What are the risks of having bariatric surgery?
One of our NHS consultant surgeons, Mr Brij Madhok, talks through the possible risks of bariatric surgery in the video at the top of this page.
How much weight should I expect to lose and what is the expected rate of weight loss?
Bariatric surgery offers significant weight loss that is often sustainable in the long term. However, the overall weight loss someone experiences can vary from patient to patient. As such, no operation can guarantee that you will lose a certain amount of weight or result in more weight loss than others. Most of the weight loss typically happens in the first 6-12 months. Long-term success depends on maintaining lifestyle changes. Weight can be regained if lifestyle changes are not sustained.
With a sleeve gastrectomy, on average you can expect to lose up to 25-30% of your total body weight over a period of 12-24 months. With Roux-en-Y gastric bypass and one-anastomosis gastric bypass (OAGB), you can expect to lose on average up to 30-35% of your total body weight over a period of 12-24 months.
How will I stop losing weight?
Weight loss after bariatric surgery will slow down and eventually stop, typically plateauing around 12 months to two years post-surgery. This is a natural process when your food intake meets the requirements of your body. Some weight regain can occur long-term, so maintaining weight loss requires commitment to a new lifestyle, including changes to the food you eat, eating behaviours and exercise.
Do I need to get regular blood tests after surgery?
Yes, you will receive regular follow-ups for two years by the bariatric team after surgery. You will then be discharged back to your GP. The dietitians will periodically ask for blood tests as part of this service to monitor for any nutritional deficiencies post-surgery. Long term it is important that you have a routine blood test once a year via your GP to monitor your nutritional health.
How long do I need off work after surgery?
Time off work depends on what you do for a living. You need to consider that you won't be able to drive for at least two weeks post-operation, your energy levels and attention span may be impaired, as you will initially be on a modified texture diet after surgery and won't be consuming many calories. You need to discuss with your employer if you can return to work on light duties or on phased return. You will require at least six weeks off work if your role involves heavy lifting.
How long before I can drive after surgery?
Our policy advises not to drive for a period of two weeks after surgery.
Will I have check-ups after surgery?
Yes, you will receive regular follow-ups for two years by the bariatric team post-surgery. A bariatric nurse specialist will contact you typically 7-10 days post-surgery, a physiotherapist will contact you approximately six weeks post-surgery, and then you will receive regular follow-ups from a dietitian up until two years post-surgery. You will then be discharged back to your GP.
How long will I have to stay in hospital?
Most patients stay 1-2 nights, with general recovery taking around two weeks. We ask patients to pack for a 48-hour hospital stay.
Does surgery have to occur under general anaesthetic?
Yes, bariatric operations are performed under general anaesthesia. This is required to ensure the procedure can be carried out safely, and to ensure that your abdominal muscles remain relaxed.
Why have I been asked to have sleep studies?
You may be required to undergo sleep studies prior to surgery to check for obstructive sleep apnoea (OSA). OSA is a condition where breathing repeatedly stops and starts during sleep, most commonly due to the airway becoming blocked. If you do experience OSA, you may require treatment before being considered safe to undergo anaesthesia. If you have been advised to use a continuous positive airway pressure (CPAP) machine to treat obstructive sleep apnoea, you must be compliant with this before surgery can be scheduled. A CPAP machine delivers a steady stream of air through a mask to keep the airway open.
Will I have to eat 'baby food' or liquids for the rest of my life?
No, you will not be on pureed or liquid food for the rest of your life. You will however be asked to follow a modified texture diet for a few weeks post-surgery, which will allowing the stomach to heal. The purpose is to minimise pressure on your newly formed stomach pouch and allow your body to adapt to eating again. The stages of a textured modified diet are typically two weeks liquid stage, one week pureed stage, and one week soft textures stage, gradually building you back up to eating normal textured food and having a normal healthy diet.
Can bariatric surgery be reversed?
Sleeve gastrectomy is a completely irreversible operation. A sleeve gastrectomy can be converted to a Roux-en-Y gastric bypass in some instances where medically or surgically indicated. The Roux-en-Y gastric bypass is permanent, but if you develop some rare complications, the bypass can in theory be reversed. However, this is rarely done. The one-anastomosis gastric bypass (OAGB) is permanent, but if you develop some rare severe complications, it can be converted to a Roux-en-Y gastric bypass.
Will surgery fix all my problems (i.e. pain, other health problems)?
Bariatric surgery has been shown to help improve certain obesity related conditions, including type 2 diabetes, obstructive sleep apnoea (OSA), hypertension and acid reflux. In some cases, a health condition may be completely reversed. While losing weight reduces physical strain and can alleviate musculoskeletal pain and sleep disturbances, it is important to note that surgery does not "fix" the underlying causes of chronic conditions like arthritis or fibromyalgia. Similarly, while many patients experience an initial boost in mood and self-esteem, surgery is not a cure for clinical depression or anxiety.
