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Bariatric surgery

Bariatric surgery introduction

Bariatric surgery or weight loss surgery is an effective treatment used for some people who are morbidly obese, they may have significant health problems related to obesity such as Diabetes, sleep apnoea, Hypertension and arthritis, this is just a few of the health problems that can be improved significantly after weight loss due to bariatric surgery.

Who is eligible?

In most countries a person with a BMI (body mass index) of 35 and have co-morbidities such as type 2 diabetes or hypertension, or if you have a BMI over 40 without co-morbidities. In some cases, such as certain ethnicities the BMI range may be lower to qualify.

How do I get Surgery?

If you fit the requirements you should initially see your family doctor who will discuss your individual case and if bariatric surgery is appropriate. They will then refer you to a centre that can offer the pre and post operative care and expertise.

If you decide to have your operation privately you should still discuss your wishes with your family doctor. It is important you get the right level of preparation and follow up care as this varies greatly between centres. Follow up care for the rest of your life is important to ensure you remain healthy in the years after surgery. Some GP’s may not agree to continuing the follow up care if you chose to have you surgery privately.

 

Types of weight-loss surgery procedures

There are several types of bariatric surgery and you will discuss with your Bariatric team which surgery will be the most suitable for you. All operations are carried out under general anaesthetic (asleep), using laparoscopic techniques (keyhole surgery). Although the laparoscopic surgery gives a shorter hospital stay, you will still need several weeks to recover before returning back to normal activities.

We will briefly explain the two most common procedures.

 

Gastric Bypass

Gastric bypass is the most complex of the three procedures. A small pouch ( about the size of an egg) is formed from the top part of the stomach, the pouch is then attached to the small intestine bypassing the main part of the stomach and around 1 metre of small intestine. Whilst food no longer passes through the remnant stomach it still has a blood supply and other organs filter secretions into the stomach and through the bypassed intestine to help with the digestive process.

Because there is an element of malabsorption with the bypass you will not be able to absorb essential vitamins and minerals from your food therefore you will need to take a daily vitamin, iron and mineral supplement. Baricol Complete contains all the essential nutrients required after Gastric Bypass

Sleeve Gastrectomy

The sleeve gastrectomy involves removing around 80% of the stomach, a narrow tube of stomach (approx 100mls capacity) is formed, you will feel full after eating a small amount of food. Although the new stomach can stretch slightly over time, it will not go back to its original size.

Usually this operation is not suitable if you suffer from gastric reflux, after surgery the pressure in the stomach increases which could increase the symptoms of gastric reflux. Because most of the stomach i removed you will not be able to absorb essential vitamins from your diet, in particular Vitamin B12, therefore you will need to take daily vitamin, mineral and iron supplements for the rest of your life to maintain good health. Baricol Complete contains all the essential nutrients required after Sleeve gastrectomy.

 

Preparation for bariatric surgery

You will be required to go through essential assessment and education sessions before having bariatric surgery, this can include assessments with Dietitians, Nurses, Physicians, Psychologist and Surgeons over several months. During this period of time, any investigations that you require will be completed. During the pre-operative phase you will have to demonstrate that you have made significant changes to your diet and lifestyle, these new habits will help you live with the consequences of bariatric surgery. Dietary changes will usually result in weight loss, however it is essential that you become self aware of your eating habits and food choices.

In the weeks prior to your operation you will be asked to follow a strict liver reducing diet, this diet, which is low in carbohydrates and calories, helps to reduce the glycogen stores in the liver and to make moving it during the operation safer. The time that you have to follow the diet ranges from 2-6 weeks, your dietitian will advise you on how long you will need to follow the diet

Life after bariatric surgery

During the first few weeks after surgery you will be on a liquid only diet. This is to allow the new stomach to heal, textures will be reintroduced gradually. The diet may vary form centre to centre and differs depending on the type of surgery, but a typical plan is:

Weeks 1 & 2 fluids only – including nutritious shakes, soups, ( e.g. Slimfast, Meritene) milk based drinks as well as hydration fluids such as water, no added sugar squash, tea and coffee. Fizzy drinks are no longer advised after bariatric surgery.

Week 3 – Puree texture e.g yogurt consistency, any food made into a puree

Week 4 & 5 – Soft food e.g food mashable with fork

Week 6 onwards – normal textured balance healthy diet.

In addition, you will be advised to

Eat slowly, chew carefully, small mouthfuls at a time and wait a minute between mouthfuls. Reintroduce textured foods gradually, some foods you may struggle with initially, if this happens try them again in a few weeks time. While it is important to progress gradually to a normal diet it can vary between individuals. If you are struggling to progress through the stages intact your dietitian for advice.

After your surgery you will be asked to attend regular follow up appointments, currently you will continue to be seen by the bariatric team for 2 years after your operation. Take a daily vitamin and mineral supplement – Baricol complete offers a convenient , and tailored alternative to prescription vitamins available in the UK and most markets in Europe.