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One of the biggest concerns of bariatric patients is whether they can drink alcohol after bariatric surgery or not. This is such an important matter that some patients postpone their surgery just because they’re not ready to quit drinking.If you’re looking for the most honest, yet harsh, answer, yes, you have to stop drinking alcohol as it does not have any place in a healthy lifestyle. A lot of things change in your body when you undergo weight loss surgery. So, it makes complete sense when you’re told you cannot have the same eating and drinking habits as before.This prohibition is necessary for your health because drinking alcohol will cause you serious problems. Let’s dig deeper into this topic to understand what these dangers are and if there is any way you are allowed to consume alcohol without damaging your body.

Side Effects of Alcohol after Bariatric Surgery

1- Changes in Metabolism

One of the changes that occur in your body after gastric bypass surgery is the faster pace of elevating blood alcohol levels. Also, eating less by itself results in faster alcohol absorption in patients’ bloodstreams. So, you have just a single drink and become drunk in a blink of an eye.According to the British Journal of Clinical Pharmacology, a study in 2002 proved that due to the higher sensitivity of gastric bypass patients to ethanol, they experience a more rapid absorption of ethanol.

2- Slowing Weight Loss

Why do you want to have weight loss surgery? Isn’t it because you have to lose your excess weight rapidly? Then, if I tell you something will slow it down, will you want to have it?Well, that’s what alcohol does to your body. The excess calorie content in alcohol has a direct impact on your weight loss procedure as it does not only slows down your weight loss process but also might cause weight gain.

3- Risk of Addiction

In many cases, postoperative patients eat a lot of food because they’re addicted to it. How do most people eliminate their addiction? By replacing it with a new one. In bariatric patients’ cases, they give up eating too much but are in danger of food addiction, or other types of addictive behaviors.

4- Risk of Nausea and Vomiting

One of the risks of gastric bypass and sleeve gastrectomy is vomiting. On the other hand, when you’re drunk, there’s a high chance of vomiting. As we said before, metabolism changes after weight loss operations lower the time it gets for a person to get drunk and to the vomiting point.By drinking after the operation, you’re doubling the possibility of vomiting, which can cause inflammation in your stomach and make you suffer a lot.Nausea is another complication of weight loss procedures that brings about a noticeable inconvenience. Drinking is one of the actions that can increase the chance of nausea.

5- Low Blood Sugar

Due to the rapid weight loss after the operation, the glycogen level in your body is less than before. The reduction in complex carbohydrates use adds up to this lack of blood sugar. Moreover, alcohol consumption decreases glycogen.So, some patients end up having hypoglycemia, which is low blood sugar. Damage to the brain or nerves or in some cases, losing consciousness occurs to people with hypoglycemia.If you experience some of its symptoms, including loss of balance and poor sight, you should contact your doctor immediately. Meanwhile, you can take some glucose tablets. Also, try eating nutrients that have complex carbohydrates and preferably, protein.

Alcohol After Gastric Sleeve

As you might already know, during gastric sleeve surgery 75% of the patient’s stomach is removed. This removed part is responsible for producing hunger hormone and also, affects acid production in the stomach.Sleeve patients aren’t in the clear just because there is no bowel bypass. There are alcohol-absorbing consequences to the sleeve gastrectomy as well. As a result, the enzyme that is responsible for digesting alcohol in your stomach does not exist anymore.This is the reason why gastric sleeve patients are at higher risk of intoxication as their small bowel receives undigested, full-strength alcohol.

Alcohol After Gastric Bypass

Before gastric bypass surgery, patients have a larger stomach which allows food, alcohol, and digestive enzymes to mix. As a result, alcohol is absorbed in the small bowl more slowly. But after gastric bypass surgery, everything is different.In other words, alcohol is poured directly into the small bowel without digestion. What happens next is the immediate absorption of alcohol into the bloodstream of bariatric patients.

I Still Want to Drink Alcohol, What Should I Do?

• First of all, avoid alcohol for at least a year after surgery.
• If that’s a very long time for you, make sure not to use alcohol during the rapid postoperative weight-loss period, which lasts about 6 months after surgery.
• Before drinking alcohol, consult with your bariatric surgeon and dietitian. If you’re permitted to drink again, do NOT try carbonated beverages and sugary drinks.
• After consultation with your doctor, first, try alcohol at home. Try small amounts in the beginning. You don’t want to shock your body at all.
• Do not indulge in alcohol consumption. Beware of your frequency of alcohol consumption.
• Remember that after a bariatric procedure, even small amounts of alcohol can cause intoxication and low blood sugar.
• You will have different emotions after surgery till your body gets used to its new conditions. If you find yourself drinking whenever you’re dealing with negative feelings, consult with your doctor because probably you need psychiatric treatment.
• If you want to drink, at least try to choose low-calorie drinks like Never drink and drive, even after consuming only minimal alcohol: red or white wine, no-sugar bloody mary, light beer, and hot toddy (herbal tea with whiskey).
• Avoid high-calorie drinks like sugary cocktails and margaritas.
• If you’re going out, try not to leave home with an empty stomach. Eat a high-protein snack. This way, you’ll avoid alcohol abuse.
• Avoid driving, even if you had a small glass of wine.
• Try drinking with food because it reduces the pace of alcohol absorption. 
• When you try alcohol for the first time after your surgery, do it at home, to see how much is safe to drink until intoxication occurs and how long it lasts.
• Do not miss your vitamins; alcohol makes the absorption of some vitamins difficult.

Alcohol Abuse or Alcohol Use Disorder

AUD or Alcohol Use Disorder developed mostly in patients who have this disorder before surgery, which is why some bariatric surgeons do not admit to performing an operation on them.According to studies, this condition mainly appears in the first two years of patients’ post-operative life. Also, AUD is mostly seen in patients who undergo gastric bypass. But if you can get used to controlling your alcohol use or eliminating it from your life in the first two years, you’re one big step ahead.

Ways that Help You Reduce Your Alcohol Consumption

1- Ask for Your Doctor’s Help

Never lie to your surgeon, psychiatrist, and dietitian during your follow-up sessions. There is nothing to be ashamed of. There are hundreds of people that experience the exact same circumstances you are feeling. So, if you’re secretly still drinking and can’t quit, tell them. They will certainly help you.

2- Meditate on Your Goal

Constantly remind yourself of your ultimate goal when you agreed on a surgery. You came all this way to have a healthy lifestyle, better body image, and improved quality of life. Just close your eyes and think about your ideal body image. Imagine yourself doing all the activities you were not capable of doing before. If quitting alcohol is all it takes, why not? It’s worth it, isn’t it?

3- You Need the Help of Your Beloved Ones

If you’ve read our article on the psychological and physical effects of bariatric surgery on patients, you know one of the ways you can reduce the risks is through the companionship of your family and friends. You need to first, educate yourself and then, inform them of all the changes your body will go through.Let them know how your body needs to replace a new addiction with food addiction. Whenever you feel like you cannot tolerate not drinking, spend time with them. Let the emotions and the enjoyable time you spend with them distract your mind.

The necessity of a bariatric surgery psychological evaluation is not apparent to all patients and hence many of them feel stressed when it comes to this step of their bariatric assessment. I have prepared this article with the aim of helping you have a clearer understanding of this psychological assessment as one of the major parts of your pre-surgery experience.

Why Bariatric Surgery Psychological Evaluation Is Necessary?

Weight loss surgery is not an overnight decision. Most obese patients spend months and even years researching and evaluating in order to make the best decision. The more you know about bariatric procedures, the higher your chance of success is. But there is some information about you yourself that may not be easy for you to collect. This is when a psychiatrist comes to your help to better understand your aims in addition to your psychiatric conditions.

Are You Mentally Ready for the Surgery?

As I’ve said many times in all my articles, both the short and long-term success of your surgery depends to a high extent on your commitment to your new post-surgery lifestyle. According to a study by Dr. Allison G. Dynder, a clinical psychologist, psychological evaluation of candidates helps the psychiatrist and bariatric surgeon to better understand the readiness of patients.During this clinical assessment, a psychologist, a psychiatrist, or mental health professional who is familiar with bariatric surgery procedures examines patients from a psychological perspective and realizes their motivation, readiness for surgery, and all the mental factors and behavioral challenges that could cause success or failure or surgery.These factors reveal whether patients can make any required adjustment through surgery and the necessary lifestyle changes. Also, this includes psychosocial evaluation of patients as well. So, they might need to know about the social consequences of obesity in your life too.

Psychological Support Both Before and After the Surgery

In your pursuit of improved quality of life and mental and physical health conditions, a proficient bariatric psychologist must accompany you from the very beginning of this journey to months or sometimes years after it.After examining your mental situation, their main responsibility is to target your mental worries and trying to take a load off your shoulder by educating you. The more you know about this psychosocial assessment and how you should handle its challenges, the more relaxed you will feel.If bariatric surgery candidates need therapy prior to weight-loss surgery, they will be provided with psychological treatment to achieve the best bariatric outcomes.Beware that this clinical assessment is not the same for all patients. But it is important that you have a positive experience and be able to build a trustful relationship with your psychologist because if you pass this state conveniently, later, when you will experience the psychological negative effects of bariatric surgery including mood swings, you’ll feel more comfortable to share your thoughts with them.No one can provide you with sufficient psychological support like an expert.

Sections of a Bariatric Surgery Psychological Evaluation

Even though this test seems very frightening, it will lessen your stress if you know what it contains. The questions the psychologist asks helps them gather useful data on your behavioral and emotional status. In addition, your motivation and expectations must become clear during the assessment too as their necessary domains for assessment.- The Behavioral assessment covers aspects mostly related to your previous attempts to lose weight and nonsurgical treatment of obesity, eating, dietary habits (like overeating), frequency of physical activity, and your capacity for taking risks when it comes to health and psychological issues. – To examine your cognitive and emotional readiness, the psychologist makes sure whether you know everything about weight-loss surgical procedures, alongside the associated risks. In simple words, they want to make sure whether you know what you are agreeing to or not.Also, they will want to know how familiar you are with the dangers of severe obesity, the causes of morbid obesity, in addition to your reaction to psychosocial factors that could cause you emotional, mental harm.- Some psychiatrists ask bariatric surgery patients questions about their developmental history. This information helps them discover your family history, the traumas of your life, history of depression, and your critical ups and downs. Many obese patients suffer from childhood traumas, like the history of abuse or sexual abuse in the early ages, which caused them eating disorders in their adulthood. These obstacles challenge patients when it comes o adjusting to their new healthy lifestyle.- Ultimately, you are asked questions about your current life situation, the stressors that noticeably affect your life, and the emotional support you get from your family and friends. More importantly, what is your motivation and expectations?Here’s a more detailed overview of what psychiatrists ask during the assessment of candidates:

Who Might Fail a Weight-Loss Surgery Psychological Evaluation?

This question is basically wrong because this test is not a kind of pass or fail. Its main goal is for you, your surgeon, your psychiatrist, and the whole bariatric surgery team to recognize the potential challenges you, as a bariatric patient might face in the future and try to prevent them as much as possible.If patients are excluded from surgery just because of eating disorders, no one can undergo weight-loss surgery because let’s face it, most of the obese patient population suffers from eating disorders like anxiety eating.If there’s any serious concern, your psychologist will share it with you and work on a solution to prepare you for the surgery. If a specific treatment is needed, you’ll be given recommendations. However, there are some rare cases that surgeons refuse to perform surgery on until they are assured there is no danger for the patient and they’re mentally ready.- Hospitalization due to mental health issues over the course of last year- Previous suicide attempt, more than once- Uncontrolled severe anxiety disorders- History of not following medical instructions- Not controlled, serious personality disorders- Alcohol or active substance abuse within the last 6 months- Not controlled mental illness- Severe eating disorders- Not enough self-motivationBeware the final decision depends on your surgeon’s decision.

