Obesity Surgery Your Questions Answered - Obesity Surgery Guide

1.  How much weight will I lose?

This depends on what type of surgery you have had.  On average, if you have undergone gastric banding then you are looking at a 50 to 60% weight loss.

If you have had gastric bypass (Roux-en-Y) then you are looking at a bit more, say around 60 to 70%. 

If you have had a biliopancreatic diversion (with or without a duodenal switch) then you are looking at 70% weight loss.

And, if you have had a sleeve gastrectomy then weight loss is likely to be 30 to 50%, but bear in mind that this is often performed as the first part of a two stage approach.  This is often performed before a gastric bypass or a duodenal switch. 

Remember; these are average figures and all patients are different so they can vary slightly.

2. Will there be some pain after surgery?

You can expect there to be some discomfort such as a sore and swollen abdomen.  This is entirely normal and is as a result of two things: the incision/s (open or keyhole) where the camera and instruments were passed through can be quite sore.  And you may find that you have pain in your left shoulder: this is actually due to a deeper pain in your diaphragm. 

Also, your surgeon may inflate the abdominal area using carbon dioxide in order to have more space to work in.  Bubbles or pockets of gas can remain which can cause some pain.

However, you will be given painkillers such as ‘co-codamol’ which will help to ease the pain.

3. What can I eat after surgery?

For the first 24 hours you will only be able to take small sips of water.  You will then progress onto a liquid diet (soups etc) for two weeks.  This is followed by two weeks on semi-solid food and then finally, you can try solids.

Remember that your diet is very important and so you will need to monitor it very carefully. You will have to get used to eating much smaller portions and, if you have always been a ‘quick’ eater, you will have to change to being a much slower one.

If you’ve had gastric banding then you will have to get used to the band and how it feels.  This means only eating small amounts and slowly.  Do not drink water at the same time and try to avoid fatty or high calorie foods.  Your dietician will be able to advise you about this.

If you’ve had a gastric bypass or a biliopancreatic diversion with or without duodenal switch (BPD/DS) then you will be encouraged to follow a healthy diet.  This means fish, chicken, fresh fruit, vegetables and wholegrains.  You will only be able to eat small amounts and it is recommended that you avoid sweets or sugary foods as these can cause ‘dumping syndrome’.  Again, your dietician will be able to advise you about this.

4. How much time will I have to take off work?

This very much depends upon the type of job that you do.  If you do an office job then you can return to work after a week if you’ve had gastric banding; and after two weeks if you’ve had a gastric bypass or a BPD/DS.    

If you have a physical or manual job then you will need longer time off work.  This may mean a couple of weeks for gastric banding and three weeks for a gastric bypass or a BPD/DS. 

It will take around six to eight weeks before the abdomen and bowel is healed so it is important that you avoid any strenuous activities or sport until it has done so.

5. Can I exercise?

Yes.  To start with we would recommend that you do walking as you want to avoid putting any undue strain on your surgical wound.  That rules out lifting weights at the gym!  Once this wound is healed you can then try any exercise that you’d like.  Exercise along with your diet forms part of your aftercare plan and it vitally important to your progress.
 
6. I want to have this surgery done on the NHS, how long will I have to wait?

Any surgery undertaken on the NHS will mean spending some time on a waiting list.   A lot depends on where you live and you may find that there is a waiting list of two to three years for surgery.

Due to competing demands for cash within the NHS some procedures attract a greater amount of funding than others.  And, every area has a PCT (Primary Care Trust) which decides how the funding is allocated.  If a particular procedure ‘uses up’ a large amount of funding then there may not be money available for your procedure.

Obesity is still not seen as a top priority (although things are changing) and as such is lower down the funding list.  Some PCT’s do not have funding for obesity surgery and this is something you will have to check with them. 

Visit the BOSPA (British Obesity Surgery Patient Association) website for more information.

7. Will there be much scarring?

Surgeons try to ensure that scarring is kept to a minimum.  Some people are prone to thicker scarring than others.  Your clothing will hide these scars and they will gradually fade.

