What happens after the procedure?

You may want to access support in the first few weeks and months following your surgery. This is because you are getting over an operation and coming to terms with changes in your eating. It really takes time to get used to eating such small amounts and not being able to eat the foods you want.

Initially, it will be necessary to take liquids and then gradually progress towards normal food. Even when fully recovered, you will not be able to eat as you did prior to surgery. You will have to eat slowly, chew your food well and even then certain food will have a tendency to stick. White bread and stringy meat are particular culprits in this regard.

If you have had a band you may be frustrated in the lack of early weight loss. The key to success is to be patient. It may take a few band adjustments before you reach the green zone, and begin losing significant amounts of weight.

If you had a bypass, it is typical to lose 6-12kgs (1- 2 stones) per month for the first three months. The weight loss then gradually slows down to approximately 2-3kg per month towards the end of the first year. You may experience appetite loss, changes in bowel habit, high levels of nausea, vitamin / mineral deficiencies. You will also require lifelong nutritional supplements.

You are not alone! We encourage all post-operative patients to attend our patient support group each month to gain valuable contacts and share your stories. Many of our patients have struck up life-long support and friendships through attendance at the group.

Further follow up after surgery

Roux-en-Y or Single Anastomosis Gastric Bypass
People who have undergone a bypass will be followed up at 3 weeks following surgery by the clinical nurse specialist. You will then be followed up every three months for the first year, twice during the second year with a yearly review for life, either at this hospital or with your GP. Your hospital appointments will either be with the dietitian, clinical nurse specialist or a surgeon.

Gastric Bands
Your first appointment will be 3 weeks after surgery by the clinical nurse specialist. The clinical nurse specialist will book your first band adjustment at this time. You will be seen very regularly in the first six months to ensure that your band is adjusted to give you optimal weight loss and support you with making appropriate changes to your eating habits. After the first year, you will be seen approximately every six months by the surgeon or nurse specialist. Appointments with the dietitian can be made either at your request or by other members of the multi-disciplinary team if they feel you need some further support.
 
Sleeve Gastrectomy
People who have undergone a sleeve gastrectomy will be followed up at 3 weeks following surgery by the clinical nurse specialist. You will then be followed up every three months for the first year, twice during the second year with a yearly review for life, either at this hospital or with your GP. Your hospital appointments will either be with the dietitian, clinical nurse specialist or surgeons. 

Gastric band Adjustments
The first gastric band adjustment is at 6-8 weeks following surgery, and subsequent band adjustments will depend on whether you have reached the green zone. The first adjustment is carried out in the x-ray department. Here, the band position is checked and the amount added titrated to your individual needs. Subsequent adjustments will usually be done in clinic. X-ray adjustments can be arranged as clinically necessary.

The Green Zone
The aim of band adjustments is to reach the green zone where you feel satisfied after a small meal and are not seeking food between meals. It is possible for the band to be too tight as well as under filled and both of these situations will lead to inadequate weight loss and potential complications. When at the green zone, you should be able to eat a wide variety of solid foods.
the green zone
Obtaining Further Surgery for skin reduction

You may find that after significant weight loss, you have some excess skin. Obviously, we encourage rigorous physical activity and toning to try and keep this to a minimum. However, it is likely that you will all have some level of excess skin.

We do support a referral to our sister plastics team at the Royal Free Hospital but you will need to meet a certain set of strict criteria:

BMI below 35 kg/m2
Stable weight for past 6 months
Non-Smoker
Significant psychological or physical impact resulting from the excess skin.

There is then a process to go through to secure surgery:

Assessment by plastic surgeon
Review by clinical psychologist
Tribunal (you are not required to attend) to review case and make funding decision

If funding is refused, unfortunately there is no process by which to appeal. Obtaining plastic surgery is not an automatic right after bariatric surgery and not part of your original procedure.
Working on it!