How to Pass a Pre-Bariatric Surgery Psychological Evaluation

That is the main question most patients have before their pre-operative psychological testing. But the truth is if you don’t have severe psychiatric disorders, there is no room for extra worries. And it is not like they want to fail you for no reason but they should be sure you are ready. For instance, if you have not controlled bipolar disorder, the aim of this evaluation is not to exclude anyone from the weight-loss procedure but to make sure they will be mentally healthy during their post-operative life.The psychiatrists who are responsible for evaluation prior to bariatric surgery are usually specialized in health psychology and do their best to help you maintain healthy in the future and experience the best postoperative outcomes.So, you only need to do one thing: tell them the truth. Do not hide your psychiatric history from your surgeon and bariatric psychologist. Even if they identify you are not ready for surgery, they will do their best to help you complete all the stages of preparation for surgery and become mentally ready for the procedure.So, no worries. Just tell the truth and be yourself. Tell them all the difficulties that are affecting your life because of extreme obesity, all the psychosocial stressors that do not let you be as happy as you deserve.And be sure everything will be ok!

Gastric sleeve leak is a hole or unsealed staple tissue in the stomach. It’s a complication that rarely happens after bariatric surgery. It is possible to prevent it, diagnose it and treat it. It’s good to know all the potential risks and recognize their symptoms. Its symptom of discomfort and pain differ from one patient to another and needs immediate medical care. 

The reasons behind leakage vary and that’s why patients build curiosity if some habits would cause leakage. This article will cover some of the questions you ask and the more factual side.

How would you understand if you have a leak? What does a gastric sleeve leak feel like? Let’s dive in for details:

What is a gastric sleeve leakage?

Gastric sleeve leakage is when fluids find a passage to drip out from the stomach due to the incompletion of healing surgical stitches. There are also other, less common reasons for it such as infections, the type of food intake, or the portion of food intake.

Despite its uncommonness, the leakage appears on the stapled tissue, but it is never a good sign because the fluids that leak may include stomach acid that helps digest food and may cause setbacks in the abdominal cavity.

What does a gastric sleeve leak feel like? 10 common symptoms

If you experience any of these common symptoms, medical attention is essential ASAP. If the symptoms are left behind or ignored, they may worsen in the future or even be life-concerning. If you want to know what does a gastric sleeve feel like, here are the gastric sleeve leakage symptoms that you could encounter:

1. Fever
2. Rapid heart rate
3. Abdominal pain
4. Nausea and vomiting
5. Swelling or redness around the surgical incision site
6. Difficulty breathing or shortness of breath
7. Inability to eat or drink
8. Blood pressure
9. Fatigue or weakness
10. Chest pain

What to do at home until you are taken to the hospital

If you are suspicious about abdominal leakage whether it’s you or your loved ones, call an ambulance for professional help. In the meanwhile, you can consider these ideas to reduce leakage or pain until you are taken care of in the hospital.

Do not eat or drink food: Avoiding food intake will help the leakage to reduce, but you can have small sips of water to wet your tongue in order to avoid dehydration.

Avoid physical activity: Rest on a sofa or bed, this helps to reduce pain and discomfort.

Keep track of the symptoms: Telling the doctor how you felt and are feeling at the moment will help them to find the root of the problem faster.

Remember, what you do at home is not a solution to the problem, it is only to maintain calm and stabilize the situation while professional help is on the road.

How common is it?

Studies show that there is only a 1-2% possibility for the leakage to occur. This depends on the doctor’s experience and the techniques that are used for the procedure.

Gastric sleeve surgery mainly has a very high success rate worldwide. With technology and experience, it is less likely to occur. At the end of the day, it depends on the techniques of how the surgery was done, the experience of the doctor, and other factors.

However, you will also be acknowledged of your post-op life before the surgery about how to reduce the chances of complications for a better recovery, and leakage is one of them.

When is it most likely to happen?

There are two main moments for gastric sleeve leakage to happen. It could be post-surgery early stages or delayed leak after gastric sleeve.

The stitches are most vulnerable when the patient is newly out of the surgery and eventually strengthen and heal day by day.

Post-surgery recovery time up until a month, the leak risk is slightly higher than long-term recovery. However, it can be easily directed and taken care of ASAP. The late leaks on the hand can happen after 3 months or more. The factors behind it could be poor healing, infection, or erosion of the staple line.

How to prevent

The gastric sleeve heals over time with the staple line, and you can also prevent complications and emergency surgeries also, support the healing process with the following steps:

1. Experienced surgeon: Being handled by an experienced is more promising to have excellent outcomes.
2. Pre-op instructions: A diet plan and exercise routine reduce the risk of complications in general and if you’re taking some medications, your doctor should know that because it may affect the outcomes of the surgery.
3. Post-op instructions: It is an understatement to say it’s important to follow the given instructions after the surgery. There are specific constructions to follow for recovery time, diet choice in different periods of time, and body activity. Not only this prevents leakage, but it also helps increase your quality of life.
4. Follow-up appointments: Generally your doctor writes down post-op visits after a period of time to evaluate your health status overall. This could help with complication prevention and the possibility of leakage in case there are indoor or outdoor agents.

Following these steps significantly improves recovery, and surgery purpose and counter future burdens including leakage issues.

How do doctors diagnose a gastric leak?

Generally, doctors take 3 important steps to track staple line leak, clinical assessment, imaging studies, and laboratory tests. Here is how to detect a leak after gastric sleeve step by step:

1. The doctor will discuss the pain and discomfort that you experience and ask you about your medical and surgical history. The clinical assessment plays a role in physical examinations such as fever, abdominal pain, or tenderness to see if there are any hints of infection.
2. Thanks to technology, the doctor may do some image studies and take CT scans, upper GI series, and endoscopy to visually capture the rear or hole that causes leakage. All those examinations are done with non-invasive methods such as x-rays, methylene blue solution, and endoscopic camera, which are performed to detect air, fluid leakage, or any other abnormalities.     
3. Finally, there are blood tests to check for any red flags such as infection to examine blood cell count or CRP (C-reactive protein) levels.

If the leakage is exposed during diagnosis, treatment will be essential and will prevent a serious downhill road. The treatment might include antibiotics, abdominal cavity drainage, surgical fix for the leak or all combined.

Treatment options 

Regardless of the treatment approach, it is important to address gastric sleeve leakage promptly to minimize the risk of leak and ensure a successful recovery. It is essential to consult with a healthcare provider for a proper diagnosis and treatment plan.

Gastric sleeve leakage has surgical and nonsurgical treatments. There are a few ways for gastric sleeve leak treatment and here is what doctors would consider depending on your condition:

Surgical conditions

If the case is severe, the patient will need a surgical procedure to close the tear or hole that causes the leaking.

In some cases, there could be a damaged stomach piece removal and reattaching of the remaining stomach together. This is a bit more invasive method but also likely to happen extremely rarely.

Non-surgical conditions

In non-sever cases, there is a feeding tube that feeds your body. You get all the nutrition needed carefully and monitored by your doctor. It can be bypassed through your nose or it may be oral nutrition. All this helps the injured area to heal and you are safely hydrated at the same time. 

Another way to solve gastric sleeve leakage is by endoscopic management that has a camera attached to it. The sleeve is fixed without surgery by inserting a thin tube until it reaches your stomach and with the doctor’s touch, it can be fixed.

Regardless of the treatment plan, your doctor will choose the best method for you and minimize the risks of complications in the future.

FAQ that you might be wondering

There are many additional curious questions our patients ask if some habits could cause leakage. These habits are not direct causes for leakage but some of them can be a risk for complication or the cause of delay of healing. Let us talk about them one by one.

Can smoking and alcohol cause a leak?

Doctors can’t recommend enough to temporarily stay away from smoking and drinking alcohol, at least until you’re fully recovered from your surgery. Both smoking and alcohol can impair the healing process and increase the risk of infections and leakage. 

It is best to postpone such habits for a few months not to only avoid complications but to also help with your recovery.

Can coughing cause a leak?

Coughing or sneezing causes no harm to the stitches. These are natural body reactions not related to the surgery. It could be cold or allergy, either way, it won’t affect the stomach stitches and it will not cause gastric sleeve leakage.

In case you are suffering from acid reflux post-surgery and you are chronically coughing, it will still not cause leakage. However, after consulting your doctor, you may use certain meds for coughing that could fix this problem.

Can coffee cause a leak?

Doctors recommend not drinking coffee for a few reasons such as dehydration and a rising appetite. However, you can consume coffee a month after the surgery. It is important to listen to your doctor’s post-op advice because the stomach is very sensitive right after the surgery and you only need to consume what you are advised. 

You should always be hydrated, coffee causes dehydration, and it can lead to the risk of complications. Even after recovery time, you can only consume small amounts of coffee with low caffeine.

Can having intercourse cause a leak?

Generally, intercourse does not affect the surgical stitches and it won’t cause leakage. However, it is best to wait 7-28 days after bariatric surgery. 

And if you are interested in having sexual activity during the 1-4 weeks after surgery, it is best to avoid harsh and sudden movements so the stomach stitches won’t be irritated. It is a matter of physical movements during intercourse, just like working out, things should be taken slowly for safety and not cause irritation in the healing process.

You should always be hydrated, coffee causes dehydration, and it can lead to the risk of complications. Even after recovery time, you can only consume small amounts of coffee with low caffeine.

The main disadvantage of our sedentary lifestyles, easier work, and bad eating habits is obesity! There is an increase in the number of obese people around the globe, regardless of age. Bariatric surgeons are at the forefront of this battle against obesity. Obesity surgery is applied to restore people’s health. However, this treatment method cannot respond due to some reasons, then bariatric surgery revision is required.

Bariatric Surgery Revision

As the number of performed bariatric surgery performed increases, the number of patients who are in need of bariatric surgery revision also increases. Losing weight has a difficult process. During this process, when people encounter psychological or physiological problems and need another operation, they are adversely affected. Re-operation becomes mandatory, especially in cases where the person cannot make changes in his/her lifestyle after the surgery, and also in the case of the development of postoperative complications.

Why Is Bariatric Surgery Revision Necessary?

There are two important points for bariatric revision surgery.The first reason is that the weight loss process for some patients is temporary and stops after a while.After the first operation, both appetite and eating patterns change. As a result, patients lose weight rapidly and their health improves noticeably. However, after a while, the person starts to return to his old habits and in this case, obesity re-enters their life.Another reason is patients think surgery is the magical solution and there is no need for them to continue their efforts and be faithful to a healthy lifestyle. Therefore, the weight loss results will not blast for a long time.Gastric Banding Revision SurgeryIf the band slips over time, the desired effect is prevented, so a re-operation is required.Gastric Botox Surgery RevisionIn gastric Botox, revision surgery is applied when the Botox melts over time and causes the stomach to return to its original state.

What is the Cost of Bariatric Surgery Revision?

Your doctor will determine this because they’re the ones that define the process of the operation and its difficulty. Therefore, it is not easy to determine an exact number.Revision surgery costs as much as the first surgical operation in every country, but depending on the difficulty of the operation it can increase up to double the price of the first.Europe; 10-50,000 EurosAmerica; $8-45,000Asia; It has costs between $5-38,000.

Gastric Bypass Revision Surgery

If the method used in your previous obesity surgery is gastric bypass, the preferred method in revision surgery will vary. The laparoscopic Distal Roux-en-Y gastric bypass method is used for bariatric surgery revision bypass. With this procedure, your nutrients and calorie absorption are reduced, which will prevent you from regaining weight. Thus, a smaller revision is obtained by supporting your previously performed bypass surgery.

How Long Does Revision Obesity Surgery Take?

Revision bariatric surgery may not include only a single operation. In this case, the process will take longer. However;

• Depending on the previous weight loss surgery, the method of the second surgery is determined.
• The duration of all identified methods is approximately 20 to 60 minutes.