8. Can you regain weight after weight loss surgery?

If you do not stick to the diet and exercise plan that forms part of your aftercare then you will start to regain weight.  Remember the old energy balance formula – energy in versus energy out.  If you take in more calories than you need then you will put on weight.  If you burn off more calories than you need then you will lose weight.

Weight loss surgery is not ‘a cure’ for excess weight.  If you return to old eating habits then you will most certainly gain weight.  This is a permanent change of lifestyle which means that you have to stay with it for the rest of your life.

9. Can anyone with a weight problem have surgery?

Surgeons have a strict set of criteria which they use to assess a patient’s suitability for surgery.  These criteria are recommended by NICE and are meant to safeguard the patient as well as the surgeon. 

Obesity surgery is really only to be considered when you have tried all other forms of weight loss such as diet, exercise and weight loss medications.  It is not an easy option: like all surgery it does come with risks and they need to be weighed up against your weight problems.  Obesity does increase your risk of suffering from a weight-related condition such as heart disease or stroke.  It can also take a few years off your life so consider this against the benefits and risks of obesity surgery.

Many people who have chronic weight problems can have surgery: if not then there is the option to have the gastric balloon.  However, any decision on your suitability for surgery is made via a discussion between you and your surgeon. 

As well as suitability criteria there are a set of guidelines for exclusion from surgery.  These include alcohol and/or drug abuse and a history of severe heart or lung problems.

10. Can I drink alcohol?

Yes, but only in moderation.  Alcohol tends to contain a lot of calories and so can result in weight gain if you are not careful.  Be aware that after surgery any alcohol that you have will be absorbed a lot quicker into your bloodstream which means that intoxication will be quicker.

Too much alcohol can also lead to stomach ulcers so try and limit your intake.

11. How soon can I drive after surgery?

Your recovery – depending on what procedure you have had, will take a few days and so we recommend that you do not drive in that time.  You will be recovering from the effects of the anaesthesia and any painkillers given to you following surgery.  These can make you drowsy so driving is not advisable.

You may want to wait until a week to 10 days following surgery before driving.

12. Which is the best surgery for me?

Everyone is different and so there is no hard and fast rule regarding the ideal procedure.  Every procedure is safe and effective and they all have their benefits and risks. 

There is no ‘one size fits all’ procedure.

This is something that you need to discuss with your surgeon.

13.  Does gastric banding always work?

In the majority of cases it is successful but like any type of surgery there are a few failures.  These tend to average around 10 to 15% and failure happens for a variety of reasons:

• Failure to stick to a prescribed diet.
  
• Lack of exercise or refusing to undertake an exercise plan.
  
• Slipping or leaking of the band.
  
• Non attendance at the follow up sessions.

If someone is reluctant to work with the band or to comply with the diet and exercise plan then there is very little that can be done.

14. Does gastric bypass always work?

Every surgical procedure has a failure rate and gastric bypass is no exception.  Failure can be down to a reluctance of the patient to follow a healthy eating plan and exercise schedule; not taking the required daily vitamin/mineral supplement and not attending any aftercare appointments.

15. Can I still go out for a meal with family and/or friends?

Yes.  Even though your diet has changed and you are eating smaller portions you can still enjoy a meal out.  As long as you think carefully about what you can eat and choose small portions then there shouldn’t be a problem.  Try to avoid fatty or spicy foods and rich, sugary desserts and you will be alright.

16. I have sagging folds of skin after surgery, will I need
      cosmetic surgery?

It is certainly an option.  The older you are the less elasticity your skin has which means it will be more prone to ‘drooping’ than a younger person’s skin.

After obesity surgery you will find that you have lost a great deal of weight but are now left with a few stubborn fat deposits and unsightly folds of skin.  Cosmetic surgery procedures such as liposuction (fat removal) and abdominoplasty (tummy tuck) can help.  These and other similar techniques are called ‘body contouring’ and are designed to give you a more natural looking shape. 

You are advised to wait for two years following your obesity surgery before embarking upon cosmetic surgery.

This cannot be done on the NHS so you will have to ‘go private’ which means paying for it yourself.  If you have private medical insurance then you may find that your insurer does not cover cosmetic surgery as it is as seen as a form of enhancement.

You may be looking at paying £4,000 for this surgery.