How much weight will I lose?
Everyone is different and several factors affect this. Assuming that the operation has gone well, weight loss of about 1 kg (2 pounds) per week is common in the first few months after the operation. It is generally faster after a gastric bypass than after a gastric band. With all the operations, weight loss tends to slow down after 6 months but it can continue for 2-3 years if you continue to eat appropriately and increase your level of activity/exercise. Slow, gradual weight loss is desirable: losing weight too quickly is unhealthy and can lead to nutritional deficiencies. If all goes well, you can expect to lose on average, about 50% (half) of your excess body weight in the first few years and it can continue beyond this. Success depends on sticking to the rules of your new eating behaviour supported by your weight loss surgery operation.
How long will it take to recover after surgery?
The intragastric balloon is just a day case procedure done under sedation and requires only a few hours in hospital. It is common to feel quite nauseated for several days, even a week or two afterwards and some time off work is recommended during this period.
Patients having the laparoscopic gastric band typically spend less than 24 hours in hospital and most are ready to return to work after about a week. Gastric bypass surgery and the sleeve gastrectomy involve a hospital stay of 3-5 days and perhaps a month off work. If open surgery is required or if complications develop, recovery may take longer. Remember, losing weight can make you tired in itself.
What sort of follow up is required after I leave hospital?
You will leave hospital with clear instructions about what to eat for the first few weeks. You will also have the contact details for our nurses and dietitian in case you have any problems, or concerns. The nurses will contact you within the first week at home to check on your progress and make further appointments - perhaps weekly or fortnightly during the first 6 weeks depending how you cope with your weight loss operation. After 6 weeks, further appointments are made every four to twelve weeks for the first year, again, depending on how you get on. Depending on what operation you have had, follow up visits will be every three to six months during the second year and ideally every 6 months after that, forever.
Will you keep me under review?
Yes, we will follow you closely over the post-operative period and you total package includes follow-up for 12 months. After that, an annual check up is often all that is necessary. This would include doing some blood tests to look for early signs of nutrient deficiencies. You will be able to eat most foods with time. Some foods will pass through the bowel very quickly, and trial and error will help you avoid these. However, we recommend that you do take multivitamin tablets (which often contain other important things like iron and calcium) to minimise the risk of deficiencies. Such follow up can often be arranged with your GP and does not require you to return to see your hospital specialist.
Can the operation be reversed?
The operations are designed to be permanent (with the exception of the intragastric balloon, which is designed to be removed after 6 months) because obesity is a chronic disease that requires lifelong treatment. However, a gastric band can be removed. This requires another operation, usually laparoscopic (keyhole) but sometimes the band can be removed endoscopically (telescope through the mouth). This decision will be made after discussion with your surgeon. After removal of the gastric band your stomach will nearly always return to its original form and your digestive system should function normally.
It is much more difficult to reverse a gastric bypass although it can be done. This usually requires open surgery, not laparoscopic. Because of the previous cutting and rejoining of the stomach and intestines, your digestive system will never be quite the same again and your digestion may not return completely to normal.
The sleeve gastrectomy cannot be reversed, as much of the stomach has been taken away. However, it can be converted to a gastric bypass. This can usually be done laparoscopically.
Remember that if your operation is undone - whatever operation it was in the first place - your weight is very likely to increase.
Will I need plastic surgery for the surplus skin when I have lost a lot of weight?
Not necessarily. Slow weight loss often gives the skin time to shrink back towards its original size. Before any plastic surgery should be considered, your weight should have stabilized. This is likely to be at least a year or two after the operation. It is also recommended that you should have almost reached your target weight as well, before considering plastic surgery. Plastic surgery has all the risks and complications of major surgery of course, and could be expensive. We suggest that you give yourself plenty of time before you decide to have more surgery.
Will I feel hungry after weight loss surgery?
As a rule, no. The gastric band gives you a feeling of fullness by reducing the capacity of your stomach and also by holding the food in your stomach pouch for some time after you've eaten. The gastric bypass and sleeve operations also give you a smaller stomach so only a small meal makes you feel satisfied. If you follow the dietary guidelines and eat slowly, you should not feel hungry very often.
What about pregnancy?
Becoming pregnant can be easier as you lose weight. Indeed, some patients have weight loss surgery primarily for this aim. Your menstrual cycle may become more regular as you lose weight. If you have a gastric band, it can be loosened as your nutritional requirements increase through the pregnancy. After pregnancy, the band may need to be tightened again either to help you lose weight gained during pregnancy or help you keep your weight stable. If you have had a gastric bypass or sleeve gastrectomy, you may need extra nutritional supplements during pregnancy. This can be guided by our dietician in addition to your GP and midwife.
Will I need to take vitamin supplements?
We recommend these as a matter of routine, as you may not get enough essential vitamins and minerals from three small meals a day. After a gastric band, vitamin and mineral supplements are probably not absolutely necessary. But if you have had a gastric bypass operation, you will certainly need vitamin supplements because nutrients are not absorbed very well from your diet anyway. From time to time, our nurses and dietician will check whether you are getting enough vitamin B12, folic acid, calcium and iron by discussing your diet and taking blood tests.
What about taking medication?
You should be able to take any of your usual prescribed medication, although after a band you may need to break large tablets in half or dissolve them in water so they do not get stuck in the stomach, leading out of your gastric pouch. If tablets sit in the small stomach pouch for a long time, they may irritate the stomach and even cause ulceration. It is worth checking with your doctor about this with any new tablets that are prescribed. We hope in the long term to reduce the number of tablets you need to take. For many patients, as they lose weight, they can safely stop taking blood pressure, diabetes, and arthritis medication. Stopping such medication should be under the guidance of your GP or hospital doctors.
What if I go out to eat?
You should order only a small, entrée or starter sized amount of food and eat slowly so that you finish at the same time as everyone else. You might want to let your host or hostess know in advance that you cannot eat very much. Remember that we discourage drinking at the same time as you eat a meal, as this tends to wash things down and reduces the feeling of fullness from food sitting in the stomach. If you are embarrassed asking for child's sized portions, BOSPA (the British obesity surgery patients association) produces a handy credit card sized card that explains why you cannot eat larger portions. Membership of BOSPA is via their website.
What about alcohol?
Alcohol has a high number of calories and breaks down vitamins so is generally discouraged. However, the occasional glass of wine or equivalent is OK and may even be good for you in other ways. Be wary of fizzy drinks if you have a gastric band in place as it may be difficult to burp up the gas. We recommend that you should avoid calorie containing drinks such as alcohol while you are in the weight loss stage following your surgery.
How does weight-loss compare after the various different operations?
Many studies have been done to compare the gastric band and the gastric bypass. Patients having the gastric bypass operation generally lose weight more quickly in the first year, but then their weight loss slows down. Over the longer term the gastric bypass is shown to produce more weight loss, with less weight regain further down the line.
There is relatively little information about the long term outcome of the sleeve gastrectomy as it is a newer procedure. However, results suggest that the weight loss profile is similar to that achieved after a gastric bypass – at least for the first few years. Some surgeons are concerned about late weight regain following a sleeve gastrectomy owing to gradual dilatation of the stomach tube with time. However this has yet to be proven.