What Should I Ask the Obesity Surgeon About Revision Surgery?

If you have decided to have obesity revision surgery, the questions you should definitely ask your doctor are;

• What complications may I encounter in the future?
• What kind of life awaits me after the surgery?
• What are the complications from previous surgeries you have performed?

The purpose of these questions is to know all the possible side effects and prepare yourself. The last question is somehow the most important one; it is your right to ask the percentage of postoperative complications the doctor has encountered in their previous surgeries, and it is vital to choose a doctor with a low complication rate in their portfolio.

Does My Insurance Cover the Costs of Bariatric Revision Surgery?

Unless certain conditions are met, Insurance companies do not cover the costs of bariatric surgery. For this reason, the second revision bariatric surgery will not be accepted by your insurance. However, if the person’s previous weight loss attempt is unsuccessful and their BMI is over 40, some insurance companies cover the price with a certain limit.

Bariatric Revision Surgery Types

Bariatric revision surgery options vary depending on your previous bariatric surgery.

• If you have had gastric bypass surgery before, you can choose the ROSE (Restorative Obesity Surgery Endoscopic) procedure and gastric banding.
• If you have undergone gastric banding, you can have gastric bypass surgery.
• You can also have gastric bypass surgery if you have had sleeve gastrectomy surgery before.

In addition, your doctor may give you different recommendations depending on your situation.

Age Restrictions for Bariatric Revision Surgery

While performing bariatric surgery revision, the age range of the person is taken into consideration as well as the weight status of the person. Too young people or patients with a BMI over 40 may be too old to have a second surgery. Considering the urgency of the situation, the age restrictions for bariatric surgery are a maximum of 70 and a minimum of 16. It is not considered appropriate to process people outside this age range.

Is Bariatric Revision Surgery Difficult? Is it risky?

Obesity surgery might bring about different risks in the first surgery. The second operation on an already modified stomach brings greater risks. If revision bariatric surgery is performed by a good doctor, the risk of complications is 9%. However, as a result of the doctor not being successful in his field, this rate can be carried to large figures such as 19%. For this reason, the second operation must be performed by a good doctor.

Is a New Psychological Evaluation Needed for Bariatric Surgery Revision?

Psychological evaluations before bariatric surgery help to understand whether the patient is ready for this surgery. This evaluation must be made before the second operation to be performed on the person who has failed to lose weight in a sustainable way in the previous operation. Especially if the reason for the failure of the person is to continue bad eating habits, this evaluation is more important.

Bariatric Revision Surgery for Protrusion and Erosion of Gastric Band

One of the most preferred methods in bariatric surgery is the use of a laparoscopic band. However, this method is one of the main reasons for revision surgeries as it causes more problems in the future.Generally, as a result of the Laparoscopic band, there are many complications such as protrusion, erosion, pouch enlargement, decrease in weight loss and return to weight gain over time and development of reflux.If your revision surgery is due to erosion or protrusion of your band, this band is usually removed in bariatric revision surgery and a different method is tried for the stomach.

Effects of Revision Bariatric Surgery

Revision bariatric surgery helps reduce obesity caused by weight regain.The reason for bariatric revision surgery is basically that the effects of the old surgery disappear and people start to gain weight again.As a result of studies conducted in only one clinic, an increase in the weight loss of patients was observed at the rates of 18%, 41%, 40%, and 47%, respectively. Acceptable risks and a revision surgery performed by a specialist doctor increase the likelihood of success. However, it is very important that the person is psychologically strong.If you are confident, there is no reason not to trust your surgeon!

Bariatric surgery, also known as weight-loss surgery, has become the ultimate solution and most effective treatment for obesity when exercise and diet won’t work anymore. According to the U.S. Centers for Disease Control and Prevention, its popularity is increasing every day, among women in particular.There are three main problems obese women face more than others during pregnancy: babies with larger birth weights, gestational diabetes, and high blood pressure. Therefore, the majority of bariatric surgery cases are now performed on reproductive-aged women who want to eliminate these problems and become pregnant. However, one question still exists: is pregnancy after bariatric surgery safe?After reading this article, you’ll have a thorough insight into a comparison between pregnancy before and after this operation, the pros and cons of pregnancy after weight-loss surgeries, the best time to get pregnant, practical suggestions regarding detailed guidelines of nutrition and exercise before and after pregnancy, in addition to the answers of some of your most common questions. 

Pregnancy Before and After Bariatric Surgery

Obesity creates a lot of physical problems for women including the ones that affect their reproductive system, most of which can be solved after bariatric surgery and reaching a healthy weight, hence the better overall physical condition. Findings of a reported issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing in November 2004 showed that for the first time, women who were dealing with infertility due to obesity and had to have gastric bypass surgery or any other types of weight-loss surgery faced notable growth in their regular ovulation.Even though women with a higher BMI are at more risk of infertility or miscarriage, bariatric surgery can also create some worries for women, for instance, what if my baby is smaller than normal because I eat less than before and they might not get as much nutrition as needed?The good news is that just like obesity that has a final treatment, which is bariatric surgery, all the troubles women might face during pregnancy after these surgeries are solvable! However, still, you need to have clear-cut information on these problems and the solutions.The table below indicates a comprehensive comparison of pregnancy before and after bariatric surgery.

Obesity-Related Risks During Pregnancy	Post-Bariatric Surgery Risks During Pregnancy
Gestational diabetesBlood pressure disordersLarger than normal size babiesPostpartum hemorrhageNot being able of natural deliveryDelay in maturity	Fetus or babies with sizes smaller than standardSlower growthPremature birth

Now that you have a clear image of the disadvantages of pregnancy while obese and after bariatric surgery, let’s delve into some medical solutions you’ll find super practical in order to have a happy, healthy pregnancy.

The Best Time to Get Pregnant After Bariatric Surgery

Most doctors recommend postponing pregnancy until at least 12 months after the surgery. The main reason for this recommendation is that obesity is associated with increased pregnancy complications, like gestational diabetes and preeclampsia (pregnancy-related high blood pressure). These problems do not vanish as soon as the surgery is done and are most likely to be treated at some point between 12 and 18 months after bariatric surgery.The other logic behind this idea is that after bariatric surgery you’ll start to lose weight. So, it is better to wait till your BMI stabilizes, and then you can get ready for pregnancy with ease of mind.However, as there are still some successful pregnancies right after the surgery, some experts believe there is no specific time, just do it whenever you feel ready!Regardless of the time of your pregnancy, it is wise to take everything into consideration. After all, pregnancy by itself brings about some abnormalities in your physical situation. You do not want to make it worse by not paying enough attention to your health and that of your baby.

Recommended Birth Control for Pregnant Women After Bariatric Surgery

If you’ve decided to listen to the first group of doctors, you need to prevent pregnancy as much as possible till at least 12 months after your operation.For sufficient contraception, your body needs a certain amount of hormones. Taking pills is a popular method among women, however, they cannot give you the necessary hormone and that is not something you can gamble on.Therefore, it is suggested that you take barrier methods. If you yourself are willing to make changes to your body in order to prevent pregnancy before your scheduled time, you can try female-controlled methods. If not, simply just ask your partner to use male condoms. This can all be arranged in an agreement between the two of you. But remember, it’d be much better if you do not jeopardize your condition by taking oral medication and depending solely on them.

Nutritional Guidelines for Pregnancy After Bariatric Surgery

The amount of nutrition your body delivers is for sure different before and after weight-loss surgery. By now you might be used to taking vitamins and mineral supplements every day in order not to lose your strength due to eating less than before the weight-loss surgery.You might be under the wrong impression that now that you are eating less, the fetus will not grow as much as it is supposed to. No worries because your baby takes what they need for growth from you. So, as long as you are healthy, they’re healthy.Even women who did not undergo a bariatric procedure could face problematic nutritional deficiencies during pregnancy. What you need to know is accurate information about the exact nutrition your body needs during this time, and of course, the necessary amount your body should be given on a daily basis.

Supplement	Daily Necessary Amount
Iron	45 – 600 mg
B12	350 – 500 mcg (Orally taken) 1000mcg (Injections)
Folic Acid	400 – 800 mcg
Vitamin D	3,000 – 8000 mg(Pay more attention to Vitamin D absorption in the last trimester)
Calcium	1,500 – 2,400 mg
Protein	Minimum level ==> 60 grams per day

Monthly Necessary Check-ups During Pregnancy After Bariatric Surgery

In addition to getting the vital nutrition for the health of yourself and your baby, don’t forget to have your provider check your vitamin levels regularly. These check-ups differentiate a bit based on the type of surgery you had. Here’s a detailed presentation of what you need to know. Just find the ones related to your surgery and keep up with the suggested plan. 

Glucose Tolerance Test (OGTT) After Weight-Loss Surgery

Do not forget continuous glucose monitoring during this time as well. If your BMI is over 30 it is likely that your doctor will regular glucose tolerance tests (OGTT or mini-GTT) to check whether you have gestational diabetes or not.A Glucose Tolerance Test is not advised just in case of bypass surgery because you might face what is called ‘dumping syndrome’. So, to make sure there is no gestational diabetes, consult with your surgery team and doctor to give you a replacement.

Food to Avoid While Pregnancy after Bariatric Surgery

– Fish and Shellfish

• Raw shellfish contains harmful bacteria, viruses, and toxins that might give you food poisoning. So, try to avoid them as much as possible.
• Too many pollutants like dioxins in oily fish make it a dangerous food for your baby’s health. Do not eat this type of fish more than twice a week.
• Tuna is a rich resource of Omega 3 and protein for pregnant women. However, the permitted amount is 2 steaks of tuna steaks. at most

Other foods and Drinks to Avoid during Pregnancy after Bariatric Surgery

– Caffeine

maximum amount of caffeine you can take is 200mg per day. Here’s a list of some of the most popular drinks and food with their specific caffeine level:

• Instant coffee (one mug) ==> 100mg
• Filter coffee (one mug) ==> 140mg
• Cola (one can) ==> 40mg
•  Milk chocolate (one 50-gram bar) ==> 10mg (or less)
• Green and regular tea (one mug) ==> 75mg
• Dark chocolate (one 50-gram bar) ==> 25 mg (or less)

– Alcohol

not specific to pregnant women that had weight-loss surgery. No woman should drink alcohol during pregnancy because it will result in serious harm to the baby.

Will my baby have any side effects because I’ve had bariatric surgery?

If you still have this question, do not worry. All you need to do is to make sure you have appropriate eating habits and your body is delivered all the necessary nutrition, including vitamins and mineral supplementation.Also, to prevent any childhood obesity problems for your baby, have a balanced diet while pregnant and after that during the breastfeeding period.

Focus on Healthy Weight Gain

If you’re not mentally ready for any kind of weight gain, then you’re still not ready for a pregnancy. But if an unexpected one occurred, try to forget weight loss. However, it is important to control your weight in order not to gain excessive weight as it will affect both your mental and physical situation. So, try to focus on healthy weight gain instead.The American College of Obstetricians and Gynecologists (ACOG) published some numbers that indicate the ideal weight gain for women according to their BMI before pregnancy:

BMI	Ideal Weight Gain During Pregnancy
18.5–24.9	25–35 lbs
25–29.9	15–25 lbs
30 <	11–20 lbs

If your body image irritates you as it might remind you of how you used to look, take it as a serious matter and visit a psychiatrist immediately.

