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World Class Bariatric Aftercare

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Post-operative diet

The post-operative bariatric surgery diet is a fundamental part of how successful you will be in achieving safe, successful long-term weight loss. The diet should be a lifelong, lifestyle change and commitment. It is certainly not a quick fix or a diet that you follow in the short term to then go back to old eating habits and food choices. If you do not follow all the dietary advice and rules after having bariatric surgery you are likely to get less than expected weight loss and even have weight regain, particularly in the longer term. All of the post-operative bariatric surgery diets are designed to ensure that you aim to meet your nutritional needs and have safe, successful long term weight loss. It is important that you consume a good quality, nutritious diet to help prevent nutritional deficiencies and complications.

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The dietary stages after bariatric surgery:

Every bariatric surgery procedure has the same four dietary texture stages. These dietary stages are:-

Stage 1- liquids only
Stage 2- pureed/blended food
Stage 3- soft and mushy, crispy foods
Stage 4- solid textured foods

How you progress through these four dietary stages will depend upon the bariatric procedure that you have had and the bariatric centre/surgeon where you had your surgery. You should be provided with written dietary advice and instructions from the dietitian where you had your bariatric surgery. It is very important that you follow the dietary advice provided to prevent surgical complications and nutritional deficiencies to achieve safe, successful weight loss.

Bariatric dietary rules:

For every bariatric surgery procedure there are dietary rules, which should be followed. By following these dietary rules you are less likely to experience problems such as pain on eating and vomiting. These dietary rules are:-

  1. Chew food well
  2. Eat slowly
  3. Do not take food and fluid together. Wait at least 30 minutes before and 30 minutes after food for drinking fluids
  4. Do not progress through the dietary stages too quickly
  5. Underestimate, rather than over estimate your portion sizes

If you vomit after eating food, one or more of the following is likely to have occurred:

  1. You ate too much
  2. The texture of the food was unsuitable/too much
  3. You ate too quickly
  4. You did not chew your food enough
  5. You had fluid and food too close together

If you follow the bariatric dietary advice and rules, then you should not experience vomiting. If you are vomiting on a regular basis and feel that you are following the dietary advice and rules, you should contact your bariatric centre/surgeon for advice.

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Bariatric caution foods:

There are some solid foods, which may be more difficult to tolerate in the longer term. These are foods that are more likely to become stuck, give you pain and may make you vomit.

The caution foods should only be introduced once you can manage all other food textures, usually towards 12 months after bariatric surgery. Caution foods should not be introduced in the early stages after bariatric surgery as your may cause surgical problems/complications.

The bariatric caution foods to avoid are: -

  • Non-toasted bread particularly soft and white
  • Pasta
  • Boiled rice
  • Meat particularly dry, fibrous meat such as steak, chops, barbequed meat
  • Stringy vegetables such as green beans, celery
  • Sweetcorn
  • Mushrooms
  • Lettuce
  • Pineapple
  • Pips, seeds, skins, piths from fruit and vegetables
  • Nuts
  • Dried fruit
  • Oranges

Some people can manage some or all of the caution foods in the longer term from 12 months after bariatric surgery. These caution food textures, if tolerated tend to make people feel fuller quicker and for longer to help maintain their weight loss lifelong.

Intragastric balloon:

The gastric balloon works by restricting your portions sizes and reducing your appetite.

Once the gastric balloon is inserted, you will be able to begin taking small sips of water. Over the next few days you will gradually build up your fluid intake as tolerated.

Usually from day 3-7 after the gastric balloon is inserted you can begin moving onto stage 2 (pureed diet). Over the first 4-6 weeks you will gradually move through the dietary stages. Most people can eat a solid textured diet from week 4-8 after the gastric balloon was inserted.

Once your diet is established on stage 4 (solid texture), you should only be able to eat up to three tea plate sized portions of food per day.

You will still need to follow the bariatric dietary rules. The bariatric caution foods should be introduced into your diet once you can tolerate a varied textured diet.

EndoBarrier:

The EndoBarrier works by affecting how food is absorbed in the small intestine and may reduce your appetite. EndoBarrier does not restrict portion sizes.

