How soon can I have my bariatric surgery?
There are a series of steps that each patient has to take before surgery:
- A health assessment and discussion about the types of surgery and non-surgical therapy available. We currently offer 7 different operations, revision operations and surgery for management of complications of other surgery. Many patients alter their decisions about which treatment to seek based on this first appointment.
- A second medical appointment after a cooling off period of at least a week in order for patients to consider what other issues need to be taken into account before surgery.
- Access to funds (health insurance, super, paying directly).
- 2 – 3 weeks of Optifast to minimise liver size to make surgery safer.
Once the above has been resolved surgery can happen within 4-6 weeks from initial consultation, depending on your chosen procedure and availability of your surgeon. Many patients who require treatment faster find that Dr Yee or Dr Maani have a reasonably flexible approach to scheduling their surgery.
How much weight will I lose following surgery?
The amount of weight you can lose following surgery will depend on the type of surgery that you undergo, your genetic makeup and ability to adhere to the post bariatric program (diet, exercise). On average patients who have a lap band will lose 20 – 25% of their total body weight (TBWL). A sleeve gastrectomy will give you 25 – 35% TBWL and a gastric bypass would be around 30 – 40%.The larger the surgery the easier it is to achieve greater weight loss but the greater the risks of vitamin and mineral deficiencies long term.
How quickly will I lose weight following weight loss surgery?
Generally after a sleeve gastrectomy we expect to see 50% of the total expected weight loss to occur by 3 months following surgery and the remaining weight loss by 12 months. This can average out at about 1 – 2 kg of weight loss per week, but plateaus when no weight loss is experienced and can last several weeks. It is important for patients to come to their follow up appointments so that we can track their weight loss and make adjustments to their diet/exercise plan to ensure that they are on track. Occasionally patients will require medication to improve their overall weight loss.
Will I experience a lot of pain following weight loss surgery?
As with most keyhole operations surgery is well tolerated with pain not being a significant complaint. Most patients will require some oral pain relief for 2 – 3 days post op. Occasionally whilst in hospital patients will be administered pain relief via a PCA (patient controlled analgesia).
How long will I be in hospital following my weight loss surgery?
Most patients will stay in hospital for 2 nights, although occasionally 3 nights. Generally once someone can tolerate a litre of fluid within 24 hours and are comfortable on oral painkillers and mobilising freely, they are safe for discharge.
Do I have to lose weight before surgery?
Yes. We recommend at least 2 weeks on a VLCD (very low calorie diet) prior to surgery, with guidance from our dietician on a meal plan leading up to surgery, such as Optifast. This helps to shrink the liver which sits above the stomach, thereby allowing us to perform the operation safely as there is more space to operate. Even 3 – 4 kg weight loss is usually sufficient for the surgery in most patients. This diet also kick starts the body into ketosis, the state your body will be in for the first 6 months following surgery. This is your body metabolising fat as energy.
How long do I need to follow a VLCD program prior to surgery?
On average, patients will need to follow it for for 2 weeks prior to surgery, however depending on your starting weight and medical conditions, you may need to follow it for longer (4-8 weeks). If this is the case, you may require more than 3 VLCD products per day. This can be discussed with your dietitian.
What are the side effects of VLCD Programs?
Hunger, fatigue, headaches, nausea, bad breath and lack of concentration are common in the first 3-4 days. Your body will adjust to the new energy-burning system and you will feel satisfied with minimal amounts of food. Most symptoms will pass by days 4-6.
So much emphasis is placed on protein after surgery, why do we need protein?
Protein is important while healing and to prevent muscle and hair loss while losing weight. Not eating enough protein can result in a weaker immune system and can result in inadequate weight loss long term. Always include protein rich foods at mealtime and ensure to eat your protein foods first for adequate nutrition.
I’m eating well, do I still need to take my multivitamin?
Yes. The rate of vitamin and mineral deficiencies is very high after surgery, especially with the gastric sleeve and bypass. Most vitamin deficiencies produce minimal symptoms until they are quite advanced and some will lead to irreversible complications such as bone fractures or injury to nerves. A daily multivitamin is a cheap insurance policy to avoid nutritional complications. Patients will need at least yearly blood tests on top of this.
I’m not opening my bowels daily, what should I do?
After weight loss surgery, many people will develop a new bowel habit. Opening your bowels every 2-3 days is ok as long as you’re not uncomfortable. During the recovery period, you may find your bowels behaving differently often from one extreme to the other but this should settle as you return to normal eating. Constipation is managed by ensuring adequate fibre, fluids and regular physical activity. As this may be difficult in the first 2 weeks, a mild laxative such as Lactulose may be beneficial during this time. As your food intake increases and you are able to include adequate amounts of fluids daily, a soluble fibre supplement such as Benefiber can be useful.
When can I start drinking alcohol after surgery?
Its preferable to delay alcohol until healing is completed. In the long term however, alcohol is a very common cause of weight regain and major illness after surgery, especially bypass surgery. Alcohol is high in energy, is an appetite stimulant, and drinking promotes poor food choices. Generally, the consumption of more than 5-6 standard drinks per week will guarantee weight regain and ill health after bariatric surgery.
I do not suffer any reflux post surgery, do I need to take the anti-reflux medication and for how long?
After sleeve or bypass you should take anti-acid medication for a month. Those patients who take aspirin or anti-inflammatory drugs, those who smoke or people who have difficulty with their alcohol intake will need the anti-reflux/anti-acid medication lifelong.
Will I lose my hair following bariatric surgery?
Hair Loss generally occurs after significant weight loss for any reason, and this predominately relates to deficiencies in silica and protein intake. To minimise this it is best to take hair skin and nail supplements, as well as maintain a daily protein intake of around 60g. Most patients will not lose their hair, but if they do this generally exists between month 3 and 9 after surgery with everything returning to normal by a year. Hair loss can occur with some nutritional deficiencies also.
When can I get pregnant following bariatric surgery?
Pregnancy should be delayed until your weight is stable for at least two consecutive months. Weight stability can be achieved by 12 months following sleeve gastrectomy and by 18 months for gastric bypasses.
Will I have excess skin following bariatric surgery? And what can I do about it?
As a result of bariatric surgery you will have excess skin. Unfortunately there is no way of ‘getting rid’ of excess skin through any form of exercise/toning. The only way to deal with excess skin following weight loss from bariatric surgery is through body contouring surgery (plastic surgery). While this is a concern for most people before bariatric surgery, probably only 1 in 4 people post-op chose to have excess skin removed as many find their skin shrinks sufficiently well after they lose weight.
What are the age limits of bariatric surgery?
We are often asked if somebody is too young or too old for bariatric surgery because of concerns about fairly major surgery for themselves or their family members if they are they are below 20 or above age 65. When somebody presents with a weight problem at the extremes of age it is very important to individualise their care and make very considered decisions.
The simple answer is that bariatric surgery can be considered at any age (although very unlikely for young children), depending on the condition of the patient and their quality of life. Click here for our in-depth explanation with regards to age limits for bariatric surgery.