Exercise During and After Pregnancy

Exercise will become an inseparable part of bariatric surgery patients. On the other hand, pregnant women are strongly advised to do some regular exercise in order to have healthier babies and easier delivery. Therefore, as a pregnant woman, you should consider routine physical activities that fit your physical circumstances.If you’ve just become pregnant, it is not a good time to begin a new exercise routine. Keep up your previous one, and if you were not used to exercising at all, just try to add some effective, yet not so intense activities to your lifestyle, for instance, walking.Before PregnancyIf you’re not used to exercising, just consult with your doctor to see how you can slowly add it to your life. Here are a few points to consider:-  Swimming and walking are good for you and your baby.- An activity/exercise regime of a minimum of 30 minutes per day and five times a weekAfter Pregnancy- Don’t start with heavy activities. Just give it a shot slowly, stick to the plan, and improve it gradually.- The best time for exercising is after nursing as your breasts are not that full and movement is much easier.- Wearing a sports bra adds up to the comfortability of your workout to a high extent. Wear one, especially in case you’ve got large breasts.- It’d be better if you do not drink water during exercise. However, a glass of water before and after the workout is strongly recommended.- Walking is a great way of exercise both during and after pregnancy. You can take short walks outside with your baby as well.- If the weather is not good for a pleasant, short walk outside the house, try having some fun activities in the house with your little one, maybe dancing?- Make sure to take a shower or at least wash your breasts after exercise as some babies prefer their food not to be salty.

Can I Get Pregnant with an Intragastric Balloon in My Stomach?

In comparison with other types of bariatric surgery, the gastric balloon is much simpler and reversible. However, if you’re planning to lose weight using a gastric balloon to increase fertility, it is better that you reach your ideal weight and then go for pregnancy.But sometimes, women get pregnant while having the balloon in their stomachs. This is not so problematic, but the removal of the balloon depends on its type. The 12-months balloons will be dissolved at the end of the year and there is no need for your doctor to remove them, but, the 6-month ones should be removed mostly by anesthesia, which is not suitable for pregnant women, thus not suggested.

Breastfeeding After Having Bariatric Surgery

Most women are concerned about whether they still can breastfeed after bariatric surgery or not. The answer is yes. Breastfeeding is recommended, however, specific attention to nutrition is still very important in this period.If you have any type of nutrition deficiencies, this will affect your milk since it will lack the necessary supplements for your baby’s growth.You can simply consult with your baby’s pediatrician, let them know about your bariatric surgery and your previous and current circumstances, and ask them to monitor your baby’s growth even more closely.If you have not reached your ideal weight before pregnancy and you’re still a bit overweight, there is a probability of after giving birth your milk comes later than usual. In this case, just talk to your doctor and ask for some advice that’ll streamline the breastfeeding process.

Nausea During Pregnancy after Bariatric Surgery

Nausea and vomiting are common in pregnancy. But you can manage it with dietary advice that’ll help you avoid or treat complications:

• Avoid food with strong odors.
• Eat small but frequent meals.
• Take a short walk before meals.
• Make a list of all the food that cause you nausea and try to avoid them.

Bottom LineEven if you’re not thinking about having a child, you might change your mind at some point in the future. However, obesity is a barrier that not only makes pregnancy so risky but in some cases makes it almost impossible.You might have tried everything but still, you’re dealing with excessive weight. In case you’ve done your research and found weight-loss surgeries practical, do not worry about pregnancy after the operation.The problems your mind is concerned about now, including any potential nutritional deficiencies, can all be controlled to a high level after bariatric surgery. But obesity creates barriers on your way to motherhood that cannot be overcome under any circumstances.Just wait for some months after surgery, prepare your mind and body, and you’re good to go: welcome to motherhood! 

Whether you are planning your bariatric surgery or already had one, it’s crucial that you know the most important facts about dumping syndrome after gastric bypass and gastric sleeve. It is one of the most common conditions after weight loss surgery. Luckily, most bariatric patients experience only mild symptoms, and they usually last from a few weeks to a few months.

Let’s have a closer look at the dumping syndrome definition, symptoms, levels, and causes. We’ll also give you some hints on how to prevent and treat dumping syndrome after gastric sleeve and gastric bypass surgery.

Caution!If you experience some of the symptoms, call your doctor immediately.

What is dumping syndrome?

Dumping syndrome can be defined as a common health condition in which food moves rapidly from the stomach to your small intestine. Another term used for this syndrome is rapid gastric emptying. (1)

There are two types of dumping syndrome you may experience: early or late. Early dumping syndrome is a condition that occurs from 30 to 60 minutes after eating, while late dumping syndrome happens after 1 to 3 hours following your meal.

An early syndrome is the most common type, while a late one happens to only 25% of weight loss surgery patients. However, it’s sometimes difficult to understand the difference between these two. Moreover, they can also occur at the same time. (2) It’s always best to consult your doctor about the symptoms you experience after your gastric surgery.

What are the levels of dumping syndrome?

The symptoms after gastric bypass and sleeve gastrectomy may differ, depending on the level. Symptoms of both early and late dumping syndrome can become mild or severe. Specialists have created many different kinds of questionnaires and scales to measure dumping syndrome symptoms. Some of them include only early dumping and therefore can be filled out by the patients. Other are scales that include lists of both early and late dumping, and these complications need to be measured by your doctor.

What are the symptoms of dumping syndrome?

In order to differentiate the two levels of this syndrome, here is a list of all the potential symptoms.

Early dumping syndrome symptoms can be listed as:

• diarrhea and nausea,
• feeling uncomfortably full,
• pain and cramping,
• tiredness 
• headache,
• fast or irregular heartbeat,
• extensive sweating.

Late dumping syndrome symptoms occur due to low blood glucose and include:

• feeling light-headed or fainting,
• feeling shaky
• feeling extremely tired, and weakness
• heart palpitations,
• sweating,
• trouble concentrating (1)

How long does dumping syndrome last?

It varies. Early dumping syndrome usually takes a maximum of 3 to 4 months after the procedure. Late dumping syndrome may on the other hand continue even for a year.

The length of dumping syndrome is related to the type of dumping level you’re experiencing, as well as your diet choices and lifestyle changes. As long as you are implementing your doctor’s instructions and following your dietary recommendations, you decrease your chances of the symptoms.

Does it improve over time?

Yes, it does. Most patients experience mild symptoms that improve over time, so in most cases, dumping syndrome is not a permanent condition. Only in very rare cases, only if not treated properly, it may persist for years.

Is dumping syndrome a serious condition?

Yes, dumping syndrome may become a serious condition. In some cases, it may be the reason for a very quick loss of weight and cause some nutritional deficiencies. If a symptom such as diarrhea continues for a long time, it may lead to dehydration. Remember that this kind of problem might usually be controlled and prevented.

Can this syndrome be a sign of a more serious condition?

Yes, it can. When it comes to late dumping syndrome, a lot of sugar enters your small bowel and for this reason, your body absorbs it too quickly. This is the reason the pancreas releases too much insulin which results in a very low level of sugar in your blood. This condition is called hypoglycemia. (3)

How common is it and who is more likely to have it?

What are the chances of dumping syndrome after gastric sleeve and gastric bypass surgery? Studies show that approximately 20-50% of patients who had stomach surgery develop some of the symptoms, from 5 to 10% of them in a severely disabling form. These numbers differ depending on the type of procedure.

It’s much more likely that you will experience the symptoms after your gastric bypass surgery. About 85% of gastric bypass patients will experience some dumping syndrome symptoms at some point after their surgery, and around 40% among sleeve gastrectomy patients. (2)

What causes dumping syndrome?

Reasons for this syndrome are mostly related to surgical operations performed on your stomach. However, there are also disease-related causes of this condition.

Food high in sugar is likely to cause dumping syndrome. This is because the high amount of sugar gets more water into the small intestine and this way can move gastric contents faster. Apart from meals high in sugar, also high-fat foods may be the reason.

You should definitely avoid rapid eating. It will lead to sudden fill and sudden emptying. Take small bites and chew your meals slowly.

Keep in mind that drinking while eating your food can also trigger dumping syndrome symptoms. Instead of water intake during your meals, drink your liquids continuously throughout the day.

What types of gastric surgeries can cause?

Weight loss surgeries that can cause dumping syndrome include gastric bypass and sleeve gastrectomy. Other stomach surgeries that may be the reason for this syndrome are pyloroplasty, esophageal surgery, vagotomy, and Nissen fundoplication.

Can it occur without gastric surgery?

Yes, it can. Disease-related causes are:

• Diabetes
• Exocrine pancreatic insufficiency
• Duodenal ulcers
• Zollinger-Ellison syndrome
• Functional dyspepsia
• Cannabis hyperemesis syndrome

Can stress trigger dumping syndrome?

You should know that stress doesn’t trigger dumping syndrome. Anxiety however is one of the late symptoms.

You need to remember though that stress can affect your stomach in a negative way. It’s easy to be confused if your symptoms are because of stress or dumping. Common symptoms related to stress are heartburn, indigestion, nausea or even vomiting, in extreme cases. Diarrhea, constipation, and pain in your stomach may also be the symptoms of long-term stress.

How it’s diagnosed

If you had a gastric bypass surgery or a sleeve gastrectomy, your doctor can diagnose dumping syndrome based on your symptoms. It’s possible that they can also decide you should take some tests to confirm the diagnosis. There are 5 key methods of diagnosing it, and two of the most popular are the oral glucose tolerance test and the gastric emptying test.

The most common way to diagnose dumping syndrome is an oral glucose tolerance test, which measures your blood sugar before and after drinking a glucose solution. This test can also measure your red blood cell count. If there is an increase after you drink the glucose, it means that the excess fluid volume moves from your blood to your intestines. When your blood sugar drops from 1 to 3 hours after the test, you suffer from a late dumping syndrome.

Another way of detecting is a gastric emptying test, which measures how rapidly the food moves through your stomach. A very small amount of radioactive material will be added to your food and a doctor will then observe how your meal moves through the stomach. This way they will be able to measure your gastric emptying rate.

How it’s treated

You can cure dumping syndrome by changes in your diet and exercises. If changing your eating habits and staying active don’t improve the symptoms, your doctor may prescribe medications. In some rare cases, when dumping syndrome is a result of gastric surgery, and when all other solutions fail, your physician may recommend another surgery to treat it.

What you can do is…

You can implement some dietary changes into your eating habits, as well as stay active after your surgery. Try drinking around 2 liters of water a day. Keep in mind it’s better to drink liquids between, not during the meals. You should also lie down for 15 minutes after you eat.

Try to stay away from any kind of sugar, refined or natural, until your symptoms are gone. You can start consuming natural sugar step by step such as fruits.

You can also try to eat your meals slower. To focus only on your meal, do not eat your meal while doing other activities such as watching TV.

How does exercising help?

Physical activity helps to promote a healthy digestive system while you are in a recovery process after your weight loss procedure. Regular exercises may also help you in reducing the symptoms of dumping syndrome.

Change your diet plan

Your diet should include both protein and fat: poultry, red meat, fish, eggs, tofu, nuts, and cheese. Slowly add more fiber to your meal plan. Some patients add pectin, which is known to delay gastric emptying. It can also decrease dumping symptoms when mixed with meals that contain glucose. (4) You may also try guar gum, which has similar effects. (5) It’s best to have 5-6 smaller portions a day, instead of having 3 large meals.

Remember to check with your doctor if you can include these foods in your diet. For example, soft cheeses like mozzarella or ricotta are usually tolerated. However, you should avoid harder cheeses like cheddar, because they may be more difficult to digest.

Medications

If the syndrome continues despite changes in your diet and sports activities, a doctor can prescribe some medications to help you solve this problem. Acarbose is a kind of medication that can be used in treating diabetic patients. Its main aim is to lower your blood sugar level after it increases following your meal. This way it helps to control reactive hypoglycemia. (6) Another solution is an octreotide injection (Sandostatin drug). It’s an injected anti-diarrheal medicine. Sandostatin may slow down the emptying process of your stomach.

I did everything but I still have it

For most patients, the symptoms improve over time. If they don’t, you should definitely consult your doctor. You need to inform your physician about any long-term symptoms of dumping syndrome, because they may lead to some serious nutritious deficiencies and dehydration.