In some cases, the significant lifestyle changes and hormonal shifts following surgery can even place new stresses on a patient's mental health. Furthermore, surgery carries its own risks and can occasionally worsen certain health conditions. For instance, a sleeve gastrectomy may worsen acid reflux, and rapid weight loss can lead to the formation of gallstones. Additionally, the malabsorptive nature of some procedures can complicate the management of pre-existing conditions like coeliac disease or inflammatory bowel disease.
Are there any medications I can't take after bariatric surgery?
After bariatric surgery, you should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) including naproxen, ibuprofen and aspirin — as they increase the risk of stomach ulcers and bleeding. If you require any of these, please discuss with your GP prior to surgery to seek alternatives. Before taking any medication after surgery, please speak with your GP or pharmacist to confirm it is safe to do so.
Can I start smoking after bariatric surgery?
Smoking or using nicotine-containing vapes is very strongly discouraged after bariatric surgery. In the short term, smoking increases the risks of infections and leaks at the staple line, can contribute to poor wound healing and may increase the risk of bloods clots (i.e. deep vein thrombosis, pulmonary embolism). Long-term there is a risk of developing a stomach ulcer, which can cause significant pain when eating and may require further medical treatment and occasionally further surgical or endoscopic procedures.
Can I conceive after bariatric surgery?
Yes, you can conceive after bariatric surgery. Some patients have bariatric surgery to lose weight to improve fertility. It is important to wait until your weight has stabilised after the initial rapid weight-loss phase, typically 12-18 months after the operation before you try to conceive. You need to give your body enough time to adjust and reduce the risk of nutritional deficiencies for both you and your baby.
In view of this, you are recommended to use contraception during the first 18 months post-surgery. Oral contraception may not provide sufficient protection after bariatric surgery as lower absorption rates are suspected. It is therefore recommended you use an alternative form of contraception during this time.
If you fall pregnant at any point following bariatric surgery, you should inform your GP and midwives and contact your bariatric team as soon as possible so that they can begin to monitor you more closely. If you have already been discharged from the bariatric service, your GP should re-refer you.
Will I lose hair after bariatric surgery?
Hair loss is common and usually temporary after bariatric surgery. The most common cause of hair loss is Telogen Effluvium. This is a natural response to the significant "shock" of surgery and rapid weight loss. This usually resolves within the first 12 months post-surgery.
However, hair loss can also occur due to nutritional challenges. Hair loss can be managed by ensuring adequate protein intake within your diet. We advise you include 60-100g protein per day into your diet. We also advise you to continue to take your nutritional supplements, so your body receives sufficient vitamins, including zinc and iron, which are crucial for healthy hair.
Will I need to take supplements? Are these prescribed or will I need to buy my own?
You are strongly encouraged to take vitamin and mineral supplements after bariatric surgery to support your dietary intake and reduce the risk of nutritional deficiencies. You will be given a limited supply of these when discharged from hospital along with a letter to ask your GP to prescribe in the long term. Depending on where you live, your GP practice may not be able to prescribe vitamin and mineral supplements and may request that you purchase your own. Although advice on supplements can change over time, we recommend taking a daily A-Z multivitamin and mineral, vitamin D +/- calcium, iron supplement, as well as vitamin B12 injections every 12 weeks.
Can I drink alcohol after bariatric surgery?
You can drink alcohol after bariatric surgery. However, it is recommended to avoid alcohol early on and limit your intake due to risk of rapid intoxication, negative effects on weight loss, and potential for addiction. Alcohol will have a stronger intoxicating effect than before surgery as it will be absorbed much faster. Also consider alcohol is high in sugar and calories which can lead to weight gain. Alcohol can interfere with absorption of essential vitamins and minerals leading to nutrient deficiencies. There may be a higher risk of developing an alcohol use disorder after bariatric surgery. There is also increased risk of developing stomach ulcers. Some alcoholic drinks and their mixers are carbonated. Carbonated drinks should be avoided after surgery. We advise following the government guidelines regarding recommended weekly units for alcohol.
What can I do if I have excess skin?
Some patients will develop excess skin post-surgery due to significant weight loss. Some patients find excess skin unsightly or troublesome. Excess skin removal is not easily available on the NHS, and you would likely need to investigate having this surgically removed on a private basis. Not everyone will experience excess skin after surgery, and it is difficult to determine who will experience excess skin and who won’t.
Can/should I exercise after bariatric surgery?
Movement is encouraged immediately after surgery, beginning with short walks around the ward. However, we advise not lifting anything heavier than a kettle full of water for the first six weeks after surgery whilst you are still recovering. You will receive a telephone call from one of the Physiotherapy team around six weeks after surgery who will be able to advise on how to increase activity levels safely. However, it is recommended that you engage in physical activity regularly long term if possible, incorporating a mixture of cardiovascular and resistance-based exercise. Resistance training (e.g. lifting weights, bodyweight exercises, using resistance bands) is especially important for helping to maintain muscle mass whilst you are losing weight.
