CALCULATE YOUR Body mass index

In order to become a candidate for bariatric surgery, a person has to to meet the following criteria:

* BMI >=30 + a co-morbidity:
* Diabetes mellitus
* Sleep apnea



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Gastric bypass surgery

Gastric bypass surgery is one of the most frequently performed weight loss surgeries. This procedure is often referred to as a “combined” surgery because the size of the stomach is reduced by forming a small pouch (15-30 ml in volume) from the upper part of the stomach and by reducing the length of the digestive tract. This reduces the size of the stomach by almost 90%, so there is less capacity for food and the patient feels an early sensation of fullness. Normally, from the stomach, the food is passed into the small intestine, where a major part of nutrients and calories are absorbed, and then the food further passes into the large intestine. During the gastric bypass procedure, the reduced stomach is connected directly to the middle part of small intestine, causing a decrease in the absorption of calories and nutrients, because their “path” becomes shorter. The length of this “bypass” is decided according to the patient’s body mass index (BMI).

Gastric bypass surgery is carried out under general anesthesia, using a laparoscopic approach that is minimally invasive. However, as any other surgery, gastric bypass also has some risks and the patient’s condition should be carefully evaluated to avoid complications.

Anastomosis is a surgical connection between the stomach and an intestine, or between two intestinal elements using special sutures or staples. If such connections heal improperly after the gastric bypass surgery, following complications are possible:

Gastric bypass efficiency

Studies show that gastric bypass procedure helps patients lose 65 – 80 % of their excess weight. Moreover, scientists observed a significant decrease in associated co-morbidities:

Gastric bypass surgery is only a step in the overall weight loss process. It is essential for the patient to correct his or her natural habits, starting before the operation. It is recommended to avoid snacks and eat 5-6 meals per day, taking time to take small bites and chew the food well. If the patient dismisses the doctor’s recommendations it may cause various complications and the desired results may not be achieved. Motivation and psychological condition of a patient are very important.

 

Gastric sleeve surgery

Gastric sleeve surgery is performed in order to limit the patient’s food intake by making the stomach smaller and amending the structure of the gastrointestinal tract. This surgical procedure is performed inside the abdominal cavity of the patient, which can be accessed in two ways. The first technique is more common because it is a less invasive laparoscopic procedure. During the surgery, several small incisions are made to insert instruments and a tiny camera to guide the surgeon. The second way is an open surgery, when the stomach is accessed through a vertical cut in the patient’s abdominal wall. During the gastric sleeve procedure, the surgeon removes about 80% of the stomach and leaves a narrow tube, which looks like a “sleeve”, hence the name of the procedure. The loose ends of the stomach are closed with surgical staples or sutures. The patient’s intestines stay intact while the capacity of the stomach is permanently reduced limiting the food intake.

Weight loss mechanism

After the procedure, the stomach’s capacity will be significantly reduced to usually be able to contain about 150 ml of food, compared to 500 ml or more before undergoing the procedure. This change allows the person to lose weight, because the amount of food that can be consumed at one time is reduced. The stomach walls are stretched more readily, providing the feeling of fullness quicker. Also, hunger is directly affected due to the reduced stomach area, which produces a “hunger hormone” called ghrelin. This substance activates the appetite centre in the brain and contributes to how you feel and relieve hunger. These two mechanisms are very important to weight loss.

Who should consider the gastric sleeve surgery?

The patient has to meet certain requirements before the procedure. The person is suitable for the gastric sleeve surgery when their efforts to lose weight by exercise and diet have been unsuccessful and the patient has a body mass index (BMI) of 40 or higher. Sometimes patients who have BMI of 35 or more may be considered for the surgery, if they have a disabling, or even a life threatening problem related to obesity like type 2 diabetes, high blood pressure, or sleep apnoea. However, some additional disorders or diseases, for example advanced cancer and severe cardiopulmonary, hepatic or end-stage renal disease, are considered contraindications for this procedure. Furthermore, the patient needs to understand the principles and nature of the gastric sleeve surgery, and adopt appropriate postoperative rehabilitation and change their lifestyle accordingly.

Results of sleeve gastrectomy

Usually after the gastric sleeve surgery 60-65% of patient’s excess weight is lost. The results strongly depend on how consistently the patient follows their eating and exercise regime after the operation. Though the overall complication rate is low, there are still potential risks and complications to this procedure. An infection of the incision or staple line leaks from the stomach into the abdominal cavity, which cause bleeding and infection are most commonly occurring complications. Rarely, the patient might have some digestion tract disturbances, such as nausea, reflux and vomiting, some vitamins and minerals may not be well absorbed due to the decreased size of the stomach, however these complications tend to be temporary.

