Weight Loss Surgery
A meal with solid food- 4 weeks. The diet recovery after surgery involves 2 weeks of fluids, the rule of thumb here is that if you can suck it through a straw then you can have it. As the goal is to lose weight most patients stick with water and Very Low Calorie Diet (VLCD) shakes such as Optifast and Kicstart. Higher calorie fluids such as juice and protein Up & Go can be used if you are feeling fatigued or lack energy. V8 juice is a good option for vitamins and fiber, thin soups are another option. This is followed by 2 weeks of soft diet, as a guide, if you can mash it through the prongs of a fork you can have it, bolognaise, scrambled egg, mash potato and avocado are examples of foods that may be eaten.
Yes! Once discharged from hospital the aim is to drink 1-1.5 litres of fluid per day, aiming for 1.5-2 litres per day is unrealistic for many patients. I encourage formal exercise from 2 weeks post-op onwards, it is best to start with short walks from week 3 and build up slowly from there. Aerobic workouts such as bootcamp are not recommended until at least week 5 as it takes this amount of time for most to be able to get enough calories to recover from a session. Resistance training can start from week 6 although it is very rare to see patients lifting weights at this stage, most wait until at least 4 months post-op.
It is best to wait until you have practiced your new slow eating technique with solids at home before going out socially, it is not unheard of for patients to be having such a good time that they forget they’ve had the surgery and eat to quickly causing an uncomfortable feeling of blockage below their breastbone. Once your new eating technique is a habit going out will be much easier. You will only need to order an entre or kids sized meal, sharing a plate with your partner is a good option otherwise plan to ask for a leftover bag to take home. Socialising over food and drinks after surgery is best done once you have a good knowledge of what your new small stomach is able to tolerate and have a plan around this in order to have a good time.
Current guidelines recommend no alcohol for 6 months after surgery. Many people start drinking after 2 months. Every time you consume alcohol a mild gastritis (inflammation of the lining of the stomach) develops and we do not want this in the weeks after surgery as your stomach is healing the incisions that have been made in it. Be mindful of driving under the influence as blood alcohol levels will rise much more rapidly after surgery.
For sleeve gastrectomy I recommend a multivitamin and vitamin D tablet once a day for one year and then once your routine blood panel shows no issues that regime can be relaxed. Vitamin D may also be taken as a once a week tablet or via oral drops. As gastric bypass works via malabsorption a multivitamin and vitamin D tablet once a day is recommended for the rest of your life in order to prevent vitamin B12, iron and calcium deficiencies. The supplements that are most appropriate for you will be discussed during your consult with the dietician.
Most patients would describe themselves as being fully recovered between 1-2 months post-op. It is best to have someone at home with you for at least 3 days once leaving hospital. You can drive within 4-5 days when you are sure pain won’t distract you from the road. If you have a desk job it is usually 2 weeks off work and any job with a physical component 3-4 weeks.
I recommend no heavy lifting (nothing greater than 10kg) for 4 weeks after surgery to avoid a hernia through the surgical incisions. In reality this is almost impossible for any mum, so do your best, you can minimise picking up your kids by asking them to hop on the couch next to you for a cuddle and asking your partner or parents to help as much as possible. Once the majority of your excess weight is lost it will be much easier to do activities with your children and role modelling a healthy life-style is a major benefit.
Every person is different! We need to discuss your medical and surgical history, and your goals. It is true to say for the majority of people a sleeve gastrectomy is the safest way to achieve their goals. If you have severe gastro-oesophageal reflux disease (GORD), complications of GORD such as oesophageal inflammation or you are an insulin dependent diabetic then a gastric bypass will be the recommended operation.
Sleeve gastrectomy approximately 1 hour. Gastric bypass approximately 2.5 hours.
Loose skin is a fact of life after losing weight, some people have a small amount, some people more, all patients say they much prefer to live their lives at a reduced weight with some lose skin than the life they were living before their surgery. Factors that lead to more loose skin- if your fat distribution is mostly in the lower central abdomen causing an apron effect, if you’ve had multiple pregnancies, if you have very rapid weight loss due to poor nutrition, if you’ve been obese for many years. Patients in their teens and 20’s have remarkably elastic skin and are less likely to face these issues than patients in their 40’s. If you would like excess skin treated then body contouring surgery is usually performed once your weight has stabilized at 12-18 months post-op.
Most patients experience some degree of temporary hair loss. It typically begins at 3 months after surgery and is due to the first 3 months being the most difficult time to consume enough protein and nutrients. It will slow down at around 9 months post-surgery and you will find new hairs re-growing. Hair grows back at a rate of half an inch per month. Patients who minimize their hair loss do so through consuming a high protein diet using eggs, tuna, baked beans and protein supplements.
Current guidelines recommend waiting 12 months as conceiving before this may lead to premature birth and low birth weights. For those struggling to fall pregnant be prepared to start using contraception once your weight loss begins as many patients unexpectedly fall pregnant at around 6 months after their operation.
Guidelines recommend not falling pregnant until 12 months after weight loss surgery as there are reports of premature birth and low birth weight in some studies. I recommend that patients with polycystic ovarian syndrome (PCOS) begin using barrier contraception during their rapid weight loss phase. When you are at lower weight your pregnancy is much safer as there is reduced risk of gestational diabetes, pre-eclampsia, induced labour, post-partum bleeding, C-section and procedural complications (for example, an epidural). You will need to avoid the oral glucose tolerance test (OGT) that screens for gestational diabetes as the sugary drink can cause dumping syndrome (light-headedness, palpitations, nausea). Other screening methods such as finger prick testing may be used. From a nutrition point of view, regular blood tests ensure your protein and micronutrients are at normal levels and appointments with a dietician are essential.
Losing a large amount of weight by any method can lead to the development of gallstones. In the general population it is estimated that 20% of adults have gallstones but only 4% develop symptoms that require cholecystectomy (gall bladder removal). The scientific literature varies with the rates of cholecystectomy after weight loss surgery, for sleeve gastrectomy the rate is 5-10%, while for bypass some studies report up to 30% of patients requiring cholecystectomy.
It is important that your calcium, vitamin D and parathyroid hormone be monitored if you are post menopause so as to reduce your risk of developing osteoporosis. With a sharp decline in circulating oestrogen post-menopausal women are already at risk for osteoporosis and weight loss surgery increases that risk. A bone densitometry scan may be performed peri-operatively to serve as a baseline test for monitoring into the future. Most sleeve patients will be able to consume enough calcium in their diet and do not require a supplement however gastric bypass patients are at higher risk of osteoporosis and hip fracture so should strongly consider taking a calcium and vitamin D combination tablet.
Call us to make an appointment and bring along a referral from your GP. At your first appointment I take your medical and surgical history, discuss your goals, explain the steps to prepare for surgery, describe your surgery and hospital stay and of course answer any questions. You will receive a large information pack to read through at home. From there, if you choose to go ahead, we perform a blood panel, liver ultrasound and swallowing test as routine pre-operative work-up. At the second meeting (last appointment before surgery) your test results will be discussed and consent forms completed for your hospital stay.