Does it need to be monitored?

Yes, it does. Dumping syndrome may last for years and get dangerous for your health. Especially late dumping syndrome may persist for a very long time. Specialists advise patients who experience severe symptoms to contact the doctor and check if there is anything to worry about. (7)

When dumping syndrome is diagnosed, you should consult a dietitian. They will explain to you all the necessary dietary changes and adjust them to your needs. It is important that you monitor your weight to make sure you consume the required calories and nutrition. If symptoms do not improve after dietary modifications, see your doctor again. You may need some prescribed medications as an addition to your diet.

What are the long-term effects?

Some patients with long-term dumping syndrome might start to avoid eating to prevent the symptoms. This can lead to unhealthy weight loss and malnutrition. It can cause dizziness, tiredness, and lack of focus.

Can dumping syndrome cause weight gain or weight loss?

The result of a dumping syndrome can be both weight loss and weight gain.

For some sleeve gastrectomy patients dumping syndrome symptoms can be extremely stressful, so they limit the amount and type of food extremely, therefore losing extreme weight. (8) On the other hand, if you avoid healthy foods that are rich in nutrition, you may tend to replace them with liquids high in simple sugars that will give you an energy boost. This way you will experience both excess calorie intake and you may cause insulin-related problems that may also result in gain weight in the future.

Knowing this, it’s important that you talk to your doctor when your first symptoms occur.

How to prevent

If you want to try to prevent dumping syndrome from happening, there are some foods you can avoid in your diet. One of the side effects of dumping syndrome is that you eat properly which allows you to quickly learn what you should and shouldn’t include in your diet after the bariatric surgery.

What foods should be avoided to prevent this syndrome?

Avoid simple carbohydrates. Any sort of sweets, sugary drinks, fried food, and high-processed meals need to be excluded from your new healthy diet. You shouldn’t eat fruit that has a digestive effect, such as peaches or apricots. You also need to avoid any milk products other than cheese. It’s recommended to exclude food in extreme temperatures, so the meals that are too hot or very cold. Extreme temperatures can increase gastric motility and emptiness. Remember not to drink while you eat, but half an hour before and after your meals and between them.

Unfortunately, some effects of obesity might stay with you for the rest of your life, even when you reach your ideal weight. After all, some changes are irreversible.

That’s why even though bariatric surgery is the ultimate solution for obese patients, still there is one big concern: what to do with excess skin after weight loss surgery?

Before going through any type of weight loss surgery, a lot of questions about excess skin prey on your mind: how much bariatric surgery causes loose skin? Why my skin becomes saggy in the very first place? Isn’t there a solution for saggy skin? Can I improve my skin elasticity after the surgery?

In addition to the physical hassles saggy skin brings about, most people don’t like to see their bodies in such form. After all, weight loss surgery is both about improving your health and the betterment of your appearance.

The first and foremost point you should bear in mind is that all people do not experience excess skin after weight loss surgery in the same ways. There are many factors that directly or indirectly affect this process.

However, the good news is that like all the other side effects of bariatric surgery, this one has many solutions as well. So, stay with us for the next few minutes to get a better overview of excess skin after surgery and the ways you can overcome this obstacle.

Why Do I Have Loose Skin After Weight Loss Surgery?

In general human skin is elastic, which is because of some proteins like collagen and elastin fibers. After gaining some weight, your skin is stretched, however, when you lose that extra weight, your skin elasticity allows it to snap back to its former shape.

But all of this process depends on the duration and the amount of excess weight. If you’re overweight for a long period of time, or the excess weight is high, these collagen and elastin fibers lose their functionality noticeably. So, when you lose that extra weight, your skin won’t gain its former shape, which means the extra body weight is gone, but instead extra skin has remained.

Even thinking about it is frustrating, isn’t it? But no worries, with some changes in your lifestyle, you can simply treat and manage extra skin after weight loss surgery. Moreover, if you find them difficult, you can always go for plastic surgery.

What Factors Affect Loose Skin After Bariatric Surgery?

Depending on your age, genetics, amount of weight loss, sun exposure, smoking, length of time being overweight, and the overall circumstances before and after weight loss surgery, you might experience loose skin differently.

How to Avoid/Reduce Loose Skin After Weight Loss Surgery

The ways that help you in the process of excess skin removal after bariatric surgery are basically divided into two groups. The fastest, most popular solution is surgery. However, you might want to know whether there is a non-surgical treatment for wrinkly loose skin after bariatric surgery or not.

First, let’s take a look at the most effective excess skin removal ways that need no surgery. Then, if you’re not satisfied, you can take a look at the different surgical options you have.

1- Stick to a Healthy Diet.

If you’ve been considering bariatric surgery for some time, you might have been overwhelmed with advice on maintaining a rich, healthy diet. But nothing is as important as what nutrition your body’s delivered.

Remember when we talked about collagen and elastin fibers that are responsible for your skin firmness and how they are damaged after a long time of being overweight?

Make sure your diet contains a sophisticated amount of proteins, collagen in particular.

Chicken, fish and shellfish, egg whites, berries, and tropical fruits are rich resources of collagen. Take a look at the list of other food containing the highest amount of collagen. Make sure to have enough of them in your everyday meals.

Do not forget vitamin C and Omega-3 fatty acids as they’re necessary for increasing skin elasticity, especially in parts that damage the most including face and abdominal skin.

2- Take Care of Your Skin.

When it comes to skincare, a lot of people are strongly resistant as they think it requires a lot of time and money. But if you’re thinking about bariatric surgery, you must have skincare as an inseparable part of your life.

You don’t have to necessarily use expensive cosmetics in order to avoid or minimize loose skin. There are many home remedies, like using aloe vera gel, that’ll help you have firmer, healthier skin. Just make sure not to underestimate the significance of daily skincare even before going through weight loss surgery.

3- Exercise Regularly.

Sticking to a regular exercise schedule improves the process of tightening both your muscles and skin. Moreover, being physically active is something you must add to your post-bariatric surgery life.

But it does not have to be a heavy schedule. You can start by taking regular walks and then go to the next level by adding swimming, dancing, yoga, or even lifting weights to your plan.

Just be careful not to be hard on yourself, otherwise, you’ll damage your body in addition to eliminating the joy of exercise. Moreover, focus more on parts like abdominal muscles where more saggy skin may occur.

4- Give Your Skin Enough Time.

In most cases, your skin gets back its firmness to some degree. However, its pace might be slower than that of your weight loss. Don’t be disappointed. You should at least give your skin 12 months as it is the average time for your body to recover.

If implied all the above-mentioned treatments, yet got no noticeable response after 12 months after the surgery, you can start to think of surgery as the final, yet a certain solution for excess skin.

5- Cosmetic Surgery

If you don’t want to undergo another operation after bariatric surgery, that’s totally fine. However, some people do not get the satisfactory outcome of nonsurgical treatments.

Cosmetic plastic surgery has proven to be the fastest, most practical solution for bariatric patients who suffer from any type of post-surgery skin breakdown. Known as body contouring procedures, these types of plastic surgery are performed after weight-loss operations on specific body parts including the abdomen, chest area, upper arms, thighs, and face. The surgery includes one of the following procedures:

• Lower body lift (circumferential body lift)
  • Panniculectomy
  • Thigh & buttock lift
• Upper body lift procedures
  • Abdominoplasty (tummy tuck)
  • Panniculectomy (skin removal surgery)

Other medical solutions:

• VelaShape (makes skin more flexible using infrared, suction, and radiofrequency)
• ThermiTight (shrinks the tissues under the skin using radiofrequency)

 A Word to the Wise

Do not postpone bariatric surgery in fear of saggy, excess skin caused by fast weight loss. Remember, the younger you are, the better your chances are that your skin will get back to its pre-obesity days.

Make up your mind and take action today. Rest assured that the problems regarding loose skin after weight loss surgery can be solved much easier than the troubles obesity will get you into.

Our world is moving toward an overall higher body mass. Technological progress provided us with chances of more jobs that just require sitting and thinking while minimizing the amount of time we have for physical activities.

The food industry advertises its unhealthy, easy-to-prepare products as people prefer to spend less time on cooking, and more time on working.

Parks are getting destroyed in order to have more space for our massive highways and malls.

The above-mentioned causes alongside many other factors, hand in hand are directing us to more obese populations.

According to WHO, there were more than 1.9 overweight people in the world in 2016. This number is only for 18-year-old and more people. So, the other 340 million obese people were excluded from this number.

Obesity severely affects people’s quality of life while most solutions for this intense problem are irreversible and in most cases not even that effective. However, science has come to our rescue one more time and surgical procedures, also known by the name weight loss or bariatric procedures have proven to be the ultimate solution for obesity.

As obesity creates many more problems that affect short and long-term mortality, it is important for the surgical patient to make sure the solution they’re choosing for their problem notably reduces the risk for mortality.

Just like all the other medical methods, bariatric procedure is not pure from side effects. But what are these risks? To be more accurate, does this surgical procedure increase or decrease the risk of death? How? These are the questions you must find clear-cut answers to while considering weight loss surgery or any other solution.

This blog post is the result of studying the most credible researches alongside collecting the experience of the most accredited experts.

Obesity Death Rate vs. Bariatric Surgery Mortality Rate

Obesity, morbid obesity, in particular, is not just about not being able to wear any clothes you like or not feeling good enough about your appearance.

It causes some serious problems, including respiratory conditions, most of which not only put overweight people in great danger but decrease their life expectancy to a high extent.

Using the data-driven by previous studies, here’s a statistical analysis of the problems caused by bariatric surgery and obesity and the mortality rates of obese patients before and after the operation.

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), during a current study researchers examined the gastric bypass operation mortality rate of super-obese patients who had undergone surgery.

Following 10-year data, the results showed a 48% decline in death because of obesity and other diseases associated with being overweight and that these health benefits increase with time.

Another original observational study detected the effects of bariatric surgery in mortality on 4047 Swedish obese subjects that included both gastric bypass patients who underwent weight-loss surgery and nonsurgical controls, also called the controlled group, who received not nonsurgical treatment of obesity.

Here’s a chart review of the maximum weight loss bariatric surgery patients experienced:

	1-2 Years After the Surgery	10 Years After the Surgery
Gastric Bypass	32%	25%
Vertical-Banded Gastroplasty	25%	16%
Banding	20%	14%

Calculating the number of obese patients in the controlled group and the surgery group in addition to the data regarding the weight loss results and fatality rate, the researchers found out that the patients who accepted the surgery faced more long-term weight loss in addition to decreased mortality rate.

The reason for this noticeable long-term survival after the bariatric operations is pretty clear. According to Science Daily, overweight people, the ones with severe obesity, in particular, have higher chances of getting diabetes, different types of cancer, cardiovascular disease, high blood pressure, and etc.

These serious problems put them at greater risk of premature death to a high extent, about 50 to 100 percent more than people with BMI less than 30.

Short-Term Death Rates After Bariatric Surgery

One of the most significant factors to obese patients who are considering sleeve gastrectomy, bypass bariatric surgery, or other types of weight-loss operations, is to gather trustworthy information on the death rate after bariatric surgery in the short run.

A report published by the US National Institute of Health reveals the results of a study analyzing a follow-up period of 30 days and mortality rate during this time.

Of the 6118 patients included in the research, 18 people died, 16 of whom had Roux-en-Y Gastric Bypass (RYGB) and only 2 had gastric sleeve.

As gastric bypass mortality rate was about 0.3%, the probability of short-term death after this weight-loss surgery is so little.

Sleeve gastrectomy death rate is even less and close to 0 based on this study.

Most of the other studies observing the short-term fatality rate after bariatric surgery confirm this result as well.

Blood clots, internal hernia, nausea are some other complications that occur after bariatric surgery but do not result in death.

