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FAQ

Intragastric Balloon
The balloon works by reducing the amount of solid food you can eat.  The silicone balloon is filled with sterile fluid and sits within the stomach.  It helps you to feel full (when eating solid food) more quickly and therefore can help you from eating a large meal.  The less you eat, the more weight you will lose.  It is important to follow dietary advice.


The balloon can be inserted for patients with a BMI of 27, or above. The balloon is a removable device.  Once placed, it stays in the stomach for up to 6 months, before it is removed.  The main advantage of the gastric balloon is that neither insertion nor removal requires an anaesthetic.  The procedure is performed by a doctor qualified in endoscopy (this does not have to be a surgeon) and can be performed with or without sedation.  You do not need to be put to sleep.  The procedure is done as an outpatient, meaning you can go home usually after a few hours after the balloon has been placed or removed.



The doctor will spray your throat with some local anaesthetic, and possibly give you some sedation.  This will not put you to sleep, but will make you feel more relaxed and less anxious.  The doctor will look down into your stomach with a camera (perform an endoscopy) and then remove it.  The balloon will then be fed down into your stomach through your mouth in the same way. The balloon is attached to a syringe, which allows the doctor to inflate it with fluid.  The fluid usually contains saline and a harmless medical blue dye, which, if the fluid were to leak, would turn your urine blue.  Once the balloon is inflated, the camera and the syringe tubing are removed and you are taken through to recovery.  The procedure usually takes around 20-30 minutes.



The main risks associated with having the gastric balloon are related to the camera procedure used to place or remove the balloon.  There is a risk of the camera pushing through the wall of the oesophagus or stomach, known as a perforation.  In this case, you would need an operation to fix it.  The general risk of this is 1 in 1500 patients. Other risks of endoscopy include a sore throat, and a very small risk of bleeding if the veins in your stomach or oesophagus are very large. 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.  You would know because the fluid in the balloon would turn your urine blue.  If this were to occur, you should contact your bariatric team. Finally, although the balloon needs removal after 6 months, sometimes the doctor is unable to remove it.  This is more common if the balloon has leaked and it has passed out of the stomach.  Sometimes the balloon can pass down the small bowel and get stuck. Very occasionally, this may cause a blockage and you may need another procedure - either a camera rectally or an operation - to remove it.



The balloon can be effective at helping you lose weight, and most people will find they lose 1-2 lbs per week if they follow the appropriate diet and exercise. It is mainly used for people who do not have much weight to lose, or for people who are having another bariatric procedure, and they need help to lose some weight before their operation, because they are a higher anaesthetic risk for bariatric surgery.  If you eat foods that pass through the stomach easily, such as cream, ice cream, chocolate, crisps, you will not lose as much weight and may not lose any weight at all. Some patients have been known to have high calorie sloppy foods that pass easily through the stomach around the balloon.  However this defeats the object of having a balloon, and by not making the right dietary choices will not help you lose weight, and is definitely not recommended.  Alcohol is also very high in calories, so it is advisable to reduce or avoid alcohol intake. Also it is advisable to avoid all high calorie drinks.



Before having any operation or procedure, it is important to read about the different type of surgeries/procedures available, and decide which you think will be the best one for you. Speaking to your family doctor or the bariatric team can help you make this decision. You will be told not to eat or drink anything the night before, and the morning of your procedure.  This is important, because if you have any food or fluid in your stomach, it makes the procedure much more difficult.  You must follow this rule, or the doctor will cancel your procedure.


Not usually.  Although it is always useful to watch what you eat, there is no special diet needed before you have the balloon placed.


Often the only member of the team you need to see before having the balloon placed is the surgeon or gastroenterologist.  They will go through the risks of balloon procedures with you in the clinic, and again on the day of your procedure. In some centres you will also see the dietician, who may talk to you about your diet after you have the balloon placed.


    This is not usually necessary.  The balloon is a temporary procedure designed to help you lose weight, but because it is not permanent and needs removal after 6 months, it is rare that the doctor wants you to see a psychologist.

      The balloon is rarely placed on the NHS, except occasionally in people with very high surgical risks, who need to lose weight before the surgeon and anaesthetist will perform a bypass or sleeve.  If you wish to pay privately, you and the surgeon will discuss it and decide if the balloon is suitable for you.  Unless you have had a large operation on your stomach, you are usually OK to have the gastric balloon.


      Balloon insertion varies in cost but is usually around £2500-5000.


      In most centres, the surgeon and dietitian will see you a few weeks after you have the balloon placed to make sure you are not having any problems.   In some centres the dietitian will see you for a follow up for the 6 months to ensure you have successful weight loss and help you consider how you are going to maintain the weight loss achieved in the longer term. After 6 months the balloon needs to be removed.  You should receive an appointment from your bariatric team for this, however if it is approaching 6 months and you have not had an appointment, you should contact your team.



      This varies from hospital to hospital, but in many cases you do not need any pre-operative assessment.  Some centres will take some blood tests before the procedure, particularly if you take any blood thinning medications.  You do not need a general anaesthetic.


      The surgeon will have a look into your stomach with the camera before the balloon is placed, and therefore you do not usually need any pre-operative investigations.


      No.  Placing the balloon is done with a camera that goes down your mouth and into your stomach.  It is rarely done under a general anaesthetic.  This is a completely different procedure to having your gall-bladder removed and cannot be done at the same time.


      After the procedure you will be taken into the recovery room. Some centres will give you a drink straight away, others will ask you to wait for an hour and then give you a drink.  You should also receive dietary advice from the dietitian.  Once you are able to drink properly without vomiting and your sedation/drowsiness has worn off, you will be allowed to go home. The gastric balloon can make you feel very sick, cause vomiting and can give you pain, cramping and heartburn for around 10-14 days after placement.  If you can get through this period, you usually start to feel better and can go back to eating properly. A minority of patients are not able to tolerate the above symptoms and early removal of the balloon is needed.  Keep in mind that the point of the balloon is to make you eat less, therefore you should be careful with your diet. When the balloon is removed, you should not have any symptoms, and you will find your portion sizes will increase.  Do not forget that you still need to watch what you eat, or you will put all of the weight back on.



      You don’t usually need to stay for more than a few hours after balloon placement, unless you have any problems.  You should not drive yourself home.


      The balloon is designed to make you feel fuller and reduce your portion sizes. However if you choose softer, easier to tolerate, high calorie foods such as chocolate, ice cream, biscuits and crisps or drink and eat together (making all foods sloppy) you will not feel full, as these foods will slide past the balloon without feeling much if any restriction.  You need to ensure you eat a solid textured diet to make you feel fuller for longer.  This will help you to lose weight.  If you feel hungry, try having a drink of water, as the body can often not tell the difference between hunger and thirst.  If you decrease the amount of food you eat, your stomach will shrink and eventually you will start to feel full more quickly.



      The procedure is relatively simple and does not involve an operation; therefore as soon as you feel ready, you can begin with liquids.  It is advisable to stick to liquids for the first 48 hours to ensure you give time for things to settle.  After then you will move onto a pureed diet and will gradually increase the texture and portion sizes over the following weeks.  Once your diet is established you shouldn’t be able to manage more than a tea plate sized portion at meal times of normal solid textured food. 



      As soon as you feel up to it.  There is no reason you cannot exercise or swim as soon as you feel well enough.


      Yes.  The balloon needs to be removed after 6 months.


      It is not uncommon for people to complain that they have not lost any weight with the gastric balloon.  This is because it is still possible to eat high calories foods, even with the balloon in your stomach.  Your weight is related to how many calories that you eat.  If you eat more than recommended for your body size, you put weight on.  If you eat less than recommended, you lose weight.  The balloon can make you feel full more quickly, when eating solid textured foods but if you ignore this, drink and eat together or ignore the full feeling and keep eating, you will not lose weight. Your stomach can stretch over time, so it is possible to feel hungry even after you have eaten a big meal, especially if you are used to big meals. If you do not lose weight, you can talk to your surgeon about having a different procedure, but ideally you need to change your eating habits if you want to lose weight.



      You do not need a general anaesthetic to have the balloon placed therefore you can move yourself onto the bed to have the balloon placed.  You will stay on this trolley until you are no longer feeling drowsy, at which point you can sit up yourself.  If you need assistance the staff will help.


      Yes - A daily complete A-Z multivitamin and mineral supplement is recommended whilst the balloon is in for 6 months.


      You do not usually need any investigations after the balloon has been placed.  If you cannot tolerate the balloon, or after 6 months, it is removed in the same way it was placed.  If you have any problems, such as the balloon leaking, it is removed in this same way.


      No you will not experience dumping syndrome with a balloon.


      It is unlikely that you will have a problem with loose skin after having a gastric balloon, because weight loss is usually not as much as with the other weight loss operations If you do lose a lot of weight you may find that you have some loose skin. Sometimes the skin will also shrink, but it may not.  If the loose skin upsets you, you can speak to your surgeon about referring you to a plastic surgeon, but the NHS will not pay for skin surgery.


      This is very unlikely, but if you do lose too much weight, the surgeon can remove your balloon, and you should find that it settles, as you will be able to eat more.


      Yes, once the initial adjustment symptoms have settled, you can go on holiday with an intra-gastric balloon.  It is perfectly safe to fly.


      Weight regain is very common after having the balloon removed.  You need to be careful that you do not start eating too much again once you no longer have the balloon.  Keep a food diary, or keep going to a slimming club - this will help maintain your weight.  As long as you are careful, this can help prevent weight regain.  It is important to come up with a plan before your balloon is removed, on ways to maintain the weight loss you have achieved.


      There is no reason you cannot get pregnant whilst you have a gastric balloon, but if you do, you should speak to your surgeon and decide whether or not it should be removed early.   In the early days, when vomiting is common, the absorption of some contraceptives can be affected.  Once these symptoms have settled the balloon should not affect any of your normal contraception.


      SCUBA diving (Self-Contained Underwater Breathing Apparatus) involves descending down underwater where the pressure is higher than it is on land.  The balloon is filled with fluid, and therefore should not be affected by the pressure changes that occur during scuba diving.  There is however a very small chance of the balloon bursting or leaking because of the increased pressure underwater, but this is unlikely.  If this occurs, you will notice because your urine will turn blue and you should make an appointment to see your surgeon.  It is advisable to descend and ascend in the water slowly which can help protect your balloon.



      If you have a perforation (either the balloon or the camera used to place it, goes through the wall of the stomach or oesophagus), this becomes a surgical emergency.  This is extremely unlikely, if it does occur, it should be picked up whilst you are still in the hospital. Also contact the team if you are concerned about not been able to keep any fluids down and you are beginning to feel dehydrated.  If you start to notice your urine is blue at a later date, you should contact your bariatric team.  You will be sent an appointment to have the balloon removed and maybe replaced.



      Your bariatric team should send you an appointment to have your balloon removed after 6 months.  If you do not receive an appointment, you can contact the bariatric team or the hospital and remind them that you need the balloon removing.  They will then send you an appointment.


      If you do not receive an appointment or forget to get the balloon removed, it should not cause major problems in the first few weeks.  The balloon is only licenced by the government and NHS for 6-months use, which means it has a 6-month lifespan.  After this, the balloon can leak or burst.  There are cases of people being very ill and needing emergency surgery because their balloon stayed in too long, so you should contact your surgeon as soon as you remember. We cannot guarantee what will happen to you if your balloon stays in longer than it should.



      Yes in most cases.  The balloon can be removed whilst you are in theatre before the surgeon does the main operation.  In some centres the surgeon will remove the balloon a few weeks before surgery, so that any tissue reaction in the stomach that the balloon might have caused can settle down.


      Endo Barrier
      The Endobarrier works by lining the first part of the small bowel and preventing you from being able to absorb as much of the food you eat.  The barrier, produced by Elemental Healthcare, GI Dynamics is placed for 6 months.  When you cannot absorb food, it allows you to lose weight, as you are not taking in as much energy as normal.  The Endobarrier is being advertised in the UK more as a way of improving type 2 diabetes than as a weight loss procedure, but is successful in doing both.



      The Endobarrier is a removable device.  Once placed, it stays in for up to 6 months before it is removed, which is the main advantage.  The procedure is performed by a doctor qualified in endoscopy (this does not have to be a surgeon) and is done under a general anaesthetic.  The procedure takes about 30 minutes and is done as a day case meaning you can go home usually the same day it has been placed or removed. Endobarrier is very good for people who want to improve their diabetes.  It is thought that because of where the Endobarrier sits, food doesn’t mix with the juices from your pancreas straight away.  The pancreas is the gland that secretes insulin, which is the hormone that controls your blood sugar.  In diabetic people, they still produce insulin, but the body cannot use it as well as in someone without diabetes.  The Endobarrier is thought to increase your body’s ability to use insulin, therefore improving your diabetes even with modest weight loss.



      Once you are asleep under the anaesthetic, the doctor will look down into your stomach with a camera (perform and endoscopy) and then remove it.  The doctor will pass a guidewire down the tube and out of the end of your stomach into your small bowel.  The Endobarrier device will then be fed down into your stomach through your mouth in the same way. Once the end of the device is in the correct place, the surgeon expands the end closest to the stomach, which fits nicely in the small bowel and anchors it in place.  The Endobarrier is drawn down the bowel naturally, so that it lines the first 60cm of your bowel.  The food you eat passes through the middle of this tube, until it comes out the other end.  Here, it joins with the digestive juices, bile and pancreatic juices and from there on, digestion is normal.



      The main risks associated with having the endobarrier are related to the camera procedure used to place or remove it.  There is a risk of the camera pushing through the wall of the oesophagus or stomach, known as a perforation.  In this case, you would need an operation to fix it.  The general risk of this is around 1 in 1500 patients.  Other risks of endoscopy include a sore throat and a very small risk of bleeding if the veins in your stomach or oesophagus are very large. The Endobarrier can become dislodged and move, in which case it would probably need to be removed early.  The most common complications are pain within your abdomen, nausea and vomiting.  On very rare occasions the Endobarrier can become infected. Finally, although the Endobarrier needs removal after 6-12 months, sometimes the doctor is unable to remove it.  Sometimes the balloon can pass down the small bowel and get stuck.  Very occasionally, this may cause a blockage and you may need another procedure - either a camera up from the bottom end or an operation - to remove it.



      The Endobarrier can be effective at making you lose weight and most people will find they lose 1-2 lbs per week if they follow the appropriate diet and exercise.  It is mainly used for people who do not have much weight to lose or for people who need to improve their diabetes.  Most studies say patients lose approximately 10-20% of their excess weight (the amount you weight above your ideal weight).  If you eat foods that pass through the stomach easily, such as cream, ice cream, chocolate, crisps, you will not lose as much weight.  Some patients have been known to puree high calorie foods, as they pass easily through the stomach around the balloon.  However this defeats the object of having a balloon and by not making the right dietary choices will not help you lose weight and is definitely not recommended.  Alcohol is also very high in calories, so it is advisable to reduce or avoid alcohol intake.



      Before having any operation, it is important to read about the different type of surgeries available and decide which you think will be the best one for you. Speaking to your family doctor or the bariatric team can help you make this decision. You will be told not to eat or drink anything the night before and the morning of your procedure.  This is important, because if you have any food or fluid in your stomach, it makes the procedure much more difficult.  You must follow this rule or the doctor may cancel your procedure.



      Not usually.  Although it is always useful to watch what you eat, there is no special diet needed before you have the balloon placed.


      Usually, the only member of the team you need to see before having the endobarrier placed is the surgeon.  They will go through the risks of the procedure with you in the clinic and again on the day of your procedure.  In some centres you will also see the dietician, who may talk to you about your diet after you have the Endobarrier placed.


      This is not usually necessary.  The Endobarrier is a temporary procedure designed to help you lose weight but because it is not permanent and needs removal after 6-12 months, it is rare that the doctor wants you to see a psychologist.


      The Endobarrier is rarely placed on the NHS.  If you wish to pay privately, you and the surgeon will discuss it and decide if the Endobarrier is suitable for you.  Unless you have had a large operation on your stomach, you are usually OK to have the Endobarrier.  It is mainly useful for people with a BMI of 30-50kg/m2 (you can check your BMI on your home page of the www.simplyweight.co.uk website) and for people with type 2 diabetes.



      In some centres, the surgeon and/or dietician will see you a few weeks after you have the balloon placed to make sure you are not having any problems, although in some centres, they will only see you routinely if you have any problems.  In some centres the dietician will see you for follow up for the 6 months to ensure you have successful weight loss and help you consider how you are going to maintain the weight loss achieved in the longer term.  After 6-12 months the Endobarrier needs to be removed.  You should receive an appointment from your bariatric team for this, however if it is approaching 12 months and you have not had an appointment, you should contact your team.



      This varies from hospital to hospital, but in many cases you do not need any pre-operative assessment.  Some centres will take some blood tests before the procedure, particularly if you take any blood thinning medications.


      The surgeon will have a look into your stomach before the Endobarrier is placed and therefore you do not usually need any pre-operative investigations.


      No.  Placing the Endobarrier is done with a camera that goes down your mouth and into your stomach.  This is a completely different procedure to having your gall bladder removed and cannot be done at the same time.


      After the procedure you will be taken into the recovery room.  Some centres will give you a drink straight away, others will ask you to wait for an hour and then give you a drink.  You should also receive some dietary advice from the dietician.  Once you are able to drink properly and are no longer drowsy, you will be allowed to go home. The Endobarrier can make you feel very sick and can give you pain, cramping and heartburn.  If you can get through this, you start to feel better and can go back to eating properly.  If these symptoms do not go away, you should contact your doctor.  Keep in mind that the point of the balloon is to make you eat less; therefore you should be careful with your diet. When the Endobarrier is removed, you should not have any symptoms.  Do not forget that you still need to watch what you eat or you will put all of the weight back on.



      You don’t usually need to stay for more than a few hours after balloon placement, unless you have any problems, although this depends on how you feel.  It is rare that you need to stay in the hospital overnight.


