What happens after the procedure?
You may want to access support in the first few weeks and months following your surgery. This is because you are getting over an operation and coming to terms with changes in your eating. It really takes time to get used to eating such small amounts and not being able to eat the foods you want.
Initially, it will be necessary to maintain a liquid diet and then gradually progress towards soft and finally onto a regular textured food.
Even when fully recovered, you will not be able to eat as you did prior to surgery. You will have to eat slowly, take very small bites, chew food very well and even then, certain food will have a tendency to stick. For example, white bread and stringy meat are particular culprits in this regard.
If you have had a band you may be frustrated in the lack of early weight loss. The key to success is to be patient. It may take a few band adjustments before you reach the green zone, and begin losing significant amounts of weight.
Please remember, you will require lifelong nutritional supplementation.
Further follow up after surgery
Roux-en-Y or Single Anastomosis Gastric Bypass
People who have undergone a bypass surgery will be followed up over the telephone at 3 weeks post-operatively by the Bariatric Nurse Specialist.
You will then be followed up at 3 months, 6 months and 18 months after surgery by a Specialist Bariatric Dietitian.
You are also followed up by your surgeon and / or Registrar at 12 months and 24 months post-operatively after which you will be discharged back to your GP’s care..
Your first appointment will be 3 weeks after surgery by the clinical nurse specialist. The clinical nurse specialist will book your first band adjustment at this time. You will be seen very regularly in the first six months to ensure that your band is adjusted to give you optimal weight loss and support you with making appropriate changes to your eating habits. After the first year, you will be seen approximately every six months by the surgeon or nurse specialist.
Sleeve Gastrectomy
People who have undergone a sleeve gastrectomy will be followed up at 3 weeks following surgery by the Bariatric Nurse Specialist.
You will then be followed up at 3 months, 6 months and 18 months after surgery by a Specialist Bariatric Dietitian.
You are also followed up by your surgeon and / or a Bariatric Registrar at 12 months and 24 months post-operatively after which you will be discharged back to your GP’s care.
The first gastric band adjustment is at 6-8 weeks following surgery, and subsequent band adjustments will depend on whether you have reached the green zone. The first adjustment is carried out in the x-ray department. Here, the band position is checked and the amount of fluid added will be titrated to your individual needs. Subsequent adjustments will usually be done in clinic. X-ray adjustments can be arranged as clinically necessary.
The Green Zone
The aim of band adjustments is to reach the green zone where you feel satisfied after a small meal and are not seeking food for 4-5 hours between meals. It is possible for the band to be too tight as well as under filled and both of these situations will lead to inadequate weight loss and potential complications. When at the green zone, you should be able to eat a wide variety of solid foods.
Obtaining Further Surgery for skin reduction
You may find that after significant weight loss, you have some excess skin. Obviously, we encourage rigorous physical activity and toning to try and keep this to a minimum. However, it is likely that you will all have some level of excess skin.
We do support a referral to our sister plastics team at the Royal Free Hospital but you will need to meet a certain set of strict criteria:
• BMI below 35 kg/m2
• Stable weight for past 6 months
• Non-Smoker
• Significant psychological or physical impact resulting from the excess skin.
There is then a process to go through to secure surgery:
• Assessment by plastic surgeon
• Review by clinical psychologist
• Tribunal (you are not required to attend) to review case and make funding decision
If funding is refused, unfortunately there is no process by which to appeal. Obtaining plastic surgery is not an automatic right after bariatric surgery and not part of your original procedure.