Gastric Bypass Surgery
Pre-operative Gastric Bypass Surgery Preparation After initial evaluation prior to gastric bypass surgery, you will be commenced on a low-calorie liquid diet. The standard time is two weeks but if you have a high body mass index (BMI) it will be for four weeks. The liquid diet is prescribed for four main reasons, to promote a degree of liver shrinkage, which makes the liver smaller and less fragile as it needs to be gently lifted to allow the operation to take place below, it also allows the individual to demonstrate the motivation and ability to tolerate a liquid diet as is required post operatively and it achieves a degree of weight loss and demonstrates the motivation required by the individual to make dietary changes. Support Prior to Gastric Bypass Surgery Discuss with close family and friends if you decide to proceed with gastric bypass surgery, you will need their support as you make changes to your diet and lifestyle. Ideally it would be great if you could have someone at home with you for the first one or two weeks during your post operative recovery. It's important to plan for your post operative diet and identify foods you like whether it be a certain type of soup, smoothie, build-up, complan etc. You should also make sure you have ready chewable multivitamins and some sort of blender to make nutritional drinks, all these things can be discussed with your dietician during the assessment. It's also a time to think about and reflect about your relationship with food and what factors may trigger you to make certain choices such as stress or boredom. Finally it is also a good time to think about exercise and starting to try and think about how you can incorporate it into your life, make your goals realistic, a short fifteen minute daily walk is a good start to build on, you don't have to become a marathon runner, just try and build up to a 30 minute daily walk over the few months after your bypass surgery.
Gastric Bypass - The Day of Surgery
The Day of your Gastric Bypass Surgery Two to three weeks before Weight Loss Surgery you will need some blood tests, this includes a full blood count, liver and renal function tests, blood grouping and tests for calcium, iron, vitamin B12 and folic acid. On the day of surgery, you will be admitted and seen by the anaesthetist and Mr Whitelaw. Depending on the type of surgery you are having will depend on how long you spend in the operating theatre, but between one and a half to two hours is normal for a Gastric Bypass. After surgery ou will go into the operating recovery area where you will be monitored for a while to check you are waking up and that your blood pressure and pulse are normal. You should expect to have an intravenous bag of fluids (drip), a patch on your shoulder releasing analgesia to control post operative pain and extra oxygen delivered to your nose for the first six to twelve hours. It is likely that you might also have some right shoulder pain caused by the air that was used to inflate your abdomen. This will subside within 24 hours but can be uncomfortable. After Gastric Bypass Surgery Immediately after waking up from surgery, you will be encouraged to start having sips of water, tea, or coffee. The first morning after your surgery you will be reviewed by Mr Whitelaw and encouraged to drink 'thin' fluids such as tea, coffee, water, squash as tolerated. Your fluid intake can increase gradually and then you can move onto more nutritious fluids. You should not drink anything too hot and at this stage. You will be encouraged to get up and start mobilising as soon as possible after surgery which is really important to prevent, deep vein thrombosis and other post surgical complications. All being well most patients are discharged home one day after surgery.
Gastric Bypass - What to expect after Surgery
Care at home after Gastric Bypass Surgery On returning home after gastric bypass surgery you will be tired for a few days as you recover from the effects of the anaesthetic. You will have five small wound sites on your abdomen with an invisible dissolvable stitch, covered with medical skin glue so you can bath or shower immediately. You can drive as soon as you feel you are able to carry out a simulated emergency stop comfortably. Avoid any strenuous heavy lifting. Move around and take as much gentle exercise as you can slowly building it up to regular walks. Its really mportant that you get up and move around. Weeks One to Two after Gastric Bypass Surgery During these weeks after gastric bypass surgery, you should limit yourself to liquids only. It is important you take in adequate nutrition and hydration. Small quantities of about half a cup of nourishing fluids should be taken at regular intervals. You will have discussed this with your dietician, but examples are blended soups, ensure, complain, build up, yoghurt blended with fruit, milk. You should also start to take vitamin supplementation and aim to drink around 1.5L of sugar free fluids per day. Avoid carbonated fizzy drinks. Constipation may be a problem as there is little fibre in this type of diet so you can use a non-bulk forming laxative such as lactulose, senna, or syrup of figs. You can return to work after one to two weeks if you feel able and continue with light exercise. Weeks Three to Four after Gastric Bypass Surgery At the end of week three after gastric bypass surgery, you can introduce a light pureed diet. Foods such as thick soups, flaky soft fish, scrambled eggs, porridge, and yoghurt. Aim for four small meals a day and continue to keep yourself well hydrated with fluids and continue to take your daily vitamins. It is important to take small mouthfuls and chew the food thoroughly and stop eating once you feel full. Try and take your fluid intake in-between meals so they do not fill you up and prevent you from eating at mealtime. Week Eight and Onwards From eight weeks onwards after gastric bypass surgery it is important that you are on normal foods. Foods should be high in protein and low in fat and sugar. Certain foods can be problematic following Gastric Bypass surgery, different individuals experiences may differ, but white untoasted bread and stodgy foods generally can be difficult and may feel like they get stuck in the pouch. The main rule to follow is don't eat in a hurry or rush your food, sit down and eat, take small mouthfuls, chew all your food properly and stop eating when you feel full. Drink and hydrate yourself well in between meals. If you drink and eat at the same time the fluid will fill the pouch, so it’s important to space things out during the day. Aim to make healthy food choices, plan if you can in advance by shopping ahead and preparing food ahead where you can. Use a smaller plate or ideally a ramekin bowl to help adjust to smaller portion sizes.