      The Endobarrier is not designed to stop you eating.  Therefore you can still eat as much as you did before.  However, if you are trying to lose weight, you need to be careful about what you eat and reduce the amount or your portion sizes.  The Endobarrier is more effective at helping people improve their diabetes than it is a weight loss solution.  So if weight loss is your primary goal, you should perhaps consider one of the other bariatric procedures.


      The procedure is relatively simple and does not involve an operation; therefore as soon as you feel ready, you can begin with liquids.  It is advisable to stick to liquids for the first 48 hours to ensure you give time for things to settle.  After then you will move onto a pureed diet and will gradually increase the texture and portion sizes over the following weeks.  Once your diet is established you simply need to be careful with what you eat so that you do not eat too much.



      The Endobarrier is a removable/reversible.  The risks of this procedure are low, but it is not as successful at achieving long term weight loss as the other operations.  The band, sleeve and bypass all involve an anaesthetic and you need to stay in hospital for a few days.  They are more risky, but are much more successful at achieving weight loss than the Endobarrier.  Talk to your surgeon about the best operation for you.


      Yes.  The Endobarrier needs to be removed after 6-12 months.


      It is not uncommon for people to complain that they have not lost any weight with the Endobarrier.  This is because it is still possible to eat high calories foods, even with the Endobarrier in place.  Your weight is related to how many calories that you eat.  If you eat more than recommended for your body size, you put weight on.  If you eat less than recommended, you lose weight.  If you do not lose weight, you can talk to your surgeon about having a different procedure but you really do need to change your eating habits if you want to lose weight.  The Endobarrier is a better procedure for people who want to improve their type-2 diabetes than purely for weight loss.



      You do not need a general anaesthetic to have the endobarrier placed therefore you can move yourself onto the bed to have the endobarrier placed.  You will stay on this trolley until you are no longer feeling drowsy, at which point you can sit up yourself.  If you need assistance the staff will help.


      Most centres will advise you to take a daily vitamin and mineral supplement to prevent any nutritional deficiencies. 


      Once the Endobarrier is placed endoscopically, no further routine investigations are required.  You will require regular follow up with the dietitian to ensure that you follow the appropriate diet.  The Endobarrier can be in place for between 6-12 months.  If you do have problems, you may need a gastroscopy (telescope examination) to assess the Endobarrier.



      No you should not experience dumping syndrome with the endobarrier.



      It is unlikely that you will have a problem with loose skin after having the Endobarrier placed, because weight loss is usually not as much as with the other operations.  If you do lose a lot of weight you may find that you have some loose skin.  Sometimes the skin will also shrink but it may not.  If the loose skin upsets you, you can speak to your surgeon about referring you to a plastic surgeon but the NHS will not pay for skin surgery.



      This is very unlikely, but if you do lose too much weight, the surgeon can remove your Endobarrier and you should find that as it settles, you will be able to put weight back on.



      Yes you can go on holiday and it is perfectly safe to fly.



      Yes, it is safe to go scuba diving or underwater swimming with an Endobarrier in place.



      Endobarrier is not the best procedure for making you lose a lot of weight - if this is your primary goal, you should consider one of the other bariatric procedures. Some people do find that they lose weight with the Endobarrier.  Keep a food diary or keep going to a slimming club - this will help maintain your weight.  As long as you are careful, this can help prevent weight regain.  It is important to come up with a plan before your Endobarrier is removed on ways to maintain the weight loss you have achieved.



      There is no reason you cannot get pregnant whilst you have an Endobarrier, but if you do, you should speak to your surgeon and decide whether or not it should be removed early.  It is not clear if the Endobarrier affects the oral contraceptive pill, so if you are concerned, you should take extra precautions.



      Your bariatric team should send you an appointment to have your Endobarrier removed after 6-12 months.  If you do not receive an appointment, you can contact the bariatric team or the hospital and remind them that you need the Endobarrier removing.  They will then send you an appointment.



      If you do not receive an appointment or forget to get the Endobarrier removed, it should not cause major problems in the first few weeks.  The Endobarrier is only licenced by the government and NHS for 12-months use, which means it has a 12-month lifespan.  We cannot guarantee what will happen if your Endobarrier stays in longer than it should.



      This is possible.  The Endobarrier can be removed whilst you are in theatre before the surgeon does the main operation.  In some centres the surgeon will remove the Endobarrier a few weeks before surgery, so that any tissue reaction in the bowel that the Endobarrier might have caused can settle down.



      Revisional surgery
      If you are having revision surgery, it is probably because you have either not lost weight with your original operation or you have experienced problems.  The most common reason patients say they need revision surgery is because they feel they originally chose the wrong operation.  This may or may not be true in your case. The most common conversion is from the band to gastric sleeve and then gastric band to gastric bypass. It is also possible to convert from gastric sleeve to gastric bypass. Converting any operation to the bypass is slightly more complicated than performing the original operation but in most cases it is successful and people find they lose weight effectively.  The most important thing to remember is to change your eating habits before you have surgery and then stick to them for the rest of your life.



      Revisional surgery is used either to correct a problem with an existing obesity operation or in an attempt to achieve further weight loss after a “failed” operation or where the patient has regained weight after initial successful weight loss.



      In most cases the revisional surgery can be performed laparoscopically (via keyhole), although the risks of needing conversion to open surgery are much higher.  The specific type of revisional surgery is dependent on the reason for performing the surgery.  This can be anything from the re-positioning of a slipped gastric band to the refashioning of a gastric bypass.  It often involves conversion from one type of surgery to another, for example conversion of a band to a bypass or a sleeve to a bypass.



      Revisional surgery is a bigger operation than the original surgery.  Although major complications such as heart attacks, strokes, blood clots and death are extremely rare, they can occasionally happen during this operation.  Your surgeon will discuss these risks with you.  Approximately 1 or 2 people out of every 100 will have one of these complications.  The other complications that can occur after a gastric bypass are usually less serious but can sometimes cause problems, and may mean you need another operation.  When the surgeon joins the bowel to the stomach or the bowel to the bowel, he either uses a stapling device or stitches the tissues together.  This is like joining 2 tubes together and this join can sometimes leak.  In this case, it usually takes an operation to fix it. This join can also bleed and if it bleeds enough, you may need a blood transfusion.  Most of the time this bleeding will stop on its own.  The joins between the stomach and the bowel heal in the first couple of weeks after surgery but sometimes it can over heal, causing a narrowing, known as a stricture.  Sometimes this stricture needs stretching with a camera test and a balloon.  This may need repeating a number of times.  There may have been some scar tissue formed within your abdomen after your first operation.  This can sometimes make the second operation slightly more difficult.



      This depends on which operation you are converted to and how much you change your eating habits after surgery.  You must remember that the most common reason for needing conversion is because you failed to lose weight with your first operation and this is most often because you did not change your eating habits enough the first time around. In general after the gastric bypass, you can expect to lose around 60-70% of your excess weight - the amount you weigh on top of your ideal body weight.   The gastric sleeve weight loss tracks slightly less weight loss.  If you eat foods that pass through the pouch easily, such as cream, ice cream, chocolate, all of which are very fattening, you will not lose as much weight as other people. Alcohol is also very calorific, so it is advisable to reduce or avoid alcohol intake completely. Most people find that their weight loss slows after the first 12-18 months and they may not lose much more.  It is important to maintain your diet in order to prevent weight regain.  Although you are unlikely to lose as much weight as you would after the bypass or the sleeve, the gastric band can still be very successful but you have to be careful about your diet and stick to the rules.



      The cost of revisional surgery depends on what exactly is being performed.  It may range from £2000-£4000 for repairing gastric band tubing, to £11000-£13000 for a major conversion procedure i.e. converting a band to a gastric bypass.



      It is important that you have regular follow up from the team where you had your surgery.  You should see your surgeon and dietitian and nurse if necessary.  People who have regular follow up and contacts with the dietitian are more likely to have a better quality diet and successful long term weight loss and prevent nutritional deficiencies.



      This depends on how quickly you recover from your surgery.  Most people need to stay in hospital for 2 or 3 days after surgery, although very occasionally you need to stay in for a bit longer.  You will only be allowed home when your pain is under control with medication and you are not being sick.  The dietician will see you to talk to you about what to eat after surgery.  It is important that you understand this information.  It is helpful if you have someone at home that can help you, as you will feel very uncomfortable when you first get home.



      It is very important that you follow the dietary advice that you have been provided by your dietitian.  You should feel full if you choose the right texture and foods for the stage that you are at after your revisional surgery.  If you eat solid, textured foods in the long term you should still feel full.  If you choose soft, liquid, melt in the mouth foods (such as crisps, chocolate, ice cream, biscuits and milkshakes) they will easily glide through the gastric pouch and not make you feel full.  This will slow your weight loss and even lead to weight regain.  Also be aware that what you are experiencing may be emotional hunger or physical hunger. Seek the support of a bariatric mental health professional (bariatric mental health nurse/psychologist/counsellor) if need be.



      The dietary stages of the revisional surgery vary slightly between bariatric centres.  You should follow the dietary advice from the centre and dietitian where you had your revisional surgery.  The dietary stages will still be the same, but how long you are on each stage may vary between centres.  As a general rule you will be on liquids for the first few days after surgery and then move onto a pureed diet from day 3 onwards.  Some centres may advise you to follow a liquid only diet for the first two weeks before you can move onto a pureed diet.  It is important that you do not try and progress through the dietary stages too quickly, as this may give you problems of pain and vomiting.  It may take you longer to work through the dietary stages, compared to someone who followed all the dietary advice provided by the dietitian.



      During the first week after revisional surgery, you will usually be advised to follow a liquid and/or pureed diet.  Your diet should be low fat, low sugar and high in protein.  Most people use meal replacement drinks, smooth soups and smoothies to ensure that they are having appropriate nutrition from their diet.  Your dietitian will be able to provide you with the appropriate diet to follow.



      By 3-6 months after revisional surgery, you should be able to manage a solid textured diet.  However it may take up to 12 months to be able to eat a varied solid diet.  Be sure to follow the dietary stages provided to you after the surgery by your dietitian.



      Technically, it is possible to convert most of the operations to another one.  The band and sleeve can be converted into a gastric bypass and this is the most common type of revision operation.  The bypass is the best of the 3 commonly performed procedures in the UK at achieving weight loss.  If the bypass fails, it is almost always because you either have a complication or you are eating too much (or eating the wrong foods).  Alcohol contains a lot of calories, so this can sometimes be the cause of limited weight loss if you drink a lot.  In this case, if you have not managed to lose weight, you need to examine your eating habits.  On occasion, the pouch of a gastric bypass can have a gastric band placed around it, although this is unlikely to make a significant difference to your weight.  The bypass can technically be converted to a biliopancreatic diversion and duodenal switch operation but this is a difficult operation and many people experience problems following this type of surgery.



      If you still fail to lose weight after a revision operation, there is probably very little else that a surgeon can do to help you.  You need to seriously look at what you are eating and ask yourself why you are not losing weight.  Remember, although certain medications and conditions can make it difficult to lose weight, the ONLY way we can put weight on is by eating.  Food makes us gain weight - the more we eat, the more weight we put on. Bariatric is not a miracle cure and does not do all of the work for you.  You still need to monitor your food intake or you will put any weight you do lose straight back on.  You CAN still put weight on after gastric bypass.



      Gastric bypass surgery works by stopping you from absorbing some of the food you eat. Unfortunately this means that some of the vitamins and nutrients in your food do not get absorbed either.  Lack of vitamins and minerals can cause problems, such as hair loss, teeth problems and can make you ill, so it is important to take your multi-vitamin and mineral supplements.  You need to take multi-vitamin and mineral tablets each day for the rest of your life. These can be prescribed by your G.P, purchased from your local chemist. You will also need a B12 injection from your GP every 3 months for the rest of your life.



      Thiswill depend upon which revisional surgery you have had.  Iron deficiency anaemia can occur followingrevisional surgery, as your iron from your diet is reduced.  If you have a gastric bypass or duodenalswitch and you will absorb less iron. Some centres advise all people who have gastric bypass and duodenalswitch surgery to have iron supplements daily lifelong, whilst others adviseiron supplements only if you have an iron deficiency indicated by bloodresults.
      Not everyone gets dumping syndrome and the symptoms are different for different people.  Dumping is when food enters your small bowel too quickly, which is common after gastric bypass, gastric sleeve or biliopancreatic diversion surgery.  It can make you feel faint, dizzy, unwell, get abdominal pain, bloating, and diarrhoea.  Not everyone gets all of these symptoms.  The most common causes of dumping syndrome are from sweet or fatty foods, and it can be common with carbohydrates (pasta, bread etc.).  If you find that you get dumping syndrome, the best way to avoid it is to avoid eating the types of foods that cause it for you.  Unfortunately there is no medication that can prevent dumping and it is usually something you have to learn to avoid.



      Itis not very common for people to lose too much weight, but if you do, youshould seek the advice of your dietitian. They can go through your diet with you and suggest ways that you canincrease the amount of food, or the energy value of the food you eat.  Get specialist advice from your dietitian, aslosing too much weight can make you ill. On very rare occasions the dietician may ask you to see the surgeon ifyou lose too much weight and become ill.

      No.  In general, when you have revisional surgery following the gastric bypass, the surgeon will either re-fashion the gastric pouch, lengthen the small bowel bypass or place a band around the gastric pouch.  None of these require “removal”/reversal of the bypass.



      Many surgeons are willing to perform revisional surgery even if they did not perform the original surgery.
      Usually not.  The only reversible operation is the gastric band and conversion to any of the other operations means your operation cannot be reversed.



      BPD/Duodenal switch
      The biliopancreatic diversion (BPD) and duodenal switch (DS) operations work in a similar manner to the gastric bypass.  They work by reducing the volume of food that you can eat at any one time and also by stopping you from absorbing some of the food you eat.  During surgery, the surgeon disconnects the majority of your stomach from the oesophagus (food pipe), leaving a small egg cup sized pouch in the BPD or a sleeve of stomach in the DS.  This pouch/sleeve is where food sits whilst it is digested.  As the remaining stomach is so small, you feel full after a very small amount of food.  The surgeon brings a loop of small bowel from near the end where it joins the large bowel and joins it to the stomach.  The bowel above this connection cannot absorb any food, so the remaining bowel, which is much shorter than in someone who has not had surgery, needs to absorb the food.  In the gastric bypass, around 1-2 metres of small bowel are bypassed.  In the BPD/DS operations it can be much more than this. Due to both the restriction (small stomach) and malabsorption (short bowel means you cannot absorb food), you lose weight.



      The BPD/DS are the most effective operations at making you lose weight, but are rarely performed in the UK.  This is because of the unpleasant side effects that these operations cause (see “What are the risks associated with BPD/DS?”).  The sheer amount of weight you lose means these operations are very useful in diabetic patients and have the best chance of getting rid of your diabetes but they can cause other problems.  The BPD/DS are permanent operations so they cannot be reversed unless you have problems.  There are operations that can undo the BPD/DS, but these are very difficult and can be risky.



      The BPD/DS are usually performed by keyhole surgery.  There are usually about 5 or 6 small wounds for the surgeon to place the instruments they need into the abdomen.  During surgery, the consultant disconnects the majority of your stomach from the oesophagus (food pipe), leaving a small egg cup sized pouch in the BPD or a sleeve of stomach in the DS.  This pouch/sleeve is where food sits whilst it is digested.  As the remaining stomach is so small, you feel full after a very small amount of food.  The surgeon brings a loop of small bowel from near the end where it joins the large bowel and joins it to the stomach.  The bowel above this connection cannot absorb any food, so the remaining bowel which is much shorter than in someone who has not had surgery, needs to absorb the food.



      The BPD/DS operations are no longer routinely performed in the UK, because they have very significant complications.  BPD/DS surgery is a big surgery. Although major complications such as heart attacks, strokes, blood clots and death are extremely rare, they can occasionally happen during these operations. Your surgeon will discuss these risks with you.  Approximately 1 or 2 people out of every 100 will have one of these complications.  The major complication that occurs after a BPD/DS is malabsorption.  This means that because you cannot absorb much in the way of food, you do not absorb the vitamins and minerals that your body needs to keep you healthy.  This can unfortunately make you quite sick, even if you take your multivitamins.  The other complications are usually less serious but can sometimes cause problems and may mean you need another operation.  When the surgeon staples your stomach and bowel, this is like stapling thick sheets of paper together and these staples can sometimes come apart, causing a leak.  This join can also bleed and if it bleeds enough, you may need a blood transfusion.  Most of the time this bleeding will stop on its own.  The staple line in the stomach heals in the first couple of weeks after surgery but sometimes it can over heal, causing a narrowing known as a stricture.  Sometimes this stricture needs stretching with a camera test and a balloon.  This may need repeating a number of times.  Sometimes, people lose too much weight following these operations and this can mean they need feeding through the veins.



      Everyone loses different amounts of weight with the BPD/DS, but in general you can expect to lose around 70% of your excess weight (the amount you weigh above your ideal weight).  The amount of weight you lose depends on what you eat and how strictly you stick to the post-operative diet.  The BPD/DS make you feel full very quickly, especially when you eat solid foods.  They also prevent you from absorbing some of the food you eat, meaning that you don’t put weight on.  If you eat foods that pass through the stomach easily, such as cream, ice cream, chocolate, all of which are very fattening, you will not lose as much weight as other people.  Some patients have been known to puree foods such as pizza or burgers, as pureed food passes easily through the remaining stomach but this defeats the object of having surgery and will not make you lose weight.  It is definitely not recommended.  Alcohol is also very fattening so it is advisable to reduce or avoid alcohol intake. Most people find that their weight loss slows after the first 12-18 months and they may not lose much more.  It is important to maintain your diet in order to keep from putting your weight back on.



      The BPD/DS are not performed much in the UK because of how commonly patients experience problems following them.  They are occasionally suitable for people who are extremely obese but the bypass can be just as successful and has fewer complications.  Anyone who is thinking about having a weight loss operation should have tried everything else to lose weight beforehand.  If you are diabetic the bypass may be a better operation but if you do not have diabetes, the sleeve is just as good as the bypass.  Although the BPD/DS are extremely effective, the BPD/DS are usually reserved for people who have failed to lose weight with another operation and who desperately need to lose weight to get healthy. The BPD/DS are bigger operations than the other commonly performed operation such as the bypass or sleeve but are very effective at making you lose weight.  People who have had big operations on their abdomen before might find that the surgeon cannot do the operation because of scar tissue or at least not do a keyhole operation.  Although this is rare and is something they will discuss with you before your surgery.



