Weight loss surgery isn’t a ‘quick fix’ or a certainty that you will lose weight. It is a tool to help your weight loss. Successful weight loss will be entirely down to you making good dietary choices and being as physically active as possible. In the initial period after surgery you will only be able to eat very small portions and will probably not feel hungry. Both these factors may change with time.

It is important to realise that we don’t always eat because we are hungry.  We might eat out of habit or because we have learned to turn to food as a comfort when we are bored, or upset, or even happy.  This “head hunger” does not disappear with surgery and you must learn to overcome this if you want to be successful with your weight loss.

You should start to practice the following skills in preparation for surgery. These are designed to help you adapt to life after the operation.

• Have three small meals a day. Choose quality over quantity – go for healthy, great tasting, textured food in smaller but delicious servings.
• Avoid snacking between meals unless you are genuinely hungry. Try to choose a piece of fruit or other healthy option.
• Eat slowly: put a small amount of food in your mouth at a time and chew this very well. Eating at a table without any distractions (no TV) and putting down cutlery between mouthfuls can help.
• Do not aim to eat until you are ‘full’. After surgery, overeating will stretch your stomach pouch, causing discomfort and may make you vomit.
• Do not drink with meals. Wait at least 30 minutes after a meal before you have a drink. Make sure you have at least 2 litres of fluid a day.
• Avoid all fizzy drinks.
• Choose textured foods that satisfy your stomach. Drinking high calorie liquids or eating foods that ‘melt’ (crisps, chocolates, cakes, biscuits, ice-cream) will mean that you won’t lose weight. These foods slip straight through, don’t make you full and result in a very high calorie intake. Your dietician will provide information on appropriate ‘textured’ foods.
• Get out and be active! Swap computer and TV time with active time to improve fitness and energy levels and get the most out of your weight loss.

Certain foods can be a problem for some people. These can include chewy meats, soft white bread, rice, fibrous fruit and vegetables, nuts and seeds. These should be avoided at the beginning and re-introduced slowly once a ‘normal’ diet has been established. Everyone is different as to what they can manage and you will need to find out what is right for you by trial and error.

You will be given lots of help and information about the pre and post-operative diets that need to be kept to by our dieticians and nurses.

Most people recover very quickly after weight loss surgery and feel ready to go back to normal activities after a few days. It is important to remember though that you have had a major operation and to take it steady for a few weeks.

Wounds - The small wounds on your abdomen will either be glued or covered with a waterproof dressings after the operation. The dressings should be left for two- three days from the day of the operation (only change if the wound is oozing or the dressing has lifted off and is no longer waterproof). By that time, the wounds are usually healed enough to remain uncovered and the stitches used are dissolvable. You can shower as normal from the day of surgery but avoid baths until wounds are fully healed approximately 6 weeks after surgery. If you notice any sign of wound infection (pain, redness, swelling or pus) you are advised to visit your Practice Nurse or General Practitioner for a wound check.

Exercise - Gentle outdoor exercise is important as well as getting plenty of sleep and keeping your fluids up. You should gradually try to increase your exercise until you are walking for 30 minutes per day. You should aim to walk at a speed that makes you slightly short of breath and sweaty.

Driving - You may drive as soon as you can comfortably wear a seat belt and are able to perform an emergency stop. You should check with your insurance company for their specific advice about driving after keyhole (laparoscopic) surgery. It is advisable to avoid heavy lifting for at least two months after abdominal surgery.

Pregnancy - Losing weight can increase fertility but we strongly recommend that you do not become pregnant for 2 years following surgery as weight loss may have effects on the unborn child. If you do not already have regular contraception it may be worth visiting your local family planning centre for advice. If you get pregnant with a gastric band, the band can be deflated during the period of pregnancy to ensure the baby gets sufficient nutrients and that you can breastfeed afterwards. The band can then be re-inflated when the time is right.

Emotion – It is common for patients to feel tearful, irritable and vulnerable in the first few weeks after surgery. This is a normal response as surgery is a life changing event. This is usually temporary and improves once you start eating more solid food and get back to your normal routine. Please contact a member of the team if you need reassurance or are finding it difficult to cope

Partying – Being socially active is very important to positive emotional wellbeing, but be careful not to overdo it. We advise you not to drink any alcohol for 3-6 months after surgery and may be more prone to the intoxicating effects of alcohol than you used to be. Also bear in mind that alcohol contains calories without any nutrients and can be high in sugar. You may resume sexual activity as soon as you feel comfortable.

