You will see the surgeon and dietician. Once you decide about surgery the date will be arranged. Patients need investigations prior to surgery, and at times these may take several weeks to complete.
You will be asked to attend our clinic for a pre-operative assessment. At this appointment we will ask you about your medical history, any medication you may be taking, and any operations you may have had in the past. You may need to undergo some routine tests eg, heart trace (ECG), X-ray, blood tests. You will also be weighed.
14-21 days before your operation you will need to be on a very low calorie diet such as optifast. This will shrink your liver, which becomes big and fatty in people who are overweight. It is very important that this diet is strictly followed. A smaller liver will make it easier for the surgeon to access your stomach and reduce your anaesthetic risk. You may also lose weight during this period. If you do not follow the diet there is the chance of your surgery not being able to be undertaken. It is very important that you are as healthy as possible before the operation and that you do your best to lose weight. You should not gain weight, as this may prevent you from having the surgery. You will have had an opportunity to discuss the operation with the doctors in clinic and with the dietitian at the group session. Hopefully, any concerns you may have will have been explained.
We advise you to stop smoking before your operation. Smoking increases your anaesthetic risk. Surgery will not be undertaken if you continue to smoke.
A nurse will check your temperature, pulse and blood pressure. You will be asked to put on a disposable gown and pants. You will also be given some white/black stockings to wear. These promote blood flow through the deep veins in your legs, and therefore reduce your risk of developing a blood clot. You will be asked to wear these for 6 weeks following your operation. Other health professionals may need to see you at some time before the operation, including the anaesthetist and physiotherapist. If you use a CPAP machine at night, please bring it into hospital with you.
Your operation will be carried out under general anaesthetic, which means you will be asleep. The anaesthetist will visit you before your operation and discuss the anaesthetic with you.
After the operation you may be on the High Dependency Unit (HDU). This is a unit which provides more intensive nursing. Patients with sleep apnoea and/or respiratory complications often go to the high dependency unit. You will have your pulse, blood pressure, breathing and wounds checked regularly by a nurse. It is usual to feel sleepy for several hours. You will be given oxygen through a face mask until you are more awake. Anaesthetics can sometimes make people feel sick. It is important you inform the nurse immediately if you feel sick. They may offer you an injection which will help to settle it. You may have a catheter in your bladder to monitor your urine output. You will have a drip (intravenous tube) running into a vein in your arm/hand, which will give you fluids until you are well enough to drink orally. Within the first 24 hours of your operation you will be able to sip fluids and you will continue on thin fluids for 2-3 weeks. From week three you will start on a diet of pureed food. This allows any swelling around the new joins to settle. Taking solid food too early may result in vomiting and this may cause problems with your new stomach. Following your operation, the dietitian will help you adjust to your new diet, particularly in the first few months.
Wounds are usually sutured with subcuticular stitches (under the skin). You will have dressings/large plasters covering your wounds.
Most patients having this operation experience some pain. If you have pain, it is important to tell the nurses, who will give you drugs to help. You may have a patient controlled analgesia device (PCA), whereby you press a button and a machine gives you a small dose of a painkilling drug. This will be explained to you before your operation and is very safe and easy to use.
You will be encouraged by the nursing staff and physiotherapists to get up and move around as soon as possible after your operation. This is important to reduce the risk of blood clots and to prevent problems with your chest.
You will be able to go home approximately 3 days after your operation. Everyone is different and some people need to stay in hospital longer than others.
You are likely to feel tired and need to rest during part of the day but this should improve with time. You may also not feel like eating. It is important that you have small, regular meals 3 times per day.
Check your wound for signs of infection-redness, pain and heat. If any of these occur, see your GP as you may need a course of antibiotics. Your abdominal area is likely to feel bloated and sore for a few weeks. This is normal. Take either the pain killers you were given from the hospital or a mild pain killer such as paracetamol.
You will need to take about 1-2 weeks off work, depending what job you do.
We would normally expect you to take about 3-4 weeks to get back to normal activities. You should avoid heavy lifting for 8 weeks.
Do not drive until you can wear your seat belt comfortably and feel able to perform an emergency stop. Your insurance company may refuse to meet a claim if they feel you have driven too soon.
As you start to feel better, it is important to introduce gentle exercise such as walking. As you start to lose more weight, you will find that you feel more energetic and are able to undertake more vigorous exercise. This will also help you to lose weight and to tone muscles.
You may be sent home with a 21 day supply of a blood-thinning drug called clexane. This will be given through a small injection into the skin on your abdomen. This helps to prevent blood clots. Some tablets are going to be too big for your new stomach. Your GP may already have changed these to chewable, dissolvable or syrup form. If not, do this where possible. In some cases the medication doses may change or you may be advised to stop taking some of your medication. If you are on medication for diabetes, you may need to have regular checks with your GP or practice nurse in order to monitor your diet and medication.
You will need to supplement your diet with a vitamin and mineral supplement every day, for the rest of your life. This ensures that you are receiving all the essential nutrients. Initially, chewable or dissolvable vitamin and mineral supplements will be required to ensure that they can pass through the new stomach. You may also need to have Vitamin B12 injections.
An outpatient appointment will be made for you approximately 4-6 weeks after your operation in order that the team can check on your recovery. You will also be seen by the dietitian in order that your weight, diet and nutritional status can be carefully monitored. You will be reviewed at 4-6 weeks, 6 months and 12 months and 2 years. After 2 years you will be discharged back to your GP for annual follow up.
As you start to lose weight, you will feel much healthier. You must remember that these changes will affect your life in terms of eating out, going out for a drink with friends, going on holiday and buying clothes. The support of family and friends is very important, particularly if you have to prepare large meals for other family members. Some patients have reported taste changes after the surgery and other patients have reported hair loss. It is important that you are aware of the long-term changes that will affect your lifestyle and relationships with others.
It is difficult to predict how much weight you will lose. Everybody is different and weight loss will still be dependent on your food choices and exercise. You can expect to lose between 60 to 85 % of your excess weight in the first 12 to 18 months following surgery: A man who weighs 146 kg (22 stone 13 lbs) and is 1.85 m (6’ 1’’) tall has a BMI of 42 kg/m2 • The upper limit of the ideal BMI (25 kg/m2) would give him a weight of 85.6 kg (13 stone 6lbs) • 70% excess weight loss = 42.3 kg. Total body weight = 103.7 kg (16 stone 4lbs) (BMI 30 kg/m2) • A 50% excess weight loss = 30.2 kg, with a weight of 115.8 kg (18 stone 3lbs) (BMI 34 kg/m2) The amount of weight you are able to lose and keep off after surgery will depend also on the lifestyle changes that you make, such as increasing the amount of exercise you take and eating a healthy diet. It is important to remember that the operation will not stop from you from craving certain foods or eating what you fancy.
Many patients who have lost a great deal of weight will have loose skin, particularly at the tops of their arms and legs and round the stomach. Referral to a plastic surgeon to remove the skin from these areas can be arranged through your GP, if you meet the referral criteria. It is important to remember that this will only happen when enough weight loss has been achieved and is being maintained.
We do not advise you to consider becoming pregnant until at least 6 months after your operation. This will allow your body time to adjust to its new condition and for you to be fully established on a varied, healthy diet. If you are planning to become pregnant, it is important that the doctors, dietitian and midwives looking after you are aware that you have had weight reducing surgery. They will be able to monitor both you and the baby accordingly. It is important that your diet is nutritionally balanced, which will keep both you and your baby healthy.