Welcome to Laparoscopicobesitysurgery.co.uk

What is obesity?

Obesity is defined as a weight 20% greater than ideal body weight in men and 30% greater in women. It is commonly expressed as the Body Mass Index (BMI). This is calculated from the following formula.

BMI = Weight in Kg/ Height in cm 2

To calculate you BMI click here.

Back to top

How is obesity treated?

There are a number of means of treating obesity. These include dieting, exercise, behavioural therapy, medical therapy and surgery.

Back to top

What are the risks of being overweight?

Being overweight is associated with a variety of medical conditions including high blood pressure, cardiovascular disease, diabetes, high blood cholesterol and other lipids, an increased risk of developing certain cancers, sleep apnoea, gastro-oesophageal reflux and arthritis.

If you meet the following criteria then you may be suitable for weight reduction surgery. In deciding on surgery you will need to discuss the risks of undergoing an operation against the risks of remaining obese.

1. A body mass index greater than 40 or a body mass index greater than 35 in the presence of associated conditions such as diabetes, sleep apnoea, high blood pressure etc.
2. Age greater than 18
3. To have tried other means of weight reduction such as dieting or drug therapy before considering surgery.
4. Should be fit for an operation.
5. Must understand the need for long term follow up and long term commitment to maintaining a reduced weight.

Back to top

The gastric band is placed around the upper stomach and a small tube led to a reservoir placed under the skin. The operation is performed laparoscopically (keyhole surgery) and takes only about 40 minutes. You will be allowed home at between 24 and 72 hours after surgery with a diet sheet that starts with fluids and builds up to solid food over the next 6 weeks Eight weeks postoperatively we inflate the balloon in the band using a special needle placed through the skin into the reservoir. The amount of fluid in the balloon will need to be adjusted over subsequent weeks to produce the required weight loss.

The operation is performed laparoscopically and takes approximately 4 hours. The upper part of the stomach is divided and joined onto the small bowel so that the main reservoir of the stomach is bypassed. A small amount of small bowel is also bypassed. The hospital stay is 3 to 5 days. Fluid is started on the first postoperative day and built up to full diet by six weeks.

This operation acts in a similar way to the gastric band but produces a restriction that is fixed and cannot be adjusted in the same way as the gastric band.

This operation is similar to the gastric bypass but involves bypassing a much greater part of the small bowel that in the gastric bypass operation leading to a significant degree of malabsorbtion. Whilst it can be a very effective way of loosing weight it is also associated with a number of potentially serious complications.

There are a number of operations that have been described as treatments for obesity. The author offers gastric bypass (which is the gold standard against which other procedures are judged, having been proven to provide effective long term weight loss) and gastric banding. Very occasionally, the author will recommend a sleeve gastrectomy as an initial procedure followed by a gastric bypass. For patients with a BMI less than 40 gastric banding is the treatment of choice. For patients with a BMI greater 40 gastric bypass surgery is the treatment of choice. However, these guidelines are not fixed and selection of the type of surgery should be made after discussion with your surgeon.

Studies suggest that you will loose between 30 and 74 percent of your excess weight, the most rapid period of weight loss being in the first 18 to 24 months following surgery. Heavier patients undergoing gastric bypass surgery tend to have a more dramatic early weight loss. There is a tendency to regain weight over time and so it is important to develop and maintain good eating habits. However, studies have demonstrated that patients undergoing gastric bypass maintain a weight loss of 50 to 60% of excess weight at between 5 and 6 yrs and one study demonstrated a maintained loss of 50% at 14 yrs. Studies suggest that gastric bypass surgery is the most effective surgical treatment in maintaining long term weight loss.

All surgical procedures are associated with some risk. In deciding whether to undergo weight reduction surgery it is necessary to balance the risks of the procedure against the risks of obesity.

Complications that can occur following surgery include wound and chest infections, bleeding, injuries to the stomach and bowel and leaks from joins in the bowel. It has generally been supposed that surgery on overweight patients was associated with increased risk of complications. However, a recent publication has shown that the risks are no greater than in non-overweight patients.

Weight reduction surgery has been reported to improve several comorbid conditions including diabetes mellitus, sleep apnoea and obesity associated hypoventilation, high blood pressure and serum lipid abnormalities. In a recent study, diabetic patients who underwent gastric bypass surgery had a risk of death three times less than those who had not. The results of a recent study comparing the health problems experienced by two groups of patients, one which underwent weight reduction surgery and the other who did not, are shown in the table below. Those who had undergone weight reduction surgery had fewer healthcare problems than those who had not.

You will need to eat a normal balanced diet after surgery. The operation will help in weight reduction but it is important to develop healthy eating habits, eating small portions. Sweets, ice-cream and sugar rich drinks must be avoided since they contain a large number of calories which will cause weight gain. Patients undergoing gastric bypass surgery will need to take vitamins, iron and calcium supplements lifelong.

You should not become pregnant during the period of rapid weight reduction since but there is not reason not to after your weight loss has stabilised. Appropriate birth control measures should be taken during this period.

How much time will I need off work?

This will depend of the nature of your work, but most people will be able to return to work within 2 weeks.

Back to top

How soon after surgery will I start to loose weight?

Form patients undergoing roux-en-y gastric bypass, sleeve gastrectomy and pancreatico-biliary bypass weight loss starts from the time of surgery. The gastric band is inflated 6-8 weeks after surgery and may take a number of inflations before weight loss begins.

Back to top

Is there anything else I need to know?

Weight reduction surgery is a partnership between patient, the patient’s family, surgeon, dietician and other healthcare individuals. In order to loose weight and keep it off it is necessary not just to have the operation but also to eat a balanced diet and to exercise regularly. Many overweight patients find exercising difficult, either because they are embarrassed to go out, or because have arthritic joints or they find their ability to exercise is simply limited by their size. Even so exercise is an important part of losing weight and keeping it off. Walking for half an hour morning and evening, swimming, going to the gym’ are good forms of exercise. If you can’t manage these then do what you can. Even simple measures can help. Take the stairs rather than the lift or escalator, walk to the shops if they are close by rather than take the car or bus.
The type of exercise matters less than the fact that you do it and that you do it regularly.