Follow up

We look after our patients closely after surgery and are always available for any problems or questions you may have. The first check up after your operation is generally at six to eight weeks. After that the follow up regime will vary and you will be given further details at the time of your operation. You will require regular blood tests for the rest of your life after bariatric surgery.  It is important that you attend any follow up appointments or let us know if you can’t attend so that we can re-arrange it for you and offer the original appointment to another patient.

We are funded to support patients for two years following surgery.  After this time your care will be handed back to your GP. 

This operation involves removing approximately 80% of the stomach, leaving a thin tube or sleeve (about the width of your thumb) which holds about 50-100mL of fluid (about ½ cup of tea). The ‘gut’ or digestive tract remains intact below the stomach. It works by restricting the volume of food you can eat. It also removes some stomach cells that produce a hormone that controls hunger, so patients often don’t feel as hungry afterwards. This has positive effects on diabetes and often patients can stop their medication after surgery. The operation takes about one hour and the hospital stay is 1 day.

Advantages: Sleeve gastrectomy is simpler than gastric bypass and has similar initial effects on diabetes. You will need to take vitamins for life afterwards.

Disadvantages: It may worsen severe acid reflux and is irreversible.

The gastric bypass is a more complicated procedure and involves the creation of a small pouch at the top of the stomach with staples. The remaining stomach stays in place. A section of intestine is ‘plumbed’ into this pouch so that the food bypasses the rest of the stomach and enters the intestine lower down. There are therefore two joins of the intestine inside. It works by limiting the amount you can eat at each mealtime but also by altering the hormone levels produced by the gut to improve diabetes and make you less hungry. The operation takes about one hour and the hospital stay is usually 1 day.

Advantages: It is very effective at weight loss and may be the best option in diabetes and acid reflux.

Disadvantages: The risks of surgery are higher than for simpler operations, it is essentially irreversible and you will need to take daily vitamin supplements for life after surgery.

The band consists of a silicone tube with a balloon device on one end and an inflation port on the other. It is fitted at the very top of the stomach with a small ‘inflation port’ underneath the skin on the left hand side of the tummy. It works by dimming the appetite and slowing your eating down. This, together with behavioral changes and mindful eating aims to result in lessening the volume of food you eat.  The tightness of the band can be adjusted by altering the volume of liquid within the band by a simple injection into the port. The operation takes less than an hour, although there is time taken in both putting you to sleep and waking you up afterwards so the overall time away from the ward is three to four  hours.

Advantages: The gastric band is the simplest and safest procedure. There are no permanent changes made to the stomach and it can be removed (although this would allow your weight to regain, so you should consider the operation as permanent).

Disadvantages: It may not work for everyone and up to ten per cent require further surgery, possibly as an emergency and it may not reduce appetite. You will need to attend hospital frequently for checks and adjustments initially.

North Bristol NHS Trust performs different types of weight loss operations of which all are keyhole (laparoscopic). This involves five small incisions (cuts) on the abdomen 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 ‘pre-operative liver shrinking diet’. This will be fully explained to you by the Bariatric Clinical Nurse Specialist pre-operatively 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 1 day for a Bypass or Sleeve Gastrectomy and a day case for Gastric bands or Intragastric Balloons.  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.

Revision surgery

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.

We have strict criteria as to who is eligible for weight loss surgery. This not only depends on your weight, but also the presence of other health problems or psychological issues. Not everyone is suited to surgery as it means a complete change in lifestyle and some people find difficultly coping afterwards. Most of our patients however do very well and achieve good long term weight loss.

If your GP considers that you may be suitable for surgery they will refer you to us. You will then undergo detailed assessment with members of our team. This will include a nurse, dietician, and a surgeon. You may also be required to see a weight loss physician and psychologist. You may need to come back on a few occasions to address issues identified at that time or perform pre-operative tests. Once the team as a whole are happy that you are ready to go ahead with surgery we will add your name to the waiting list. This whole process can take a number of months. During the assessment, the types of operation will be discussed with you as not everyone is suited to each procedure.

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