      The cost of BPD/DS surgery will vary between hospitals but you should expect to pay around £10,000-13,000 for this type of operation.


      It is important that you have regular follow up from the team where you had your surgery.   You should see your surgeon, dietitian and nurse if necessary.  People who have regular follow ups with the dietitian are more likely to have a better quality diet, successful long term weight loss and less nutritional deficiencies. 


      This depends on how quickly you recover from your surgery.  Most people need to stay in hospital for 2 or 3 days after surgery, although very occasionally you need to stay in for a bit longer.  You will only be allowed home when your pain is under control with medications and you are not being sick.  The dietician will see you in the hospital to talk to you about what to eat after surgery and it is important that you understand this information.  It is helpful if you have someone at home that can help you as you will feel very uncomfortable when you first get home.



      It is very important that you follow the dietary advice that you have been provided by your dietitian.  You should feel full if you choose the right texture and foods for the stage that you are at after your BPD or DS surgery.  If you eat solid textured foods in the long term you should still feel full.  If you choose soft, liquid, melt in the mouth foods (such as crisps, chocolate, ice cream, biscuits and milkshakes) they will easily glide through the surgery area and not make you feel full.  This will slow your weight loss and may even lead to weight regain. 



      The dietary stages of the BPD and DS vary slightly between bariatric centres.  You should follow the dietary advice from the centre and dietitian where you had your BPD/DS surgery.  The dietary stages will still be the same but how long you are on each stage may vary between centres.  As a general rule you will be on liquids for the first two weeks after surgery and then move onto a pureed diet from week 2 onwards. It is important that you do not try and progress through the dietary stages too quickly as this may give you problems of pain and vomiting.  It may take you longer to work through the dietary stages compared to someone who followed all the dietary advice provided by the dietitian.



      During the first week after BPD/DS surgery, you will be usually advised to follow a liquid and/or pureed diet.  Your diet should be low fat, low sugar and high in protein.  Most people use meal replacement drinks, smooth soups and smoothies to ensure that they are having appropriate nutrition from their diet. Your dietitian will be able to provide you with the appropriate diet to follow.


      By 3-6 months after BPD/DS surgery, you should be able to manage a solid textured diet.  However it may take up to 12 months to be able to eat a varied solid diet.  Your dietitian will be able to provide you with the appropriate diet to follow.


      They are all very similar operations, although with the BPD/DS, the majority of the stomach is removed, where as it is left in your abdomen and can still produce digestive juices after gastric bypass.  In the BPD/DS, the length of bowel that cannot absorb food is much longer and therefore you lose more weight but you cannot absorb as many nutrients or vitamins.  Although each operation can be very successful at helping you to lose weight, there are significant differences between each and it is important to choose the correct operation for you.  Neither operation is reversible.  Talk to your surgeon about the best operation for you.



      No. The surgeon removes most of your stomach during the operation and once the stomach has been removed, it cannot be replaced.  The surgeon re-plumbs your bowel, which can be very tricky to reverse.


      It is very unlikely that you will not lose weight following the BPD/DS - in fact many people find they lose too much weight and this can make them ill.  In the majority of case if you do not lose weight, it is because you are still eating too much.  Some people have been known to puree pizzas or junk food, or melt mars bars, because they think this is OK after surgery as it is sloppy/liquid.  This is NOT the case - food is just as fattening when pureed as when it is solid.  You still need to be careful about what you eat after surgery.  Bariatric surgery is not a miracle cure and does not do all of the work for you.  You still need to monitor your food intake or you will put any weight you do lose straight back on. You CAN still put weight on after surgery!



      Yes.  The BPD/DS work by reducing how much food you eat but also reduce how much food you can absorb in your bowel.  Unfortunately this means that some of the vitamins and nutrients in your food do not get absorbed either.  Lack of vitamins and minerals can cause problems such as hair loss, teeth problems and can make you ill, so it is important to take your multi-vitamins.  You need to take a multi-vitamin tablet each day which can be purchased from your local chemist or online and you will need a B12 injection from your GP every 3 months for the rest of your life.



      Most centres will advise lifelong iron supplementation after BPD/DS due to the reduced iron dietary intake and malabsorption of iron from the diet.  Your dietitian will be able to advise you on suitable iron supplementation. 


      You will need to have your blood checked regularly either by your bariatric team or your GP.  This is to make sure you are not lacking in any minerals or vitamins and make sure you are getting a good diet.  At first these blood tests are done every 3 months but they can sometimes become less frequent after surgery as long as you are maintaining a healthy balanced diet.  Most people do not need any other investigations unless they have a problem.  If you experience any symptoms such as vomiting or heartburn or do not feel well, it is worth seeing your bariatric team or GP and they may send you for some investigations to make sure you do not have a complication from your surgery.



      Not everyone gets dumping syndrome and the symptoms are different for different people.  Dumping is when food enters your small bowel too quickly, which is common after gastric surgery such as the BPD/DS.  It can make you feel faint, dizzy, unwell, get abdominal pain, bloating, and diarrhoea.  Not everyone gets all of these symptoms.  The most common causes of dumping syndrome are from sweet or fatty foods and it can be common with carbohydrates (pasta, bread etc.).  If you find that you get dumping syndrome, the best way to avoid it is to avoid eating the types of foods that cause it for you.  Unfortunately there is no medication that can prevent dumping and it is usually something you have to learn to avoid or live with.



      Sometimes after the BPD/DS people can lose too much weight because they are unable to absorb much food.  If you do, you should seek the advice of your dietitian.  They can go through your diet with you and suggest ways that you can increase the amount of food or the energy value of the food you eat.  Sometimes this can be quite simple like mixing cream into a cup of tea of coffee but it is best to get specialist advice as losing too much weight can make you ill.  On very rare occasions the dietitian may ask you to see the surgeon if you lose too much weight and become ill.



      • Weight loss is generally greater
      • You are unlikely to suffer from dumping syndrome or marginal ulcers




      Gastric bypass
      Dumping syndrome is when people get symptoms of sweating, feeling dizzy, faint or unwell, get abdominal pain and bloating, nausea, vomiting or diarrhoea.  It is caused when food leaves the stomach and enters the first part of your small bowel too quickly.  It is more common after gastric bypass and very occasionally sleeve gastrectomy and does not usually occur after gastric band surgery.  If you experience symptoms like these after band surgery you should see your GP or spe
      Gastric bypass works by reducing the volume of food that you can eat at any one time and also by stopping you from absorbing some of the food you eat. During surgery the surgeon disconnects the majority of your stomach from the oesophagus (food pipe), leaving a small egg cup sized pouch.  This pouch is where food sits whilst it is digested.  As the pouch is so small you feel full after a very small amount of food.  The surgeon re-connects this pouch to your small bowel downstream.  The bowel above this connection cannot absorb any food so the remaining bowel, which is much shorter than in someone who has not had surgery, needs to absorb the food.  Due to both of these factors you lose weight.  The bypass is both a ‘restrictive’ operation (meaning you can’t eat as much because you feel full quickly) and a ‘malabsorptive’ operation (meaning you cannot absorb some of the food).



      Of the 3 most common operations (gastric band, gastric bypass and gastric sleeve/sleeve gastrectomy), the bypass is the most successful in making you lose weight.  Although the other operations are also very effective, people tend to lose more weight after the gastric bypass. This is very useful in diabetic patients and has the best chance of eliminating your diabetes symptoms.  Some people also find that they no longer like sweet foods after gastric bypass which can be useful if you have a sweet tooth. Although the risks of a gastric bypass operation are slightly higher than for a gastric band, there are very few long-term complications, so once you have recovered from surgery, it is rare for you to experience significant problems. The bypass is a permanent operation, so you do not have to attend the hospital for adjustments like you do with the gastric band.



      The bypass is usually performed by keyhole surgery.  There are usually about 5 or 6 small wounds for the surgeon to place the instruments they need into the abdomen.  The surgeon disconnects some of the small bowel, usually 1-2 metres downstream from the stomach, and then disconnects most of the stomach from the food pipe (oesophagus) creating an egg-cup sized pouch.  Where the small bowel has been disconnected, the surgeon brings the bottom part of the small bowel (which is still connected to the large bowel) up and connects it to the pouch of stomach at the bottom of the oesophagus.  This means that the rest of the stomach and the top part of the small bowel are not connected to anything.  The surgeon measures down from the join between the oesophagus and small bowel and reconnects the loose bit of stomach and small bowel to the rest of the small bowel.  When you eat, the food passes down the oesophagus, through the small pouch of stomach and down the small bowel.  Part way down the small bowel, the food is joined by all of the digestive juices from the stomach, liver and pancreas, and after this, digestion is normal.  This operation means that only part of your small bowel can absorb food.



      Gastric bypass surgery is a major surgery.  Although major complications such as heart attacks, strokes, blood clots and death are extremely rare, they can occasionally happen during this operation.  Your surgeon will discuss these risks with you.  Approximately 1 or 2 people out of every 100 will have one of these complications.  The other complications that can occur after a gastric bypass are usually less serious, but can sometimes cause problems and may mean you need another operation.  When the surgeon joins the bowel to the stomach or the bowel to the bowel, he either uses a stapling device or stitches the tissues together.  This is like joining 2 tubes together and this join can sometimes leak.  In this case, it usually takes an operation to fix it.  This join can also bleed and if it bleeds enough, you may need a blood transfusion.  Most of the time this bleeding will stop on its own.  The joins between the stomach and the bowel heal in the first couple of weeks after surgery but sometimes it can over heal, causing a narrowing known as a stricture. Sometimes this stricture needs stretching with a camera test and a balloon.  This may need repeating a number of times.



      Everyone loses different amounts of weight with the gastric bypass but in general you can expect to lose around 60-70% of your excess weight (the amount you weigh above your ideal weight).  The amount of weight you lose depends on what you eat and how strictly you stick to the post-operative diet.  The gastric bypass makes you feel full very quickly especially when you eat solid foods.  It also prevents you from absorbing a lot of the food you eat, meaning you absorb less calories.  If you eat foods that pass through the pouch easily, such as cream, ice cream, chocolate, crisps all of which are very fattening, you will not lose as much weight as other people.  Alcohol is also very fattening, so it is advisable to reduce or avoid alcohol intake completely. Most people find that their weight loss slows after the first 12-18 months and they may not lose much more.  It is important to maintain your diet in order to avoid weight regain.  Although the gastric bypass is very successful, you still have to be careful about your diet and stick to the rules long term.



      The gastric bypass is suitable for patients who have a BMI of more than 40 or patients with a BMI of 35 or above with two obesity related illnesses (for example high blood pressure and type 2 Diabetes.) You can see your BMI on your profile on the home page.  Anyone who is thinking about having a gastric bypass should have tried other weight loss options to lose weight beforehand.  The bypass is a good operation for people who need to lose a lot of weight, especially for people with type 2 diabetes who need to lose weight to improve their blood sugars.  Although, you do not need to have diabetes to have this operation. A gastric bypass is often the most suitable choice for people who nibble and snack, especially on sweet foods and are concerned that it may be too difficult to make the necessary changes needed for other surgical options. The gastric bypass is a bigger operation than the gastric band but is very effective at helping you lose weight.  People who have had big operations on their abdomen before might find that the surgeon cannot do a gastric bypass or at least not do a keyhole operation but this is something they will discuss with you before your surgery. The gastric bypass means you will never be able to eat a large sized meal again, so you must be prepared to change your eating habits for the rest of your life.  However, you must be prepared to do this, the surgeon will talk to you and help you to decide if the bypass is the right operation for you.



      Gastric bypass surgery varies in price but will usually cost somewhere in the region of £8000-£11,000


      It is important that you have a regular follow-up after surgery.  You should see your surgeon and dietitian and nurse if necessary.  People who have regular follow up with their dietitian are more likely to have a better quality diet, successful long term weight loss and less nutritional deficiencies.  Some people may find they need the input form a bariatric mental health professional to help them change habits, thinking patterns and deal with emotional eating etc <
      This depends on how quickly you recover from your surgery.  Most people need to stay in hospital for 2 or 3 days after surgery, although very occasionally you need to stay in for a bit longer.  You will only be allowed home when your pain is under control with medication and you are not being sick.  The dietician will have seen you prior to you hospital admission to talk to you about what to eat after surgery and it is important that you understand this information.  It is helpful if you have someone at home that can help you as you will feel very uncomfortable when you first get home.



      It is very important that you follow the dietary advice that you have been provided by your dietitian.  You should feel full if you choose the right texture and foods for the stage that you are in after your gastric bypass surgery.  If you eat solid, textured foods in the long term you should still feel full.  If you choose soft, liquid, melt in the mouth foods (such as crisps, chocolate, ice cream, biscuits and milkshakes) they will easily glide through the gastric pouch and not make you feel full.  This will slow your weight loss and even lead to weight regain. If you feel physically full, but are craving food and experiencing high levels of emotional hunger, it may well be worth seeing a bariatric mental health practitioner



      The dietary stages of the gastric bypass vary slightly between bariatric centres.  You should follow the dietary advice from the centre and dietitian where you had your gastric bypass surgery.  The dietary stages will still be the same, but how long you are on each stage may vary between centres.  As a general rule you will be on liquids for the first few days after surgery and then move onto a pureed diet from day 3 onwards.  Some centres may advise you to follow a liquid only diet for the first two weeks before you can move onto a pureed diet.  It is important that you do not try and progress through the dietary stages too quickly as this may give you problems of pain and vomiting.  It may take you longer to work through the dietary stages, compared to someone who followed all the dietary advice provided by the dietitian.



      During the first week after gastric bypass surgery, you will usually be advised to follow a liquid and or pureed diet.  Your diet should be low fat, low sugar and high in protein.  Most people use meal replacement drinks, smooth soups and smoothies to ensure that they are having appropriate nutrition from their diet. Your dietitian will be able to provide you with the appropriate diet to follow.


      By 3-6 months after gastric bypass surgery, you should be able to manage a solid textured diet.  However it may take up to 12 months to be able to eat a varied solid diet.  Be sure to follow the stages of diet provided to you by the dietitian after your surgery.


      There are 2 main types of gastric bypass.  The “Roux-en-Y” bypass is the one most commonly performed in the UK and is the one your surgeon is most likely to perform.  This bypass involves 2 joins in your bowel.  This type of bypass is well established and there are very good long-term results.  Another type of bypass is called the “mini gastric bypass (MGB)" or "one anastomosis gastric bypass (OAGB)". This type of bypass is becoming more commonly performed, but there are no long-term studies yet that show the results from this operation.  There are a few surgeons around the UK that perform this operation and it only involves one join, but it is not clear if patients lose as much weight with this as with the traditional bypass.  Indeed there is now some evidence that it may even lead to better weight loss. However, some surgeons think that the side effects with this type of operation, such as heartburn, may be worse, although there is very little evidence. Discuss your options with your surgeon.



      Although each operation can be very successful at helping you to lose weight, there are significant differences between each and it is important to choose the correct operation for you.  The main differences are that the gastric band can be reversed in the future if necessary, whereas the gastric bypass and sleeve gastrectomy cannot be reversed.  The band can be the most difficult procedure to work with after surgery. It is the easiest procedure to cheat, if sloppy foods are eaten or you drink and eat at the same time, it is often possible to still eat large amounts, even with a perfectly adjusted band. Gastric band adjustments are needed, sometimes for many years or life. The bypass and sleeve are slightly more complicated operations than the band and you need a slightly longer stay in hospital but the weight loss is usually better and quicker than with the band. The gastric sleeve is often a good choice for people who are volume eaters and favour mainly savoury foods. The gastric bypass is often a good choice for people who have type 2 Diabetes and who frequently nibble and snack on foods and have a real sweet tooth.  Each operation has risks and can cause complications - the band has slightly fewer complications in the first few weeks after surgery but has more long-term complications than the bypass or the sleeve.  Talk to your surgeon about the best operation for you.



      Not really.  Because the surgeon has to “re-plumb” your bowel, the anatomy inside your abdomen is changed. Although the bowel changes can be relatively easily reversed, it can be very difficult to reverse the changes to your stomach. It is possible to lose too much  weight following surgery and become ill - in these cases there are operations that the surgeon can perform to reverse the bypass but this is a very large and tricky operation, which can be quite risky, does not reverse all of the surgery and often needs to be done as an open operation (not keyhole).  Therefore, unless you have major problems, your operation is to all intents and purposes not reversible



      It is unlikely that you will not lose weight following the gastric bypass.  The bypass works by reducing the amount that you can eat and stopping you from absorbing all of the calories.  If you do not lose weight, in the majority of cases it is because you are not following dietary advice.   Long term you will still need to monitor your food intake, or you will start to regain weight.


      Yes.  Gastric bypass works by stopping you from absorbing some of the food you eat.  Unfortunately this means that some of the vitamins and nutrients in your food do not get absorbed either.  Lack of vitamins and minerals can cause problems, such as hair loss, teeth problems and can make you ill, so it is important to take your multi-vitamin and mineral supplements every day as advised by your dietitian. You will also need a B12 injection from your GP every 3 months for the rest of your life.



      Iron deficiency anaemia can occur following gastric bypass surgery, as your iron from your diet is reduced and you absorb less iron The daily multi vitamin and mineral supplements, recommended by your dietitian will contain iron, however sometimes extra iron supplementation is needed. Iron deficiency is diagnosed by blood results.  You should ask your dietitian if you should take extra iron supplementation.


      You will need to have your blood checked either by your bariatric team or your GP.  This is to make sure you are not lacking in any minerals or vitamins and make sure you are getting a good diet. These blood tests are done usually every 6-12 months but they can sometimes become less frequent after surgery as long as you are maintaining a healthy balanced diet.  Most people do not need any other investigations, unless they have a problem.  If you experience any symptoms such as vomiting or heartburn or do not feel well, see your bariatric team or GP and they may send you for some investigations to make sure you do not have a complication from your bypass.