Once the EndoBarrier is inserted, you will be able to begin taking small sips of water. For the first 7 days after the EndoBarrier is placed you will need to follow a nutritious liquid only diet.

From day 8 you will be able to move onto stage 2 of the diet (pureed). After 2 weeks you will gradually move through stage 3 (soft, mushy and crispy) and stage 4 (solid texture) of the dietary stages.

Most people can eat a solid textured diet from week 4 after the EndoBarrier was placed. You will need to ensure you follow a reduced calorie, healthy diet to have successful weight loss results.

You will still need to follow the bariatric dietary rules. The bariatric caution foods should be introduced into your diet once you can tolerate a varied textured diet.

Gastric band:

The gastric band works by restricting your portions sizes and reducing your appetite.

Once the gastric band is placed, you will be able to begin taking small sips of water. Over the next few hours following surgery, you will be able to gradually build up to small frequent sips of other nutritious liquids.

Most bariatric centres advise a nutritious liquid only diet for the first 2-4 weeks following surgery. How long you are advised to follow each of the dietary stages will depend upon your bariatric centre and dietitians advice. Most gastric bands are not inflated at the point of having the gastric band surgery. Most gastric bands are first adjusted at 4-6 weeks after surgery.

After following a liquid only diet, you will gradually progress through stage 2 to 4 of the diet. Most people who have a gastric band placed can eat solid textured foods (stage 4) from week 4-6 onwards.

Once you have had your gastric band adjusted, and each time you have an adjustment you will be advised to go back to a liquid only diet and begin progressing though the dietary stages again. How quickly you progress through the dietary stages after a band adjustment will depend upon how tight or loose you band is. How quickly or slowly you progress through the dietary stages after an adjustment gives little indication of whether the band is adequately adjusted.

If you gastric band is adequately adjusted you should be able to manage up to three, tea plate sized portions of solid textured food per day. The band should also reduce your appetite. You will need to follow the bariatric dietary and caution food rules to prevent any problems such as pain and vomiting. You will require daily, lifelong vitamin and mineral supplements.

Gastric bypass:

The gastric bypass surgery works by restricting food portions sizes, reducing the amount of nutrition absorbed and decreasing your appetite.

The gastric bypass diet should be high in protein, low in fat and sugar. Some people will experience dumping syndrome symptoms after gastric bypass surgery. This is usually related to consuming too much sugar. By using artificial sweeteners and using reduced sugar/no added sugar drinks, dumping syndrome symptoms should be reduced.

Initially after gastric bypass surgery you will be able to take small sips of water. This will gradually build up to more frequent sips of water, usually over the first 24 hours after surgery. How slowly or quickly you move through the four dietary stages will depend upon the advice from your dietitian and surgeon.

Most bariatric centres will advise a nutritious liquid only diet for the first 2-7 days.

You will then move onto stage 2 (pureed) diet from day 3 to day 8 after surgery, depending upon how long you have been advised to follow the liquid only stage for. You may be following a liquid and/or pureed diet for at least the first 3-6 weeks after gastric bypass surgery.

Whilst you are following the pureed stage of the diet you will only be able to manage 2-3 tablespoons of pureed food for a meal. It is important that you ensure that you have a sufficient amount of protein rich foods/fluids and other nutrients in your daily dietary intake.

Over the next 6-12 months you will gradually work through the dietary stages to stage 4 (solid texture), up to 3 tea plate sized portions per day. You will need to follow the bariatric dietary rules and caution food advice. You will require daily, lifelong vitamin and mineral supplements.

Sleeve gastrectomy:

The sleeve gastrectomy surgery works by restricting food portions sizes and reducing appetite. The sleeve gastrectomy diet should be high in protein, low in fat and sugar.

Initially after sleeve gastrectomy surgery you will be able to take small sips of water. This will gradually build up to more frequent sips of water, usually over the first 24 hours after surgery. How slowly or quickly you move through the four dietary stages will depend upon the advice from your dietitian and surgeon.

Most bariatric centres will advise a nutritious liquid only diet for the first 2 days after surgery. If liquids are tolerated, you will then move onto stage 2 (pureed) diet from day 3 after surgery, depending upon how long you have been advised to follow the liquid only stage for. You may be following a liquid and/or pureed diet for at least the first 3-6 weeks after sleeve gastrectomy surgery.