Long-Term Death Rates After Bariatric Surgery Procedures

But what about the long-term mortality rate? After all, bariatric surgery affects the patients for a lifetime. So, does it decrease this lifetime in the long run?

Let’s take a look at a study that included a 10-year follow-up of 4344 Brazilian bariatric surgery patients from January 1, 2001, to December 31, 2010.

The total death rate, regardless of the relativity of the death to weight-loss surgery or not, was 1.9%. The 10-year mortality rate was 3.34%, only 1% of this number was due to causes related to surgery.

If this result is not enough for your research, you can take a look at one of the longest studies that examined bariatric patients; this is a 23-year study that explores the mortality and rate in patients undergoing bariatric surgery.

This study, done and published by BMC, shows even more extended results than their previous study that observed patients for 17 years after the operation.

Based on its results, surgical treatments eliminate the fatal effects of obesity. In addition, its preventive effects remain for a long time, even 23 years after the surgery.

What Factors Affect Weight Loss Surgery Fatality Rate? How to Reduce Them?

It is clear for most people why severe obesity kills: type 2 diabetes, high blood pressure, kidney, liver, and heart disease, cancer, obstructive sleep apnea syndrome, and so on and so forth.

But a lot of people might not know factors for mortality after bariatric surgery as they’re not so many and not very probable.

However, it is necessary for obese patients to be aware of them and any probable methods that could help reduce these factors.

Severity of Obesity

Studies that evaluated mortality risk after weight loss surgery among super obese patients mostly found higher BMIs riskier, especially in super-obese patients with BMI higher than 70.

Even though bariatric surgery is more responsive for more obese patients, their high BMI increases the risk of death as well.

So, this is exactly why losing weight before the surgery is of high importance. The more you reduce your BMI, the higher your survival rate will be.

Types of Bariatric Surgery

There is not only one single type of weight-loss surgery, which makes making the right choice even more challenging for patients.

Two of the most popular bariatric procedures are gastric sleeve and gastric bypass surgery. Even though the ultimate goal of both of them is fast, sustained weight loss, they’re different in their procedures and other areas as well. Therefore, you must have enough information about both of them in order to be able to compare gastric sleeve and gastric bypass procedures.

One of the risk factors that require indispensable analysis is their surgical mortality rate.

Researches that delve into the safety of gastric sleeve and gastric bypass surgery, have estimated an 0.8% probability as the 30-day mortality rate of gastric sleeve and 0.14 for gastric bypass.

So, if you’ve thoroughly analyzed both of these procedures and still find gastric sleeve right for your situation, just go with it as it is in most cases the safer one.

Cardiovascular Causes

Cardiovascular causes are one of the most frequent reasons for mortality among bariatric patients.

The American Heart Association‘s guidelines suggest some necessary pre-surgery actions, including chest X-rays.

If you have morbid obesity and after consultation and check-ups, your doctor still recognizes you as a high-risk patient, you can always think about ways of non-surgical effective treatment for obesity.

Also, if they suggest that you postpone the time of surgery so that you can be more prepared and less of a risky patient, just put your trust in this plan and stick to it.

Regular Follow-ups, a Practical Solution to Reduce Post-Surgery Risks

A number of complications after bariatric surgery are solvable in case of regular follow-ups after the surgery. These risks include hypertension, diabetes, hyperlipidemia, and psychological problems like depression and suicidal thoughts.

Before the surgery make sure whether it is possible to have sufficient follow-ups of both your physical and mental situation in the clinic or any institution you are going to have the surgery at.

Surgical procedures better be performed in institutions with adequate follow-ups of superobese patients’ overall circumstances in addition to the best practices in bariatric surgery.

Bariatric Surgery Is Becoming Safer

According to a study that looked into the rates and causes of death after bariatric surgery among Pennsylvania residents from 1995 to 2004, the death rate in the follow-up decreased from 13% in 1995 to 7% in 2004. And the number might be even less right now.

The trends and progress of weight loss surgery, in addition to the enhanced expertise of surgeons, caused improvement in the safety of bariatric procedures.

So, when choosing your surgeon, be careful to choose a proficient one.

A Word to the Wise

The more accurate your pre-surgery tests are, the more aware your surgeon will be of your physical and mental conditions, hence helping you even better. So, please do not resist these tests and take them patiently.

If you’re told that you have to lose some weight before the surgery, take your time and listen to your doctor’s advice/

Also, educate yourself and your family about the surgery. Nothing can put you in danger more than lack of knowledge.

Finally, start your healthy lifestyle even before the operation. Work on your mind and your body. The more prepared you are, the better the results will be.

This document has been prepared by Dr. Ceyhun Aydoğan in 5 sections in order to help obese patients, who are considering excess weight loss surgery, gain accurate insights on the types of surgery, their risks, diet before and after surgery, and the average cost of each surgical procedure. You might feel depressed, isolated, and be suffering both mentally and physically. You might find yourself alone in this process and feel like no one else understands what you’re going through. To be honest, you’re not the only person feeling disappointed because of obesity-related difficulties. Just take a look at the map below to see how many people are dealing with the same challenges as yours. 

According to WHO, in 2016, there were about 1.9 billion obese people in the world. See? You are absolutely not alone!Weight loss surgery has raised in popularity over the last decades due to the increase of severe obesity in different parts of the world because when exercise and diet can’t eliminate extreme obesity, surgical options are the final solution to enhance obese patients’ health conditions. The variety in surgical procedures and methods used in these operations has led to the invention of different types of weight loss surgery including gastric bypass, gastric sleeve, biliopancreatic diversion, and so on. This variety acts as a double-aged sword since having more options brings about more confusion as well. But no worries at all! After reading this beginner-level series you will have more than enough information about bariatric surgery and will be able to easily determine the most suitable type of weight-loss operation for your situation.To evaluate your knowledge of bariatric surgery and find on which topics you need more information, just take a look at these questions and see if you have the answers:1- Do I know weight loss surgery pros and cons?2- Am I aware of the changes I have to make after the procedure?3- Do I know the qualifications for weight loss surgery? Is bariatric surgery right for me?4- Is bariatric surgery covered by medicare?5- Am I ready to make a lifelong commitment to change my lifestyle?6- Do I know how to prepare for this journey?So, have you got sufficient information on this topic? If not, no worries at all. By the end of this guide, you’ll have more than enough information to make the best decision. 

What Is Bariatric Surgery and How Does It Work?

Bariatric or metabolism surgery are the names generally given to all types of weight loss surgery, mainly because they directly affect surgical patients’ weight and metabolism to enhance the quality of their lives. These types of surgery are performed when excessive weight cannot be lost through changes in lifestyle and exercise. Most of the patients who have decided to have an obesity operation are under the impression that gastric reduction operations are only tube stomach (vertical sleeve gastrectomy) operations. However, this is not the case.

Does Bariatric Surgery Work?

Morbid obesity creates serious health problems that can be solved to a high extent, in some cases completely, by choosing the right type of surgical treatment for adolescent obesity. These problems include:- High blood pressure- Type 2 diabetes- Obstructive Sleep Apnea – Depression, anxiety, and other psychological challenges- Snoring- High cholesterol- Fatty liver disease – Kidney diseases- Gestational diabetes- Cancer- PCOS and other pregnancy problems – Heart diseaseUnfortunately, the list does not end here. But, having to deal with even one of them can turn your life into a nonstop nightmare. You might have tried tons of diets and plans to get rid of the excess weight, but not have been successful till this moment. Luckily, there is one solution that almost all obesity specialists have recognised as the most effective solution for sustained, long-term weight loss with a notably high success rate.

Cancer

The reason for devoting one section to cancer is that even though most people are aware of some problems related to obesity, especially cardiovascular, liver, and kidney diseases, but unfortunately, not a lot of people are aware that obesity raises the possibility for different types of cancer.

Bariatric Surgery Requirements

Before moving forward, you must know who qualifies for bariatric surgery. Let’s overview the features of the best candidates for bariatric surgery.

• Psychiatric Evaluation

First of all, it is necessary for patients to pass a psychological evaluation so that a specialist can find out whether they’re mentally ready or not. The purpose of this evaluation is to determine the patient’s psychological readiness for the operation and gather information about their behaviors such as motivation about the operation and self-preparation.

• BMI > 40

Candidates for bariatric surgery must tick some other boxes as well. Except for passing the psychiatric evaluation, you must have a body mass index (BMI) of 40 and above. 

In case of complications such as type 2 diabetes, high blood pressure, or sleep apnea, the necessary amount of BMI is between 35 and 40.

• Not Being a High-risk Patient

Pre-surgery check-ups should prove you’ve got no medical conditions that put you in the group of high-risk patients. Also, you should be mentally ready so that post-surgery depression is avoided as much as possible. If you have these requirements, make sure to check out the next section, Chapter 2, where you will be provided with information about the types of stomach reduction surgery.

How Old You Have to Be to Get Bariatric Surgery

Regarding the age of patient characteristics and age, there are two groups that are not advised to undergo weight loss surgery.- The first group is children, basically, anyone under 14 who has not undergone puberty yet. Even though childhood obesity causes serious problems that jeopardize their health, surgical solutions will also affect children’s health. Therefore, most doctors tend to control these complications using nonsurgical methods until they grow up.Moreover, for obese patients under 18 doctors do the examinations very carefully and make the final decision according to their overall physical and mental circumstances. – The second group are people above the age of 65 who have weaker mobility and general health. Before undergoing bariatric surgery, an experienced surgeon will make sure the obese patient is not a high-risk one. This determination is mostly done through cardiology and lung assessments. 

Who Is Not a Good Candidate for Bariatric Surgery?

If you have at least one of the below-mentioned conditions, then you should reconsider your decision on surgical options: – Being medically fragileIn case you have a serious chronic illness, cardiovascular complications, or spent more than one month in the hospital during the last month, you are considered as medically fragile. This term includes other conditions as well. That’s why you should provide your doctor with all your medical history. – Psychiatric disorders, significant eating disorders in particular – Not willing to change your lifestyle, for instance, quitting smoking and doing exercise- Alcohol addictionIn case you want to know who qualifies for bariatric surgery and all the characteristics of good candidates, in a nutshell, take a brief look at the table below.

Bariatric Surgery Statistics

As one of the types of invasive surgery, weight loss surgical options mostly bring about some concerns related to life after surgery its success rates, and complications. This is a very sensitive matter and cannot be covered in a few paragraphs. So, to complete this puzzle, you’d better read the third chapter, which is about all the risks after the operation. But for now, you should know the failure rate of bariatric surgery has decreased in the last decade and is getting even lower with all the study and research done in this field alongside the improved proficiency of bariatric surgeons. Also, these risks are not the same for all people and differ from person to person depending on each individual’s overall situation. 

Weight Loss Surgery Options

Gastric reduction surgeries performed with laparoscopic (closed) methods are basically divided into two groups known as restrictive and malabsorptive (absorption preventer) operations.However, some types of procedures are considered as combinations of the two as some features of both of these methods are mixed during their processes. 

1- Restrictive Surgery

Any surgical procedure performed on the shape of the stomach to restrict food coming into the stomach is called restrictive weight loss surgery. For example; sleeve gastrectomy is such an operation. During this operation, only the shape of the stomach is manipulated.During restrictive procedures, the stomach size will be decreased by at least one quarter. 

2- Malabsorptive Surgery

On the other hand, malabsorptive stomach reduction operations aim to reduce the amount of food absorbed by the small intestine by performing operations related to the size and position of the intestine. Gastric bypass surgery is an example of such an operation.Detailed descriptions plus photos of these procedures are provided in the next chapter.

What Is the Process of Bariatric Surgery?

All types of bariatric surgery generally go through three main stages:1- An intravenous line will be started using IV pain medication. 2- General anesthesia is required in order to put the patients to sleep. 3- Finally a breathing tube will be inserted into the patients’ windpipe to streamline breathing through the operation and the operation begins.

