Introduction

Obesity surgery can effectively help certain patients manage their weight. It may be recommended as an addition to professional dietary advice and exercise in patients with a body mass index (BMI) > 30 kg/m2 (who have other concurrent health problems) or patients with a BMI > 40 kg/m2.

The majority of weight loss with obesity operations tends to occur in the first 2 years after surgery. After this stage a weight maintenance phase begins. 

During this time the person has the opportunity to change their eating habits, the type of food they choose to eat, their relationship with food and their lifestyle to include more exercise. The effect of the operation on weight loss gradually reduces with time for the majority of procedures – leaving the long term control of weight predominantly back with the individual and their behaviour.

Not every patient who has obesity surgery achieves sustained or significant weight loss. Approximately a third of patients will regain some or all of their original weight irrespective of the operation. Rarely a person can become malnourished after surgery and become seriously ill. There are some groups of patients in whom obesity surgery is inappropriate or too hazardous.  Check your BMI…

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Gastric Band

A gastric band is an adjustable silicone bracelet that fits around the top of the stomach. It is placed in position by a key-hole operation. The band is connected by a thin length of tubing to a small button that is placed just under the skin under the rib cage. An injection through the skin into the button can be used to increase or reduce the size of the band. Increasing the size of the band often results on an increased feeling of satisfaction and reduced sensation of hunger for a smaller portion of food. The reverse is true if the band is deflated. Bands can be done as “day-case” procedures or with overnight stay.

Gastric banding is the weight loss surgery option with the lowest risk (< 1/1000 of mortality or death from the operation). Some patients with a gastric band develop problems such as band slippage (which can distort or squeeze the stomach), infection, erosion (rubbing against the stomach) or a leak of fluid from the band. These problems can require further surgery to correct them. Such an operation could involve removal or repair of the band or even part of the stomach if it had become damaged. The chance of this is low and of the order of 2-3% in the first 2-3 years after gastric band surgery. However for bands that have been in position much longer, the risk is higher and may be as much as 20-25%.

See the graphs below to see outcomes from gastric band operations performed by Mr Hayden. The graphs show mean (average) results for cases at pre-operation, 6 weeks, 6 months and 12 months. The lines on the graph indicate the upper and lower limits between which the majority (95%) of patients are contained.

Sleeve Gastrectomy

This operation is performed under general anaesthetic. The stomach is reduced in size by removing approximately 4/5 of it using a stapling device. The remainder of the gut is left untouched. The operation is relatively simple in its concept and means that patients can eat much smaller portions of most food types. Patients are recommended to take a multivitamin tablet afterwards for life, Calcium and Vitamin D. A proportion will require regular vitamin B12 injections.

The operation usually requires a stay of 2 nights in hospital and the patient receives specialist dietary advice before and after surgery. Precautions are taken at all stages to reduce the risks of complications of surgery which can include leakage from the stapled edge of the stomach or blood clots. The risk to life from this operation is in the region of 1/250-500. The risk of leakage from the sleeve edge is less than 2%. Leakage can result in a significantly longer recovery and delay until normal post-operative eating habits are resumed.

See the graphs below to see outcomes from sleeve gastrectomy operations performed by Mr Hayden. The graphs show mean (average) results for cases at pre-operation, 6 weeks, 6 months and at 12 months. The lines on the graph indicate the upper and lower limits between which the majority (95%) of patients are contained.

Roux en y Gastric Bypass

This operation which is done under general anaesthetic involves reducing the size of the stomach using stapling devices. The small intestine is divided and joined to the smaller stomach partition (approximate size of a golf ball) using a stapling device. The small intestine is joined to itself to allow digestion to proceed. The procedure creates a significant restriction of meal size and hormonal changes that lead to a reduced feelings of hunger for many months after surgery.

This is one of the most effective weight loss operations and usually performed by key-hole surgery (5 small scars). Due to the higher complexity of the operation, the risks are higher with 1/100-200 risk of mortality or death from the procedure. There are also problems that can occur including bleeding, leakage from staples, blood clots, bowel blockages that can occur in less than 5% of patients. Blood test monitoring is recommended to detect nutritional deficiencies and supplementation is required (tablets and a 3 monthly injection). In the longer term, malnutrition is a rare complication. The operation usually requires a stay of 2 nights in hospital and the patient receives specialist dietary advice before and after surgery. Precautions are taken at all stages to reduce the risks of complications of surgery.

See the graphs below to see outcomes from Gastric Bypass operations performed by Mr Hayden. The graphs show mean (average) results for cases at pre-operation, 6 weeks, 6 months and at 12 months. The lines on the graph indicate the upper and lower limits between which the majority (95%) of patients are contained.

Malabsorptive procedures e.g. Duodenal Switch

These operations are performed to create an abnormal situation where the gastrointestinal tract fails to absorb a significant proportion of calories taken in the diet. This is usually combined with a restrictive operation to reduce the size of meals such as a sleeve gastrectomy (so-called duodenal switch procedure). These procedures are less popular in the UK due to the side effects of surgery which can be significant especially if there is a deviation from the strict post-operative dietary requirements. Careful nutritional supplementation and monitoring is required.

 

Revisional Surgery

Occasionally patients may benefit from advice regarding weight-loss surgery related problems or to help manage weight-regain after surgery. The causes of these conditions may be complex and can require further tests. Mr Hayden can advise on the pros and cons of revisional procedures with the assistance of his Multidisciplinary Team of experts.

Options such as gastric band removal, conversion from band to sleeve gastrectomy or gastric by pass or conversion of sleeve to gastric by pass or duodenal switch could be recommended and performed by Mr Hayden.

 

Skin Effects Of Weight Loss Surgery

The degree and speed of weight loss after surgery leads to changes in the body surface with looseness of the skin in areas such as the under arms and inner thighs as well as the lower abdomen (‘tummy’) and shape of the breasts. Patients undergoing weight loss surgery are usually warned about this change in appearance of the skin and many cope with this by wearing clothing that minimises the appearance.

The NHS does not usually fund cosmetic surgery to correct skin problems after weight loss surgery. Exceptions to this can sometimes be made where there is evidence that this is causing physical or psychological harm. If you are suffering from the effects of loose skin then your first step should be to discuss this with your GP.

 

Cosmetic Surgery

In order to correct loose skin problems cosmetic surgery may be recommended and referral to a plastic surgeon considered. Mr Hayden does not perform plastic surgery but would recommend you consider seeking the opinion of a Consultant Plastic Surgeon based at Spire Leeds Hospital.