Whilst you are following a pureed stage of the diet you will only be able to manage 2-3 tablespoons of pureed food for a meal. It is important that you ensure that you have a sufficient amount of protein rich foods/fluids and other nutrients in your daily dietary intake.

Over the next 6-12 months you will gradually work through the dietary stages to stage 4 (solid texture). Once established you should be able to manage upto 3 tea plate sized portions of solid food per day. You will need to follow the bariatric dietary rules and caution food advice. You will require daily, lifelong vitamin and mineral supplements.

Biliopancreatic diversion +/Duodenal Switch:

The biliopancreatic diversion (BPD) +/- duodenal switch (DS) works by restricting food portions sizes, reducing the amount of nutrition absorbed (malabsorption) and decreasing your appetite.

The diet should be high in protein, low in fat and sugar. Some people will experience dumping syndrome symptoms after BPD+/-DS surgery. This is usually related to consuming too much sugar. By using artificial sweeteners and using reduced sugar/no added sugar drinks, dumping syndrome symptoms should be reduced.

Initially after BPD +/- DS surgery you will be able to take small sips of water. This will gradually build up to more frequent sips of water, usually over the first 24 hours after surgery. How slowly or quickly you move through the four dietary stages will depend upon the advice from your dietitian and surgeon.

Most bariatric centres will advise a nutritious liquid only diet for the first 3-7 days.

You will then move onto stage 2 (pureed) diet from day 3 after surgery, depending upon how long you have been advised to follow the liquid only stage for. You may be following a liquid and/or pureed diet for at least the first 3 weeks after BPD+/-DS surgery.

Whilst you are following the pureed stage of the diet you will only be able to manage 2-3 tablespoons of pureed food for a meal. It is important that you ensure that you have a sufficient amount of protein rich foods/fluids and other nutrients in your daily dietary intake.

Over the next 6-12 months you will gradually work through the dietary stages to stage 4 (solid texture). Once established, you should be able to manage up to 3 tea plate sized portions of solid food per day. You will need to follow the bariatric dietary rules and caution food advice. You will require daily, lifelong vitamin and mineral supplements.

Vitamin and mineral supplementation

All bariatric surgery procedures require daily vitamin and mineral supplements. Nutritional supplementation is routinely advised after bariatric surgery due to the dietary restrictions, smaller portions sizes and malabsorption of nutrients with some procedures such as the gastric bypass and BPD+/-DS.

Daily vitamin and mineral supplements are advised to prevent nutritional deficiencies that can be associated with each bariatric surgery operation. Nutritional deficiencies that are commonly associated with bariatric surgery procedures include iron, calcium, vitamin D, folate and vitamin B12.

If nutritional deficiencies are left untreated or nutritional supplements are not consumed as advised, it can lead to long-term health problems such as osteoporosis and anaemia.

It is essential that you body receives sufficient, good quality nutrition from food and fluids that you consume after bariatric surgery; this will help reduce the risk of developing a nutritional deficiency.

Which nutritional supplements you require will depend upon factors such as:-

  • The bariatric procedure you have had
  • Your dietary intake
  • Any vitamin and mineral deficiencies identified in blood tests

Your dietitian will advise you upon which vitamin and mineral supplementation you will need to take.

Which vitamins and mineral supplements to choose

There are many types and brands of vitamin and mineral supplements available from pharmacies, supermarkets and the internet. Some labels can be misleading.

It is important to choose the right vitamin and mineral supplements that provide the recommended levels that you have been advised by your dietitian to ensure that you meet your nutritional needs.

You may be advised a chewable, dissolvable vitamin and mineral supplement whilst on the liquid and pureed stage of the diet after surgery, as vitamin and mineral supplements tend to be large in size and can be difficult to tolerate in the early stages following surgery.

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Vitamin B12 injections:

One of the important vitamins the body needs is called vitamin B12. Although vitamin B12 is contained in the food we eat, the body cannot absorb it unless it is bound (meaning joined) to a protein called intrinsic factor. Intrinsic factor is produced and secreted by the stomach, and is usually absorbed in the first part of the small bowel.

