Cover image

Weight Loss Surgery

Usual weight loss after gastric bypass is two to three stone in the first six weeks, and the same again over the next three to four months.

Internationally renowned surgeon; Professor Peter Lodge has brought a new Scandinavian technique for weight loss surgery to Spire Leeds Hospital.

Testimonials

I had a large hepatocellular carcinoma (cancerous liver tumour) and without immediate surgery, I would have died, it is as simple as that. After being referred to Professor Peter Lodge by my gastroenterologist, I had a ‘left hepatic trisectione…
Mike's story

Read More…

Questions About Weight Loss Surgery

Weight loss surgery, also known as bariatric surgery, involves an operation to help a person lose weight more effectively than dieting and sustain the weight loss in the long term. Successful weight loss surgery induces the loss of up to two thirds of excess body weight over a period of two years, a goal unachievable by any other known method.

Back to top

The easiest way to find out is to measure your height and weight and calculate your Body Mass Index (BMI). You can do this using metric (cm and kg) measurements.

BMI Calculator

kg
cm

BMI is a calculated index of how overweight a person is. A normal healthy person has a BMI of 18.5 to 24.9. If a person is a little overweight, their BMI is 25-29.9. If a person’s BMI is 50 or more they are considered to be super-obese.

A BMI of more than 35 suggests that you are becoming dangerously overweight, a condition known as morbid obesity. This is because you are at risk of developing illnesses associated with being overweight – diabetes, arthritis, high blood pressure and heart disease. Breathing difficulties such as asthma and sleep apnoea can also occur. Sleep apnoea begins with snoring and eventually results in a lack of oxygen for your brain when you are asleep. People with sleep apnoea typically have to get up in the middle of the night because they feel short of breath.

Back to top

In the UK, we are guided by a group called the National Institute for Clinical Excellence (NICE) for major healthcare issues. NICE has stated that if a person has a BMI of 35 and they also have some comorbidity (illness related to being overweight) or a BMI of 40 or more without comorbidity then weight loss surgery is recommended.  This is because the chances of managing to lose weight by any other method are so low.

Back to top

Unfortunately, not everyone who fulfils NICE guidelines is approved for weight loss surgery because of funding restrictions. Talk to your family doctor to find out if funding is available for you.

If you are not eligible, relatively low cost private surgery is available at Spire Leeds Hospital.

Back to top

Unfortunately, for some people with a high BMI, dieting cannot successfully produce long term weight loss. Although a short term improvement may be achieved, the usual pattern is to put the weight back on over the next few months. Even worse, the average dieter will overshoot and then find it much more difficult to lose weight next time.

Back to top

Although exercise is an important part of maintaining a healthy lifestyle, once we become significantly overweight, exercise becomes much more difficult. Overweight people are often troubled by arthritis causing problems with back, hip and knee pain so effective exercise becomes impossible.

Back to top

In the clinic Prof Lodge will be able to advise you about other weight loss surgery options.  The bypass uses a combination of restriction of intake and also malabsorption – you eat less and you absorb less.  There are more radical malabsorption operations but they have a lot of side effects and they are rarely recommended.  There are other restrictive options, the best of which is sleeve gastrectomy as this is a more permanent solution than a gastric band.

This link will take you to a very detailed summary of what we know about all types of accepted weight loss surgery methods.

Facts about Obesity Surgery this link will take them to a very detailed summary of what we know about all types of accepted weight loss surgery methods although this was not written by me.

Lap_Sleeve_Gastro_text_1[1]

 

 

Questions About The Scandinavian Approach

The operation is called a laparoscopic Roux-en-Y gastric bypass. This involves putting 4 small telescopes (called ports) into the tummy to allow special instruments to enter the abdomen to do the surgery. In addition a very small retractor is used. The first stage is to create a small pouch from the stomach, reducing its capacity. The second stage involves bypassing a portion of the intestine to reduce absorption. The final stage involves carefully checking all the stitch lines and joins before removing the ports.

