PREOPERATIVE
Patient attends preoperative visit with surgeon (1-2 weeks prior to surgery) to discuss post-operative course and expectations
Patient attends a separate educational class reaffirming short and long term expectations and recognizing complications
Patient given binder with all encompassing information related to perioperative journey
Patient given post-op scripts and 2 years of follow up appointments
2 week liquid diet prior to surgery if BMI > 45
NPO > 2400
OPERATIVE
Fluid management and Urine output:
1. intraop fluids limited to 1L
2. Foley not placed vs placed, but removed POD1
Intraop nausea management:
1. Decadron 8 mg
2. scopolamine patch for sleeve gastrectomy
Intraop pain management:
1. local long acting anesthetic at all incision sites and preperitoneal
2. toradol 30 mg
VTE prophylaxis:
1. preop lovenox 40mg
2. SCD
POSTOPERATIVE
Fluid management:
1. limited to 100cc/h
2. hep lock in AM if tolerating liquids
3. liquid diet started 2 hours after surgery
Nausea management:
1. Zofran
2. Phenergan
Pain management:
1. PCA (morphine or dilaudid) until POD1
2. Liquid narcotic POD1
3. Around the clock toradol
VTE prophylaxis:
1. SCD while in bed
2. Lovenox 40mg continued 14 days post op
Anticipated discharge for patients is POD1
80%+ patients are discharged POD1orPOD2
No routine use of drains
No contrast studies to rule out leak (selective use of contrast study to evaluate anatomy of sleeve gastrectomy, however, this does not delay onset of PO intake)