After surgery, particularly after the sleeve gastrectomy, gastric bypass and BPD/DS, it is more difficult to absorb vitamin B12 from food. The reduced stomach size cannot produce as much intrinsic factor to convert vitamin B12 from food to vitamin B12 that your body can absorb.

Patients often have a lack of vitamin B12 from their diet and a reduction in intrinsic factor. It is for this reason that most patients are recommended to have a vitamin B12 injection once every 3 months, lifelong to prevent a deficiency occurring.

A lack of vitamin B12 can make you feel very tired, lacking in energy and if left untreated can cause permanent nerve damage. It is important to make sure you get these injections so that you can live a normal healthy lifestyle.

Vitamin B12 tablets that can be purchased, however for the same reason that the body cannot absorb vitamin B12 from your food after surgery, you will not absorb vitamin B12 from a tablet. This is why injections are recommended to ensure your body receives the required dose to prevent a deficiency occurring.

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Blood tests:

The most accurate way of determining whether you have a nutritional deficiency is to check your vitamin and mineral blood levels. It is recommended that people should have their blood micro-nutrient levels checked before surgery and then annually lifelong.

How often you have blood tests will depend upon the quality of your diet, any signs and symptoms of a nutritional deficiency that you may have and the level of deficiency. The micro-nutrient blood tests that are recommended are:

  1. Iron and ferritin
  2. Full blood count
  3. Vitamin B12
  4. Folate
  5. Magnesium
  6. Selenium
  7. Zinc
  8. Vitamin A (BPD+/-DS)
  9. Vitamin D
  10. Calcium

If you are found to be deficient in any of these vitamins or minerals, then you should be advised to take additional nutritional supplements to help correct the levels. It is recommend that you have your micro-nutrient blood levels checked at least once a year for life.

Medications

Medications can come in a variety of preparations:

  • Tablets (some can be crushed or dissolved, others must be swallowed whole)
  • Liquids
  • Injections
  • Patches

It is very important that after surgery, you continue to take all of your medications, unless to are told to stop by a doctor.

Once you have had your operation, you may find it difficult to swallow some of your tablets. In general, anything bigger than a small paracetamol may be difficult to take.

Before your surgery, it is worth seeing if any of your tablets can be changed, either to another preparation (i.e. liquid), or if you can crush or dissolve them. Sometimes, if a medication cannot be crushed or dissolved, or if there is no alternative preparation, it may need to be changed to a different one.

It is a good idea to speak to your GP or local pharmacist before your operation, to make sure that you will be able to take all of your medications after surgery. They should be able to offer you advice as to what to do with all of your tablets.

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Diabetes:

One of the main advantages to losing weight, either by dieting or by having a weight loss operation, it that it can often improve type 2 diabetes.

For patients that take insulin injections as well as tablets, it may be that they no longer need the insulin. Some people may find that they can either reduce the dose of their medications, or even stop their tablets.

It is vital that you do not stop your medications unless you are told to by a doctor or your bariatric dietitian.

If you stop your medication without being told to, it can cause a lot of damage to your eyes, kidneys, nerves, heart and blood vessels.

Make sure you continue to check your blood sugar regularly, as you did before your surgery. You may find that you need to see your practice nurse more often whilst your body gets used to a new way of handling your blood sugar.

Complications

In any operation, there are always a few risks that you should know about. The biggest risks are of having a heart attack or stroke whilst you are under the anaesthetic. This is rare, but if you are very obese, your heart is already under strain and this increases the risk slightly.

There is a risk of getting a blood clot following a weight loss operation, either in the legs or the lungs. You will be given injections to take at home for the first week or so to minimise this risk and it is important that you take these injection.

There is a mortality (death) risk with bariatric surgery. This risk is extremely small (1-2 people out of every 1000 patients), and is much lower than for many other types of surgery, but it does exist.

Other complications that can occur with any operation include:

  • Chest infections
  • Wound infections
  • Pain
  • Scarring
  • Constipation

Sometimes the holes that the surgeon makes in your abdomen to place the instruments they need inside you can bleed. Most of the time this can be sorted without any further surgery. Rarely, a knuckle of bowel can get stuck in one of these holes, called a port-site hernia, and this needs an operation to fix it.