      Not everyone gets dumping syndrome and the symptoms are different for different people.  Dumping is when food enters your small bowel and is absorbed too quickly, which is common after gastric bypass.  It can make you feel faint, nauseous, sweaty, dizzy, unwell, abdominal pain, bloating, diarrhoea and sickness.  Not everyone gets all of these symptoms.  The most common causes of dumping syndrome are from sweet or fatty foods and it can also be common with carbohydrates (pasta, bread etc.).  If you find that you get dumping syndrome, the best way to avoid it is to avoid eating the types of foods that cause it for you.  Unfortunately there is no medication that can prevent dumping and it is usually something you have to learn to avoid.



      It is not very common for people to lose too much weight, but if you do, you should seek the advice of your dietician.  They can go through your diet with you and suggest ways that you can increase the amount of food or the energy value of the food you eat.  Usually this is quite simple but it is best to get specialist advice as losing too much weight can make you ill.  On very rare occasions the dietician may ask you to see the surgeon if you lose too much weight and become ill.



      Diarrhoea can be a common problem after bypass surgery.  This is often because you do not absorb as much food and fluid because your bowel is deliberately made shorter by the surgery.  If you eat a high fat diet, you may find the diarrhoea also smells and is difficult to flush away.  Dumping syndrome also causes diarrhoea.  This is when food enters the small bowel too quickly and it draws a lot of water into the bowel with it.  This then passes quickly through your system and causes diarrhoea.  If you get bad diarrhoea that doesn’t improve after a few days/weeks, you can ask the pharmacist for a medication such as Imodium which can help or you should see your GP.



      You can ask your bariatric team or GP for a prescription for an antacid tablet.  Hopefully this should settle the problem but if it does not, you should seek medical advice.


      Sleeve gastrectomy
      Gastric sleeve, or sleeve gastrectomy, works by reducing the volume of food that you can eat at any one time. There is also a significant effect on hormones that help you feel less hungry and feel fuller for longer.  During surgery, the consultant removes approximately 75% of your stomach, leaving a thin tube of stomach.  This tube or sleeve, is where food sits whilst it is digested.  As the gastric sleeve holds approximately 100-150mls of fluid, you feel full after a very small amount of food.  The sleeve is called a ‘restrictive’ operation (meaning you feel full with a smaller portion of food.).



      Sleeve gastrectomy is very successful at helping you to lose weight.  People tend to lose more weight with the sleeve than with the band, although not quite as much as with the bypass.  Diabetic patients have a good chance of becoming symptom free. The risks of a gastric sleeve or bypass operation are slightly higher than for a gastric band, however there are very few long-term complications compared to a gastric band. Once you have recovered from surgery, it is rare for you to experience significant problems. The sleeve is a permanent operation, so you do not have to attend the hospital for adjustments like you do with the gastric band.



      The sleeve is usually performed by keyhole (laparoscopic) surgery.  There are usually about 5 or 6 small wounds for the surgeon to place the instruments they need into the abdomen.  The surgeon inserts a tube down your throat into your stomach and then uses his instruments to push this tube so it sits along the inner (or ‘lesser’) curve of your stomach.  They then use a stapling device to staple along this tube, disconnecting most of the stomach and leaving a thin sleeve of stomach, which is still connected to your oesophagus and bowel at either end. The excess stomach is then removed and the wounds closed with stitches, staples or glue.  Sometimes the surgeon will use special glue on your stomach, which helps to stop the stapled area from bleeding.



      Sleeve gastrectomy (gastric sleeve) surgery is a big operation.  Although major complications such as heart attacks, strokes, blood clots and death are extremely rare, they can occasionally happen during this operation.  Your surgeon will discuss these risks with you.  Approximately 1 or 2 people out of every 100 will have one of these complications.  The other complications that can occur after a sleeve gastrectomy (gastric sleeve) are usually less serious but can sometimes cause problems and may mean you need another operation.  When the surgeon staples along the length of your stomach, this is like stapling a pile of thick sheets of paper together and these staples can rarely come apart, causing a leak.  In this case, it often takes an operation to fix it, although sometimes placing a tube down your nose and stopping you from eating or drinking can allow it to heal itself over a few days.  This join can also bleed and if it bleeds enough, you may need a blood transfusion.  Most of the time this bleeding will stop on its own.  The surgeon may staple line reinforcement or a special glue to help prevent this.  The staple line in the stomach heals in the first couple of weeks after surgery, but sometimes it can over heal, causing a narrowing known as a stricture. Sometimes this stricture needs stretching with a camera test and a balloon and this may need repeating a number of times.



      Everyone loses different amounts of weight with the sleeve gastrectomy (gastric sleeve), but in general you can expect to lose around 60-70% of your excess weight (the amount you weigh above your ideal weight).  The amount of weight you lose depends on what you eat, activity levels and how strictly you adhere to the advised post-operative diet.  The gastric sleeve makes you feel full very with a small portion of food, especially when you eat solid foods.  If you eat foods that pass through the stomach easily, such as cream, ice cream, chocolate, crisps all of which are very fattening, you will not lose as much weight as other people. Also drinking with meals makes food pass from the stomach quicker, it is advisable to not drink before meals, during meals and to wait 30 minutes after finishing a meal before having a drink. Alcohol is also high in calories and to be avoided for the first 12 months after your operation. Most people find that their weight loss slows after the first 12-18 months and they may not lose much more.  It is important to maintain your healthy diet and exercise in order to prevent weight gain.  Although you are unlikely to lose as much weight as you would after the gastric bypass, the gastric sleeve is generally still very successful.



      The gastric sleeve is suitable for patients who have a BMI of more than 40 or BMI of 35 with two health related obesity caused conditions. You can see your BMI on your profile on the home page.  Anyone who is thinking about having a gastric sleeve should have tried other options to lose weight beforehand.  The sleeve is a very good operation for people who need to lose a lot of weight.  If you are diabetic the bypass may be a better operation, but if you do not have diabetes, the sleeve can be as good as the bypass, especially if you do not have a particularly sweet tooth. The sleeve is a bigger operation than the gastric band, but is very effective at helping you to lose weight. People who have previously had big operations on their abdomen might find that the surgeon cannot do a sleeve because of  the scar tissue from the previous abdominal surgery, or at least  might not  be able to do a keyhole operation, although this is rare and is something they will discuss with you before your surgery. The sleeve gastrectomy means you will never be able to eat a large sized meal again, so you must be prepared to change your eating habits for the rest of your life.  You should be prepared to make dietary changes, the surgeon will talk to you, and help you to decide if the sleeve is the right operation for you.



      The cost may vary between hospitals, but the usual cost of a sleeve is around £8000-£11,000.



      It is important that you have appropriate follow up with the dietitian and surgeon after gastric sleeve surgery.  Follow up and monitoring can be in outpatient clinics and/or via email, telephone and should be for at least the first 12 months after surgery.  It is important that you attend your follow up appointments and keep in contact with your bariatric team to ensure that you have safe, successful long term weight loss. 



      This depends on how quickly you recover from your surgery.  Most people need to stay in hospital for 2 or 3 days after surgery, although very occasionally you may need to stay in for a bit longer.  You will only be allowed home when your pain is under control with medications and you are not being sick.  The dietitian will see you in the hospital to talk to you about what to eat after surgery and it is important that you understand this information.  It is helpful if you have someone at home that can help you, as you will feel very uncomfortable when you first get home.



      Depending on how long ago your surgery was, you may find your food portions will gradually increase.  However in the longer term you should not be able to manage more than a tea plate sized portion of normal textured food.  If you do not feel full it is likely you are choosing softer, easier to tolerate foods with sauces, gravies, salad dressings and mayonnaise.  By adding extra sauces to food, it helps ‘wash’ the food through the gastric sleeve allowing you to tolerate more food than you would if the food was drier.  As these softer foods do not stay in the gastric sleeve for long, they do not tend to make you feel full. Also if you are eating little and often (grazing) on snack type foods such as biscuits, crisps, chocolate and ice cream rather than sitting down to meals your will not feel full as these foods, melt and glide through the gastric sleeve.  If you increase the texture of foods at meal times by adding foods such as more vegetables and salads, you should find that these foods make you feel fuller for longer and reduce your appetite in between meals.  It may also be worth considering whether you are eating the wrong foods or snacking between meals due to emotional hunger not physical hunger.



      Each surgeon and dietitian has a preference of when you can start eating again after your surgery.  Usually for the first 48-72 hours after your surgery you are advised to follow a liquid only diet.  On day 3 for the first 3 weeks you will then be able to have a pureed diet, gradually increasing the textures, foods and portion sizes over the following months. 



      For the first 48-72 hours post-surgery you will be following a liquid only diet, after this period you will be able to follow a pureed diet or liquid diet.  Many people prefer to use nutritious liquids such as meal replacement drinks, fruit smoothies, yoghurt drinks and milk as these drinks provide a good amount of nutrition and fluid.  You will also be able to have approximately 2-3 tablespoons of pureed diet for a meal, using protein rich food sources such as fish, meat, peas, beans, lentils and dairy containing foods.



      Usually from around month 3-6 onwards (but sometimes later) after your surgery you will be able to begin to move onto solid textured foods (stage 4) You will be following a pureed/liquid diet for the first 3-4 weeks, (stage 2) you will then move onto a ‘soft, mushy, crispy’ stage of the diet (stage 3).  These foods include minced meat/fish in sauce, softly cooked vegetables, soft fruits and crackers.   It will take between 3-6 months (sometimes longer) to be able to eat a good quality, varied solid dry textured diet. 



      No.  The surgeon removes most of your stomach during the operation and leaves a thin sleeve of stomach.  Once the stomach has been removed, it cannot be replaced.



      It is unlikely that you will not lose weight following the gastric sleeve.  The sleeve works by reducing the amount that you can eat, although it is possible to stretch your sleeve if you eat too much.  If you do not lose sufficient weight after gastric sleeve surgery, in the majority of cases it is because you are still eating too much, especially if choosing poor quality foods.  Gastric sleeve is not a miracle cure and does not do all of the work for you.  You  need to monitor your food intake/quality of food. It is possible to regain weight if making poor choices.




      Yes.  The gastric sleeve works by reducing how much food you eat.  Lack of vitamins and minerals in your diet can cause nutritional deficiencies, so it is important to take a complete A-Z multi-vitamin and mineral twice a day.  These can be purchased from your local supermarket, chemist or online.  Your dietitian will advise you of quality brands. You will also need a B12 injection from your GP, once every 3 months for the rest of your life.



      It is not routinely advised that everyone needs iron supplements after a gastric sleeve.  If you take a daily A-Z vitamin and mineral supplement, this should contain 100% RDA of iron.  If you eat a good quality diet and remember to take your daily A-Z vitamin and mineral supplements you are less likely to require additional iron supplements.  However if an iron deficiency is suspected and confirmed with blood tests, then iron supplements will be advised.



      You will need to have your blood checked regularly either by your bariatric team or your GP.  This is to make sure you are not lacking any minerals or vitamins, as long as you are maintaining a healthy balanced diet, most people are generally okay.  Most people do not need any other investigations, unless they have a problem.  If you experience any symptoms such as vomiting or heartburn or do not feel well, it is worth seeing your bariatric team or GP and they may send you for some investigations to make sure you do not have a complication from your surgery.



      It is unlikely that you will experience dumping syndrome after a gastric sleeve.  However a small number of people do report experiencing dumping syndrome after a gastric sleeve.  Dumping is when food enters your small bowel too quickly, which is common after gastric surgery, particularly with the gastric bypass.  It can make you feel faint, dizzy, unwell, abdominal pain, bloating and diarrhoea.  However, not everyone gets all of these symptoms.  The most common causes of dumping syndrome are from sweet or fatty foods and it can be common with carbohydrates (pasta, bread etc.).  If you find that you get dumping syndrome, the best way to avoid it is to avoid eating the types of foods that cause it for you. Unfortunately there is no medication that can prevent dumping and it is usually something you have to learn to avoid.



      It is not very common for people to lose too much weight but if you do, you should seek the advice of your dietitian.  The dietitian can go through your diet with you and suggest ways that you can increase the amount of food or the energy of the food you eat.  On very rare occasions the dietitian may ask you to see the surgeon if you lose too much weight and become ill.



      It is advisable to avoid getting pregnant for 12-18 months after your operation. This is so that your body can adjust to the weight loss and ensure that you are able to manage a good quality diet.  If you are planning a pregnancy, inform your dietitian who will be able to give you more specific advice about appropriate nutritional supplements to take and ensure that you have nutritional monitoring throughout your pregnancy. There is little evidence about whether the gastric sleeve stops the oral contraceptive pill from working but if you are worried, you can use a different type of contraception.  See your GP about other forms of contraception - they will be able to talk to you about the most suitable one for you.  Many women find that their fertility increases dramatically when they lose weight, which means they can get pregnant more easily.  Make sure you take precautions if you do not want to get pregnant!



      Yes there is no reason why you can’t undertake these activities.  In fact some people take up these sports, once they have lost weight as they feel they can do a lot more things that they couldn’t do before.  However, we do not advise swimming until you have had your wounds checked usually 4 weeks after your operation to ensure that they have healed to reduce the risk of infection.  If you are unsure then speak to your bariatric team.



      You should not experience diarrhoea after gastric sleeve surgery.  If you do you should contact your bariatric team, as it could be that you have a bowel infection.  A stool sample can be taken by your GP and treated with antibiotics.  Some people find probiotic drinks and yoghurts help to put good bacteria back into your gut.



      It is not very common for people to lose too much weight but if you do, you should seek the advice of your dietitian.  The dietitian can go through your diet with you and suggest ways that you can increase the amount of food or the energy of the food you eat.  On very rare occasions the dietitian may ask you to see the surgeon if you lose too much weight and become ill.



      Gastric band
      The gastric band is a tool which when used properly can help you eat less. It involves placing a silicone band around the upper part of the stomach, to decrease upper stomach size and reduce food intake. There is a tube attached to the band which is accessible via a port which is placed under the skin of the abdomen. This port is used to inject fluid into the band to inflate/adjust it. These adjustments alter the restriction around the stomach. The restriction creates a small stomach pouch above the band and the remainder of the stomach below the band. This smaller pouch stomach reduces the amount of solid textured food that can be eaten at one sitting. The exact way the band works is not clear.  One school of thought believes that the food sits above the band for some time before passing through to the lower stomach, making the body think it is full. Another school of thought believes that as solid textured food passes through the tightened area of the pouch, that it has an effect on stomach nerves which help turn off hunger. We cannot be sure how it works for sure, however the result is an increased feeling of fullness after eating solid textured foods. It is important to follow dietary advice for a successful weight loss result.



      The gastric band can be taken out if you experience any problems, whereas the other main surgeries (gastric bypass and sleeve gastrectomy) are permanent.  You need to have a general anaesthetic to have the gastric band fitted, but the operation itself is usually more straightforward than the other surgeries, and this means that the risks associated with surgery are reduced.  People usually only need to stay in the hospital overnight after having the band, and some people can even go home on the same day if they are well enough. Some people prefer the gastric band because, to an extent, you can control how tight it is by having band adjustments (where the band is filled with fluid).  Fluid can be injected in or taken out of the band depending on how much restriction is required The other advantage of the band is that because none of the stomach is removed, it is still able to produce all of the hormones and enzymes that your body needs to digest your food and keep you healthy.  You may still need to take vitamin supplements, but side effects such as diarrhoea and dumping syndrome are less common with the band than with some other operations.



      The band is fitted during a keyhole operation.  There are usually about 4 or 5 small wounds for the surgeon to place the instruments they need into the abdomen.  The surgeon makes a tunnel behind the stomach, and fits the band around it.  Above the band, the stomach forms a ‘pouch’ which is around the size of an egg-cup, and once this pouch is full, you will feel like you cannot eat any more until the food has passed through the band.  Once the surgeon has placed the band in the correct position, it is fastened and stitched or stapled into place to try and stop it from moving or ‘slipping’. Attached to the band is some tubing, which allows fluid to be injected into the band, adjusting how tight it is. The surgeon will then place a port underneath the skin by the tubing, and fasten the tubing on to it.  It is then stitched to the abdominal wall, and the skin on top of it closed in the same way as the other wounds. When you go back to the ward, you will be able to drink, and then follow the advice given to you by the dietician.  It will be about 4- 6 weeks before you go for your first band fill.



      During the operation, you need a general anaesthetic.  Although general anaesthetics are very safe these days, there are still small risks, especially if you already have health problems.  The most serious risks are of having a reaction to the drugs, having a heart attack or stroke, or of getting a blood clot in the legs, which can travel to the lungs, called a pulmonary embolus.  You will be given injections and stockings to wear to try and avoid this. During the operation itself, there can sometimes be some bleeding, as the surgeon has to cut some of the tissues in order to put the band around the stomach.  The liver can often be very large (which is why people go on a pre-operative diet), and this can sometimes prevent the surgeon from being able to do the operation.  Very rarely, the band can be put in the wrong place, especially if there is a lot of fat within the abdomen itself but this can usually be fixed with another operation. The main risks of gastric band surgery occur after the surgery, sometimes years later.  The gastric band can slip on the stomach, which can cause pain, heartburn, and can make you vomit constantly.  Sometimes removing all of the fluid from the band for a few weeks can treat this, but it sometimes needs an operation to re-position the band.  Occasionally the band can’t be re-positioned and it has to be taken out.  The gastric band can erode into the stomach (go through the wall) and unfortunately it has to be taken out.  The band can also either leak fluid, meaning that you need to get it tightened more often, or it can absorb more fluid, making it too tight and you need to have fluid taken out. Some people can experience problems with the gastric band port, which is usually placed below the ribs on the left side of the abdominal wall, just underneath the skin. The port can sometimes get infected, which sometimes means it has to be taken out.  The port can also erode through the skin, and again, needs removing.  Most of the time the port can be replaced at a later date, but sometimes these complications mean that the band no longer works, as the fluid will leak out. Finally, the port can ‘flip’ over, making band adjustments difficult.



