Mr Roger Ackroyd answers the Top FAQs about Weight Loss (Bariatric) Surgery
Mr Roger Ackroyd, Consultant General & Bariatric Surgeon
Claremont Clinics: Monday PM.
Read all about Weight Loss Surgery at Claremont here
What weight loss operations are available to me at Claremont? It is very important to understand that Bariatric Surgery is not suitable for everyone. Your BMI and personal circumstances will be evaluated and this procedure is not performed for cosmetic purposes. The main procedures that we offer are laparoscopic gastric banding, laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. In selected cases, we offer intra-gastric balloon insertion. We also perform revisional surgery for people needing further surgery, either for problems with a previous procedure or for inadequate weight loss with a previous operation.
What is the difference between a gastric bypass and a sleeve gastrectomy? In a gastric bypass operation, the upper stomach is divided to form a small pouch. The bowel is then divided lower down and joined on to the pouch. This leads to a bypass of most of the stomach, the duodenum, and the first part of the small bowel. As well as restricting the amount of food that can be taken in, this leads to a degree of malabsorption, which further aids weight loss. In a sleeve gastrectomy operation, the stomach is stapled and most of it is removed, leading to a much smaller stomach. This operation works by reducing the amount of food that can be eaten. Both operations also have an effect on hunger, which further helps weight loss.
How do the operations work? All the operations produce a degree of restriction, reducing the amount of food that can be eaten. Most also have an effect on satiety and appetite, resulting in a reduced feeling of hunger. Laparoscopic gastric bypass also produces a degree of malabsorption, which means that a proportion of the calories taken in are not absorbed, resulting in further weight loss.
How much weight will I lose? The weight loss that you can expect is variable from person to person. It depends on your starting weight, which procedure is performed and how well you stick to the dietary instructions given to you. Generally speaking, the weight loss with a sleeve or bypass is greater than with a band. Most people can expect to lose a good percentage of their excess weight over the first 12 months.
How safe is obesity surgery? Obesity surgery is very safe these days. Obviously no operation is totally without risk but we do a huge number of operations here at the Claremont and we have had very few complications. All surgeons (including Mr Ackroyd) submit their data to the National Bariatric Surgery Registry and the mortality figures are exceedingly low. The overall mortality rate is significantly less than 1 in 1000.
Are there any new procedures in bariatric surgery? Yes, there are one or two new operations in obesity surgery. The mini gastric bypass (or one anastomosis gastric bypass as it is sometimes known) is a variant of the standard Roux-en-Y gastric bypass, which is gaining in popularity around the world. This operation gives similar (or possibly even slightly better) weight loss results to a normal gastric bypass. Another new operation is the SADI-S procedure, which is showing promise, but this is largely for revisional surgery.
I have been told that gastric banding is becoming less popular and that the sleeve gastrectomy operation is tending to replace it. Is this true and if so, why? Yes, laparoscopic gastric banding is definitely becoming less popular. It is still a good operation but requires intensive follow-up in order to be successful. Many patients fail to lose as much weight as they would like with a band. Also there is a definite incidence of significant post-operative problems, such as band slippage and erosion, which is putting many patients off. The sleeve gastrectomy is a bigger operation but once it is done, it is done. There is no need for adjustments and such intensive follow-up. The weight loss results are also excellent. This is now the commonest weight loss operation that we perform here at the Claremont Hospital.
I have had a gastric band in the past but I am not happy with my weight loss. Is there anything else that can be done? The first thing to do is to assess your band and why it is not giving you the desired weight loss. It may be that a simple band adjustment is all that is required. In some cases, it is possible to remove the band and convert to a different procedure, such as a sleeve or bypass. We can assess you for this and if appropriate, perform the revisional surgery here at Claremont.
How much weight will I lose? The weight loss following this type of surgery is extremely variable and is largely dependent on you and how well you work with your operation. If you do work with the operation, there is no reason why you shouldn’t lose a great deal of weight. Indeed it is possible to lose most of your excess weight following these operations. The sleeve and bypass tend to lead to greater and more rapid weight loss than the gastric band.
Will the weight loss be permanent or am I likely to regain the weight later? Most people will keep most of the lost weight off. There is an incidence of late weight regain with these operations but this is usually in people who do not stick to the dietary instructions they are given.
I have been told that there is a danger of putting my weight back on after this type of surgery. Is this true? Yes, there is an incidence of late weight regain after bariatric surgery, but this is usually after several years in patients who fail to follow the dietary instructions given to them by the Dietitian. Most patients do very well and keep most of their weight off, if not all of it.
What is the best weight loss surgery for me? There are three operations which we offer for weight loss surgery; (1) laparoscopic gastric banding, (2) laparoscopic gastric bypass and (3) laparoscopic sleeve gastrectomy. It all depends on your size and eating habits as to which one is best for you. The laparoscopic band is the quickest and easiest form of surgery but is only suitable for volume eaters, much less so for nibblers, grazers and sweet eaters. The gastric bypass is particularly good for people with a sweet tooth, nibblers or Type II Diabetes. The sleeve gastrectomy is now the most popular form of weight loss surgery and is suitable for all comers.
What are the risks and complications? No operation is without risk, and weight loss surgery is no different. With any operation or anaesthetic, there is a risk of bleeding, infection, clot in the legs or lungs and heart problems. Specific problems of laparoscopic gastric banding include band slippage or erosion and problems with the tubing or port. With a sleeve gastrectomy or gastric bypass, the main risks are staple line bleeding or leakage. With a gastric bypass there is also a risk of internal hernia formation, which can cause problems with the small bowel. However, although potentially serious, these risks are relatively uncommon. There is a risk of dying after this type of surgery but this risk is extremely low and is less than the risk of being very overweight.
Is it painful? Does it hurt after the surgery? Very few operations are completely pain-free and weight loss surgery is no exception. However, the pain experienced following this type of surgery is usually minimal and relatively short-lived. Most people go home within 1-2 days following the surgery and are absolutely fine.
How long until I can fly, go to the gym or swim again? It may be a week or 2 before you are feeling up to exercise following surgery. You should be able to start gentle exercise after 2 or 3 weeks. You can swim as soon as the skin wounds are healed, which is usually after 2-3 weeks. We don’t recommend flying for about 6 weeks after the surgery, although if necessary, you could probably fly after a couple of weeks.
An initial private consultation with Mr Ackroyd costs £150. For more information or to book an appointment, call our Private Patient Team on 0114 263 2114 or email email@example.com. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
**Mr Ackroyd and his team also offer premium pre and post op care for bariatric (weight loss) surgery patients to ensure the best possible long term outcome. Click the link below**
Copyright Roger Ackroyd, 2017.