Appleton Surgical Ltd . Registered in England and Wales

Registered Office: 38b High Street, Keynsham,  Bristol  BS31 1DX

Registered No: 8095737

© 2018 by Shaun Appleton MS FRCS Created with Wix.com

Weight-Loss or Bariatric Surgery

Obesity is now a significant problem throughout the world. Being obese is associated with major health issues such as diabetes, cardiovascular disease and increased rates of certain cancers. Many of these health issues can be resolved with significant and sustained weight loss.

 

Most people do not choose to be obese. However, many struggle with losing weight or, more importantly, keeping the weight off. Dieting may work in the short term but many people find the weight comes back when they revert their old, long-established and difficult to give up eating patterns.

 

Weight-loss surgery, also known as bariatric, metabolic or obesity surgery, has been available for many years and is currently the most successful way of achieving significant and sustained weight loss.

 

I have been performing weight-loss surgery in Buckinghamshire for over ten years with some excellent results. I work with an experienced team of nurses, dietitians and anaesthetists to try and get the best result for my patients.

 

We treat patients who fulfil the NICE recommendations for consideration of bariatric surgery.

GASTRIC BANDS - We don't put gastric bands in but are happy to discuss band adjustments or issues with bands put in elsewhere.

Contact our Bariatric Co-ordinator Julia Sedda on 07908 689724 or e-mail who will be happy to give you more information.

Gastric Bypass

How does the Gastric Bypass work?

 

The Gastric Bypass has long been considered the ‘gold standard’ operation for obesity, against which all other operations are judged. It has stood the test of time, first being performed in the USA in 1967 and continues to provide reliable, long-term weight loss. It is now common practice for this operation to be performed using keyhole (laparoscopic) surgery. 

 

The operation works by changing how food flows through the intestines. The stomach is turned into a small pouch - about the size of an egg. The small intestine is then measured, transected and reattached onto the new stomach pouch, ‘bypassing’ the rest of the stomach and the first 1-2 meters of small intestine.  

 

Weight loss is achieved in two main ways;

 

Physical The bypass reduces the amount of food a patient can take in at mealtimes. Portion sizes are reduced leading to an early feeling of fullness. There is also a small element of malabsorption because of the food ‘bypassing’ a part of the small intestine. However we know that, over time, the body adapts to this change and so the malabsorption part becomes less of a feature.

Hormonal Bypassing the first part of the small intestine affects the production of normal gut hormones, which control appetite. Most patients find that their appetites are greatly reduced and they feel far less hungry. Bypass surgery also affects the hormones which control blood sugar. Because of this, gastric bypass can be very effective in treating diabetes and many patients are able to come off diabetic medication soon after surgery.

 

Q: Where will the surgery take place?

 

A: All surgery is performed at The Shelburne Hospital, High Wycombe. Out-patient follow-up appointments can be organised at The Shelburne, The Chiltern Hospital or The Paddocks Clinic.

Q: How long will I be in hospital?

 

A: Because the bypass is performed using keyhole surgery, most patients will stay in hospital for 2 - 3 nights. Most patients take 2 weeks off work (depending on the nature of their job) and we advise patients not to drive until they can safely do an emergency stop. For most people, that is between 1 - 2 weeks.

 

Q: How often will I need to come back to be seen as an out-patient?

 

A: Regular follow-up is very important after gastric bypass to ensure that you get the best weight loss possible and to ensure that you are not developing any vitamin deficiencies. We see you at 2 weeks and 6 weeks post-op. After that, we will see you at 3, 6, 9 and 12 months post-op. The dietitian will also see you regularly in addition to these appointments. After this, we advise that you are have blood tests done annually by your GP. We would usually see you once a year following this, just to check that all is well.  However, we are available at all times for any queries you may have.

 

Q: How much weight can I lose?

 

A: Research has shown that, on average, patients having a gastric bypass can lose up to 60 - 70% of their excess weight in the first year. It is likely that more weight will be lost in the second year following surgery and then weight loss will plateau by year 3. Of course, weight loss can be affected by other factors including patient’s age, activity level and basal metabolic rate. 