      Everyone loses different amounts of weight with the gastric band, but in general you can expect to lose around half of your excess weight (half the amount you weigh above your ideal weight).  The amount of weight you lose depends on what you eat, and how strictly you stick to the post-operative diet.  The gastric band makes you feel fuller, more quickly, especially when you eat solid foods.  If you eat foods that pass through the band easily, such as cream, ice cream, chocolate, all of which are very fattening, or sloppy foods using gravies and sauces, these people will not lose as much weight as other people.  Also eating and drinking fluids together makes food sloppy, which then slips/glides through the band. Alcohol is also very high in calories, so it is advisable to reduce or avoid alcohol intake. Most people find that their weight loss slows after the first 12-18 months, and they may not lose much more.  It is important to maintain your diet in order to prevent weight regain.  Although you are unlikely to lose as much weight as you would after the gastric bypass or the gastric sleeve, the gastric band can still be very successful, but you have to be careful about your diet and stick to the gastric band rules.



      Before having any operation, it is important to read about the different type of surgeries available, and decide which you think will be the best one for you. Speaking to your bariatric team will help you make this decision. Although the gastric band is initially a safer operation, sometimes the long-term risks such as band slippage, erosion and port problems means that you will need more follow up from the hospital or your GP than with the other operations.  You may find that you need your band adjusting from time to time for the rest of your life and you can get a complication many years after your original operation. The dietician will give you some dietary information before you leave the hospital and it is important to stick to this advice.  You will need to stick to this advice for the rest of your life if you want to prevent weight regain.  The more strictly you stick to this diet, the more weight you will lose.



      Gastric band surgery varies in price but will usually cost somewhere in the region of £5000-£8000.  Unless gastric band fills are covered in the package price, these will cost between £100 and £400 each, depending on whether or not x-ray screening is employed


      You should expect to be reviewed in the outpatient clinic within 4-6 weeks of the surgery.  The surgeon/nurse seeing you will ask how you are getting on, may check your wounds and will usually arrange for you to have your first band fill.


      A gastric band fill is where liquid is injected through a special needle (Huber needle) into the band port.  The band fill (adjustment) will make the band feel tighter to restrict the amount of food that you are able to manage and make you feel full for longer.  Everyone requires different amounts of fluid in their band to get the same dietary restriction.  The amount of fluid added to the band is determined by the health professional adjusting it, a clinical judgement is made.  The amount of fluid added to the band will depend on what dietary restriction or lack of dietary restriction you had before the fill and your weight loss, whether you are eating the correct texture of food and following the gastric band rules and whether you have any adverse symptoms. It can take a few band fills to get the adjustment and dietary restriction right. Often smaller volume adjustments are tolerated better, leading to less adverse symptoms post adjustment. The band fill can either be performed in the clinic or sometimes it is done in the x-ray department.  You will usually be asked to drink some water to see how easily you can swallow and thus calibrate the adjustment.  If the band fill is done under x-ray control, you may be asked to drink some fluid that shows up on the x-ray to determine how tight the band is.



      The red, amber and green gastric band colour chart is used by some centres to discuss what restriction the gastric band is giving you and determine if a band adjustment (tightening or loosening) is needed to get the right band adjustment for you, this is sometimes called the sweet spot or green zone. The green area indicates that your band is appropriately adjusted, allowing you to make good dietary choices and textures with the appropriate portion control and feeling full, with minimal/no vomiting and having the expected weight loss.  The amber zone is when your band restriction is variable and possibly unpredictable if maybe that you can manage some foods one day but not the next.  You may only be able to eat a limited, softer diet and have to add sauce and gravy to food to be able to get the food through the band.  In the amber zone you may not be losing as much weight as expected.  You may be advised to either modify the texture of your diet to make you feel fuller for longer, eat slower and chew more thoroughly, increase your hydration level between meals or have your band loosened to allow you to make better food choices, which will encourage further weight loss. Or it may be that you are following all of the advice correctly and you still are able to eat large portions, in this case you require an increase in the volume of fluid in your band. The red zone indicates that your band is over restricted (too tight).  You may experience frequent vomiting, unable to tolerate any solid diet and only a limited liquid diet and suffer from acid reflux (indigestion).  If you were in the red zone you would be advised to have your band loosened. 



      This depends on how quickly you recover from your surgery.  Most people need to stay in hospital for one night after surgery, although very occasionally you may be able to go home on the same day.  You will only be allowed home when your pain is under control with medications and you are not being sick.  The dietitian will see you prior to your surgery date to talk to you about what to eat after surgery and it is important that you understand this information.  Sometimes you may need to stay in the hospital for a little longer, especially if you have no one to look after you at home.



      Yes.  The port is placed under your skin, so that the nurse/doctor/dietitian can feel it during your band adjustments.  It is common to feel sore for a couple of weeks post-surgery. When you lose weight, especially if you lose a lot of weight, the port site may become more prominent.  Again, as long as this is not uncomfortable, it is nothing to worry about. If the port becomes uncomfortable, you should see your surgeon, or ask your GP to refer you to the bariatric team.  In some cases, the port site can be moved, although there is no guarantee that moving it will make much difference to how it feels.



      Band erosion is when the band rubs against the stomach and starts to cause damage.  The band should sit on the outside of the stomach, but when it starts to erode, part or all of the band travels through the wall and ends up inside the stomach itself.  It causes symptoms such as abdominal pain, heartburn, vomiting and feeling unwell.  Unfortunately, if erosion occurs, the only way to treat it is by removing the band.  Treatment is necessary, because occasionally if the whole of the band erodes into the stomach it can cause problems such as blockage of the stomach, or, if the band passes through the stomach, blockage of the bowel.



      The band sits just below the top of the stomach, creating an egg cup sized pouch. The food sits in this pouch, before passing through the band.  However sometimes, the band can slip down the stomach and the pouch becomes much bigger.  Due to this, people experience symptoms of abdominal pain, heartburn, and sometimes vomit constantly.  Occasionally, people find that nothing passes through the band and they are unable to swallow anything, including fluids. Slippage is diagnosed with a test called a contrast swallow.  Patients drink a type of dye called barium, and then x-rays are taken.  The position of the band can be seen on this x-ray.  Usually, this test is only performed if the patient complains of symptoms. Once band slippage is diagnosed, taking the fluid out of the band can often treat it.  In many cases, the band falls back into the correct position.  However, in some cases the band needs repositioning, which requires an operation.  Sometimes the band cannot be repositioned, and in these cases, it sometimes needs removal.



      In many cases, this means that the gastric band is not tight enough or you are not eating the correct texture of food.  The band should be tight enough to make you feel full after a small amount of solid, textured food.  However if you can still eat as much as you like, even when eating the correct texture of food and not eating and drinking together it is worth contacting your bariatric team for assessment.  Just because you can eat as much as you like does not mean you should - you still need to watch the amount of food you eat. Do not forget that foods that are sloppy or liquid (e.g. cream, sauces and gravies) slide through your band very quickly and this may mean you can eat more of them. Avoid eating and drinking together, this also will often allow more food to be eaten in one sitting. Keep your calories in drinks low and avoid high calorie, low quality foods.
      You will be able to take small sips of liquids after your surgery.  Most centres advise a liquid only diet from the first 2-4 weeks.  This will involve you using liquids such as meal replacement drinks, smoothies, milk, yoghurt drinks and smooth soups.  After this time you will then move onto a pureed diet.  For most people at 4-6 weeks after having your gastric band placed you should be able to eat a solid diet. 


      You will be on a liquid/puree only diet for the first week after surgery.  You will only be able to sip small amounts of liquids at any one time.  This will involve you using liquids such as meal replacement drinks, smoothies, milk, yoghurt drinks and smooth soups.


      You may feel sick in the early stages during your recovery following the gastric band.  This may be due to the general anaesthetic.  It is important to remember to only take small sips of liquids at any one time.  Most people use a water bottle with a sports cap or use a straw to prompt them to not take gulps of fluids when they feel thirsty, as this is more likely to make you feel sick.  You should also avoid fizzy drinks as these can cause bloating.


      Most centres advise you to move onto a solid diet from week 4-6 weeks onwards after having your gastric band placed.  By this time you may not feel much dietary restriction as the band will have loosened off due to the swelling around the band area reducing.  At week 4-6 you will usually have your first gastric band fill and you will then need to go back to a liquid/pureed diet and work through the advised dietary stages again. 


      The gastric band port is usually placed under the skin on the left side of your abdomen below your ribs.  This is connected to the band, and it is through this port that fluid is injected to adjust your band.  Sometimes this port can become infected, especially if the skin is not cleaned properly before fluid is injected into it.  The port can however become infected even if everything is cleaned properly, because it is a foreign body.  If you get a port infection, you might notice pain or redness over the port site.  Occasionally, this can be managed with antibiotics, however in many cases the port may need to be removed.



      Many different types of gastric bands are available.  There are minor differences between them, for example the shape, the insertion technique and the fill volume. Different surgeons may employ different makes of bands but most bands are fine and there is little to choose between them.


      Although each operation can be very successful at helping you to lose weight, there are significant differences between each and it is important to choose the correct operation for you. The main differences are that the gastric band can be reversed in the future if necessary, whereas the gastric bypass and sleeve gastrectomy cannot be reversed.  The bypass and sleeve are slightly more complicated operations than the band, and you need a slightly longer stay in hospital, but the weight loss is usually better, and quicker, than with the band. Each operation has risks and can cause complications - the band has slightly fewer complications in the first few weeks after surgery, but has more long-term complications than the bypass or the sleeve.  Talk to your surgeon about the best operation for you.



        The gastric band can stay in for life.  The band can be taken out if you have any problems, or if you decide you do not want it anymore.  But if you have no problems, there is no need to remove it.  In most cases, the band still works well after 10 years, but you still need to be careful about what you eat and work with it as a tool.



      The gastric band can be reversed if necessary.  The main reasons for needing to remove the band are if you have any complications such as band erosion or slippage, or if you decide you no longer want the band.  In either case, removing the band involves another operation, similar to when the band was placed.  It can usually be done as a day case operation but sometimes you need to stay in the hospital overnight.  The operation involves a general anaesthetic and the surgeon will create the same small wounds in your abdomen as your first operation. Again, these wounds will take a few weeks to heal.  In some cases, the surgeon can replace your band at the same time, or remove the band and convert to another weight loss procedure, but this is not always possible.



      The best way of making sure you lose weight with gastric band surgery is to stick to the advice the dietician gives you.  Many people say they do not lose weight, but it is often because they are eating the wrong foods or because they are drinking alcohol, which is very fattening (high calorie).  If you do not lose weight, there is the possibility of going for more surgery. It is very unlikely that the NHS will pay for this. It is technically slightly more difficult for the surgeon to convert the band to a sleeve gastrectomy or a gastric bypass, than if it was a straight forward first time sleeve gastrectomy or gastric bypass surgery.  The risks of conversion are only very slightly higher than the risk of having a sleeve or bypass from the start.  The choice of whether or not to have more surgery is up to you but you should talk to your bariatric team if you are considering it.



      Yes, this can happen, but it is rare.  If this happens the fluid can leak out of your band, meaning that the band might not work properly.  You may find that you have no restriction and can eat more than you could before.  The tubing can be replaced but this will need another operation.  If the problem with the tubing is next to the port itself, it can sometimes be repaired under local anaesthetic but in most cases it is better to have a general anaesthetic.  If the problem is with part of the tubing inside your abdomen, you will need to have a general anaesthetic to replace it.  You may find that the port also needs replacing at the same time.



      In most centres the band fills are done by feeling for the port and injecting it with fluid (clinical adjustment).  Some bariatric centres do most of their band fills using X rays (radiological adjustment); this is the centre’s choice.  If the port cannot be identified, the radiologist can use an X Ray to see where the port is and access it to adjust your band.    Very occasionally the port cannot be accessed especially if it has flipped over and you need a small operation to fix it back into its proper place.



      Most centres advise a daily vitamin and mineral supplements after a gastric band.  This is due to the portion size restriction and sometimes limited dietary choices and variety with the gastric band diet.


      You should not require iron supplements with a gastric band.  However, some people may require them if they are found to be anaemic.  This is usually caused by a lack of iron in their diet or not taking the recommended daily vitamin and mineral supplements.


      Following gastric band, as long as a balanced diet is being eaten and daily multi vitamin and mineral supplements are being taken as advised there are not usually any deficiencies. If you are concerned about your health or energy levels, you should discuss this with your dietitian, who will advise what blood tests are needed and any necessary further supplementation. If you experience any symptoms such as vomiting or heartburn or do not feel well, see your bariatric team or GP and they may send you for some investigations to make sure you do not have a complication from your band.



      Some people do lose too much weight after bariatric surgery, although this is more common with gastric bypass or sleeve gastrectomy than with the gastric band.  If you find that you are still losing weight after you have reached your weight loss target, it is worth speaking to your bariatric team or GP about getting your band loosened.  As long as you maintain a healthy diet, you should be fine after band surgery. If you get your band loosened, you are able to eat more.  However, if you start to eat too much, or the wrong foods, you will gain weight.  It is important to keep track of what you are eating even after you have lost your weight as weight regain is a very common problem.



      Yes, you can go on holiday with a gastric band. Avoid flying in the first couple of weeks post-surgery, but following this, it is safe to fly with a gastric band  Most bands do not set off the security scanners at the airport. Restriction can become tighter during a flight, this usually settles once landed, but sometimes does not. Have only liquid foods during the flight to avoid problems. Also if your band is particularly tight prior to your travels, it is advisable to have a little fluid taken out prior to the flight.



      It is advisable to avoid getting pregnant for 12-18 months after bariatric surgery. This is so that your body can heal and get used to having the gastric band.  If you get pregnant accidentally - contact your bariatric team or GP to get advice.  The contraceptive pill should still be effective after band surgery as long as you take it properly.  If you are worried, you can use a different type of contraception, such as condoms or see your GP about other forms of contraception - they will be able to talk to you about the most suitable form of contraception for you.



      Some people may find they have bad breath.  Although this can mean there is a complication, such as band erosion, this is not always the case.  The first thing to do is see your dentist, who can check your teeth and oral hygiene.  Changes to your diet can have an effect on your teeth, making cavities more likely and this is a common cause of bad breath.  If your teeth are fine, chewing gum after a meal or cleaning your teeth more often can help to freshen your breath.  If none of this helps with your breath, it may be worth seeing your bariatric team to check there is no complication with your band.  They may do an investigation such as a camera test or a dye test to make sure the band has not eroded into your stomach.



      Symptoms like these can suggest that the gastric band may be too tight or may have slipped on your stomach. If the band is too tight, having a little fluid removed will resolve the problem. The band should sit just below the top of the stomach, forming a small pouch above it. Sometimes, the band can slip down the stomach making the pouch bigger.  When this happens, the band lies in the wrong position and food and fluid cannot pass through it.  In this case, you need to contact your bariatric team.  They will do some investigations to see if the band has slipped and will usually take the fluid out of your band, deflating it. Sometimes, this allows the band to move back into its proper position. You may need an operation to reposition your band.  If you find that you are unable to keep even fluids down you should attend your local A&E department and they will refer you to the surgical team who will be able to sort you out.



      Constipation can be common and is usually because you are not drinking enough fluids.  Increasing your fluid intake will help.  You also need to ensure you eat a regular diet of fruit and vegetables which contain fibre and help to prevent constipation.  Simple over the counter remedies for constipation such as lactulose or Senna can also be of help.  If you find that you are still constipated, it is worth seeing your GP or local pharmacist who may be able to offer you some alternative medications.



      Diarrhoea is not as common after gastric band surgery as after bypass or sleeve gastrectomy.  If you feel unwell and have diarrhoea you should see your GP.  Sometimes, diarrhoea is because the body is getting used to losing weight or to your new diet.  If you feel fine and do not think diarrhoea is related to anything you have eaten, you can try an over-the-counter medicine such as Imodium.  If you get any blood in your diarrhoea you should seek medical advice immediately.



      In the majority of cases, yes the surgeon will remove your band.  If you are having revisional surgery, it is usually because you have either not lost weight with the band and/ or because you have had a complication. Sometimes it is possible to repair a slipped gastric band during surgery.  The gastric band causes scarring on your stomach, meaning that a gastric bypass could be difficult, if the scarring is severe. Scar tissue is thicker than normal tissue, which means that the stapling device used in a gastric bypass may not be able to go through the tissue safely and securely.  A gastric sleeve is usually therefore the best option as the surgeon can avoid the area of scar tissue on your stomach. Gastric bypass and gastric sleeve are both very effective weight loss surgeries. In recent years the gastric sleeve has become the most popular procedure of choice. However if someone has a real addiction to sweet foods, nibbles and grazes on foods and has type 2 Diabetes then the gastric bypass is often the better choice for this type of eater. However someone with the above eating habits can still be very successful with a sleeve if they are prepared to change their dietary habits.



      No, we generally do not do gastric band inflations until 4-6 weeks post-op as everything is still healing and you should not be on normal solid foods as yet. Please continue to make good food choices until this time.  Also it may be worth considering whether you are actually feeling physically hungry or whether it is emotional hunger?


      There is nothing to suggest that it is dangerous.  Silicone implants have been used in various areas of surgery for more than 50 years.  There were a lot of concerns and legal actions raised regarding the liquid silicone used in breast implants. However, this turned out to be more of a political and legal dispute than a true medical problem.  The Gastric Band is made of solid silicone and has no liquid component.  Therefore it cannot leak into the tissues in the way that liquid silicone possibly could.  The likelihood of any problem is extremely low.  However, it could be that information about problems relevant to this question may become available in the future. 



      We don’t really know. We have been using the Gastric Band for more than 20 years and there has been no sign of it wearing out.  However, we do not know how it will last in the longer term. Realistically it may be that a device such as this may not last 40-50 years.  We do expect that somewhere down the track it may no longer be possible to adjust the band and should this occur, the band may need to be replaced.  It will remain to be seen if and when this should become necessary. 



      An advantage of the Gastric Band is its adjustability.  If you have an illness that makes it inappropriate to have a restriction on your food intake then the fluid can easily be removed and there would be very little limitation on nutrition.  Once you have recovered from the illness, the fluid can be added again and the band tightened.


