Early Post-operative period

Patients are typically in hospital for about 1 to 3 days after a band placement, and 3 to 5 days after gastric bypass for weight loss.

Intensive dietetic intervention, which begins before the surgical procedure, is reinforced on the ward before the patient leaves hospital.

Many individuals undergoing bariatric procedures are on a number of different medications for various problems, and the ward pharmacist would work in close liaison with the bariatric team to ensure appropriate doses and formulations (e.g., suspensions) are available to patients after restrictive or malabsorptive procedures.

For minor surgical issues in the initial period, such as those related to wound healing, patients would be expected to have access to ward staff after they go home.

Band Fills

Individuals who have a gastric band are reviewed 4 to 6 weeks after surgery for “filling” of the reservoir to tighten the restriction. This procedure is often performed by a radiologist initially. Subsequently, further adjustments are made as needed and may be performed in some centres without radiological control. Sometimes, a number of adjustments are needed before an optimum level of restriction is achieved, and it is important that patients are well aware of this vital process.

Later Post-operative period

All patients undergoing bariatric surgery need to be assessed and followed-up carefully for their nutritional status. Micronutrient deficiencies are more common with bypass procedures, but may occur with any procedure. The majority of patients with a gastric bypass will need vitamin B12 and calcium supplementation lifelong. Clinical and biochemical assessments are performed as needed, and no later than 6 months after the procedure. The absence of weight loss does not preclude vitamin or trace element deficiency.

Lifestyle change support is essesntial after weight-loss surgery. Numerous issues are interlinked in the complex phenomenon that is severe obesity. Much distress can result from changes in relationship to food and social or family dynamics, for example, if appropriate preparation and support is not planned.

Expected weight loss

A number of metabolic benefits are seen in patients who undergo bariatric surgery. For example, after a Roux-en-Y bypass procedure, individuals with insulin-requiring Type 2 diabetes have been noted to stop needing insulin well before significant weight loss is seen. This effect is believed to be related to changes in gut hormones.

Discussions regarding long-term weight loss often quote the Swedish Obese Subjects Study. This was a prospective, controlled study where 4047 obese individuals either underwent bariatric surgery or conventional treatment. The following diagram summarises percentage weight change over 10 years.

The data shown represent individuals with mean BMI 41 kg/m2 and mean age 48 years.

Results

Sjostrom L, et al for the Swedish Obese Subjects Study Scientific Group. Lifestyle, Diabetes, and Cardiovascular risk factors 10 years after bariatric surgery. New Eng. J. Med (351): 2683-2693. 2004.
© 2004 Massachusetts Medical Society. All rights reserved. Used with permission