Frequently Asked Questions

The amount of weight you can lose following surgery will depend on the type of surgery that you undergo, a patient’s genetic makeup, and their adherence to the post bariatric program (diet, exercise). On average patients who have a lap band will lose 15 – 25% of their total body weight (TBWL). A sleeve gastrectomy will give you 25 – 30% TBWL and a gastric bypass would be around 30 – 40%. However, surgery such as the gastric bypass will mean taking vitamin supplements for the rest of your life and is a more complicated operation.

Generally, after a sleeve gastrectomy we expect to see 50% of the total expected weight loss to occur by 3 months following surgery and the remaining weight loss by 12 months. This can average out at about 1 – 2 kg of weight loss per week, but plateaus when no weight loss is experienced are normal and can last several weeks. It is important for patients to come to their follow up so that we can track their weight loss and make adjustments to their diet/exercise plan to ensure that they are on track. Occasionally patients will require medication to improve their overall weight loss.

As with most keyhole operations, surgery is well tolerated with pain not being a significant complaint. Most patients will require some oral pain relief for 2 – 3 days post op. Occasionally whilst in hospital patients will be administered a PCA (patient controlled analgesia).

Most patients will stay in hospital for 2 nights, although on occasion 3 nights. Generally, once a patient can tolerate a litre of fluid within 24 hours, and are comfortable on oral painkillers, and are mobilising freely, they are safe for discharge.

There are a series of steps that each patient has to take before surgery:

• Usually 2 medical/surgical appointments and 1 dietician appointment are required before surgery, however some patients schedule potential theatre dates after their first appointment.
• Access to funds (insurance, super, paying directly).
• 2 – 3 weeks of Optifast to minimise liver size to make surgery safer.

Yes. We recommend at least 2 weeks on a VLCD (very low calorie diet) prior to surgery, with guidance from our dietician on a meal plan leading up to surgery, such as Optifast. This helps to shrink the liver which sits above the stomach, thereby allowing us to perform the operation safely as there is more space to operate. Even 3 – 4 kg weight loss is usually sufficient for the surgery. This diet also kick starts the body into ketosis, the state your body will be in for the first 6 months following surgery. This is your body metabolising fat as energy.

On average, patients will need to follow a VLCD for 2 weeks prior to surgery, however depending on your starting weight and medical conditions, you may need to follow it for longer (4-8 weeks). If this is the case, you may require more than 3 VLCD products per day. This can be discussed with your dietitian.

Hunger, fatigue, headaches, nausea, bad breath and lack of concentration are common in the first 3 -4 days. Your body will adjust to the new energy-burning system and you will feel satisfied with minimal amounts of food. Most symptoms will pass by days 4-6.

Protein is important while healing and to prevent muscle and hair loss while losing weight. Not eating enough protein can result in a weaker immune system and can result in inadequate weight loss long term. Always include protein rich foods at mealtime and ensure to eat your protein foods first for adequate nutrition.

Sleeve and Bypass procedures will change your stomach function permanently. They lead to a permanent reduction in absorption of minerals which require stomach acid to be best absorbed (Iron, Calcium, Magnesium etc) and an increased requirement for some vitamins such as Thiamine. Patients who stop taking multivitamin supplements are almost guaranteed to get some sort of vitamin or mineral deficiency, however many of these can occur years after surgery.

After weight loss surgery, many people will develop a new bowel habit. Opening your bowels every 2-3 days is ok as long as you’re not uncomfortable. During the recovery period, you may find your bowels behaving differently often from one extreme to another, but this should settle as you return to normal eating. Constipation is managed by ensuring adequate fibre, fluids and regular physical activity. As this may be difficult in the first 2 weeks, a mild laxative such as Lactulose may be beneficial during this time. As your food intake increases and you are able to include adequate amounts of fluids on a daily basis, a soluble fibre supplement such as Benefiber can be useful.

Alcohol is a “triple threat”, it’s high in calories, it stimulates hunger and it promotes eating of high fat/high carbohydrate foods. Patients after many bariatric surgeries are at increased risk of developing alcohol dependency disorders after surgery, and regular alcohol consumption after Bypass surgeries will reliably cause stomach ulcers to develop.

With this in mind however, occasional alcohol consumption is safe once the stomach has healed at around 1 month post-operatively.

We like patients to be on anti-acid tablets (Pariet, Nexium, Losec etc) for 1 month after Sleeve surgery and 3 months after Bypass surgery. Bypass patients who are on Aspirin or anti- inflammatories (Neurofen, Voltaren etc), who smoke or regularly take excess alcohol need to stay on these tablets lifelong.

Hair Loss generally occurs after significant weight loss for any reason, and this predominately relates to deficiencies in silica and protein intake. To minimise this it is best to take hair skin and nail supplements, as well as maintain a daily protein intake of around 60g.

Pregnancy should be delayed until your weight is stable for at least two consecutive months – approximately at the 12 month mark for Sleeves, 18 month mark for Bypasses.

As a result of bariatric surgery you will have some excess skin, however the amount of loose skin varies a lot from person to person. The older you are and the more weight you lose the more likely this is to happen. Unfortunately, there is no way of ‘getting rid’ of excess skin through any form of exercise/toning. The only way to deal with excess skin following weight loss from bariatric surgery is through body contouring surgery (plastic surgery). Around 1/3 of patients seek this option after bariatric surgery.

You will need to make an appointment with your GP to ask for an EPC to be used for our practice Dietician Tania Chaanine.

Ensure a copy of your EPC is provided to the Upper GI Surgery practice. The EPC is only valid for one calendar year at a time.

• Bulk billed follow up
• Two Dietitian appointments
• Nutrition pack consisting of
• Portion Perfection bariatric bowl and plate
• 1 month supply of bariatric multivitamins
• A copy of Your Complete Guide to Nutrition for Weight Loss Surgery by Sally Johnston
• Enrolment to the Fresh Start online support, education and coaching program

Following gastric sleeve surgery, your stomach will never grow back to its original size. The remaining part of your stomach will stretch or expand, as it does in everyone who has the surgery, however, it will always be tiny when compared to your pre-surgery stomach. 

Mild stomach stretching is normal, but on occasions, we certainly find individuals where stomach stretching has likely contributed to weight regain and these people may benefit from re-do surgery. If we operate on someone who has a behavioural driver of weight regain, the weight loss results will be disappointing because surgery won’t make people who are doing the wrong thing do the right thing. If someone is regaining weight after surgery we encourage them to return for follow-up so we can assess their stomach size and their eating and exercise behaviour, and offer help to get them back on track.

Click here to read ‘Can you stretch your stomach after gastric sleeve surgery?’.