FAQs about bariatric surgery

No surgery is without risk, and bariatric surgery has particular risks. During the consultation visit, these risks will be discussed in detail so that an informed decision can be made.

The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring.

You will have pain after surgery.But it should be the usual pain after any surgery but it may be lesser in laparoscopic surgery.Still it depends upon your body condition and the type of procedure done for you. Ask our surgeon about other questions during the consultation.

You will likely go home the day after your surgery if you are:

• Drinking all your fluids
• Doing well walking
• Going to the bathroom
• Not having uncontrolled nausea or vomiting

Most patients will have a small tube to allow drainage of any accumulated fluids from the abdomen.This again depends upon the type of surgery and the decision taken during operation. This is a safety measure, and it is usually removed before you are discharged from the hospital.

Pain as already explained.There may be nausea due to anaesthesia but it would be controlled by medications. Other risk is blood clots in the legs which could be prevented by appropriate medications and stopped once you start walking.

You will be required to walk the evening of your surgery. You will have mild pain, but this is the best way to speed up your recovery.

Walk every two to four hours in the hospital, and at home after discharge. Patients who do this feel remarkably well one week following surgery.

Do not drive until after you stop taking pain medicine and are pain free for twenty-four hours.

The basic rules are simple and easy to follow:

• Exercise is key to weight loss and weight maintenance after bariatric surgery. Start with fifteen to thirty minutes each day after surgery. Slowly add to your time to do sixty minutes or more each day.
• Immediately after surgery, your Nutritionist will provide you with special dietary guidelines. You will need to follow these guidelines closely. Allowing time for proper healing of your internal and external wounds is necessary and important.
• When able to eat solids, eat three meals per day, no more. Protein in the form of lean meats (chicken,mutton and fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
• Never eat between meals. Do not drink flavored or carbonated beverages; even diet soda, between meals.
• Drink two to three quarts or more of water each day. Water must be consumed slowly, one to two mouthfuls at a time, due to the restrictive effect of the operation.

When you have weight-loss surgery, you lose weight because the amount of food energy (calories) you’re able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for sixty minutes will tell your body that you want to use your muscles and force it to burn the fat instead.

Many patients are hesitant about exercising after surgery, but exercise is an essential component of post-surgical success. Exercise actually begins on the afternoon of surgery--the patient must be able to get out of bed and walk. The goal is to walk a little farther the next day, and progressively farther each day after that, including the first few weeks at home. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient's overall condition. Some patients who have severe knee problems can't walk well, but can swim or bicycle. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.

Contact your original surgeon. He or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.

• The staples used on the stomach and the intestines are very tiny in comparison to the staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it’s hard to see other than as a tiny bright spot. Because titanium and stainless steel are inert in the body, they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they won’t be affected by MRI or set off airport metal detectors.

Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid, crushed or capsule form.

Most patients have no difficulty in swallowing these pills.

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about six weeks.

It is strongly recommended that women wait at least 12-18 months after the surgery before a pregnancy. Approximately 12-18 months, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.

Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.

Patients are highly encouraged to stop smoking at least three months before surgery. Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases rates of infection, and interferes with blood supply to the healing tissues. It’s possible your surgery could be canceled if you don’t comply.

Patients may wonder about this early after the surgery when they are losing 10 to 20kgs per month, or when they've lost more than 45-50 kgs and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight-loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months.

The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.

Many people heavy enough to meet the surgical criteria for weight-loss surgery have stretched their skin beyond the point from which it can snap back. Some patients choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Your surgeon can refer you to a plastic surgeon to discuss your need for a skin removal procedure.

While exercise is good in so many other ways and is highly recommended, unfortunately many patients may still be left with loose skin.

Most patients say no. In fact, for the first four to six weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger. This is usually caused by the types of food you're consuming, especially starches (rice, pasta, potatoes). Be sure not to drink liquid with food since liquid tends to wash food out of the pouch.

Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight-loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight-loss surgery. Usually no change in dosage is required.

NSAIDs may create ulcers in the small pouch or the attached bowel. If you have gastric bypass you may take paracetomol. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight-loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.

A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20 percent of patients develop a hernia. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common. The chance of an abdominal hernia after laparoscopic surgery is less than one percent.

Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Most patients experience natural hair re-growth after the initial period of loss.

Scar tissue, or adhesions, is formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.

It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.

Although generally accepted guidelines from the OSSI indicate surgery for those 18 years of age and older.

The concern is that younger patients have not reached full developmental or emotional maturity that is necessary to make this type of decision. It’s important that young weight-loss surgery patients have clear understanding of the lifelong commitment to the altered dietary and lifestyle changes necessary for success.

This is reviewed on a case by case basis. Those on the higher end of the age spectrum require very strong indications for surgery and must also meet stringent Medicare criteria. Typically the risk of surgery in this age group is increased and the benefits, in terms of reduced risk of mortality, are reduced.As per OSSI guidelines it is upto age 65.

Weight-loss surgery may significantly prolong your life if you are:

• Suffering from Type 2 diabetes (or other serious obesity-related health conditions)
• At least 45kgs over your ideal body weight
• Able to comply with recommended lifestyle changes (daily exercise and low-fat diet)

According to current research, weight-loss surgery can improve or resolve associated health conditions, including: