Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Post Bariatric Surgery Monitoring (Draft)

Checked: not set yet by vicky.ryan Next Review: not set yet

Overview

Patients who have had Bariatric Surgery carried out under the NHS have follow up within specialist services for the first 1-2 years post surgery.

These guidelines are aimed at all non-specialist clinicians, dietitians and nurses to aid management of these patients once they are discharged back to primary care and aid management of any patients where follow up guidance by the surgical team was not issued.

Please note that patients who have moved area or who undergo a private procedure are likely to have had less specialist follow up and may need to be managed in primary care earlier, post procedure.

Ten top tips for the management of patients post bariatric surgery in primary care

1. Keep a register of bariatric surgery patients and record the type of procedure in the register. Please note that follow up varies according to the type of surgery.

2. Encourage patients to check their own weight regularly and to attend an annual BMI and diet review with a health professional.

3. Symptoms of continuous vomiting, dysphagia, intestinal obstruction (gastric bypass) or severe abdominal pain require emergency admission under the local surgical team.

4. Continue to review co-morbidities post surgery such as diabetes mellitus, hypertension, hypercholesterolaemia and sleep apnoea as well as mental health.

5. Review the patient’s regular medications. The formulations may need adjusting post-surgery to allow for changes in bio-availability post surgery.

6. Bariatric surgery patients require lifelong annual monitoring blood tests, including micronutrients. Encourage patients to attend for their annual blood tests.(See guidance in the section below)

7. Be aware of potential nutritional deficiencies that may occur and their signs and symptoms. In particular, patients are at risk from anaemia and vitamin D deficiency as well as protein malnutrition and other vitamin and micronutrient deficiencies. If a patient is deficient in one nutrient, then screen for other deficiencies too.

8. Ensure the patient is taking the appropriate lifelong nutritional supplements required post surgery as recommended by the bariatric centre. Ensure guidance regarding vitamin supplementation has been issued by the bariatric surgery team. Request a copy for the patient’s GP records if this has not been included in the discharge information. (Also see information in the section below.

9. Discuss contraception – ideally pregnancy should be avoided for at least 12-18 months post surgery.

10. If a patient should plan or wish to become pregnant after bariatric surgery alter their nutritional supplements to one suitable during pregnancy. Inform the local bariatric unit of patient’s pregnancy and the obstetric team of the patient’s history of bariatric surgery.

Source: RCGP Ten top tips for the management of patients post bariatric surgery in primary care on the BOMSS Website Clinical Resources (bomss.org)

Specific guidance

Please see the vitamin and mineral recommendations and the blood test monitoring required in the attachments below, based on the type of surgery the patient has had. These have been developed by NBT Bariatric Dieticians.

(BOMSS) Nutritional guidance 2020 - Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

(BOMSS) Nutritional guidance 2020 - Adjustable Gastric Band

Please check that the patient is taking the nutritional supplements as recommended in the guidance - non-adherence to supplements can often be the reason for deficiencies.

NBT patients 

Should you require advice about abnormal bariatric nutritional blood test results, the Bariatric Dietitians can be contacted on: BariatricAdmin@nbt.nhs.uk. This is not a formal advice and guidance service, and timescales for when the query will be answered cannot be guaranteed. 

Please note that the dietitians are only able to answer queries about former NHS patients who underwent bariatric surgery at North Bristol NHS Trust. 

Non- NBT patients

For other patients who have had surgery done privately or elsewhere, please consider contacting the service which performed their operation for their advice if possible.

If you still require advice and guidance but cannot access it please let us know via the Feedback button (top right of this page) so that we can assess the scale of the issue.

Referral

Referral to NBT weight management services should not be required for monitoring so please use the guidance above.

Acute complications

NBT is committed to seeing emergency bariatric patients at any time via the usual channels. The patient will be followed up until their emergency problem has been resolved.

Should more intensive follow up be required, but not deemed an emergency, re-referral can be considered but further funding would need to be established.