Weight loss surgery (Bariatric surgery) is a surgical procedure performed for treatment of morbid obesity. Weight loss surgery has existed since the 1960’s.
You must be between 18- 65 years of age and your body mass index (BMI) is greater than 40 kg/m2 or greater than 30 kg/m2 with a serious obesity-related health problem.
If you are over 65 years old, you must be referred by your doctor and be in good health, since surgery is higher risk in patients over 60 years old even with testing before surgery. Patients younger than 18 years may be candidate after full medical and psychological to assess their compliance and full orientation of the procedure.
What are the main types of weight loss surgery?
Modern day weight loss procedures include:
- Adjustable Gastric Banding
- Sleeve Gastrectomy
- Roux-en-Y Gastric Bypass
- Gastric Plication
- Mini Gastric Bypass
It is important for you to understand that the risks of surgery are low and that the majority of patients have no complications. However, as with any surgery, there may be immediate and long-term complications and risks. These risks are greater for individuals who suffer from obesity. Your weight, age and medical history play a significant role in determining your specific risks.
Weight loss procedures are performed laparoscopically.
Weight loss procedures are performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision.
All patients will have an abdominal drain for 1-5 days after surgery. No urinary or gastric tubes are left after surgery.
Advantages of Laparoscopic surgery over Open surgery:
1. More magnification of the surgical field with more meticulous surgical steps.
2. Less operative time.
3. Early recovery of the patient.
4. Reduced post-operative pain resulting in easier breathing and lung function.
5. Fewer wound complications, such as infection or hernia.
6. Faster return to work.
7. Shorter hospital stay.
8. Better cosmetic results.
Gastric band can be removed at any time.
Most patients experience an improvement in control of their diabetes following bariatric surgery. 80 % of diabetes patients are able to stop taking their diabetes medications after surgery.
Weight loss surgery is not indicated for patients with type 1 diabetes.
Weight loss surgeries are not plastic procedure, but they are procedures to improve health, quality of life, and, of course body shape (significant weight loss).
Complete blood count
Fasting blood sugar
Pulmonary function tests (Spirometer)
It is indicated for medical assessment of the patient for any medical diseases and assesses fitness for anesthesia and surgery.
Remember to bring your ID, your investigations and your referral to the hospital on the day of your admission.
You should stop smoking one week before surgery.
- Stop Aspirin, Advil, Celebrex or other pain killer one week before surgery.
- Stop Marevan or other anti-coagulating agents one week before surgery.
- Stop replacement hormones and birth control pills (and find other alternate for birth control) one week before surgery.
You should follow pre-surgery diet strictly, as this will:
- Reduce the size of your liver which would otherwise be in the way
- Help to reduce the risk of complications associated with the surgery
- Lower body fat levels for better access for the surgeon
- Reduce operating time
- Improved physical function and mobility post-surgery
To minimize these risks, anti-embolism stockings will be placed on your legs and Clexane will be given.
Usually patients return home after 24 hours after laparoscopic surgery (in contrast to 3 days after open surgery).
Usually pain is present in the first 24-48 hours after the operation. Any pain afterwards should be considered with further assessment.
After weight loss surgery you will need to make changes to your eating patterns. The diet after surgery progresses from a liquid diet to a pureed diet to a soft diet and then a regular diet. This progression is designed to allow your body to heal. It is very important that you follow the diet progression to maximize healing and minimize the risk of complications.
Most patients will be able to return to work one to three weeks after their weight loss surgery date. Returning to work can be the first sign of normality.
Most patients will be able to drive one to two weeks after their weight loss surgery date.
You can go swimming after 3 weeks after surgery.
Usually pain and tiredness improve during the first week; otherwise it should be taken into consideration.
Vomiting is associated with gastric band, if the patient is not following the instructions for proper eating habits.
Using an airplane is not a problem anymore at any time. However, it is better to stay for 10 days after surgery to be assessed before travel.
After adjustable gastric banding surgery you must undergo regular check-ups as an outpatient. Initially, these check-ups is carried out 6 weeks after surgery followed by a monthly visits. The band will gradually be filled through the injection port during the first 12-18 months following surgery. Once your weight has stabilized, check-up visits will become less frequent.
Adjustment of band is usually done in the clinic and it is quiet painful as any injection in the body.
Exercise on a regular basis is necessary lifestyle change after surgery. Exercise includes a sense of well-being, increase overall energy, and minimizes muscle breakdown.
After weight loss surgery, your body goes through potentially stressful changes and significant nutritional disturbance, which can cause problems for a growing baby. So, you should wait 12 to 18 months (until your weight almost becomes stable) before getting pregnant so that your baby is not affected by rapid maternal weight loss and you can achieve your weight-loss goals.
Weight loss surgery can produce a sudden positive change in your fertility. Women with fertility problems linked to obesity who have the surgery can start ovulating regularly for the first time in years.
Gastric banding surgery is adjustable. The band can even be deflated during pregnancy. Some women who are pregnant require deflation of the band due to severe nausea and vomiting, which can occur during pregnancy and as a result of gastric banding. This is typically an individual decision depending on the womenâ€™s medical condition.
Women who have undergone gastric banding before pregnancy may have trouble tolerating prenatal vitamins. They may develop heartburn or the prenatal vitamin may remain in their esophagus where it can cause ulcers. So, it is recommended to take chewable or liquid prenatal vitamins to avoid these unpleasant situations.
Gastric bypass patients will lose around 80 % of their excess weight, sleeve gastrectomy patients will lose around 70 %, and adjustable gastric banding patients will lose around 60 %. This depends on patient follow up and necessary lifestyle changes that must occur to make them successful over the long-term.
Gastric bypass and sleeve gastrectomy patients will typically lose 2-4 Kg per week early and they will reach their expected weight loss 12-15 months after their operation. On the other hand, adjustable gastric banding patients tend to have a slower, steadier weight loss (0.5-1 Kg per week) but they will reach their expected weight loss 24-36 months after their operation.