The sleeve gastrectomy will take around 45 minutes and the gastric bypass around one and a half hour. But in case of revisional bariatric surgery these procedures can take several hours depending on the amount of adhesions caused by the previous surgery. as these procedures are performed under general anaesthesia it takes another 15 minutes to have the patient positioned plus put asleep and another 15 minutes to wake the patient up and be transported out of the OR. After that the patient will go to the recovery room to get more awake up for around half an hour.
All these bariatric operation are done laparoscopically (key hole surgery). In the sleeve gastrectomy the operation is done through three small incisions. In the gastric bypass the surgery is performed through five small incisions.
You are allowed to take a light diner the evening of surgery, but no addition food intake after mid-night is allowed. Depending on your time of surgery you can have clear liquids up till two hours before the surgery in agreement with the nurses that are taking care with you.
It is great if you can make a start in changing your life-style, however, it is not a big deal for the surgery if you cannot.
Normally, you will stay only one night in the hospital and you can leave around noon next day.
Direct after the surgery you will be able to walk, drink and take a shower. You will feel some abdominal pain, some shoulder pain (due to the gasses in your abdomen), and some nausea, which will be controlled by medication. But most of these complaints will slowly subside within 2-3 days. In case of the sleeve gastrectomy the pain might take a bit longer at the place where we removed the stomach out of the abdomen as this hole in the abdominal wall needs closure by a stitch, which causes some mild pain when moving too fast in the first two weeks after the surgery.
You will get a sick leave for two weeks (to one month) as you can start with light work after 2 weeks and heavy physical work after 1 month.
Within two-to-three hours after surgery you should start walking for five minutes per hour, which will lower the chance on venous thrombosis. This walking will also distracts you from any pain and will make you less nauseated. In the first month after surgery you should walk three times a day for 30 minutes and if you like you can start swimming one week after the surgery. One month after the surgery you can start with heavy exercises including weight lifting.
Following the surgery you should maintain a pure liquid diet for two weeks by taking by drinking small zips every five minutes (1.5 litres per day). Avoiding eating is in the first two weeks after the surgery is crucial to avoid a leak! After that you can take pureed food and slowly increase to soft diet. Especially in the beginning it is important to avoid bread and pieces of meat as they can cause discomfort if not chewed properly. After one month eating gradually becomes easier, but of cause the amount of food that can be eaten will be less than before. Further down in this brochure you will find more information on your diet. Besides of that our dietician will also provide you more detailed information and help you with any questions regarding your diet.
Yes, besides feeling less hungry patients also have the tendency to eat more fish than meat and also take more fruits and vegetables than before. Moreover, especially in the beginning patients have the tendency not to drink enough. That is why it is important to always have a small bottle of water with you and regularly (every five minutes) drink small zips, especially so in the first months after the surgery.
In the first year after the surgery you will lose around 80% of your overweight. In the long run this effect will be on average around 60% overweight loss for a sleeve gastrectomy, around 65% excess weight loss for a gastric bypass, around 70% for a mini-bypass and around 80% for a SADI bypass. Use the BMI-calculator on our website to find out what you will lose knowing that the ideal BMI should be below 25.
The sleeve gastrectomy, and even more so the gastric bypass, is very effective in getting your weight down. However, to maintain that good result it is essential that you change to a healthy life-style by having three regular healthy meals a day with fresh fruits and vegetables, thus avoiding high caloric drinks, juices, sweets, chocolate, ice creams and fast-food. Besides that it is important to excise at least 30-45 minutes every day.
It is recommended to eat on a table and enjoy the food instead of eating while watching TV; to eat from a small plate as is has been proven that you eat less/ a smaller portion when using as mall plate; to chew each mouth of food for at least one minute; to use knife and fork which will make you slow down eating; not to drink while eating; and have regular healthy protein rich meals three times a day and a piece of fruit in between the meals.
When you will be discharged from the hospital you will be prescribed painkillers (for 1 weeks), heparin injection (for 10 days) and esomeprazol/ stomach protectors (for 1 months). After two weeks you will be seen back in clinic where we will prescribe vitamins, proteins and medication to reduce the chance on formation of gallbladder stones. We advise to take the vitamins for the rest of your life, but, especially so in the first six months after your surgery it is very important to take the prescribed vitamins.
After the bariatric surgery you will experience big changes. Most of your obesity-related comorbidities like diabetes, hypertension, hypercholesterolemia, sleep apnoea, and joint pain will get in remission and you will start to feel much more energetic and healthier after a few months.
The chance on complications in skilled hands and a good team is extremely low. Most important dangerous complications are anastomotic leak and the pulmonary embolism. In skilled hands a leak can happen in two of a thousand of patients, and can be avoided if patients keep up with their postoperative diet of two weeks of liquid food only. The pulmonary embolism can be avoided by walking every day after the surgery and by taking the heparin injections every day until two weeks after the surgery. The chance of mortality is extremely low with skilled surgeons (less than 0.1%), but it should be kept in mind that the life expectancy after bariatric surgery is way much better (average 12 years life-expectancy gain) than staying morbidly obese. In other words doing nothing (no surgery) is also not without a risk.
Other complications that can happen are not dangerous, like:
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