Gastric band surgery

During this surgery, the size of the stomach is reduced using an adjustable gastric band (ring). This helps the patient lose weight, because then smaller amounts of food make the person feel full, so he consumes little calories. Out of all weight loss surgeries, this technique is the least invasive one. The surgeon uses a laparoscope to perform the procedure. This allows him to avoid making large incisions, thus the recovery time is significantly shorter and the risk of postoperative complications is smaller.

The process of surgery:

  1. The patient receives general anaesthesia.
  2. Your surgeon will make small incisions near the belly button and place a small laparoscopic camera through the incision into the abdominal cavity.
  3. Your surgeon makes a few additional small incisions to insert the surgical instruments and introduces carbon dioxide into the abdominal cavity to create a workspace.
  4. The surgeon performs the surgery observing the view on the monitor. He places a special band on the upper part of the stomach to create an hourglass shape.
  5. The ring has a reservoir that is filled with saline, which is later connected to a small capsule under the skin. The capsule is necessary for postoperative band adjustment by removing or injecting saline from/into it.

The capacity of upper part of the stomach is usually about 100 ml, so the food intake of one time decreases greatly and the ring slows the passage of food to the lower area.

The gastric band can stay in the patient’s organism for the rest of their life. The ring is usually replaced only due to complications like changing its position or losing hermeticity.

Possible complications after gastric band surgery:

Gastric band efficiency

On average patients lose 0.5-1 kg per week after the gastric band surgery. Those, who had severe obesity normally lose more weight during the first weeks after the procedure. During the first postoperative year the average weight loss varies from 22 to 45 kg. Studies prove that gastric band procedure helps people develop better nutritional habits and keep their optimal body mass for a longer period of time.

Gastric plication surgery

Gastric plication is a modern and minimally invasive weight-loss procedure, during which the capacity of the stomach is reduced. The surgery does not require big incisions in order to reach the stomach, because it is performed using a laparoscopic technique. A few small incisions are made in the abdomen area and with the help of laparoscope (a fibre-optic instrument) the surgeon is able to see inside of your abdomen and perform the procedure. This surgical approach ensures faster and easier recovery, and leaving less scars than open surgeries.

How does it help to lose weight?

Gastric plication is a restrictive surgical procedure, which is performed to limit the amount of food the patient will be able to eat by reducing the size of the stomach. During this surgery, your doctor will not use implants or remove a part of the stomach. The surgeon will reduce the size of the stomach by sewing one or more large folds in the wall of the stomach. As a result, you will reduce daily caloric intake and lose weight without starving, because you will feel satiated after consuming a smaller amount of food.

Recovery after laparoscopic gastric plication

The recovery after gastric plication is easy and quite fast. After the procedure you will notice five or six little incisions in your abdomen area. Usually, it is recommended to stay two or three days in the hospital after this surgery. It will be necessary to follow a strict liquid diet, for the first 14 days after the laparoscopic gastric plication. Generally, patients are able to resume their usual activities within seven or 10 days after the surgery.

Results

Usually, the patient achieves their weight loss goals during the first couple of years after the laparoscopic gastric plication. The anticipated excess weight loss after the surgery varies from 40% to 100%. Clinical studies show that of 800 patients who had this procedure, the patients have lost approximately 70% of their excess body weight within the first year after the laparoscopic gastric plication. Furthermore, many other illnesses associated with obesity (diabetes, hypertension, sleep apnea and others) are improved after this procedure. However, it is essential to keep in mind that the results of this surgery (likewise of all bariatric surgeries), depend on motivation and cooperation of the patient, who should be ready to accept diet and physical activity as a natural part of his or her life.

Risks and complications

There is very little possibility of technical complications of gastric plication surgery. Complications such as leaking from sutured areas or separation of stitches happen rarely and would both need a revision surgery. Most commonly patients might feel discomfort when general anesthesia starts wearing off, these might include a headache, nausea and vomiting, sore throat, damage to teeth and others.

Who is a candidate for gastric plication?

An obese person (body mass index 35 or more) who is determined to make significant changes to her or his lifestyle is considered an ideal candidate for this procedure. However, a consultation with a surgeon is required to determine which bariatric procedure suits you the best.

Gastric balloon surgery

One of the most popular weight loss surgery choices is the gastric balloon. The main reason why people tend to prefer the gastric balloon is that it is not permanent and can be removed at any point of treatment. Sometimes the gastric balloon is inserted to prepare for further bariatric surgery. Weight loss achieved with this method is more physiological. Firstly, the gastrointestinal tract remains the same. Secondly, a permanent feeling of fullness is created, and consequently less food is consumed. Additionally, now we are able to suggest one-year gastric balloon implantation that provides tighter weight control and greater weight loss.

How is the gastric balloon inserted?