Gastric balloon:

Most of the problems with the balloon relate to the camera test used to insert or remove it. The main risks of include a sore throat, and a very small risk of bleeding if the veins in your stomach or oesophagus are very large. Very rarely, the camera can push through the wall of the oesophagus or stomach, known as a perforation. In this case, you would need an operation to fix it.

There have been cases where the gastric balloons have been inflated in the oesophagus. Although rare, you would need an operation to fix this. The balloon can leak. If this were to occur, it is not an emergency, but you should contact your bariatric team.

As the balloon only stays in for 6 months, there are no long-term complications associated with the gastric balloon. It can sometimes be difficult to remove the balloon, especially if it has leaked, but in most cases it is simple. Very rarely the balloon can cause a blockage in the bowel, particularly if it has leaked and passed out of the stomach. This may require an operation, but is extremely rare

Endobarrier:

The main complications of the EndoBarrier relate to the camera used to insert or remove it, in the same way as the balloon. There is a small risk of having a sore throat, and a very small risk of bleeding if the veins in your stomach or oesophagus are very large. Very rarely, the camera can push through the wall of the oesophagus or stomach, known as a perforation. In this case, you would need an operation to fix it.

Sometimes the EndoBarrier can slip and move down the bowel causing a blockage. This is extremely rare.

Other problems with the EndoBarrier include:

  • Nausea
  • Vomiting
  • Bleeding
  • Abdominal pain

Gastric band:

The main problems with the gastric band occur in the long-term, sometimes years after it has been placed. The only significant risks during the operation itself are of bleeding, and liver damage if the liver is big (this is particularly a problem if you do not stick to the pre-operative diet).

The main risks associated with gastric banding include:

  • Slippage- the band slips down (or rarely up) the stomach, or more often the stomach slips up through the band, which causes pain, vomiting and difficulty swallowing. This can often be treated by deflating the band and letting it settle, but sometimes needs an operation to reposition it. Very rarely, the band cannot be re-positioned and needs to be removed.
  • Erosion- the band can rub against the tissues in the stomach, and over time, work its way through so that part of it lies inside the stomach. This means the band no longer works, and you may find you can eat more than you could before. Unfortunately if this happens, the band needs to be removed.
  • Port problems- the port, which is placed under your skin on your abdominal wall, is connected to the band by tubing. This allows fluid to be inserted or removed from your band to adjust the tightness. Sometimes the port can become infected. This may need antibiotics to treat it, or it may need t be removed and replaced at a later date, giving time for the infection to settle. The port can flip over, which means it cannot be accessed for band adjustments. It may need a small operation to flip it back into a normal position. Very rarely, the port can erode through the skin. This needs to be removed, and replaced at a later date. Unfortunately, when there is no port, this means that the band often does not work.
  • Tubing problems- very rarely the tubing can leak. This means that the fluid will seep out of your band, making it loose. Occasionally this can be fixed under a local anaesthetic, especially if the problem is at the port-end, but if the problem is at the end by the band, it will need an operation to fix.

Sleeve gastrectomy:

The sleeve gastrectomy has very few long-term complications. Once you have recovered from surgery, it is unlikely that you will have any significant problems.

The main risks that can occur with the sleeve include:

  • Staple line leakage- the stomach is stapled along its length. This is like stapling a sheaf of paper. Sometimes these staples can come undone, leaving a hole in the stomach. Although this can sometimes be managed by placing a tube down your nose and into the stomach to drain off fluid, and by not letting you eat or drink for a few days, more often than not it needs an operation to fix it.
  • Staple line bleeding- the same staple line can sometimes bleed. Although some surgeons use a buttressing material or a special type of glue on the staple line to try to prevent this, it may need a further operation to stop it. Most of the time however, this bleeding will stop on its own without the need for another operation.
  • Stricture- The staple line can sometimes over-heal, leaving a narrowing in the stomach. Most of the time this is not a problem, but can sometimes be tight enough to prevent you from eating properly. In this case, you will need to have a camera test, where the doctor can stretch this narrowing with a balloon. Sometimes this procedure needs to be repeated a few times.

Gastric bypass:

Like the sleeve, long-term complications are relatively rare after the gastric bypass. Once you have recovered from surgery, it is rare to have any further problems.