Bariatric Surgery Effectiveness

According to the University of Iowa Hospitals & Clinics, during the first six months after the surgery, on average most patients with obesity lose 40 percent of their excess weight. This number will add up to 77% one year after the operation. 

To what extent you lose weight and how long you will be able to keep your ideal weight depends highly on yourself. Preventing weight regain is only possible if you manage to keep a healthy lifestyle for the rest of your life, which requires a healthy diet and eating habits alongside regular, appropriate exercise. 

Let’s have an overview of what you’ve learned so far, and what you’ll read in the next sections.

Pros and Cons of Weight Loss Surgery

Advantages

As you lose weight and become lighter, your ability to move increases, hence becoming more active. Enjoyable activities you found impossible to do in the past will become sweet again. As your new life begins, you’ll be able to walk, swim, do yoga, and do any other physical activities you were unable to do before. Even talking about it is intoxicating, isn’t it?On top of that, all the previous physical and mental complications you had to live with due to excess obesity will be out of your life. Let’s take a look at some of the life-changing effects of weight loss surgery.

• Sustained, effective weight loss
• Improving patients’ body image 
• Improved fertility in women (the ones with PCOS in particular)
• Enhanced quality of life
• Long-lasting resolution of type 2 diabetes 
• Long term psychological effects (decreased level of anxiety and depression due to excess obesity) 
• Reduced risk of cardiovascular disease
• Improvements in dyslipidemia, hypertension, and other metabolic comorbidities related to obesity

Disadvantages

Like all the other medical treatments, bariatric surgery has its own side effects. However, this does not mean that you will necessarily experience all of them. Here’s a list of major complications of bariatric surgery. 

• Dumping syndrome 
• Nausea
• Abdominal cramps
• Hernias
• Low blood sugar
• Vomiting
• Malnutrition
• Hair loss
• Loose skin
• Psychological side effects (depression, changes in social relationships, etc)

Let’s weigh your life before bariatric procedure against after it.

Preparing for Bariatric Surgery

First of all, you have to visit an expert in order to understand whether you qualify for surgery or not. After the initial observation, your doctor will provide you with some guidelines on how to prepare for the surgery, which also includes some medical tests to analyze your overall circumstances.Some of these tests are:- Chest X-ray – Cardiac evaluation – Urinalysis – Complete blood countAfterward, your bariatric surgeon will give you advice on the types of operations and together you make the final decision. Your surgeon will let you know which type he finds better for you based on some factors including your history of surgery, eating habits, overall physical and mental situation, and BMI. 

Final Step

Once you’ve set the date for your surgery, it is time to start making changes in your life:- Quit smoking cigarettes and limit drinking alcohol.- Inform your doctor of your medications and the history of your previous complications and surgeries. – Add simple, yet regular exercise to your daily life.- Practice eating in accordance with a healthy diet (suggested by your doctor).- Implement new eating habits; for instance eating slowly and not eating solid food and liquids simultaneously. – Educate yourself by reading more about your life before and after bariatric surgery and the changes your body will go through.- Take multivitamins (consult with your dietitian).- Clarify your weight loss expectations for your doctor and consult with them in order not to have any unrealistic expectations.

Weight Loss Before Bariatric Surgery

Most patients worry about whether they must lose weight before bariatric surgery procedures or not. First and foremost, you should know that one of the factors that directly increases the failure rate of weight loss surgical options is severe obesity.Therefore, most doctors ask their patients to lose some weight and provide them with helpful advice in addition to diet and exercise schedules so that they can achieve this goal.This schedule mostly includes eating healthy food in addition to adding regular activities to your life. 

Life After Bariatric Surgery

There are concerns patients might have that are related to the time right after the surgical procedures. Some of these concerns are:- How long is the recovery time?- How much pain one might have to tolerate?- What to eat and what not to eat?- What are the complications, right after the surgery?and so on and so forth.On the other hand, there are some other worries that although they might happen sometime after the surgery, yet still are important.- Is life after gastric sleeve different from gastric bypass?- Will I regain weight? If yes, when and why? – Will the limitations in my food intake affect my health? – When will I reach my healthy weight?Each of these questions is so important that one separate article can be devoted to them. However, we’ve tried to give you a brief, yet all-encompassing overview of the answers.

Recovery Time After Bariatric Operations 

Most bariatric operations are done using laparoscopic surgery procedures. Due to the small cuts that are made during these procedures, the initial recovery process usually does not take more than 2 to 3 days. In case of further complications, you might need to stay longer in the hospital to have your circumstances checked by your doctor. Depending on the type of your surgery you should rest between 3 and 5 weeks after leaving the hospital and then you’ll be able to restart your normal life.

Average Weight Loss After Bariatric Surgery

Even though your weight loss progress differs after each type of surgery, both in terms of pace and quantity, its average amount is somehow the same, especially in the long run. You can expect 35 to 45% loss of your excess weight after the simple ones. However, with more complicated procedures like gastric bypass, your body will lose 75% of its excess weight. For more details, make sure to carefully read chapter 2 where you’ll learn more about the exact differences in weight loss between various types of bariatric surgery. Moreover, the overall expected weight loss after bariatric surgery depends on other factors including genetics, age, sex, etc, which is exactly why you should consult with your doctor and have realistic expectations before you agree to undergo an operation. 

How Long Can You Return to Work After Bariatric Surgery

It mostly takes two to three weeks for gastric sleeve surgery and gastric bypass patients to go back to work. Some patients might feel better and ready to get back to work within at most a month. However, the exact recovery duration before going back to work depends on the type of surgery as well as your body’s response to it. 

ّFollow-ups After Bariatric Surgery

If you ask for one definite solution that will minimize post-operation complications it is for sure follow-up sessions. Why?- First and foremost, you cannot be sure whether your surgery was successful or not at the time of discharge. During follow-up sessions, your weight loss process and overall circumstances will be closely examined and you’ll be certain when your doctor tells you everything has gone well.- Second of all, malnutrition is the one complication that can be eliminated simply by having the right diet and taking the necessary supplies. With the help of your dietitian, probable nutritional deficiencies will be diagnosed and treated. – Last but not least, during follow-up sessions dumping syndrome and the other side effects of bariatric surgery can be diagnosed in the early stages. Therefore, you’ll be able to control and cure them before it gets severe. 

When Can You Take a Shower?

After 48 hours of your surgery, you can take a shower, but you’re not allowed to stay in a bathtub. For that, you should wait about one week. 

How You Should Take Care of Your Wounds After Weight Loss Surgery

Your wounds are not very big and are mostly small incisions because of the laparoscopic surgery. Some bandages that look like white tapes are placed on these small spots. If they become a little red or white or yellow liquids come out of them, do not worry, it is very normal; unless it becomes excessive. If the bandages don’t fall after 5 to 7 days, you can take them off yourself. Check them every day. If you see any signs of infections, or the liquid becomes smelly and more than usual, call your doctor. The scars may still stay a bit red or purple depending on the type of your skin. If you don’t have any marks remaining at all, use sunscreen whenever your abdominal skin is exposed to the sun. 

How to Manage Pain

Don’t forget that you have experienced an operation. Of course, you’ll have some pain, especially from your incisions. But it becomes better during the first three days.Your doctor will prescribe some painkillers before you are discharged. The key point is not to let your pain become intolerable. According to this pain scale, take your pills whenever you feel pain between 3 and 4. 

Keep Yourself Motivated

There might be times after the surgery that you’ll feel demotivated to stay committed to the changes you’ve made in your life. Here are some tips that will help you regain your motivation:

Carry on with Your JourneyBelieve it or not, you just took the first step of your bariatric surgery journey. But you only have a general image of what it is and there are still essential pieces to complete this puzzle and decide whether you want to have bariatric surgery and if yes, which type suits you best, what its risks are and where to have the surgery to enjoy both the most affordable prices and ultimate expertise. Let’s move on to the next chapter to read everything about weight loss surgery types.  

In the previous section, we discussed the basics of bariatric surgery. In this chapter, we will take a look at the most preferred types of bariatric surgery. Let’s get started.

Even though the cost of bariatric surgery may not initially seem reasonable for a lot of people, the long-term costs of obesity are even more. Therefore, obese patients go for different types of weight-loss surgical options mainly because of two reasons:

First, they are dealing with obesity-related complications that are difficult to tolerate and have tried all non-surgical treatments, yet got no answer. So, they need an effective treatment that will help them get rid of severe obesity and its associated difficulties.

Second, they are not experiencing any serious obesity-caused challenges but are worried about the passage of time and getting older, sooner or later they will have to deal with these challenges. 

Types of Bariatric Surgery

Although there is different information about the first bariatric surgery, most sources claim the first operation for the purpose of weight loss was performed by Dr. Kremen in 1954. Since then, because of all the research on weight-loss surgical procedures in addition to the progress of laparoscopic surgery, experts could find various surgical methods to resolve morbid obesity. 

The rising of the new surgical treatments of obesity helps more and more patients with different circumstances to benefit from this option. However, the variety of options brings about confusion for obese individuals as well. 

We’ve prepared this article with the aim of providing you with thorough information on the most common procedures, their step-by-step process, benefits, and other significant information that’ll help you decide which one is the best fit for your individual situation. 

Each surgery type helps you with sustained weight loss in a different way, all of which have been categorized into 4 general groups:

1- Restrictive Bariatric Surgery

Their main job is to shrink the size of your stomach. The capacity of an adult’s stomach is usually about 2.5 ounces of food. After undergoing restrictive procedures, your stomach can hold about one ounce. As a result, you will be able to eat less than before and start to lose weight. 

2- Malabsorptive Surgery

Malabsorptive bariatric surgery mostly changes the patients’ digestive process. By making changes in your stomach structure, a notable portion of your food intake won’t be absorbed and will be bypassed from your body. 

3- Combination of Malabsorptive and Restrictive Procedures

This type of bariatric surgery procedure not only reduces the size of your stomach but eliminates a significant portion of the nutrition taken by you from the route that food now passes through. 

4- Implanting an Electrical Device

This method that has been the newest one makes some changes in your nervous system by barging in the signals your brain sends to your stomach. 

Now that you know the ways in which these surgical processes work to expedite weight loss, it is time to get to know the procedures and their benefits and processes individually. 

Sleeve Gastrectomy Surgery

Some patients find it interesting when they realize there is a relationship between the name of this surgery and its functionality. During this surgical procedure, the surgeon removes the major part of your stomach. What remains is a banana-size organ, which is as small as a “sleeve”. 

As a restrictive procedure, this surgery limits the amount of food you can consume because it reduces the size of your stomach. 

Sleeve Gastrectomy Procedure Steps

1) Your surgeon makes small abdominal incisions in order to insert small trocars for it is necessary for laparoscopic surgeries. 

2) Then, the stomach is carefully inspected.

3) A tube, which is the exact size of the new sleeve-size stomach is inserted into it so that the surgeon can cut the right size. 

4) There is a valve between the stomach and the small intestine called the pylorus. With a distance of about 4-6 cm from this valve, the surgeon divides, using a stapler, dividing the stomach into two parts. 

 5) The line will be continued till the stomach is totally divided. After that, the banana-shaped new stomach is created. 

 6) About 75-80% of the stomach is removed and only 20% of it remains. After carefully being decompressed, the larger part is removed through a small incision. 

7) The smaller size of the banana-shaped new stomach causes patients to become full much faster than before. 

To see all the steps in one place, just take a look at the picture below.

Also, here’s a sleeve gastrectomy diagram that shows your stomach before and after the surgery.

Expected Weight Loss With Sleeve Gastrectomy

If you’re willing to undergo weight-loss surgery, one of the most important points that affect your decision is the average weight loss after each type of surgery. Here’s a diagram of the average excess weight loss most people experience after gastric sleeve surgery. 