Q: Is it reversible?

 

A: Gastric bypass is a permanent solution to obesity.

 

 

Q: What will I be able to eat after I have had my operation?

 

A: You will be on fluids only for 24 hours after surgery and will then progress on to pureed food for the next 4 - 5 weeks. By about week 6, you will be back onto normal consistency foods and will be eating the same as your friends and family, albeit in smaller quantities. There are always some foods which people find more difficult to digest following bypass surgery, but this will vary from one person to another. All of our patients are under the care of a specialist dietitian and will see her regularly to help ensure they are taking a balanced diet. Research has shown that those patients who do best in terms of weight loss stick carefully to the dieitian’s advice.

 

Q: Do I need to take vitamin supplements?

 

A: Yes. We advise that patients take a multi-vitamin tablet daily. During the first year post-operatively, we perform blood tests regularly to check for any vitamin/mineral deficiencies and these can be easily supplemented. Most bypass patients are at risk of developing vitamin B12 deficiency, although this does not tend to show until many months after surgery. This can be treated with B12 injections, which most general practitioners are happy to prescribe. 

 

Q: I’ve heard about ‘dumping syndrome’ following bypass. What is this?

 

A: This is worth a special mention. Dumping Syndrome is specifically related to eating high sugar foods following bypass. It happens because of rapid emptying and absorption of sugars in the small bowel. As high levels of sugar are absorbed, the body gives an over-exaggerated insulin response. Blood sugar levels in the body then fall rapidly and the patient gets symptoms of hypoglycaemia (low blood sugar), typically anxiety, sweating, dizziness and fainting. This is often followed by stomach cramps and diarrhoea. Although unpleasant to experience, it can actually act as a good deterrent for patients with a sweet tooth. Generally, patients only experience it once or twice and learn very quickly which foods to avoid.

 

Q: What happens to any excess skin once I have lost weight?

 

A: Again, this depends on a variety of factors, for example how much weight you have lost, your age or your skin’s natural elasticity. Some patients do not have problems with excess skin, whilst others do find it troublesome. In the latter case, we can refer you on to our plastic surgery colleagues, who can advise on the best course of action.

 

Q: What other support is available?

 

A: In addition to the support you will have from our team, we also have a local weight loss surgery support group. This group is run by patients, for patients, and is an opportunity for people to get together once-a-month to chat socially and discuss any issues which arise. Occasionally, the group has guest speakers. They might have an open  ‘Q&A’ session with myself and my surgical colleague. Our local plastic surgeons have also given talks. Whenever possible, we always encourage new, pre-op patients to go along to the support group to talk to others who have been through a weight loss procedure. Sometimes, new patients prefer to be put in touch with a previous patient by telephone, so they can ask questions in a more private forum. This is easily arranged as most of our patients are always very happy to chat to anyone thinking of having a weight loss procedure. 

 

 
Q: I still have other questions...

 

A: Please call Julia Sedda, Bariatric Co-ordinator for our unit, on 07908 689724 or e-mail her on bariatrics@me.com. She will be very happy to answer any other questions or concerns you might have.

Sleeve Gastrectomy

How does the sleeve gastrectomy work?

 

The Sleeve Gastrectomy (also known as Gastric Sleeve), is a relatively new procedure. It was originally introduced as the first stage of a 2-stage operation for very obese patients (BMI >60). This was done in order to get their weight down to a level where risk was reduced, before performing the second stage of the operation 12 months later. 

 

Nowadays, it is used as a standalone procedure to treat morbid obesity and type 2 diabetes. 

 

The procedure is carried out laparoscopically (key-hole surgery). About 85% of the stomach is removed, leaving a long, thin, banana-shaped tube, which will only hold a small amount of food (about 100mls). 

 

The sleeve helps to achieve weight loss in 2 ways:

 

Physical The operation reduces the capacity of the stomach from approximately 900mls to just 100mls. Therefore the amount of food that can be eaten is reduced.