Complications are similar to the sleeve gastrectomy, and include:

  • Staple line leakage- the stomach and bowel are joined to each other using staples. This is like stapling a sheaf of paper. Sometimes these staples can come undone, leaving a hole in the join. Although this can sometimes be managed by placing a tube down your nose and into the stomach to drain off fluid, and by not letting you eat or drink for a few days, more often than not it needs an operation to fix it.
  • Staple line bleeding- the same staple line can sometimes bleed. Although some surgeons use a buttressing material or a special type of glue on the staple line to try to prevent this, it may need a further operation to stop it. Most of the time however, this bleeding will stop on its own without the need for another operation.
  • Stricture- The staple line can sometimes over-heal, leaving a narrowing in the stomach. Most of the time this is not a problem, but can sometimes be tight enough to prevent you from eating properly. In this case, you will need to have a camera test, where the doctor can stretch this narrowing with a balloon. Sometimes this procedure needs to be repeated a few times.
  • Internal hernia- this is where the bowel twists around itself, causing a potential obstruction. This can cause abdominal pain (which can be intermittent). It can sometimes be diagnosed on a CT scan. In this case, you will need another operation to fix it.

BPD/DS:

The complications following this operation are similar to the sleeve and the bypass. These include:

  • Staple line leakage- the stomach and bowel are joined to each other using staples. This is like stapling a sheaf of paper. Sometimes these staples can come undone, leaving a hole in the join. Although this can sometimes be managed by placing a tube down your nose and into the stomach to drain off fluid, and by not letting you eat or drink for a few days, more often than not it needs an operation to fix it.
  • Staple line bleeding- the same staple line can sometimes bleed. Although some surgeons use a buttressing material or a special type of glue on the staple line to try to prevent this, it may need a further operation to stop it. Most of the time however, this bleeding will stop on its own without the need for another operation.
  • Stricture- The staple line can sometimes over-heal, leaving a narrowing in the stomach. Most of the time this is not a problem, but can sometimes be tight enough to prevent you from eating properly. In this case, you will need to have a camera test, where the doctor can stretch this narrowing with a balloon. Sometimes this procedure needs to be repeated a few times.
  • Internal hernia- occasionally after a BPD/DS, the bowel can twist around itself, causing a potential obstruction. This can cause abdominal pain (which can be intermittent). It can sometimes be diagnosed on a CT scan. In this case, you will need another operation to fix it.

The BPD/DS is not commonly performed in the UK, because it has quite a high risk of people having nutritional problems. It can also cause too much weight loss, meaning that you become ill. Sometimes this is so severe that the operation needs to be revised or even reversed- this is a very large and difficult undertaking.

Follow up

It is essential that you receive appropriate levels of good quality aftercare following your bariatric surgery that will meet your needs. The bariatric surgery aftercare and follow up is one of the key elements to how successful you will be.

Before you have your operation you should consider the level of aftercare and follow up that the bariatric centre is offering you and whether this meets your needs.

The main areas to consider for bariatric aftercare and follow up are:

  • How experienced are the bariatric surgeon and team are
  • How long is the aftercare/follow up for
  • How accessible is the bariatric team to you after surgery
  • Where and when will the aftercare/follow up be provided
  • What happens if you have problems, who should you contact
  • Who will be routinely monitoring you

If you have bariatric surgery on the NHS you should have routine follow up by the bariatric centre where you had your surgery for the first 2 years. After this time you will require lifelong monitoring by your GP or community weight management programme.

If you are self funding (paying) for your bariatric surgery, your aftercare should be included in the price. The aftercare in the private sector can vary in quality and in duration from 1 year to 3 years plus.

If the aftercare package is not automatically included in the cost and is an additional cost option then you should question how important the bariatric centre values your health and well being to ensure you have safe successful weight loss.

Gastric balloon

The gastric balloon is licensed to be in your stomach for 6 months. It is important to have regular monthly follow up during this time with the dietitian to ensure you have the expected weight loss results.

EndoBarrier

The EndoBarrier is licensed to be in place for up to 12 months. It is important to have regular monthly follow up during this time with the dietitian to ensure you have the expected health benefits and weight loss results.