The gastric balloon procedure is mostly restrictive, that means the volume of the stomach is decreased without reconstructing the gastrointestinal tract. Your surgeon inserts a soft silicone balloon into the stomach during the procedure. In order to prevent any complications, the operation is done with endoscopic guidance. After that, the balloon is filled with sterile saline or other solution.

Types of gastric balloons.

In our clinic we can offer two gastric balloon systems – Allergan and Spatz. The main difference is the period of time it can stay in your stomach – the Allergan balloon is inserted for a period of 6 months, while the Spatz balloon can stay in the stomach for one year. Moreover, the Spatz one-year balloon can be refilled if the process of weight loss would stop.

Since the gastric balloon is inserted temporarily, you will be asked to visit our clinic again, depending on the type of the balloon inserted.  The gastroenterologist will remove the balloon after 6 months (Allergan balloon) or one year (Spatz balloon).

After the procedure

Although the insertion process of the gastric balloon is not complicated, the first weeks will demand patience and determination. At first, it will be necessary to get used to a feeling of satiety. Sometimes nausea and pain may be felt during recovery, so in such cases, do not hesitate to ask a doctor to give you a prescription for medications to help relieve side effects. Furthermore, after the procedure you will have to make important changes in your eating habits. For the first 3-5 days you will be able to consume only small portions of liquids. Later, solid food will be introduced back into your diet gradually.

Complications

It is very important to understand that all surgeries involve some risk and take some precautions. Most commonly, after the gastric balloon is inserted, patients might feel some gastrointestinal symptoms. They might be nausea, vomiting, and diarrhoea. Rarely, the gastric balloon may initiate gastric perforation, formation of a peptic ulcer or gastro-esophageal reflux. On the other hand, you should not worry about it too much. Doctors make huge efforts to reduce complications to zero and some of the complications are extremely rare.

Efficiency

It is anticipated that the patient will lose from 16% to 23% of the start weight after the surgery. When the gastric balloon is removed, the sustentation of weight greatly depends on how the patient has changed their diet and developed physical habits during the period of treatment. For the 6-month balloon, approximately only one third of patients reach long-term weight loss, while the bigger part of patients return to old habits. On the other hand, clinical studies of one-year gastric balloon patients revealed more encouraging results.

Plastic surgery after Weight Loss Surgery

Weight loss surgeries can enhance the patient’s quality of life and overall well-being, for this reason interest in bariatric surgery is constantly growing. A significant weight loss usually improves the conditions of other obesity related illnesses. However, a sudden weight loss might bring unpleasant body changes like extensive skin folds, wrinkling and sagging skin. Excessive amounts of skin may also cause other health problems like inflammation. The severity of sagging skin depends on the weight before the surgery, how and when the weight was reduced. Moreover, individual features such as older age, malnutrition after bariatric surgery and factors interfering with skin elasticity might also have an impact.

When should the patient consider a post-bariatric surgery?

Additional cosmetic surgery is recommended, if the patient is satisfied with the results of weight loss surgery but still feels unattractive. Cosmetic surgeries are advised after a year and a half following bariatric surgery, when the weight loss is stable.

Which cosmetic surgeries are most helpful?

It is very personal and depends on the individual case, because the main aim is to improve body shape in such way that postoperative scars would be as traceless as possible. The most commonly performed procedures are tummy tuck, lower body lift and thigh lift.

Tummy tuck (Abdominoplasty)

If the excessive skin and fat tissue distributes through all abdomen, your surgeon might need to perform a belly button relocation. On the other hand, if there is a need to improve contour of lower abdomen part, the belly button is staying intact. The first type of procedure is more common if it is performed to the patient following massive weight loss.

Lower body lift

During the lover body lift, your surgeon places the incision around the body in order to remove excess fat tissue and skin in the abdominal area. The removal is followed by skin lift that enhances waist, buttock, outer thigh and hip shape.

Thigh lift (medial thighplasty)

This surgery enhances the inner side of thighs by removing excess skin and fat from targeted thigh side. The incision is placed in the groin area, which means that it will be covered with clothes as well as swimsuit.

Other recommended plastic surgeries

After massive weight loss, additionally to the mentioned procedures, an upper body lift, arm lift , breast lift or face-lift might be performed. However, it is recommended to perform these surgeries after a lower body lift or at least after abdominoplasty. It is every patient’s personal decision what body areas he or she might want to adjust. Our surgeons, who specialize in cosmetic surgery, have more information about an effect of surgical intervention, so they are ready to consult you before making any arrangements.

Five year follow-up plan

Amber Surgery procedures are the first steps towards a slimmer and healthier you. There are quite a few further steps you will need to take to reach your goal. That is where long-term follow-up with your surgeon and dietitian becomes very important. To achieve long lasting results we offer a 5-year follow-up with our surgeon and dietitian to our weight loss surgery patients, which is included in our standard surgery package.

Our 5-year follow-up includes:

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