- You are 25kg or more over your ideal weight.
- You have a BMI of 35 and have medical issues related to your obesity like high blood pressure, heart disease, diabetes, sleep apnea, arthritis etc.
- You are able to understand the life style and dietary changes that are required after weight loss surgery.
It depends on your surgery and your surgeon. A gastric bypass pouch will typically be about 30-50 cc, banded pouches will typically be about 60-70 cc, and sleeve gastrectomy will be between 100-150 cc.
For bypass patients, the remaining stomach goes on functioning by making digestive juices that are used for processing food later down in the small intestine. For gastric sleeve patients, the remnant stomach is completely removed from the body and sent to pathology.
You will be able to eat regular food following the transitional period after surgery. The biggest difference will simply be the portion size. After eating a few grams or less, you will feel full. You will need to avoid foods high in sugars and limit fats in your diet. You can otherwise eat a wide variety of foods but some foods such as dry meats, pasta, rice, breads, asparagus or other stringy fruits and vegetables may be difficult.
One of the key features that helps patient s control calorie intake after Gastric Bypass is the fact that food leaves the tiny stomach pouch and empties into a section of the small intestine called the jejunum. This pathway for the food is the "Roux-en-Y" of the procedure. The jejunum is not made to handle concentrated calories, especially refined sugar and high fat foods. The effect of this is that if a person consumes sugar after Gastric Bypass surgery, the presence of the sugar in this segment of intestine will create an unpleasant reaction that affects the whole body. On rare occasions a gastric sleeve patient can experience dumping syndrome. Some signs of dumping can be palpitations or racing heart, a sweaty and clammy feeling, abdominal pain and/or cramping, weakness, fatigue, dizziness, and sometimes diarrhea. Dumping syndrome is not dangerous, but it feels awful and once you react to a certain food in this way you do not want to eat that food again. This is beneficial as a negative reinforcement for certain foods. Dumping syndrome affects each person differently and you may feel any combination of the above signs. Dumping syndrome usually resolves after a year and a half.
Many patients experience food intolerances, especially to red meat, milk and high fiber foods.. It is a good idea to keep a food journal with a list of foods that are and are not well tolerated. Often food intolerances are temporary, so you may try a food again in a couple of months that was not well tolerated the first time.
Lactose ("milk sugar") is a particular type of sugar found in milk and dairy products. Absorption of lactose requires a particular enzyme that is mostly found in the bypassed segment of intestine. So many of our patients who did not have problems with milk before surgery find that after Gastric Bypass, dairy products cause abdominal cramping and flatulence. This can be treated by Lactaid, an over-the-counter enzyme supplement. The bowel also tends to adapt over time and this is less of a problem in most patients six months from surgery.
The lower part of the stomach and the upper part of the small intestine do not participate in the digestion of food after a Gastric Bypass surgery because these portions are bypassed. These sections play an important part in the absorption of some minerals (iron, calcium, magnesium) and vitamins (vitamin B-12 and vitamin B6). Patients who have had Gastric Bypass need to take multivitamin and supplemental calcium (calcium citrate) every day for life. Supplemental B-12 is also required and can be taken sublingually (under the tongue) or by injection.
Most patients notice some increase in hair loss around three to five months following surgery. For some patients the amount of hair loss is dramatic. They describe clumps of hair in their brush, hair covering the floor of the shower, etc. This occurs as part of the body's response to sudden calorie and protein deprivation just after surgery. The body puts some of its normal maintenance activities "on hold" until nutrition is coming in again and the effects take a few months to show. In fact, nothing actually happens to the hair follicles except that they become "dormant" and at the time the hair loss is noticed, the follicles are probably busy regenerating hair. It is rare for patients to have thinner hair one year after surgery than they did prior to surgery. In fact, at 18 months after surgery, most patients have fuller and healthier hair because the body's hormone balance has been significantly improved.
Rapid weight loss can causes patients to lose hair weeks to months after surgery. This is related to reduced intake of protein, nutrients and vitamins. Zinc has been shown to be involved in hair loss after weight loss surgery. It is recommend that you consume adequate amounts of protein and take a daily zinc and possibly biotin supplements after Gastric Band, Gastric Sleeve or gastric bypass weight loss surgery. Also various shampoos can help including Nioxin shampoo.
Unfortunately, the skin that holds all of your fat tissue before the surgery tends not to shrink down as the fat goes away. Most patients are left with areas of excess skin, especially the abdomen, upper arms, upper thighs, and breasts. Exercise is very important for the patient's overall success, but it is not effective in shrinking skin. However, excess skin draped over muscle is more aesthetically pleasing than skin that is draped over little muscle tissue. Many patients choose to undergo plastic surgery to remove excess skin. It is recommended to wait 12-18 months after bariatric surgery before pursuing plastic surgery. Also, it is important for a patient to be close to their goal weight and that their weight has stabilized. This allows the best results after plastic surgery.
As soon as you get home you may take a shower. You may gently wash the incision or incisions with mild soap and water. Please avoid bathing or submerging your wounds in any water for four weeks.
You can drive as soon as you are no longer taking narcotic pain medication.
As soon as you feel fit: two weeks or less for most jobs.
Your medication may need to be crushed or converted to a liquid or chewable form. Six weeks after surgery, small pills or capsules can be taken as before. Medications that come in larger pill form may still need to be broken or crushed. You may also want to check with your primary care physician to see if they are available in liquid or capsule form. Also you should avoid aspirin products and anti-inflammatories after surgery as they can cause irritation and ulcers. Remember that your vitamins and minerals should always be in a chewable or liquid form for better absorption.
It is strongly recommended you wait at least 18 months after surgery before trying to conceive. Approximately 18 months after surgery your body will be fairly stable from a weight and nutrition standpoint. You should also know that fertility usually increases with weight loss so be sure to take extra precautions.