Normal anatomy – all of the small bowel actively absorbs nutrients:

Normal anatomy - all of the small bowel actively absorbs nutrients
Acid from the stomach, bile from the liver and enzymes from the pancreas aid digestion.

 

Acid from the stomach, bile from the liver and enzymes from the pancreas aid digestion

 

 

In the Roux-en-Y gastric bypass operation, the stomach acid, bile and pancreatic enzymes are re-routed so digestion starts much further down the gut.

Untitled

The Scandinavian weight loss surgery technique is technically demanding for the surgeon, but less invasive for the patient. The result is that after successful surgery, almost all patients can go home within 24 hours of surgery. Because the joins are sewn by hand, most patients report that they can eat normally by the end of the first week after surgery.

Any weight loss operation is regarded as complex surgery so it takes time to do it well. Partly this relates to BMI and also to other surgery that you may have had before. Average times are between 1 and 2 hours but for very large patients who have had a lot of previous abdominal surgery it can take up to 4 hours.

If you have weight loss surgery with Professor Peter Lodge at Spire Leeds you should expect to be admitted to hospital on the day of the operation and discharged home the next day.

Following successful laparoscopic surgery, most people are fully recovered within 2 weeks of the operation. You may still have some trouble tolerating specific foods, but you should be back to all of your normal activities. Laparoscopic surgery doesn’t look much on the outside, but you have to remember it’s still a big operation inside so you may experience some aches and pains over the next couple of weeks while everything is healing up.

Driving really comes down to being able to concentrate and able to make an emergency stop. It would be sensible not to drive for a week, but after that it’s up to you.

For most occupations, we would recommend taking 2 weeks off work. If your work involves a lot of heavy lifting, it would be advisable to ask for light duties until 6 weeks after the operation.

Risks of surgery always have to be weighed up against the risks of not having surgery – the life time risk of remaining seriously overweight. It would not be sensible to consider an operation without thinking about the risks involved. All of these risks will be explained and written information will also be given to you to read after your consultation. Any operation carries with it a small risk of blood loss or infection. When an operation involves making joins between pieces of bowel, there is a small risk of leakage. This is the reason for staying in hospital overnight – so that you can be monitored closely to make sure everything is fine before you go home. After leaving hospital, it is important to drink plenty of fluids and to increase your activities each day to reduce the risk of deep vein thrombosis (DVT), a condition where clots form in blood vessels in the leg, as this is rarely associated with pulmonary embolus, where a blood clot travels to the lung, We recommend giving yourself a small injection of heparin, a blood thinner, each day for 4 weeks to reduce the risks and we will provide this for you. Deaths have been reported after weight loss surgery but the rate is less than 1%.

Following surgery, your stomach capacity will be reduced so you will not be able to eat a very large meal. Most patients don’t find this to be a problem as they feel full more quickly and also feel less hungry between meals. The operation also alters the way you absorb food and it is designed to drive you away from high carbohydrate high fat meals towards meals higher in proteins. If you eat too much sugar or fat in a meal you may feel lightheaded and bloated or you may get some diarrhoea – a condition called dumping. Alcohol absorption is unpredictable and you should never drink and drive. The stomach is an important organ for absorbing vitamins and some minerals, particularly iron and calcium. In weight loss surgery, much of the stomach is taken out of circuit so these things are not well absorbed. For anyone having surgery on the stomach, it is important that you take supplements to compensate for this following surgery. This will all be explained. A vitamin B12 injection is recommended about 4 times each year for anyone undergoing weight loss surgery”

Weight loss surgery is being currently promoted in many developed countries as a treatment for Type 2 diabetes mellitus, the type of diabetes associated with being overweight. This is because the surgery is so effective in reversing the need for medication. If you have been a diabetic for less than 10 years, successful weight loss surgery will almost certainly cure the diabetes overnight. If you have been a diabetic for more than 10 years, although the diabetes may not be cured, there is a very good chance that you will have better sugar control and need less medicines in the future as your weight comes down.

