What exactly does the operation involve, and what are the risks?
There are a number of different weight-loss operations available. The gastric band operation involves placing a band around the upper stomach. This band has a balloon inside leading to a narrow tube, which is connected to a reservoir placed under the skin. The balloon in the band is inflated using a special needle, which is placed through the skin into the reservoir. This will tighten the band. The amount of fluid in the balloon will need to be adjusted over subsequent weeks to produce the required weight loss. Gastric sleeve/sleeve gastrectomy involves removing 3/4 of the stomach whilst vertically preserving the continuity of stomach.
For a gastric bypass, the upper part of the stomach is divided and joined onto the small bowel so that the main reservoir of the stomach, and 1/3 of small intestine, is bypassed. Omega gastric bypass or mini gastric bypass is basically half the gastric bypass in that there is no Roux-en-Y formation of the gastric bypass. BPD/Duodenal switch includes two parts–restrictive and malabsorption. The first part is sleeve gastrectomy and the second part is the actual duodenal switch, i.e. the distal bypass starting at duodenum level. These two parts can be staggered so that one can have sleeve gastrectomy first, and then duodenal switch 6-18 months later.
How long will the procedure take?
Gastric banding and sleeve gastrectomy take about 30 minutes, gastric bypass takes forty-five minutes and, duodenal switch takes an hour and a half. Revisional surgeries take much longer.
How long will my recovery take?
You stay in the hospital for one or two nights. You are able to walk well by the second day. You can drive within a week. You are able to go back to work within a week to 10 days. You can go to gym and swimming in two weeks.
Will I be in pain after surgery?
You’re likely to experience more of a discomfort rather than pain immediately after surgery, as you will be given painkillers by vein on a regular basis. Most people do not take painkillers after two days.
How active can I be after the operation? Will I need a lot of rest?
You can start walking within a day of the surgery. It’s best to increase your physical activity gradually. You should be able to do most activities within a week. Resting and physical activity are equally important in the first week.
What support will be available to help me cope after the operation?
You have access to the bariatric nurse or surgeon 24 hours a day, and you will be seen at two weeks, four weeks and then bi-monthly for the first year, and then yearly afterwards. You can communicate by text, phone, email or visit in person. You have also access to other bariatric surgery patients via bariatric support group meetings.
How much weight will I lose and how quickly will I lose it?
This depends on what surgery you have. With gastric bypass and sleeve gastrectomy, you lose about 50-70 percent of excess weight, with gastric banding about 45 percent of excess weight and with BPD/duodenal switch about 70-80% excess weight. Most of the weight loss occurs in the first 6-12 months.
Will I put the weight back on?
You can, depending on what you are eating. This also depends on what type of surgery you have. A gastric band can be cheated and so it fails in 10-20 percent of people. Reverting back to bad habits, eating unhealthily and not exercising will cause the problem.
What will I be able to eat after the operation?
You will be on a liquid diet for 2-6 weeks, depending on what surgery you’ve had, followed by a soft diet for a couple of weeks, and then a solid diet. You have to remember to eat slowly, chew thoroughly and stop eating the moment you feel full.
How often will I be able to eat and how big should be portion sizes be?
You should aim to eat three to five times a day with a gap of three hours between meals. Initially, the portion sizes are very small and you should be able to eat small plate of food at one year. For a gastric band to work, the amount you have to eat is very small, and the gastric band has to be adjusted to achieve the desired target.
Which operation is the right one for me?
For people with a BMI of less than 40–45, sleeve gastrectomy and, to an extent, gastric banding are the treatments of choice. For those with a BMI greater than 40–45, diabetes or sleep apnoea, gastric bypass surgery or sleeve gastrectomy is the treatment of choice. If there is severe gastro-oesphageal reflux/heartburn then gastric bypass is the only answer. For those with BMI of more than 65, a duodenal switch with sleeve gastrectomy may be the right choice as performing sleeve gastrectomy first is less risky, and will make them fit for the next stage of the operation a few months later, especially in these high risk patients. However, these guidelines are not fixed, and selecting the right type of surgery for you should be made after a discussion with your surgeon.