      Not so easily.  As we eat, we always swallow air and normally we would bring this back up again quite unconsciously.  The band interferes with this easy bringing up of wind.  It is common in the first few weeks after the procedure for people to notice a difference with bloating and the feeling that they want to burp but can’t. This seems to settle over the next few months. 


      Some people worry more about the adjustments before they are done than they were worried about the operation.  Each adjustment consists of a jab with a needle and then some mild discomfort as we push on the access port.  It usually only takes a few minutes and doesn’t require any local anaesthetic.  It would hurt as much to have the local anaesthetic injected in as it does to have the whole adjustment. However sometimes patients will choose to put a numbing local anaesthetic cream on the skin above the port area an hour before their appointment.  After you have your first adjustment you should feel reassured and no longer need to worry.



      You do not want to get into difficulties while away and therefore you have to be careful to follow the rules regarding the type of food you eat.  Only drink pure clean water, take precautions to avoid food poisoning as far as possible. Take some information with you regarding the band you have (gastric band I.D card.) Before travelling ask your centre to provide you with a special (Huber) needle to take with you, to be used by a trained doctor or nurse, in an emergency. Most centres do not stock these needles. If you do experience problems while travelling abroad, provide the clinic with your bariatric team’s contact details. Flying can cause a temporary increase in the restriction you feel, sometimes this does not settle once you have landed. Therefore if your band is very tight prior to your travels, it would be wise to have a small deflation prior to flying. It is also advisable to only eat liquid foods during the flight to avoid any problems mid-air.



      This is a fairly common feeling, especially for people with bands that are quite tight or just after having an adjustment.  During the day, water content in the body changes and this may cause the band to feel “tighter” some of the time, usually in the morning Some women have also noticed that the band feels tighter during menstruation.  Some people find the band feels tighter if unwell or under a lot of stress. If you are still able to eat and it settles throughout the day, you do not need to worry. If concerned contact your bariatric team for advice.



      General
      Most of the operations work by reducing the amount of food you can fit in your stomach.  This food needs to be digested and passed out of the stomach before you can eat any more.  If you have a drink with or after food, you wash food quickly out of your stomach.  This means you will be hungry again more quickly and you will eat more overall.  This is why people can eat more soup, cream, chocolate etc. than solid foods - because it passes out of the stomach quickly. Although it is possible to have a drink with a meal, you should AVOID doing this if you want your surgery to be as successful as possible.



      You should avoid fizzy drinks.  Most of these drinks are very high in calories (i.e. they are fattening) so it is best not to drink them.  Also, because your stomach is so small, you may find that the gas in fizzy drinks make you belch much more and can stretch your stomach.  Once your stomach stretches, you find that you can eat more and this leads to regaining weight.  It can also put pressure on the staple lines in your stomach and bowel.  Fizzy drinks can also cause inflammation in your stomach, which can cause problems especially after surgery.  You should try to find alternative drinks before surgery so you can get used to not having fizzy drinks.



      Smoking is bad for your health and it is always best to stop smoking before you have surgery.  In some centres, the surgeon will not perform bariatric surgery on you until you can prove (with a breathing test) that you have stopped smoking.  Being a smoker increases the risks of having surgery and can cause you problems following surgery.  Risks of strictures, leaks from staple lines and infections are much higher in smokers than non-smokers. You should speak to your bariatric team, GP or chemist about getting help to quit smoking.



      Many people find that going to a weight loss group is still helpful after surgery.  The moral support you get from other people helps you to keep track of your eating. In most groups, you cannot enter “slimmer of the week” competitions, because having had surgery gives you an advantage, but there is no reason why you should not continue going to a slimming group. Unfortunately, some people have reported being “unwelcome” at weight loss groups after surgery, because people think it is “cheating”.  If this is the case and you are told you cannot join, particularly in groups like Weight watchers and Slimming World, you should speak to the head office - they will be interested to speak to the person in charge of your local group and ask them why.  In most groups, you ARE welcome to join!



      Unfortunately the NHS has to be very strict about the types of surgery that they will fund, because money is very tight.  There is no cosmetic surgery allowed on the NHS (face lifts, breast implants, liposuction etc.) because it is not “essential” surgery - meaning that it is done to make you feel better about yourself, rather than for health reasons.  In very rare cases, if the loose skin is so bad it causes breaks in the skin or infections, a doctor can apply to the government to get special funding, but they have to prove that it is for a health problem and not for cosmetic reasons.
      Although some people feel skin surgery should be “part of the package” of having bariatric surgery, having loose skin does not usually cause you medical problems, therefore the NHS cannot afford to pay for it. Unfortunately if you think you will need surgery to remove your skin, you will have to pay for this yourself.




        If you experience a problem that you think may be related to, or caused by having bariatric surgery, your GP can refer you back to the bariatric team.  In most centres, you will have been given a contact number for the nurse or dietitian and you can call them for advice at any time. Finally, if you become very ill or in case of an emergency, you can attend your local emergency department, who will refer you to the surgical team.  The first port of call however should be your local GP wherever possible.



      Yes.  If this is the case and you have a problem that your GP cannot help with, they can refer you to the local NHS bariatric services.  This may not be the surgeon or team that you are used to seeing privately, but they can deal with any problems related to your surgery.  Sometimes, the GP may not need to refer you to the hospital, but can ask the bariatric team for advice.  In either case, you should speak to your GP if you are worried about anything.


      Very few obesity operations are funded by UK insurance companies and as such you cannot expect any complications to be paid for by them.  In many cases, you would either need to see a private surgeon or ask your GP to refer you to an NHS bariatric consultant.  If it is an emergency, you should attend your local Accident and emergency department.



      In NHS cases, you will have to go back to your GP and be re-referred to the community weight management programme.  If you had surgery on the NHS, you will probably have already been through this programme, but you will need to go through it again.  This is because if you have not lost weight after surgery, there are probably habits, lifestyle factors, emotional issues that have prevented you from losing weight (for example:  still eating too much, eating the wrong things, not exercising enough, drinking fizzy drinks or alcohol, emotional eating).  The NHS cannot afford to give surgery to everyone who needs it and therefore if you have already had surgery once, they need to be sure you are 100% committed.  If the community weight management programme feels you are suitable for more surgery, they will refer you back to the hospital. If you want surgery privately, you do not need to attend a weight management programme, but can make an appointment to see a private surgeon.



      For the first few weeks after surgery, you may need to get some of your larger tablets changed to liquid, chewable or dissolvable medications.  Your GP can often advise you about this and change most of your medications before you come into hospital.  In general, anything larger than a paracetamol needs to be changed to liquid/chewable/dissolvable.  The dietitian is also able to advise you on which medications may need changing. When you take tablets, you should take them with water.  If you take a few different medications, you may feel very full after taking them, so you may need to take a few tablets at a time.  Your GP can advise you about when to take your medications.



      The nurses on the ward will show you and/or a family member how to give these injections.  In most centres, patients are asked to give themselves an injection of a drug called heparin (also known as clexane, dalteparin, fragmin, enoxaparin, tinzaparin) for up to 2 weeks after surgery - this is to help prevent blood clots.   1- Choose a site to give the injection - usually the stomach, upper outer arm or outer thigh. 2 - You should clean the skin with a sterile wipe that you will be given in the hospital 3 - Hold the needle at 90o to the skin (upright) like holding a pencil 4 - Push the needle into the skin and push the plunger all the way down. 5 - Pull the needle completely out of the skin and place the whole syringe in the yellow sharps bin provided. 6 - If you bleed, use a piece of tissue or cotton wool.  This should stop within 30 seconds. If you are needle phobic, you can ask a friend or relative to do this for you.  It is very important that you take all of these injections.  If you have any problems, you can speak to the nurse at your local GP practice or phone the bariatric team.



      The best idea is to place your injection needles in your suitcase.  This way, they are placed in the hold on the aeroplane, not in the cabin and therefore you should not have a problem.  It is a good idea to tell them at check-in (when you hand your luggage into the staff) that there are some medication needles in your bag. If you need to take them in your carry-on luggage, you should remove them from your bag and let the security staff know that you have them with you. If they are still in their packages, the staff can see that they are a type of medicine and you should not have a problem taking them through security.  DO NOT remove the syringes from the package until you need to use it.  You should also remove the yellow sharps bin and show the staff.



      There are some people who become overweight because they are addicted to food.  Unfortunately, if they do not get psychological help before and after surgery, they can find they become addicted to alcohol, drugs or gambling for example, after surgery.  This is known as “addiction transference or cross addiction”. The main reason for this is that they have used food as a coping mechanism before surgery, a way of managing their emotions.  After surgery, they find they unable to eat enough to manage their mood and self soothe, so they use an alternative coping strategy to self soothe instead, for example drugs or alcohol. If you feel you use food to cope in this way it is a good idea to see a mental health practitioner before having surgery. Support after surgery is also very important to help find alternative ways of thinking, changing habits, coping strategies etc.



      There are some patients who think that if they buy a take away and puree it, or melt a chocolate bar, there are fewer calories or less fat.  Food, whether in solid or liquid form, has the same amount of fat/salt/calories/vitamins/protein.  However, most commonly patients who eat soft mushy, liquid foods do it as a way of getting more food in, as it is the only way they know how to manage their feelings, using food as a coping mechanism. Having weight loss surgery involves making a big commitment to changing your eating habits and lifestyle. Consider psychological support before and after surgery



      It is not uncommon to experience some hair loss after bariatric surgery, particularly after the bypass, sleeve or biliopancreatic diversion/duodenal switch. If this occurs in the first 4-7months it is usually due to hormonal changes as a result of weight loss. Be reassured that hair does grow back. Hair loss 12 months post-surgery is usually due to vitamin or mineral deficiency. Your dietitian will advise you what blood tests are needed and any extra necessary supplementation. Often, taking multivitamin and mineral supplements can help the hair loss to slow, and for the hair to grow back



      If you can feel a lump immediately after surgery, this may be a collection of blood known as a haematoma.  Over the first few weeks after surgery, this should settle. Your body will heal the wound and there may be a small lump of scar tissue. Again, this is nothing to worry about, as long as it causes you no problems. Sometimes, even years after surgery, a lump can develop under one of the scars. This is probably a hernia.  Your GP can refer you to the hospital and the surgeon may be able to do a small operation to fix this. If the lump becomes painful, hot, red or bluish, you should seek medical advice urgently.



      Before you have any surgery on your abdomen, you should let your surgeon know that you have had weight loss surgery.  In most cases, this should not cause a problem, but sometimes (depending on the operation you need), the surgeon may want to get advice from a bariatric surgeon before they operate. Most bariatric operations are done by keyhole, which means the amount of scar tissue that develops inside your abdomen is limited.  However, in some cases, there can be a lot of scar tissue, particularly if you have had a complication after surgery.  This may make further surgery more difficult and it may have to be done as an open operation, rather than keyhole.



      In most cases, if you tell your surgeon/dietitian/nurse that you have been unhappy with your care, they will talk to you about why this is the case and try to sort any problems out.  If you do not feel able to talk to the bariatric team, you could speak to another doctor or nurse in the hospital or your GP.  They may be able to speak to the bariatric team themselves.  If you are still not happy, you can ask your GP to refer you to a different hospital with a different surgeon. IF you have an unresolved complaint, the hospital Patient Advice Liaison Service (PALS) may be able to help you.  You can find the number for them on the hospital website or by speaking to the hospital switchboard.



      A food diary can be a useful tool to keep a record of the food and drink that you consume on a daily basis.   Most people tend to keep a food diary using a notebook or use a food diary smart phone app.  Food diaries record the time of day you eat or drink something, what you ate or drank and how much.  A food diary will enable you to determine if you are following the appropriate diet and help you see progression through the dietary stages.  It can also be used to work out the number of calories or amount of protein eaten. 



      Before having any operation, it is important to read about the different type of surgeries available and decide which you think will be the best one for you. Speaking to your family doctor or the bariatric team can help you make this decision. All patients are required to do a pre surgery diet, this diet is designed to shrink the liver, making the surgery much safer. Also losing some weight reduces anaesthetic risks. Your dietitian will supply you with the pre surgery diet, which is usually followed for 10-14 days pre surgery. The dietitian will give you post-surgery dietary information before you have surgery and it is important you follow this advice after the surgery. The more strictly you stick to this dietary advice, the more weight you will lose.  Try to stop smoking or drinking alcohol prior to surgery. Smoking in particular causes lung problems which can increase the risks of surgery dramatically.  The safest way of getting through the operation is to stop smoking first, even if only for a couple of weeks before surgery.



      Not routinely.  If you have been diagnosed with gallstones and you are getting symptoms from them, your surgeon may decide to remove your gall bladder at the same time as performing your surgery, but this increases the risk of having complications from surgery and may make your recovery more difficult.  It is also more difficult for the surgeon to remove your gall bladder at the same time as doing weight loss surgery, because the port sites that are placed for the instruments in bariatric surgery are in a different place than when performing gall bladder surgery.  It is possible however, so if you do have gall bladder problems, speak to your surgeon appointment.



      Straight after surgery you will be wheeled into the recovery room, or in some cases, straight into the high dependency unit (HDU).  Here, the nurses will take a blood pressure, temperature and heart rate reading.  You will be attached to a drip, which gives you fluids and you may have a catheter to collect your urine. You may have some pain but you will be given painkillers to help with this.  Once you are fully awake from the surgery, you will be taken to the ward (if you are not on HDU) and you will be allowed to have a few sips to drink.  The staff will gradually increase the amount they let you have to drink, as you may feel quite sick after the surgery.  The nurses on the ward will regularly check your temperature, heart rate and blood pressure.  Do not be afraid to ask them if there is anything you feel you need whilst you are in the hospital.



      This depends on how you feel and how quickly you recover from surgery. Some people feel able to do exercise quite soon after surgery whereas other people take a bit longer.  There is no right or wrong answer.  You probably won’t feel like doing much exercise for the first week or so, but it is best to gradually increase the amount you do.  Start by gentle exercise such as walking and when you feel ready you can try other forms of exercise like swimming.  It’s best to avoid swimming until all of your wounds have completely healed.  We would recommend you to avoid strenuous abdominal exercises such as sit ups, rowing and weight-lifting for at least the first 6 weeks - this will allow the muscles in your abdomen to heal properly after the surgery.



      This is up to you.  There is no reason you can’t have sex as soon as you feel mobile enough and your pain has gone.  It’s probably best to avoid strenuous or vigorous sex for the first few weeks whilst your abdominal muscles are healing, but gentle sex is OK.  You may find that your sexual function improves after surgery but this doesn’t happen for everyone.



      Staff working in the operating theatres are specially trained to move very large patients.  There are also specialised pieces of equipment such as hover mattresses (which inflate and act like a hovercraft), which can help with moving you around.  The table you will be on is designed for bariatric surgery and can take very large weights, up to 500 kilograms (78 stones).  After surgery you will be very drowsy because of the general anaesthetic, so the staff will move you back onto your hospital bed.



      People who have had bariatric surgery describe many different methods for eating out and everyone is different.  Some of the tips people give include: ●     Order a starter portion instead of a main meal ●     Order a child’s portion ●     Share a meal with someone else ●     Have a coffee instead of a dessert ●     Ask the waiter if you can take your leftovers home (remember- you have paid for it) You may find your own ways of managing when you go out for a meal - if you do, please let us know at simply bariatrics.



      Loose skin is a common problem after bariatric surgery.  The more weight you have to lose, the higher the chances of getting loose skin become.  Some people say that regular exercise, massage, or moisturising their skin helps to minimise the amount of loose skin they have but this does not always work.  In many cases, there is nothing that can be done other than getting plastic surgery to remove it. It is very unlikely that you will be able to get skin surgery on the NHS, because it does not usually cause health problems - it is done for cosmetic reasons.  In most cases, if you want skin surgery, you will have to pay for it privately.  It is usually a good idea to wait until you have stopped losing weight and have maintained it for at least 6 months to a year before considering surgery or you may lose more weight and end up with even more loose skin.



      Not necessarily.  It is important to listen to the advice that you are given by your doctors, nurses and the dietitian. You will still need to monitor your blood sugars as it is important to maintain your blood glucose. You will be on a liquid or mushy diet for a few weeks after surgery and this can sometimes mean your blood sugars are better controlled than before surgery. Depending on your blood glucose, you may not need to take your insulin but in most cases, you will still need to take your tablet medications. Once you start losing weight, you might find that your diabetes gets much better or becomes symptom free. Ensure you keep a close check on your diabetes and speak to a health professional if you have any questions. Beware of putting weight back on - this can bring your diabetes back.



      In many cases, your blood pressure will start to get better as you lose weight.  You may be able to stop your medications in the future, but this will depend on your blood pressure readings.  A high blood pressure increases your risk of having a heart attack or a stroke, so it is important not to stop taking your blood pressure medications until you are told to do so by a doctor.



      There are many established support groups now either locally as a face-to-face group monthly meetings or online.  It has been shown that people who are part of a support group have better outcomes overall and are more likely to keep the weight off in the longer term.  However it is important to choose a good, well established support group that has positive feedback from other people.  This will ensure that consistent well-advised, helpful information is provided.  Avoid groups that tend to share bad habits and experiences.



      You can go on holiday whenever you feel comfortable enough and when you are comfortable with your diet.  You may find you feel tired and sore for the first few weeks after surgery, so it is unlikely that you will feel up to travelling long distances for a few weeks.  It is best not to book a holiday for about 6 weeks after your surgery, especially if this involves a flight.  Blood clots are more common after surgery and also after travelling long distances, so be aware that the risks of a blood clot are slightly increased. Check with your insurance company about travelling after surgery - some companies will not cover you for the first few weeks or months after having a general anaesthetic.