Gastric band

It is important to have regular monthly follow up with the dietitian and nurse, particularly in the first year after the gastric band is placed. You should also have access to the surgeon as necessary.

It may take a few gastric band adjustments to achieve the appropriate dietary restriction and reduction in appetite. It is important to have regular contact with the dietitian and nurse to ensure that your gastric band is adjusted appropriately within the first few months to achieve the expected weight loss results.

If you have gastric band surgery within the NHS, you can expect to have follow up for the first 2 years within your bariatric centre. After 2 years you will then monitored by your GP or local weight management programme.

If you are self funding (paying) for your gastric band surgery, your aftercare should be included in the price. The aftercare in the private sector can vary in quality and in duration from 1 year to 3 years plus.

If you have a gastric band within the private sector you should consider how many band adjustments are included in the aftercare package and who you should contact if you have any problems.

Sleeve gastrectomy

It is important to have regular follow up with the dietitian, particularly in the first year after sleeve gastrectomy surgery to ensure you have safe, successful weight loss. You should also have access to the surgeon as necessary.

If you have sleeve gastrectomy surgery within the NHS, you can expect to have follow up for the first 2 years within your bariatric centre. After 2 years you will then monitored by your GP or local weight management programme.

If you are self funding (paying) for your sleeve gastrectomy surgery, your aftercare should be included in the price. The aftercare in the private sector can vary in quality and in duration from 1 year to 3 years plus.

Gastric bypass

It is important to have regular follow up with the dietitian, particularly in the first year after gastric bypass surgery to ensure that you have safe, successful weight loss. You should also have access to the surgeon as necessary.

If you have gastric bypass surgery within the NHS, you can expect to have follow up for the first 2 years within your bariatric centre. After 2 years you will then monitored by your GP or local weight management programme.

If you are self funding (paying) for your gastric bypass surgery, your aftercare should be included in the price. The aftercare in the private sector can vary in quality and in duration from 1 year to 3 years plus.

Biliopancreatic diversion (BPD) +/- duodenal switch (DS)

It is important to have regular long-term follow up with the dietitian, particularly in the first year after BPD +/-DS surgery to ensure you have safe, successful weight loss. You should also have access to the surgeon as necessary.

If you have Biliopancreatic diversion (BPD) +/- duodenal switch (DS) surgery within the NHS, you can expect to have follow up for the first 2 years within your bariatric centre. After 2 years you will then monitored by your GP or local weight management programme.

If you are self funding (paying) for your BPD +/-DS surgery, your aftercare should be included in the price. The aftercare in the private sector can vary in quality and in duration from 1 year to 3 years plus.

Returning to work

How quickly you can return to work depends on how you feel after your operation, and what you do for a living.

In most cases, the doctor or nurse will give you a sick note for 1-2 weeks, after which, if you are not fit to go back to work, you will need to see your GP for another sick note. These notes are now called “Return to work notices” rather than sick notes!

Before you go back to work, you should make sure that you are comfortable (this may be with or without the need for painkillers), and that you will be able to drink fluids.

People who do office work, or are able to sit down at work may find that they can go back slightly earlier than people who are on their feet all day long. After surgery it will take a few weeks to months before you feel like you have all of your energy back, so it is good to make sure you can sit or stand as necessary.

If you have a more manual job, you may need to take a little longer off work, especially if your job involves heavy lifting (this can include jobs like nursing, care work and working in a lab). It is important to try to avoid lifting heavy objects for about the first 3-6 months after surgery, as this will allow the muscles in your abdomen to heal, and help to prevent hernias.

Exercise

You can start doing gentle exercise, such as walking, as soon as you feel able to after surgery. You may need to start with little bits of exercise and build it up slowly. How much exercise you do depends on how you feel.

You should avoid swimming until your wounds are completely healed, but after this, it is OK to get in a pool.

We would recommend that you avoid doing strenuous exercise for the first 3-6 months, until your body has completely healed from surgery. This will prevent you from getting hernias. This is particularly important for exercise that involves the stomach muscles, such as weight lifting and sit-ups.

Remember that after surgery, your body changes, and you may become dehydrated easily after exercise. It is very important that you keep sipping fluids little and often to keep yourself adequately hydrated.