Preoperative
Authors: Kasper Baasch Nielsen, Med. Stud., Mie Pilegaard Bjarnesen, Med. Stud., Anne Mosebo, MD, Julie Tastesen, MD and Magnus Balslev Avnstorp, 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
- 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
With the patient standing: Inspection with the arms abducted 90 degrees and the forearms extended as well as when adducted close to the body. Pinch the medial part of the arms to inspect excess skin as well as the laxity and quality of the skin.
With the patient laying down: Flexion of the shoulders and elbows in 90 degrees and assessing the previous markings in relation to the expected stress on the skin after removal of the excess skin.
Preoperative information
| Postoperative scarring | Location Size Scar might be difficult to hide Risk of widening and hypertrophic transformation |
| Postoperative risks | Infections Hematoma Ruptures of the incision site Healing complications Loss of sensation in the affected area Re-operation in case of complications |
| Pressure garments | Pressure garments will be used postoperatively |
| Excessive skin | 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 or INR monitoring. The regulations from the Danish Society of Thrombosis and Haemostasis is 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