      Weight regain can occur after any bariatric procedure.  This is more common approximately 2-4 years after surgery and in people who do not see the operation as a lifelong, lifestyle change.  The best way to prevent weight regain is to follow the advised diet, avoid snacking and increase exercise.  You will need to maintain all the changes you have made for the rest of your life.  Some people find by keeping a food diary helps them keep on track. The best advice is to only eat up to 3 tea plate sized portions per day and avoid snacking on high calorie, low nutritional value foods in between meals or missing meals. Eat a solid well balanced diet and keep calories in drinks to a minimum.  Speaking to people who have had bariatric surgery, as well as your bariatric team can be useful and can help you to find ways of preventing or minimising weight regain. 



      Water is very good for you.  The body often cannot tell the difference between hunger and thirst, so it is always a good idea to have a drink of water when you are feeling hungry.  Sometimes this can take away your hunger.  Water does not stay in your stomach for long, so it is unlikely to make you feel full for long, but it is important to keep drinking.  However, you should avoid having a drink for 30 minutes after you have a meal.  This is because the water/fluid can wash the food out of your pouch more quickly and you will feel hungry again. If you are following dietary advice and having the recommended correct texture food portions at meal times and you are still feeling hungry or unsatisfied, it is worth considering whether you are experiencing emotional hunger not physical hunger. Emotional support from an appropriately trained bariatric mental health practitioner can be helpful.



      It is advisable to have a relative or friend to help you with childcare in the early stages after a weight loss operation.  You may find it more difficult to lift/carry children in the first few weeks after your operation as you will feel sore and uncomfortable.  Most people report feeling tired, particularly in the first few weeks whilst you recover from your surgery, so you may find it difficult to look after younger children during this time.



      Some people may find they have bad breath after surgery.  This is more common in the early stages of the diet, when your diet and fluids are more limited. Try to concentrate on getting well hydrated. Discuss your dietary intake with your dietitian to see if you need to alter your diet. Changes to your diet can have an effect on your teeth, making cavities more likely and this is a common cause of bad breath.  You could see your dentist.  If your teeth are fine, try increasing your water intake, chewing sugar free gum or mints after a meal or cleaning your teeth more often to help freshen your breath.  If none of this helps with your breath, it may be worth seeing your bariatric team to check there is no complication from your surgery, although this is unlikely if you have no other symptoms.



      It is possible that this is because of your surgery. However it is important to check first that you are following the right stage of the diet and have not progressed through the dietary stages too quickly.  It is also important to ensure that you are following the dietary rules, it is vital to eat slowly, take small bites of food, chew thoroughly and wait a minute after swallowing before taking the next bite of food. Sometimes, the joins or staple lines in stomach can narrow and this is known as a stricture.  This can mean that you find it difficult to swallow as the food gets stuck above the narrowing.  You are more likely to be vomiting and have pain on eating and drinking.  If you are having problems, you need to see either your bariatric surgeon or your GP can refer you to another suitable consultant at the hospital.  There, you are likely to be sent for either a camera test or a dye test, which will identify if there is a stricture.  Strictures can usually be dilated (stretched up) using a balloon and this can usually be done at the same time. Occasionally you may need to have this procedure repeated.



      It is common for people not to drink enough, especially after surgery because of how quickly the stomach fills up.  It is important to keep sipping, little and often regularly.  Keep a bottle of water by your bed, on your desk, or in your bag. Sometimes, dry mouth can be caused by medications such as those used for blood pressure or depression.  If you are sure you are drinking enough, it is worth seeing your GP, who may be able to find alternative medications for you to try.



      Constipation is not uncommon after surgery, especially whilst you are taking painkillers. Ensure you drink plenty and are eating a good diet with plenty of fibre (fruit and vegetables).  These are the best ways of preventing constipation.  Alternatively, you can ask the local pharmacist for some simple medication to help, such as Movicol or senna.  If this doesn’t work, your GP can prescribe you a slightly stronger medication, which should help.



      After surgery you may find that you lose weight quickly.  Some people say they can drop a dress size every few weeks.  Therefore it is good advice to avoid buying expensive new clothes until your weight becomes more stable.  Advice that patients who have had bariatric surgery give include: ●     Alter or make your clothes yourself if you have the skill. ●     Buy clothes from charity shops, which can have nice/new clothes for low prices ●     Go online where you can find websites that do “clothes swaps”- popular with bariatric patients ●     Buy and wear belts or scarves that you can wrap around skirts, trousers and tops to make them look and fit better for longer.



      This is completely up to you, and varies from person to person.  Some people feel much better about the way they look after surgery and this can increase your confidence.  You need to decide when it is right for you to start dating - there is no medical reason why you can’t start dating as soon as you like.  Other people find that the weight loss doesn’t make them feel more body confident and worry what other people think of their loose skin.  It is important to feel good about yourself. Body image and confidence can be improved by working with a counsellor/psychologist. Alternatively you may wish to see your GP to discuss being referred to a plastic surgeon.



      Many people who have a problem with their weight also have an emotional relationship with food and this can often be the most difficult part after having weight loss surgery. If over eating has been used to manage emotions, this way of coping has now been removed. Some people find changing their lifestyle and dealing with emotional eating harder than others.  If this is a problem for you, ask to see a psychologist/counsellor/ mental health practitioner with experience with bariatric patients, who is specially trained in helping you understand and find alternative coping strategies. Some patients say that getting a new hobby or making new friends after surgery can help. Find other forms of reward, other than food, such as taking a walk, having a nice bubble bath, reading a book, having a massage.  Be very careful not to substitute food for alcohol, smoking or drugs.  This has been reported, transferring an addiction from food to alcohol, smoking or drugs as a means of self-soothing/coping mechanism. This is called transference. Again, the psychologist can help you with this.



      It can take some time to get used to the weight loss after surgery. Some people find it harder to adjust than others.  How you dress is up to you, but it is important to wear whatever you feel comfortable in.  Some people feel that wearing black makes them look slimmer, this is personal choice. Some patients say that they still buy clothes that are too big after surgery, because they forget they can fit into smaller clothes or they simply have no idea of their clothes size.  Trying clothes on in the shop is a good idea, especially as you get used to your new size.  There are some good undergarments made of lycra that can help to hide excess skin and many patients like to wear these as it increases their confidence.  The best advice is to wear whatever you are happy with.



      Unfortunately some patients feel like this after surgery. Weight loss surgery helps you to lose weight and get healthier, but with some patients it does not improve confidence, self-esteem and poor body image. Lack of confidence, low self-esteem and poor body image can be problematic for some people. Many bariatric services have a psychologist/ mental health practitioner who can help you with confidence, self-esteem or body image issues and can help you to adapt to life after surgery.  Your GP can also refer you to a psychologist or a counsellor.  If loose skin is the main issue and you can afford the surgery privately, you can ask your surgeon or GP to refer you to a plastic surgeon.



      Weight loss surgery helps you to lose weight and get healthier, but if your self-esteem was low before surgery, it can sometimes remain low afterwards. Surgery does not resolve any mental health problems you may have, nor does it completely change the way you feel about yourself.  Seeing a psychologist, someone who is trained in helping patients deal with low self-esteem, can be very helpful.  Ask your GP or bariatric team if you would like a referral.



      How soon you go back to work depends on how you feel and what you do for a living.  It is usual to have a week or 2-3 off after surgery, but some people may find they need longer, especially if they do manual labour. Most workplaces can amend or find you duties that do not involve heavy lifting, so it is worth speaking to your employers before surgery.  The main issue is allowing the wounds in your abdominal wall to heal before you do any strenuous work or exercise.  It is advisable to be careful for about 6-8 weeks after surgery.



      If you feel unwell in any way after discharge, it is important to seek medical advice.  Bleeding from wounds that do not stop with gentle pressure will need attention by a doctor or nurse.  If you find you are vomiting, cannot keep food or fluids down or vomit blood, you should attend your local hospital.  If your pain is not controlled with the painkillers you are given on discharge, this can mean there is a complication and you should see a doctor. If at any point you are worried or need advice, you can call the bariatric team, see your GP or attend the hospital and they should be able to help you.



      You should not be in severe pain, although some is normal.  If you have some pain, you should be taking regular painkillers in gel cap or liquid/dissolvable form.  For more severe pain, you should contact your bariatric team or GP - they will discuss with the surgeon and let you know what to do or prescribe you some stronger painkillers if appropriate.



        If on discharge from hospital you were given an anti-emetic (such as Maxolon or Stemetil) then you should start taking these regularly for the next few days and see if it settles.  If not, you should contact your bariatric team or GP who should be able to prescribe you one.  If it does not settle, you should seek medical advice.




      Check for other signs of infection such as heat or pus formation/oozing.  If you are concerned, you should see your practice nurse, GP or contact your bariatric team.  You may require some antibiotics.



      Yes, you can expect to feel tired for the first 4 weeks at least, especially after gastric bypass surgery.  Take regular short walks, around 3 times a day (5-10 minutes) and rest in the afternoons.  It should improve by 6 weeks when you will be seen for your follow-up.



      You have probably got something stuck.  You should contact your bariatric team or attend your local A+E who will discuss this with the surgeon and if needed arrange a deflation if you have a band or a gastroscopy if you have had a bypass/ sleeve/ BPD.  If you are able to tolerate fluids, then continue.  Also continue with your antacid tablets (omeprazole/lanzoprazole/pantoprazole/esomeprazole/ranitidine).



      Anti-inflammatories drugs are OK to take as long as you take them with food and your antacid tablet. (omeprazole/lanzoprazole/pantoprazole/esomeprazole/ranitidine) to help prevent gastric irritation and ulcers forming.



      Yes, they are absolutely fine after the bariatric surgery.  You may need to take them for slightly longer or have a slightly increased dose because occasionally they may not be absorbed as well as before your surgery (gastric bypass). Do not forget that antibiotics can affect contraception so it is important to use condoms whilst you are on antibiotics if you do not want to get pregnant.



      Yes, you can take sugar-free lozenges such as Strepsils. Also increase your fluid intake.



      Yes, you need to have nothing to eat or drink from 9 pm the night before.



      You should get your bloods done a week before your 3 month, 6 month and 1 year follow up (after a bypass, after 12 months ONLY with a Band), so they can be discussed at your appointments.  You will be advised if you need further bloods done at different stages.



      In the first few days after surgery this may be normal due to the gas that was used to inflate your abdomen during surgery.  However this should settle within 3-5 days.  After this, if the pain is in the right side under your ribs, it could be gallstones.  You can discuss this with the surgeon or your GP and it may be that you need an ultrasound to diagnose this.  If so, they will send you an appointment or ask you to see a surgeon for further assessment.
      If you are on blood pressure lowering medicines this can sometimes make you feel dizzy or unwell as they can cause your blood pressure to be too low, after losing weight.  If so then you should see your GP and have your blood pressure checked and the doses reviewed.  Most patients are able to have reduced doses of medication following weight loss and it is important to review your blood pressure checked every 4-6 weeks.  Check that you are also drinking plenty of fluids
      You can try a number of things such as walking around which can help. Do not eat anything else whilst food is stuck. Sip diet ginger ale, it can help the blockage to clear, either by coming up (vomit), or hopefully move through the pouch into your bowel.  Eat soft foods for 24 hours.  Keep walking/moving about.  When cleared, continue taking your antacid tablets (omeprazole/ lanzoprazole/ pantoprazole/ esomeprazole/ ranitidine) as needed.


      There is an alternative supplement for Calcium that can be taken in a chewable form or in a dissolvable form (this is less pleasant tasting).  If you would like this option then you can speak to your bariatric team or GP.



      Sometimes supplements are prescribed by the bariatric team.  Supplements can also be prescribed by your GP and or bought from the local chemist, which can be cheaper way to buy. Ensure the supplements are the ones recommended by your dietitian.



      Find a Plastic Surgeon who is fully qualified and experienced in this type of surgery.   Your obesity surgeon or GP will be able to refer you. As with all types of surgery, it is imperative to ask about the number of such operations he/she performs and about his/her results and complication rates.  Yes, your breasts, arms and thighs can sometimes be operated on in one surgery, although in some circumstances your plastic surgeon may prefer to do these as separate operations.



      Unfortunately, due to bed shortages, staff illness or infections on hospital wards, sometimes the hospital will have to cancel your operation.  This is more likely if you need to have an HDU (high dependency) bed after surgery.  The hospital has to re-arrange your surgery as soon as possible, so you should receive a new date for surgery within a few weeks. You will need to do the pre-op diet again before you come in for surgery.  Do not be too disheartened if your operation is cancelled - you WILL get your surgery as soon as is possible.



      It is not uncommon for patients to be asked to lose weight before surgery.  This is because operating on obese people can be high risk and any weight you can lose before surgery will help to make your operation safer. In some cases, the team want to be sure that you are 100% committed to having weight loss surgery and changing your lifestyle.  A good way of doing this is to ask you to lose weight before surgery.  People who are really committed come back having lost weight and in most cases they are then put on the waiting list. If you want more information on why your surgeon has asked you to lose weight, ask them in your clinic appointment - they can explain this in detail to you.



      Before having any operation, it is important to read about the different type of surgeries available and decide which you think will be the best one for you. Speaking to your family doctor or the bariatric team will help you make this decision. If you can lose weight before your operation this will help you prepare for the dietary and lifestyle changes after having your operation.  Losing weight before your operation will also reduce your anaesthetic risk. The dietitian will give you dietary information before you have your surgery and it is important you follow this advice.  You will need to stick to dietary advice for the rest of your life if you want to prevent weight regain. The more strictly you stick to this diet, the more weight you will lose. For 10-14 days before you have surgery, you will be given a pre-operative diet to follow - this helps shrink your liver, encourages weight loss and makes the operation safer for you. You may want to read about the surgery and get advice from previous patients about what foods they can eat, how to puree your food and how the surgery will make you feel. Any weight you can lose before surgery will help - it makes the operation safer and will help you recover quicker. It is important to stop smoking or drinking alcohol before surgery, if possible. Smoking in particular causes lung problems, which can increase the risks of surgery dramatically.  The safest way of getting through the operation



      The liver shrinking diet is important for reducing the size of the liver before surgery.  The liver sits in the top right of the abdomen but extends over to the left side, where the stomach lies.  If the liver is very large, it can make performing bariatric surgery difficult and more risky.  Sometimes if the liver is too big, the operation cannot be performed. This diet is low in carbohydrate and fat, meaning the stores of carbohydrate and fat in the liver are used up, shrinking the liver.  Different hospitals use different types of liver shrinking diet and you will be told about this before your surgery. Usually the diet is for the 10-14 days before your surgery.  It is important to stick to this diet as it helps the surgeon and makes the operation much safer for you.



      Most bariatric teams have a number of specialists, which may include the surgeon, the anaesthetist, the dietitian, a specialist nurse, a physiotherapist and a psychologist.  Not all patients need to see each of these specialists but everyone will see the surgeon and the dietitian. The surgeons will tell you about the operation and discuss the risks of surgery. After surgery, you may see the surgeon for a check-up, or if you have any problems but the majority of your follow up is likely to be with the dietitian or nurse. The dietitian will go through the diet that you will need to follow after surgery. For the first few weeks it is very important that you follow the diet strictly; afterwards, it is important to maintain a healthy diet.  The dietician is always available for advice and will see you at the hospital after your surgery and for the duration of your follow up. The specialist nurse is available for advice and support both during and after surgery.  In some centres, the nurse will do most of your follow up. Not everyone needs to see the psychologist but they are available both before and after surgery, particularly for patients who have had previous mental health issues such as depression, anxiety, a history of abuse, or who find it hard to adjust after surgery.  Appointments with the psychologist are often made at the discretion of your team but you can request an appointment if you feel it is necessary.



      Most hospitals around the UK follow the Government’s NICE (National Institute for Health and Clinical Excellence) guidelines, although this does vary across the country. Most people need to have a body mass index (BMI) of over 45kg/m2 before they can get surgery on the NHS, although if you have a medical problem related to your weight, you can have surgery with a BMI of 40kg/m2. You can see your personal BMI under your personal details on your dashboard on the Simply Bariatrics website’s homepage.  In most cases, you will need to go through a weight management programme before you can have surgery on the NHS. If you decide to have your surgery done privately, it is up to the surgeon to decide if you are suitable for surgery.  In general, if you are committed to weight loss by changing the way you eat and how much exercise you do and you do not have any untreated mental health issues, you will be suitable for surgery.  In this situation there is no compulsory weight management programme that you need to attend, but it is advisable to see the dietician.  Talk to your surgeon about this.



      Your GP can often help recommend an appropriate bariatric surgeon in your local area but the internet can also be a useful source of information.  There are a number of private bariatric companies that you can choose from - you can read testimonials from patients on most of these websites. The Dr Foster website (www.drfosterhealth.co.uk) allows you to search for consultants near you who specialise in obesity surgery and can show you performance data for hospitals around the UK.  This can be very helpful in deciding on where to go for your surgery.  Alternatively, have a look at the weight loss forums online.  People who have had bariatric surgery in the past are an excellent source of information about the surgeon, hospital and follow up.  Beware of going abroad for your surgery - although they may offer surgery at a cheaper price, it is best to make sure that you have surgery in a location where you have easy access to follow up.
      Not everyone needs to have an assessment with the psychologist.  A psychologist is a professional who specialises in mental health and in helping people to adjust to the changes that you need to make to your lifestyle after bariatric surgery.  In most cases, referrals to the psychologist are made at the discretion of your surgeon or the dietitian.  Sometimes you may have seen a psychologist before you are referred for surgery; other people do not need to see the psychologist at all.  Some of the reasons people may be referred to the psychologist include a past history of depression, anxiety, abuse and eating disorders, although there are many other reasons as well.  If you feel that seeing a psychologist would be helpful, mention this to the bariatric team when you go for your appointment.



      This varies from hospital to hospital.  When you go for your pre-operative assessment, you will usually have some blood tests to make sure you have no untreated problems with your liver, kidneys or blood before surgery.  These tests also make sure you do not have any major nutritional problems.  Most patients will be asked to complete a sleep apnoea questionnaire and sometimes they will be sent for sleep studies.  This is important, as you may need a something called a CPAP machine for a few weeks before surgery in order to help your lungs during the surgery and decrease your risk factors.  In many places you will see the anaesthetist, the doctor who will put you to sleep during your operation.  You may have a heart tracing, known as an electrocardiogram (ECG), which checks how well your heart is functioning. As long as there are no problems with your pre-operative investigations, you will be given a date for your surgery shortly afterwards.  Do not be alarmed if you have to go for more tests after your appointment.  These tests do not mean your surgery will be cancelled - they are simply to make sure your surgery is done as safely as possible.