An immediate benefit of weight loss surgery is an improvement in mobility. Most arthritis is aggravated by being overweight so most patients notice a rapid improvement.

If you have severe sleep apnoea and use a special breathing mask at night (a CPAP mask) it will be important to keep using this mask until you weight has reduced significantly. Your family doctor will help advise you about this. Mild sleep apnoea disappears rapidly, but it may take several months for more severe sleep apnoea to resolve.

There is no doubt that being overweight can lead to high blood pressure and that weight loss can improve it. As your weight comes down after successful weight loss surgery, your blood pressure should improve. This is something that your family doctor will want to monitor and help with as it is dangerous to stop blood pressure medications without proper advice.

The first thing to do if you are thinking about weight loss surgery is to work out your BMI. Think about what illnesses you have that could be related to being overweight – diabetes, arthritis, high blood pressure, shortness of breath, sleep apnoea – this is known as comorbidity. As mentioned above, NICE has stated that if a person has a BMI of 35 and they also have some comorbidity or a BMI of 40 or more without comorbidity then weight loss surgery is recommended. This is because the chances of managing to lose weight by any other method are so low.

First Steps

The first step with any medical condition is to talk to your family doctor. Most family doctors are aware of the problems that very overweight people have in losing weight and are sympathetic to the problem. If you don’t feel comfortable speaking with you family doctor, you can make a private appointment with Professor Peter Lodge to talk things through. A typical appointment lasts about 40 minutes.

Yes, absolutely. Each week at Spire Leeds Hospital we hold a patient weight loss forum. There you will meet patients who have had weight loss surgery as well as nurses and dieticians who can explain everything.

Complex surgery like this usually costs around £10,000, but there are some variations according to size and fitness. This may sound quite expensive but it covers a 30 day period in case there are any complications and also all outpatient follow up visits.

All options to do with the best way for you to lose weight successfully will be discussed.

The best way to prepare for any surgery is to be as fit as possible before hand. This can be difficult if you are very overweight but there are some tips you may find useful. The liver tends to enlarge as we get fatter. This is due to an increase in the number and size of the fat cells in the liver. This can make the surgery more tricky as the liver lies directly over the part of the stomach where the operation is done. Experts in Scandanavia have worked out that if a person can lose 8% of their body weight before surgery then this makes the operation easier and speeds recovery enormously. This sounds a lot but for most patients it works out to be between 1 and 2 stone. This can usually be achieved by cutting out carbohydrate as much as possible for about 6 weeks – that means no bread, potatoes, rice or pasta. In the final 10 days leading up to surgery, a special “liver shrink” diet is advised and this is something we can help you with.

After Surgery

Successful weight loss surgery aims to result in a loss of up to two thirds of excess body weight. The degree of weight loss achieved depends to some extent on how heavy you are at the time of surgery. Most patients lose 2 to 3 stone in the first 6 weeks and a similar amount over the next 4 to 5 months. The operation is designed for a gradual loss of weight over a two year period as procedures designed for more rapid weight loss have been associated with significant side effects in the past. As you lose weight it is important to increase the amount of exercise that you do. Exercise is an important component of weight loss and will help to avoid problems with loose skin. Some patients consider plastic surgery to improve body contour but you shouldn’t make decisions about that until at least 2 years from surgery.

Weight loss surgery should be regarded as the start of a new life. As mentioned above, the operation makes your stomach smaller so you will always eat smaller portions than you have been used to. Most patients don’t find this to be a problem as they feel full more quickly and also feel less hungry between meals. If you eat too much sugar or fat in a meal you may experience dumping. This is something you will learn to avoid. The majority of patients tolerate all the usual food groups in normal quantities. As your weight comes down, you will notice that your energy levels increase and you can do more exercise.

Spire Leeds Hospital has a well developed patient support network. This involves specialist bariatric nurses and dieticians and also our patient support group. Full details will be given to you if you decide to go ahead.