 2 litres of fluid daily.
Most people lose between 4-6 kg (just under a stone) during their two-week diet.
If the surgeon is concerned that your liver is insufficiently fasted and it is unsafe to proceed, your surgeon will abandon the procedure.
As the diet is low in energy and carbohydrates, most people have side effects which can include headaches, bad breath, nausea, stomach cramps, diarrhoea or constipation, fatigue, irritability, dizziness and faintness. To help ensure your safety, you will be monitored on weekly basis by telephone, if we ask you to follow the diet for more than 4 weeks.
As the diet is low in carbohydrates, people with diabetes need to be cautious. If you are on any diabetes medications and / or insulin, please contact your diabetes medication prescribing team or your GP before starting this diet as you may need to alter the dose of some of your medications and / or insulin to avoid low blood sugar levels (hypoglycaemia).
The meal replacement shakes during the liver reduction diet are not available on prescription. All options need to be purchased at your own expense.
We will give you the estimated cost of each option during the presentation at your second mandatory education session. Please note that if you have not yet completed the second mandatory bariatric education session (PS1GB) contact the bariatric service without delay, you cannot have surgery without completing this key component of the pathway. You can reach the Bariatric Service on: 0207 288 5989 or 0207 288 3071.