      There are a number of tests that will be performed.  All patients will have blood pressure and heart rate checks.  A number of blood tests will be taken to check how your kidneys and liver are functioning and how well your blood clots.  In some cases, they will perform an ECG which is a heart tracing to make sure your heart is working properly.  You will be asked to give a urine sample.  The nurses will also ask for swabs from your nose, armpits and groin.  This is to check for MRSA, a bug that lives on the skin of many people but can cause problems if it gets into one of your wounds.  If you have MRSA you will need to have treatment before surgery.  Some people will need sleep studies to look for sleep apnoea, as you may need to use a breathing machine for a few weeks before surgery.  In some centres they will perform an endoscopy- a camera that goes down into your stomach, to make sure there are no problems that will prevent you from having surgery.  They may take a tissue sample to look for bacteria known as H. Pylori - if you have this infection, you may be given antibiotics treat it.



      The sleep studies are to make sure you do not have sleep apnoea.  Sleep apnoea is a condition that causes problems with breathing during sleep.  In some cases, people can even stop breathing altogether.  You will be asleep under a general anaesthetic during your surgery, so it is important to make sure you do not have any undiagnosed sleep apnoea.  If you do have sleep apnoea, you will be asked to wear a face mask, which is connected to a pressure machine when you go to sleep, usually for a few weeks before surgery.  This mask helps to open your airways and prevent you from having problems both during and after surgery.



      Often the surgeon will want to make sure you do not have a hiatus hernia, or bacteria called H. Pylori living in your stomach.  A hiatus hernia is where part of the stomach goes through the opening in your diaphragm (the sheet of muscle between the abdomen and diaphragm that helps with breathing).  In some cases, this needs to be repaired before the surgeon can place a gastric band, or the band might not sit properly on the stomach. H. Pylori can also cause problems with heartburn and there is a very small link between H. Pylori and stomach cancer so it is a good idea to treat it before having surgery.



      Usually patients are required to cease smoking for at least 2 weeks prior to their surgery.  In some centres, you will be required to do a breathing test before surgery to make sure you have stuck to this rule and if it is found that you have continued smoking, your surgery may be cancelled. Stopping smoking before your surgery is important as surgery puts strain on your lungs and if you are a smoker, you may get severe breathing problems during and after surgery.  Smoking also increases the chances of getting post-operative infections, which can be very serious, therefore we ask people to stop.



      Generally speaking you do not stop aspirin although you may be told to stop this a few days before your surgery.  You must STOP taking all herbal remedies 2 weeks prior to surgery.  If you are taking warfarin/Plavix, you will need to discuss this with the surgeon or anaesthetist, as you will need to stop it before surgery.  Depending on why you are on warfarin, you may need to have injections to stop your blood clotting (this is especially important if you have had a heart valve replacement or currently have a blood clot in the legs, arm or lungs).  Speak to your surgeon/anaesthetist about this - do not stop it unless you are instructed to do so by a doctor. Only stop a medication you are prescribed if a doctor tells you to.



      It is advisable to see your GP and have a check-up.  If you have a chest infection you may need some antibiotics to help clear this up in order to get you well enough for your surgery.  Antibiotics will not help for a cold.  However, you should attend your appointment for surgery - the anaesthetist will see you and decide if you are fit for surgery on the day.  Generally speaking surgery is not cancelled for a small cold but may be rescheduled if you have anything more than this.



      No.  These are not fasting bloods (unless you are instructed otherwise).  They need to be done 3-72 hours prior to your operation and may be done in the hospital on the day of your operation.  Obviously if they are done on the day, you will have been fasting for your surgery but this will not affect the blood tests.



      Yes, however the surgeon/anaesthetist will need to complete a request form, advising how much is needed and when it will be needed.  We will give the form to you and you will then need to contact the Blood Donor centre to organise this. This is done rarely, as the chance of needing a blood transfusion is minimal.



      You will need to discuss all pre-op diet needs with your dietitian. You should have a contact number to call them.



      This is very common with people who are obese, studies show that up to 85% of obese patients will have suffered with a mental health problem at some stage in their lives. The most common problems are depression, anxiety, eating disorders, a history of sexual or physical abuse and a past history of self-harm or suicide. In many cases, these problems are because of the excess weight, but often people are overweight because they have had these problems.  It is very common and nothing to be ashamed of. You should seek help from your bariatric team, GP or counsellor/mental health practitioner if you feel you have a mental health problem.
      If the cause of the depression is due to your excess weight, then yes, there is a good chance that bariatric surgery will help.  Once people lose weight, they often find that they start to feel better about themselves, improved self-esteem and confidence. Sometimes it is possible to reduce or even completely come off anti-depressant medications. Sometimes food has been used, prior to surgery as a coping mechanism to deal with uncomfortable emotions, negative thoughts or traumatic memories. No longer being able to use food as a coping mechanism after weight loss surgery can result in an increase in uncomfortable emotions, negative thoughts and traumatic memories.  Some patients sometimes find a way of getting more food in to soothe these distressing negative feelings and thoughts, such as eating easy sloppy or liquid foods in an attempt to self soothe these feelings, thoughts and memories. Learning to deal with these distressing negative feelings, thoughts and memories in a positive way, often requires the support and intervention from a mental health practitioner/ counsellor/ psychologist.



      No, probably not. Some people use food as a coping mechanism to help deal with problems currently going on their lives or to manage distressing emotions, feelings or memories from the past. Food can be very effective at temporarily self-soothing. Once you have had bariatric surgery, you will find it more difficult to be able to eat as much or self soothe through foods. Some people find this very difficult to cope with and can become more depressed, anxious etc. as a result. If you are a comfort/emotional eater, it is worth seeing a mental health practitioner/counsellor/psychologist before and after you have surgery - they can help you find other ways of seeking comfort.



      It is often very difficult to tell. Depression and obesity often have what is known as a “bi-directional relationship”, meaning that they both affect each other and it is often difficult to separate the two.  The best advice if you are unsure is to talk to your GP or a mental health practitioner/counsellor/psychologist.  If you are overweight due to underlying depression, it is best to seek treatment for your depression before you undergo bariatric surgery.
      There are many methods that people use to help avoid comfort eating.  Using a diary to see which emotions cause you to seek food can often be very useful. Many people find that distracting themselves with a hobby or finding someone to talk to can help prevent them from overeating.  Exercise, even going for a short walk is another excellent method.  Beware of seeking alcohol or drugs instead of food - this is bad for your health and can make any problems that you may have worse.  Mental health practitioners/Psychologists and counsellors are very good at helping people to find new ways of avoiding comfort/emotional eating and it is worth seeing one before surgery if you feel it may be helpful.



      If this is the case, you should consider seeing a mental health practitioner/counsellor or psychologist before surgery. Once you have had surgery you will no longer be able to eat as much or as often as before and it is unlikely that you will get the same “fix” as you did before surgery.  You will need to find other ways of coping before you have surgery if you want to avoid problems, weight regain or complications from your surgery. Mental health practitioners/counsellors/psychologists can support and assist you to find more positive methods of coping.



      Everyone is different but many people have suggested ways of avoiding this. Some of these include: ●     Find a hobby ●     Exercise ●     Not buying “forbidden foods” or trigger foods ●     Use an ‘emotional diary’ - this can help to show you what emotions make you reach for food ●     Avoid alcohol as this stimulates your appetite ●     Ensure you eat a well-balanced diet throughout the day, avoiding poor quality, junk foods as sugar and processed foods can affect blood sugar and create cravings ●     Drink plenty of water between meals, it is common to confuse thirst for hunger



      This is sometimes known as “Night eating syndrome” and is a type of eating disorder.  If you had an evening meal you should not wake up hungry in the middle of the night.  People with night eating syndrome often do not eat during the day and then binge at night.  They may find themselves extremely tired during the day as a result. Sometimes a person does not remember even waking and eating during the night.  If you think you may be suffering with an eating disorder, you should speak to your surgeon or GP and they will refer you to a psychologist or counsellor before you have surgery.



      If your anxiety is because you are obese then it may help, yes.  Losing weight can help people to feel more confident and depending on the type of anxiety, you may feel much better after surgery.  Some people however struggle to adjust after surgery and may still feel anxious. This is particularly the case if you used food as a way of coping with your anxiety.  If you are suffering from anxiety, you should speak to your surgeon or GP and they may be able to refer you to a mental health practitioner/counsellor/psychologist.



      Yes.  Many people, especially those with obesity, can suffer from more than one problem at any given time.  Depression and anxiety are very common to have together, as are depression and eating disorders.  It is often difficult to separate them, and to treat one without treating the other. Speak to your GP or a mental health practitioner/psychologist/counsellor if you need more information.



      This depends on the eating disorder and what treatment you are receiving.  Some surgeons and psychologists will not recommend you for surgery until you have been (or are being) treated for an eating disorder.  It is always a good idea to seek help or treatment before you consider bariatric surgery, as any weight loss operation will change the way you can eat.  This can severely affect your eating disorder, often in a negative way and make your disorder worse.


      If you have been treated and have no more problems with your eating disorder, then it is usually possible for you to have surgery.  The surgeon may ask for a report from your psychologist/counsellor/GP to make sure that they are happy for you to have surgery.  It is possible for eating disorders to recur, so you should be vigilant for symptoms and seek help immediately in the future if these problems are returning.



      The most common eating disorders seen in people that are obese are binge eating (eating very large amounts of food in one sitting and often being unable to stop) and night eating syndrome (not feeling hungry during the day then eating at night).  There are a large number of people with obesity who used to suffer from either anorexia or bulimia and became obese once they were treated from these disorders.



      Some overweight and obese patients have a history of physical or sexual abuse.  In many cases, they became overweight in an attempt to ‘protect’ themselves from the opposite sex or as a coping mechanism.  Sometimes, once people lose weight following surgery, they start to feel more attractive, gaining more attention from others and this can bring back a lot of unpleasant memories or feelings. Sometimes this can make people emotionally worse than before surgery as they are not able to self soothe with food. If this sounds familiar, then you should seek the advice of a mental health practitioner/counsellor/psychologist before you consider surgery.  Your GP or surgeon can refer you to someone if you wish.



      If your psychologist feels you are suitable for surgery, this should not be a problem.  Your surgeon may request a report on your treatment before they consider performing surgery.



      This depends on the mental disorder, how well it is treated and how much it affects you.  If the disorder is well controlled, the surgeon may be happy to operate without referring you to a psychologist.  Otherwise, they may want you to see someone before surgery.  This is so they can make sure your operation is as successful as possible.



      Not necessarily - it depends on how well controlled your depression is.  If you are stable on your anti-depressants, this should not prevent you from having surgery.  In some cases your surgeon may ask you to see a psychologist before surgery so that they can make sure your operation is as successful as possible.



      Yes.  You should not stop taking these until you are advised to by your GP or psychologist/psychiatrist.  Sometimes your GP or pharmacist may have to change your tablet to a form that is easy to swallow or comes in a liquid.  You can speak to your GP or pharmacist before you have surgery.



      As long as you are well controlled on medication you should still be able to have surgery. Your surgeon will want to discuss this with your psychiatrist or psychologist before they do an operation.  Speak to them if you want more information.



      In some cases, medications are not as well absorbed after bariatric surgery because of the way your bowel is “re-plumbed”- this is particularly the case following the bypass, DS or BDP.  Your GP or pharmacist should be able to advise you on if your medications will be affected by surgery.  Check with them before you have your operation.



      If you have been seeing a psychologist or psychiatrist and they are happy for you to proceed with surgery, you will probably be OK to have an operation. Sometimes people with a past history of self-harm or depression can find things are slightly worse after surgery and therefore it is essential to make sure you are mentally healthy enough before you have life changing surgery.  Seeing a psychologist or counsellor can be very helpful in this case.



      This is your personal choice. We would recommend you tell your friends and family to ensure you have their support, as you may need someone to help you after the operation.  If your friends and family are not supportive, it can often be difficult to get them to understand that you can no longer eat a large meal or eat the same things as you could before.  They may even be jealous of the way you are taking measures to control your weight.  Consider talking to them about the benefits of surgery - often they are simply worried about you undergoing a large operation and if you explain how it will help you become more healthy, they are often more supportive.



      There are unfortunately some people with this attitude.  Bariatric surgery is a proven way of helping people to lose weight and become healthier. Being obese changes hormones, making it very difficult to lose weight, many people are ignorant of this fact. Having bariatric surgery is nothing to be ashamed of, in fact taking control /taking this positive step to lose weight and improve health is to be commended.



      This is your personal choice.  Having the support of friends and family and from your employer can make things easier rather than having to make up excuses for time off work, your recovery from surgery and eventually your weight loss.



      Not strictly, but the decision as to whether or not you are suitable for surgery is the decision of your surgeon and psychologist/psychiatrist.  In general, people with untreated eating disorders and/or untreated severe mental illness may not be suitable. Current, untreated alcohol and drug addiction is contraindicated.



      Sometimes your surgeon or dietitian may feel asking you to see the psychologist will help you to find new ways of adapting after surgery.  This is fairly routine and does not mean you cannot have surgery.  You should attend your appointment to see the psychologist - if you refuse, the surgeon may refuse to do a weight loss operation.



      There are numerous therapies that you can try before surgery if you feel they would be useful.  These include: ●     Counselling ●     Cognitive behavioural therapy ●     Emotion focused therapy ●     Hypnotherapy ●     Group therapy   Many community weight management programmes have access to some or all of these services and your GP or surgeon may be able to refer you to one. Alternatively many professionals doing these therapies can be found online and accessed as a private patient.



      This depends on how supportive your friends and families are and it differs from person to person.  Sometimes, nothing will change in your relationships at all. Some people say their families go a little “too far” in trying to support them –restricting/controlling their food intake/being too strict.  In other cases, your friends and family may have a negative reaction and find your new lifestyle difficult to cope with.  In all of these cases, you should talk to them, explain your needs and feelings and ask them to explain how they feel.  Often solutions can be found.



      It is possible that people will see you differently. Many people with obesity have experienced discrimination and prejudice in the past due to their size and they may find that people treat them differently once they have lost weight. Although this is not the way things should be, it is unfortunately a fact of life and society.  Others may view you negatively because you have had surgery.  This is usually because they either do not understand that surgery is designed to make you healthier or that they are envious.  Talk to them; tell them how they are making you feel.



      Many people believe all of their problems are due to their weight. This often is not the case and many of the problems you had before surgery can persist afterwards.  It is important to realise that bariatric surgery is not a miracle cure for all of your problems; it is simply a method to help you lose weight and become healthier.  A psychologist or counsellor may be able to help you examine your life and help you to solve problems that are not related to your weight.
      You can register with simplybariatrics for free but if you want to take advantage of our specialist, personalised programmes you will need to subscribe. The 100-Day simplybariatrics AfterCare programme costs as little as £1 per day while the AfterCare plus programme costs £10 per day, including personalised 1-to-1 support for 100 days.



      Your further requirements will be assessed. If you feel you need more support you might consider joining the simplyweight 100 day programme.



       You can pay online on the website using the following credit and debit cards: Delta, Solo, Maestro, Switch, Mastercard and Visa.  All transactions will be processed through Worldpay, which is a secure payment service.

      However if you are having problems paying online, please contact our head office on 01274 739039 or email us on hello@simplyweight.co.uk  




      In exceptional circumstances you are allowed to freeze or pause your membership for four weeks without charge in any year for holidays and illness. Please inform us at least 4 weeks before your holiday or planned hospital admission for this to be implemented. We will not consider extension of your subscription if you let us know after the period. Under exceptional circumstances, we will always extend the illness allowance. Please email us on hello@simplyweight.co.uk with the heading “FREEZE”.



      This is sometimes a tough decision, and depends on how much weight you wish to lose, how much aftercare you think you will need, and what medical problems you have.   Some people find they prefer an operation that can be reversed.  Other people want a life long permanent solution to their weight and health.  This usually means people can get some control over their eating and use the bariatric surgery operation as a tool to prevent them going back to their previous diet and lifestyle.   Beware that whichever operation you choose, you need to change your eating habits and adopt a healthy lifestyle - or you will get less than expected weight loss and possibly put weight back on. Bariatric surgery is a tool to help you lose weight, not a cure for weight problems. How you work with the weight loss tool will determine your weight loss results and the associated health benefits.   You should discuss each of the operations in detail with your surgeon and dietitian, who can help you to make the right decision.   In many cases, people with diabetes, or those who have a lot of weight to lose may be better with the gastric bypass, as blood glucose control is generally very good, and some people find they no longer crave sweet foods after surgery.   If you have had previous surgery on your abdomen, the bypass of BPD/DS may not be possible due to scar tissue. In these circumstances, the band or the sleeve, which only involve operating on the stomach, may be the preferred option.



      Prices may vary considerably between hospitals and surgeons but, generally speaking, prices in the UK will be in the following ranges:

      -Intra-gastric balloon £2500-£4000
      -EndoBarrier UNKNOWN
      -Gastric band £5000-£8000
      -Gastric bypass £8000-£11000
      -Sleeve gastrectomy (gastric sleeve) £8000-£11000
      -Biliopancreatic diversion/ duodenal switch £10000-£13000
      -Revisional surgery £3000-£15000 (depends on procedure)
      -POSE UNKNOWN                         



      It is a good idea to make sure that you have a friend, family member or neighbour that can help you out after surgery.  You might find that you are not as mobile as normal for the first week or so and might need some help around the house.  You will only be able to eat sloppy or mushy foods for the first few weeks after surgery.  Preparing and blending food before surgery and freezing portions into ice-cube trays, can be defrosted and eaten easily after surgery.  This can be very helpful, as you may not feel like preparing food after surgery. Make sure you have enough supplies such as painkillers, fresh clothes, and things to do (i.e. books to read). The bariatric team should provide you with a number you can use in case of an emergency or if you need any advice.