Gastric Sleeve Surgery Recovery Time

Your hospital stay is estimated at about  2 to 3 days. After that, you’ll need to rest for about 4 to 6 weeks for a full recovery and then you can get back to work and your normal life.

Benefits of Gastric Sleeve

Benefits of Gastric Sleeve

Shorter surgery time alongside simpler procedure in comparison with other surgical options.

Fewer risks, so it can be performed on higher-risk patients.

Effective Weight loss

Less recovery time

Blood sugar control and the complete resolution of obesity-related health issues including cardiovascular disease, type 2 diabetes and sleep apnea disorder

Approximately 0 chances of dumping syndrome after the operation

In case you’re interested in the side effects of gastric sleeve surgery, don’t miss the next chapter on bariatric surgery risks. 

Gastric Bypass (Roux en y Gastric Bypass)

Gastric bypass, also called Roux-en-Y gastric bypass, is one of the oldest types of weight-loss surgery, yet still one of the most popular ones.

It has been performed for more than 50 years and proved to be the final solution for morbid obesity. 

Laparoscopic Gastric Bypass Procedure Steps

Gastric bypass surgery mainly includes 4 steps:

1) The first step is the creation of the gastric pouch by making the top of the stomach into a small pouch.

2) Then, in order to create a biliopancreatic limb, the surgeon cuts a  loop of your small intestine. One end of this loop is connected to the previously created gastric pouch. 

3) The other end of this loop is reconnected to the small intestine, which acts as another anastomosis.

4) As a result, food intakes will bypass the stomach as they will be redirected to an area farther down in the digestive system. 

Here’s an image of your stomach before and after gastric bypass surgery:

Benefits of Gastric Bypass Surgery

Benefits of Gastric Bypass Surgery

Improved overall health condition including the remission for type 2 diabetes and heart disease, and resolution of sleep apnea

More overall weight loss in comparison with other types of weight-loss surgery

Healthier food choices after the surgery as consuming unhealthy food creates discomfort

Faster weight loss right after the surgery

Gastric Bypass Recovery Time

Gastric bypass might cause a longer hospital stay due to its more complicated process. However, the overall recovery time is just the same, about three to six weeks.

To know about Gastric bypass risks, take a look at the next chapter; it gives you a better understanding of why you need to stay at the hospital and under your doctor’s control after gastric bypass more than other procedures. 

Gastric Bypass Weight-Loss Chart

To have realistic expectations, you’d better know how much of your excess weight you’ll lose after experiencing Roux-en-Y gastric bypass. 

Mini Gastric Bypass Surgery

Most people who consider gastric bypass and gastric sleeve, find mini gastric bypass an attractive alternative because it is a quicker and simpler procedure. 

Mini Gastric Bypass Procedure

1) The bariatric surgeon will divide the stomach using a stapler in a way that most part of the stomach is not attached and will no longer receive food. 

2) About 2 to 7 feet of the intestines are bypassed. What remains of the intestines will be attached to the newly formed stomach. 

3) Food intakes will only flow into your tube-shaped stomach and after bypassing 2 to 7 feet of your intestines, the usual digestion process begins. 

Mini Gastric Bypass vs. Gastric Bypass

By looking at the diagram below you can see the main difference between the two procedures. There is only one join between stomach and bowel, called anastomosis, in mini bypass, but in gastric bypass there are two, which is why mini bypass takes less time. 

Benefits of Mini Gastric Bypass

Benefits of Mini Gastric Bypass

Simpler and quicker procedure

Creating only one anastomosis means less cutting, hence less risks

Faster recovery

No risk of internal hernia

Similar weight loss to other procedures

Adjustable Gastric Banding

Gastric banding is distinctive because of its less invasive and reversible nature. After this obesity procedure because of the silicone band around the top of the stomach, patients become full sooner than before.

Over the course of three years, patients will lose 40 to 60% of their excess weight. The surgeon adjusts the band from time to time after the surgery using a small port beneath the obese patients’ skin. This process is not uncomfortable or painful at all. 

When necessary, the gastric band will be removed and the stomach goes back to it original form. 

Laparoscopic Adjustable Gastric Banding Procedure

1) First of all, a tunnel is created under visualization from the lower media aspect of the right crus. 

2) Then, the surgeon grasps the band and retraces it into its right position. 

3) Finally, the band is locked using the counter tension by the graspers. You can see the direction of the graspers in the picture below. 

Here’s a diagram of gastric banding that shows the changes your stomach undergoes before and after this bariatric operation.

Benefits of Adjustable Gastric Banding 

Benefits of Gastric Banding Procedure

Least reported mortality cases among all bariatric procedures

The least invasive weight-loss surgery

No need for cutting or rerouting the intestines

Lower probability of nutritional deficiencies

Adjustability and reversibility

Is Adjustable Gastric Banding Surgery Reversible?

Yes, as we said before, gastric banding is accounted as one of the reversible bariatric procedures. So, in case any problems with the band occur, your surgeon is able to perform the gastric band removal easily using some small incisions. This is the main reason for the popularity of this procedure. 

Gastric Balloon

As the simplest bariatric procedure that eliminates adolescent obesity, gastric balloon is nowadays mostly used for patients who want to undergo weight-loss surgery, but due to high BMI are considered among high-risk patients.

After gastric balloon, they have a good few months to lose some weight, about 6 to 8 pounds per month, and then will undergo another surgical option like gastric bypass, which will help them reach their ideal weight and lose almost all of their excess weight. 

Gastric balloon procedure, performed with an endoscopic method, takes about 15 minutes. The result of this surgery is reduced capacity of the stomach, which causes obese patients to eat a lot less than before.

Gastric Balloon Procedure 

1) With sedoanalgesia method, patients will be relaxed and allowed to sleep for about 15 minutes. 

2) With the help of an endoscopic camera, the gastric balloon is inserted and placed into the stomach. This balloon is flexible, so it can easily pass through the esophagus with no hassle. 

Here’s another picture that shows how your stomach looks when it’s full after the intragastric balloon procedure. 

Candidate for Gastric Balloon

Good Candidates for Gastric Balloon

Obese patients between the ages 18 and 60

Patients with high BMI (above 40) who want to reduce the risks before undergoing another type of bariatric surgery

Patients with BMI between 30 and 39

Patients with no difficulties in the digestive system, including large stomach hernia and stenosis

Patients who have not experienced any type of bariatric surgery before

People with no alcohol or drug addiction

Biliopancreatic Diversion

Biliopancreatic diversion is one of the most complicated bariatric procedures, yet so effective especially for patients with BMI more than 60 kg/m2.

Biliopancreatic Diversion Procedure

1) During the first step, the surgeon, using metal staples, cuts through the stomach to create a pouch.

2) Then, the remainder of the stomach, which is about almost one-quarter of its original size, is removed. 

3) Finally, one end of your small intestine will be attached to the pouch. From now on, food will flow from the pouch and enter this section of the small intestine. 

Here’s a clear visual representation of your stomach after the surgery: 

Why Biliopancreatic Diversion?

Benefits of Biliopancreatic Diversion

Reducing high serum glucose and cholesterol

Effective weight loss

Reduced nutrition absorption

Beneficial for patients with BMI over 60

Biliopancreatic Diversion with Duodenal Switch

Also called a duodenal switch, biliopancreatic diversion with a duodenal switch is a type of surgery to facilitate rapid weight loss. 

This surgical process reduces the length of your small intestine in addition to the size of your stomach. Moreover, the number of nutritions you can eat and your body absorbs declines as well.  

After creating a pouch and removing the rest of the stomach, a very short part of the small intestine is attached to it. This part is called the duodenum and this step is known as duodenal switch. 

As a result, the food consumed by patients solely goes through the new stomach pouch. Because the food bypasses the small intestine, through the digestion process patients absorb fewer calories. 

Biliopancreatic Diversion With and Without Duodenal Switch

According to a clinical comparison between biliopancreatic diversion and biliopancreatic diversion, the main reason for preferring BPDDS is that even though the excess weight will be lost up to 70% after biliopancreatic diversion, there is a high risk of malnutrition and diarrhea, which can be preserved if the procedure is done with duodenal switch. 

Laparoscopic Single Anastomosis Duodenal-Ileal Bypass with Sleeve

We’ve mentioned the most popular and oldest types of bariatric surgery, but now is the time to introduce the one that is accounted as one of the most recent ones. 

Described first in 2007, BDP-DS with sleeve was invented to streamline the complex process of BDP-DS. SADI-S, just like the other bariatric surgical options solves any obesity-related severe medical condition including high blood pressure, fatty liver disease, obstructive sleep apnea, and type 2 diabetes. 

SADI- S is a perfect option for patients who have undergone sleeve surgery but are looking for even more weight loss. 

SADI-S Procedure

1) The procedure starts by making a small, tube-shaped stomach. This is exactly how sleeve gastrectomy starts. 

2) Afterward, the surgeon will divide the small intestine just after the stomach.

3) Next, to connect the intestine to the stomach, a loop of it, feet from the end, is measured and an intestine connection is performed. 

The picture below shows the stomach after the completion of this process.

Which Is the Safest Bariatric Surgery?

Before answering this question, you should know one fact: the more weight loss you experience after a type of weight loss surgery, the higher are the risks and complications. In other words, the more invasive procedures are exactly the ones that bring about noticeable, sustained weight loss.

Among all the surgical and nonsurgical weight loss procedures, there are three that are relatively known as the least risky ones:

1- Gastric balloon

Gastric balloon is a nonsurgical, yet popular bariatric procedure, and because of its nonsurgical procedure, it has the least complications. The process of the balloon insertion takes at most 30 minutes. In the case of swallowable balloons, such as the Elipse gastric balloon, the procedure is simple and you have almost no side effects after the placement of the intragastric balloon inside your stomach.

However, the weight loss that happens during the time you have it in your body is way less than the ones after more invasive ones, like gastric bypass. Moreover, if you start eating a lot and reduce your physical activity, the chance of weight regain is higher. Yet again, if you’re looking for safety, this procedure is highly recommended. It gives you the chance of weight loss for almost 6 months and then you can continue your journey more easily and with a determined mind.

2- Gastric banding

Even though gastric banding is a surgery, it is the least invasive one and has the fastest recovery as patients can go back to work after a week. The entire procedure takes 30-60 minutes. You lose weight after this surgery, even more than gastric balloon, but not as much as the amount you do with other surgical procedures.

3- Gastric Sleeve

Among the more invasive surgeries, such as gastric bypass and duodenal switch, sleeve gastrectomy still wins the safety competition. According to research led by the University of Michigan Health gastric sleeve patients experience fewer complications in comparison with patients who undergo gastric bypass.

When comparing two of the most common weight-loss surgeries, a research team led by the University of Michigan Health found that long-term, sleeve gastrectomy is safer than gastric bypass for Medicare patients.

In our weight-loss surgery types article, we have compared different types and their risks as well. You can take a look at the table that shows the exact complications after each procedure there.

Beware that the final decision is yours. Sometimes the severity of obesity does not allow less complex procedures, like gastirc balloon, to come effective. Therefore, even if you undergo them, in the case of weight regain in the future, what are the dangers of obesity?

But never make a decision if you’re not sure of it.

Revisional Bariatric Surgery

Revision bariatric surgery, or simply called revisional surgery, is performed when an obese patient experiences weight-loss surgical treatment, but is not satisfied with the result.

This may occur mostly when patients do not pay attention to their diet and exercise. However, patients are not always responsible for this failure as in some cases their bodies do not respond to the type of surgery they’ve chosen. 

For instance, if you’ve experienced lap band but have not received satisfying results even after adjusting the band, you can try gastric bypass as your revision surgery. 

However, just like any other surgical procedure, it has its own risks, so thorough consultation with your surgeon is strongly advised. We’ll talk about the risks of this surgery in the next chapter where we completely discuss the side effects of all the bariatric surgery options.