Gastric Bypass Onward Support
Long Term Follow-Up and Care after Gastric Bypass Surgery In addition to the multivitamins, you are taking you will need check-ups after surgery. Your vitamin, iron and calcium levels will be monitored periodically. Should you notice any symptoms such as reflux, abdominal pains, vomiting or excessive tiredness you should get in touch with Mr Whitelaw’s team. Exercise after Gastric Bypass Surgery As you lose weight you will lose fatty tissue, but you will also lose muscle tissue as well which is why exercise and some resistance training is important. Walking is great but we would also encourage some resistance training such as pilates or yoga. It doesn't have to be ever day but aim for a two to three times a week. There are lots of online instructors now many are free if you endure the adverts so give it a go. More strenuous exercise can start around six to eight weeks. Just aim to try and do thirty minutes a day. Post Gastric Bypass Surgery Blues After gastric bypass surgery some individuals may experience a period of post operative sadness or mood change. You have undergone life changing surgery, and it will take a period of readjustment as your diet and lifestyle changes. We will invite you back to see you for follow-up at four weeks, six- and twelve-months post operatively and annually thereafter. You will also have follow-up with your dietician at regular intervals during the first-year post-surgery. If you have any issues at all we always want to hear from you as soon as possible. External Support Groups before and after Gastric Bypass Surgery We would encourage you to join a local or social media weight loss surgery support group, ideally before surgery. There are many out there now and it would be difficult to recommend one but do go and find a network that is receptive to what you are looking to discuss and somewhere you feel comforatble to share your experience with others.
Risks Associated with Gastric Bypass
Risks Associated with Gastric Bypass Gastric Bypass is a complex surgical procedure and is not without risk. It is therefore important an individual makes themselves aware of the surgery pathway, uses the assessment programme as an opportunity to ask questions and involve family members in the process. We actively encourage relatives to attend intial apoointments if they are able to. All surgery with anaesthetic carries a degree of risk and includes rare complications such as cardiac or respiratory complications, deep vein thrombosis (clot generally in the back of the lower leg), pulmonary embolism (clot in the lung), chest infection, wound infection, and urinary tract infection. Risks specifically associated with a Gastric Bypass procedure include a less than 0.1% of death, initial sensation of difficulty swallowing post operatively, bleeding or leakage from the staple line or other anastomosis (point where the intestine is re-joined) and pouch or bowel obstruction. If in the rare event of bleeding, leakage, or obstruction, you may need an immediate return to theatre to resolve these issues. Long term risks of a gastric bypass include rarely vitamin and mineral deficiency, protein, and energy malnutrition (PEM), risk of ulceration with stricture of the gastric pouch, internal hernias, reactive hypoglycaemia (low blood sugar), dumping syndrome, changes in bowel habit, post operative depression and anxiety and a failure to maintain weight loss long term. Dumping Syndrome can occur post operatively normally after consuming foods high in sugar but also can include alcohol or high fatty foods. Basically your body produces too much insulin in response to the foods you have eaten. Symptoms include nausea, rapid heart rate, sweating, cramps, dizziness, feeling faint and general weakness. These symptoms generally improve quite quickly and are resolved long term by avoiding foods with a high sugar or fat content. Both gastric sleeve and gastric bypass patients are at an increased risk of developing gallstones in the gallbladder after surgery.
Gastric Bypass Prices
Payment
The first initial appointment at The Cobham Clinic will be charged at £150.00, this is fully refundable if you decide to go ahead with Surgery and will be deducted from your final bill. The next payment at the Cobham Clinic will be for £785.00 and this will be just before your appointment with the multidisciplinary team. The final balance will be due just before your final pre operative assessment. The Cobham Clinic does not ask for one large upfront payment giving you space and time to review your decision and ensure it is the right one for you. After an initial appointment with Mr Whitelaw you will be given an assessment prior to surgery. The assessment follows the National Institute of Excellence (NICE) guidelines and consists of a multidisciplinary team approach including dietician, specialist nurse, psychologist (at The Cobham Clinic only) and anaesthetist. The assessment reflects his NHS practice at The Luton and Dunstable University Hospital, Luton, which is one of the largest Bariatric Centres in the UK. The assessment allow you to discuss your care and expectations with each member of the team.
Appointments
Mr Whitelaw holds weekly in person clinics on a Thursday evening at Spire Bushey from 6pm, Friday evening at The Cobham Clinic from 5pm. Additionally he holds virtual clinics on Monday evening from 6pm and Wednesday evening from 7pm. Please either pop over to the appointment page here or call 07715 346331 to arrange a virtual apt.