Preoperative

Authors: Magnus Balslev Avnstorp, MD, Mette Ydo Jacobsen, Med. Stud., Mie Pilegaard Bjarnesen, Med. Stud., Anne Mosebo, MD, Julie Tastesen, MD and Emir Hansanbegovic, MD

Patient history

Note the following information concerning the patient’s weight history:

• Cause of weight loss: bariatric surgery or lifestyle changes
• Maximum weight and BMI (at any point in life), current weight and BMI, and the decrease in BMI points
• Number of pregnancies
• Any mechanical issues during sports or other physical activities

Furthermore a thorough preoperative assessment including prior medical history is fundamental. Go to the chapter “Preoperative assessment” to read more.

Physical examination

Skin overhang, laxity and the thickness of the subcutaneous tissue is systematically examined and measured in centimeters throughout the following steps:

Patient in upright position with arms abducted in 90 degrees 

• Skin overhang above and around the umbilicus
• Overhang on the horizontal bikini line in cm from right to left side
• Overhang on the mons
• Scars on the abdomen following surgery e.g. appendectomy or caesarian
• Thickness of subcutaneous fat examined by pinching 

Patient in bend forward position 

• Skin above and around the umbilicus is examined and overhang determined

Patient in laying position

• Abdominal wall muscles are examined for signs of rectus diastasis or hernia

Examination of diastasis recti is addressed in the dictionary:

Diastasis recti

Examination of hernias is addressed in the dictionary:

Hernia

Preoperative information

Postoperative scarring	Locations Size Risk of widening and hypertrophic transformation
Postoperative risks	Infection Hematoma Rupture of the incision site Healing complications Loss of sensation in the affected area Thromboembolic events Re-operation in case of complications Necrosis of the umbilicus
Drains	Drains will be applied during surgery and removal will happen postoperatively
Pressure garments	Constant use of pressure garments for the first 6 weeks. The following 6 weeks only during daytime.
Excessive skin	Inform about the risk of excessive skin returning in cases of fluctuating weight or due to natural aging of the skin

Preoperative preparation

• Broad blood samples
• ECG: in patients above 60 years of age or with known heart disease/symptoms of heart disease
• Anaesthesiological check
• Stabilize co-morbidities, e.g. diabetes
• If the patient is taking blood thinning medicine consider the need for pausation, bridging, INR monitoring. Regulations from The Danish Society of Thrombosis and Haemostasis are used in Denmark
  (https://www.dsth.dk/bridging2018/index.html)
• Assess the venous thromboembolism risk by calculating the Caprini score of the patient: https://www.mdcalc.com/caprini-score-venous-thromboembolism-2005