 

Hormonal Because a large portion of the stomach has been removed, the levels of an appetite-stimulating hormone (called ghrelin) are also reduced. Less ghrelin means you just don’t feel so hungry and therefore eat less.

 

Q: Where will the surgery take place?

 

A: All surgery is performed at The Shelburne Hospital, High Wycombe. Out-patient follow-up appointments can be organised for The Shelburne, The Chiltern Hospital or The Paddocks Clinic.

 

Q: How long will it take to recover from the surgery?

 

A: Because the sleeve is performed using keyhole surgery, most patients will stay in hospital for 2 - 3 nights. Most patients take 2 weeks off work (depending on the nature of their job) and we advise patients not to drive until they can safely do an emergency stop. For most people, that is between 1 - 2 weeks.

 

 

Q: How often will I need to come back to be seen as an out-patient?

 

A: Regular follow-up is very important after sleeve gastrectomy to ensure that you get the best weight loss possible and to ensure that you are not developing any vitamin deficiencies. We see you at 2 weeks and 6 weeks post-op. After that, we will see you at 3, 6, 9 and 12 months post-op. The dietitian will also see you regularly in addition to these appointments. After this, we advise that you are have blood tests done annually by your GP. We would usually see you once a year following this, just to check that all is well.  However, we are available at all times for any queries you may have.

 

 

Q: How much weight can I expect to lose?

 

A: Research has shown that, on average, patients having a sleeve gastrectomy can lose up to 65% of their excess weight, so it is probably somewhere between a band and a bypass.

 

Q: Is it reversible?

 

A: Sleeve gastrectomy is a permanent solution to obesity.

Q: What will I be able to eat after I have had my operation?

 

A: You will be on fluids only for 24 hours after surgery and will then progress on to pureed food for the next 4 - 5 weeks. By about week 6, you will be back onto normal, solid  foods and will be eating the same as your friends and family, albeit in smaller quantities. There are always some foods which people find more difficult to digest following gastric sleeve surgery, but this will vary from one person to another. All of our patients are under the care of a specialist dietitian and will see her regularly to help ensure they are taking a balanced diet. Research has shown that those patients who do best in terms of weight loss stick carefully to the dietitian’s advice.

 

Q: Do I need to take vitamin supplements?

 

A: Yes. We advise that patients take a multi-vitamin tablet daily. During the first year post-operatively, we perform blood tests regularly to check for any vitamin/mineral deficiencies and these can be easily supplemented.

 

Q: Can I still go out for dinner?

 

A: Definitely. Although you will be satisfied eating much less than before your surgery. Often 2 small courses will be enough but it will vary from person to person.

 

Q: What happens to any excess skin once I have lost weight?

 

A: Again, this depends on a variety of factors, for example how much weight you have lost, your age and your skin’s natural elasticity. Some patients do not have problems with excess skin, whilst others do find it troublesome. In the latter case, we can refer you on to our plastic surgery colleagues, who can advise on the best course of action.

 

Q: What other support is available?

 

A: In addition to the support you will have from our team, we also have a local weight loss surgery support group. This group is run by patients, for patients, and is an opportunity for people to get together once-a-month to chat socially and discuss any issues which arise. Occasionally, the group invites guest speakers. For example, myself and my consultant colleague have been along to host an open ‘Q&A’ session. Our local plastic surgeons have also given talks to the group. Whenever possible, we always encourage new, pre-op patients to go along to the support group to talk to others who have been through a weight loss procedure. Sometimes, new patients prefer to be put in touch with a previous patient by telephone, so they can ask questions privately. This is easily arranged, as most of our patients are always very happy to chat to anyone thinking of having a weight loss procedure. 

 

Q: I still have other questions...

 

A: Please call Julia Sedda, Bariatric Co-ordinator for our unit, on 07908 689724 or e-mail her on bariatrics@me.com. She will be very happy to answer any other questions or concerns you might have.