Frequently Asked Questions on Bariatric Surgery
- 1How much weight will I lose?
Degree of weight loss largely depends on the type of surgery performed.
The following is a range of expected Total-Weight Loss (TWL) depending on the surgery:
- Adjustable gastric banding – 15-20%%
- Sleeve Gastrectomy – 20-30%
- Gastric Bypass – 30-35%
- Duodenal Switch – 40-45%
- Intragastric Balloon – 10-15%
- Endoscopic Sleeve Gastroplasty – 15-20%
Patient results may differ. If patient weight loss targets are not met, revisions may be required.
- 2How long is the convalescence period? When will I be able to return to work?
Under normal conditions, patients are able to leave their recovery rooms and return home 48 hours after the surgery. The time required before returning to work depends on the type of work. For desk work, return times are 1-2 weeks post-op. For physical work, return times are 2-6 weeks post-op.
- 3How much pain will I feel after the surgery? How long will I be feeling pain?
Patients are given intra-venous narcotics 24-48 hours post-op. If the pain continues, patients are prescribed oral analgesics for up to 1 week post-op.
- 4When can I start exercising again after surgery?
Right away! You will take gentle, short walks even while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month (avoid competition, think participation). Build slowly over several weeks. If you swim, your wounds need to be healed over before you get back in the water.
- 5Can I have laparoscopic surgery if I have had other abdominal surgery procedures in the past, or have a hernia, or have a stoma?
The general answer to this is yes. Make sure to tell your surgeon and anaesthetist about all prior operations, especially those on your abdomen and pelvis. Many of us forget childhood operations. It is best to avoid surprises!
Sometimes your surgeon may ask to see the operative report from complicated or unusual procedures, especially those on the oesophagus, stomach, or bowels.
- 6Does type 2 diabetes make surgery riskier?
It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 Diabetes sees big improvement or even complete remission after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.
- 7Can I have laparoscopic surgery if I have heart disease?
Yes, but you may need medical clearance from your cardiologist. Bariatric surgery leads to improvement in most problems related to heart disease including:
- High Blood Pressure
- Lipid problems
- Heart enlargement (dilated heart, or abnormal thickening)
- Vascular (artery and vein) and coronary (heart artery) disease
During the screening process, be sure to let your surgeon or nurse know about any heart conditions you have. Even those with atrial fibrillation, heart valve replacement, or previous stents or heart bypass surgery usually do very well. If you are on blood thinners of any type, expect special instructions just before and after surgery.
- 8When can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?
Most women are much more fertile after surgery, even with moderate pre-op weight loss. Birth control pills do NOT work as well in heavy patients. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!
Most groups recommend waiting 12-18 months after surgery before getting pregnant.
Many women who become pregnant after surgery are several years older than their friends were when having kids. Being older when pregnant does mean possible increased risks of certain problems. Down’s syndrome and spinal deformities are two examples. The good news is that, after surgery, there is much less risk of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There are also fewer miscarriages and stillbirths than in heavy women who have not had surgery and weight loss.
Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during foetal growth (look up “epigenetics” – for more information). There is also less risk of needing a C section.
- 9Will I need to have plastic surgery?
Most patients have some loose or sagging skin, but it is often more temporary than expected. You will have a lot of change between 6 and 18 months after surgery. Your individual appearance depends upon several things, including how much weight you lose, your age, your genetics and whether or not you exercise or smoke. Generally, loose skin is well-hidden by clothing. Many patients wear compression garments, which can be found online, to help with appearance.
Some patients will choose to have plastic surgery to remove excess skin. Most surgeons recommend waiting at least 18 months, but you can be evaluated before that.
- 10Will I lose my hair after bariatric surgery?
Some hair loss is common between 3 and 6 months following surgery. The reasons for this are not totally understood. Even if you take all recommended supplements, hair loss will be noticed until the follicles come back. Hair loss is almost always temporary. Adequate intake of protein, vitamins and minerals will help to ensure hair re-growth, and avoid longer term thinning.
- 11Will I have to take vitamins and minerals after surgery?
You will need to take a multivitamin for life. You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D. You will also need to have at least yearly lab checks.
- 12Will I have to go on a diet before I have surgery?
Yes. Most bariatric surgeons put their patients on a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. This helps during the procedure and makes it safer.
- 13Will I have to diet or exercise after the procedure?
No and Yes.
Most people think of a “diet” as a plan that leaves you hungry. That is not the way people feel after surgery. Eventually, most patients get some form of appetite back 6-18 months after surgery. Your appetite is much weaker, and easier to satisfy than before.
This does not mean that you can eat whatever and whenever you want. Healthier food choices are important to best results, but most patients still enjoy tasty food, and even “treats.”
Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Sometimes exercise is work, but if it becomes a punishing, never-ending battle, you will not keep going. Instead, work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan. Expect to learn and change as you go!
For many patients (and normal weight people, too) exercise is more important for regular stress control, and for appetite control, than simply burning off calories. As we age, inactivity can lead to being frail or fragile, which is quite dangerous to overall health. Healthy bones and avoiding muscle loss partly depends on doing weekly weight bearing (including walking) or muscle resistance (weights or similar) exercise.
- 14What about if I am unable to walk?
Almost everyone is able to find some activity to “count” as moderate exercise, even those who are partially paralysed, or who have arthritis or joint replacement or spine pain. Special therapists may be needed to help find what works for you.
- 15Can I go off some of my medications after surgery?
As you lose weight, you may be able to reduce or eliminate the need for many of the medications you take for high blood pressure, heart disease, arthritis, cholesterol, and diabetes. If you have a gastric bypass, sleeve gastrectomy or a duodenal switch, you may even be able to reduce the dosage or discontinue the use of your diabetes medications soon after your procedure.