North Bristol NHS Trust performs 3 different types of weight loss operations of which all are keyhole (laparoscopic). This involves five small incisions (cuts) on the front of the tummy each usually less than one inch long. These allow the surgeon to introduce a small camera and fine instruments into the abdomen. The keyhole method allows for a quicker recovery and less chance of wound infection. While recovery is more rapid it must be remembered that you will have had major surgery.
Sometimes the operation can’t be performed using ‘keyhole surgery’, particularly if you have had previous surgery in the same area as there may be some scarring. Before your surgery the surgeon will have discussed with you the possibility of having an open operation. Obviously there will be a larger wound with this sort of operation and it is likely that you will recover more slowly as a result.
To help the operation go well it is important that before you have surgery you follow a low fat, low carbohydrate, and low calorie food intake known as the ‘preoperative diet’. This will be fully explained to you by the dietitian preoperatively and you will need to follow this for 14 days. Reducing your fat, carbohydrate and calorie intake results in the liver releasing it stores of energy, making it smaller. This helps the surgeon to see and be able to use the instruments more easily. Although you will lose weight it will not all be fat loss and you may find that you regain the lost weight after surgery.
The length of hospital stay will depend on the type of surgery but is usually 3 days for a bypass or sleeve gastrectomy and a day case for gastric bands. Before discharge you will be reviewed by the surgical team, bariatric practitioner and dietitian. Occasionally if a larger procedure is performed, or there were difficulties during the operation, you may stay longer.
The majority of people report that pain after the operation is only moderate. A few people (approx 1 in 10) complain of left shoulder pain. Movement and regular medication help, although as with many things time is often the best healer. Sickness is uncommon and is normally easy to control with medication.
We also perform surgery on patients who have had problems following their initial weight loss surgery (either performed at NBT or elsewhere). These operations can be difficult, take longer and the complication rates are therefore higher.
Risks of Surgery
The complication rates for weight loss surgery are low. Approximately 1 in 100 may have a problem after gastric band surgery, and 1 in 1000 may not survive the operation. Following gastric bypass and sleeve gastrectomy operations the risk of complications are approximately 3 in 100, and 1 in 500 may not survive the operation. These are historical figures and may in fact be much lower. Patients at higher risk are those who are heavier, older, those with other significant health problems or if they have had previous operations in that area.
The risks of gastric band surgery are low, but the band can occasionally slip, become infected or erode into the stomach. The oesophagus (gullet) can also stretch above the band if you overeat. If these complications occur, generally the band will need to be removed.
Gastric bypass and sleeve gastrectomy operations involve cutting the stomach, so leaks can occur. Should this happen then further surgery is usually required to deal with the leak. Bleeding from the staple lines can also happen and may require a blood transfusion. Internal twisting of the bowel can happen at a later stage following gastric bypass.
One of the major risks of this type of surgery is of blood clots within the legs (DVT), which can occasionally dislodge and get stuck in the lung (PE). We cannot completely get rid of this risk, but we can try to reduce it by giving you compression stockings to wear during and after the operation, giving blood thinning injections during your stay and getting you up and about as soon as possible after surgery. The risk of clots doesn’t go away for a few weeks, so it is important to keep wearing the stockings at home and being as active as possible.
Before being discharged from hospital you will be given information as to what to look out for when you get home, as well as what to do and who to contact if you are worried.