Obesity Surgery & Weight Loss Surgery Clinic

The number of people whose excess weight seriously threatens their health has doubled in the last ten years. By the time 'Obesity Epidemic' headlines began appearing, at Abbey Sefton Hospital our Obesity Surgery Centre was already established and performing bariatric (obesity) surgery.

Over 700 procedures have by now been performed by a team comprising Bariatric Services Manager, Lead Bariatric Nurse, dedicated surgeons and anaesthetists, specialist ward nurses, dieticians, respiratory physicians, theatre nurses and technicians. With the addition of cognitive behaviour therapy and specialist physiotherapy, our total package of care has further support services to aid you to get the best result from your procedure.

We offer a number of different ways to reduce weight through surgery. At your first visit a consultant surgeon specialising in obesity will carry out an assessment of your particular needs and discuss your dietary habits and lifestyle. Together we will then choose the procedure most likely to maximise your weight loss in a safe and controlled way and tailor-make a fully costed personal treatment plan.

Bariatric surgery gives you the physical tool to assist you in losing the weight you may have tried in vain to achieve by diet or lifestyle changes. Now these methods become essential to maintaining the benefits of surgery long term. Studies have shown that the most successful outcome from surgery is gained by patients who understand the need for long-term follow-up, build exercise into their daily routine and make the necessary emotional and mental changes. We are geared to provide you with continuing, comprehensive help.

COGNITIVE BEHAVIOUR THERAPY

At our cognitive behaviour workshop you will receive information, support and help in improving success following surgery. It is led by a specialist Clinical Psychologist who also runs the monthly support group which continues on from the workshop.

EXERCISE

Although exercise is extremely important following surgery, we realise there are drawbacks to going to a gym. That is why we offer the services of a dedicated physiotherapist with 17 years experience working with sportspeople who will tailor make an exercise programme specific to your personal needs.

MONITORING

Your consultant will wish to see you as an outpatient for a post-operative visit. He will then continue to oversee your treatment plan which will entail seeing you regularly over 12 months and, less frequently, over subsequent years.

Weight reduction surgery becomes an option when obesity reaches a point called morbid obesity where the risks of serious weight related illnesses increase dramatically. For example, very obese men aged 25-35 are twelve times more likely to die prematurely than those with normal weight. The complications of morbid obesity include diabetes and high blood pressure which in turn can lead to heart attacks, congestive heart failure and stroke.

WHO IS SUITABLE FOR SURGERY

To help us decide on suitability for surgery we follow the guidelines suggested by the National Institute of Clinical Excellence (NICE) central to which is the body mass index (BMI). You can work yours out by dividing your weight (in kg) by your height (in metres) then dividing the result again by your height (in metres).

To be considered for bariatric surgery:

• Your BMI should be over 40, or over 35 if you already have a weight related medical condition.
• You should already have seriously tried to lose weight several times with medical help but have failed to maintain weight loss;
• You should be fit enough to have surgery and no psychological or medical reasons to make it inadvisable;
• You should understand the need for long-term follow-up and commit to changes in lifestyle.

GENERAL WEIGHT SURGERY GUIDELINES

As well as cutting down the risk of critical medical conditions including diabetes, heart disease and certain cancers, surgery can help to ease a host of other related health concerns such as sleep apnoea (stopping breathing whilst asleep), asthma, lower-back pain, urinary stress incontinence, degeneration of knees and hips, depression, menstrual irregularity and infertility. You will also recover confidence in yourself and your appearance.

WEIGHT SURGERY BENEFITS

The overall medical and emotional benefits of Bariatric surgery can begin almost immediately. Over time these improvements may be seen in:-

• Type II diabetes
• Hypertension
• Arthritis
• Obstructive sleep apnoea
• Mobility
• Gastro Oesophageal Reflux Disease

• Cholesterol
• Polycystic Ovary Syndrome/Fertility
• Weight loss
• Self esteem
• Quality of Life

WEIGHT SURGERY RISKS

• Internal infection from leakage of digestive juices into the abdominal cavity
• Hernias
• Gallstones or gallbladder disease due to rapid weight loss
• Wound infections
• DVT's or pulmonary embolism
• Vitamin deficiencies - this may be preventable if taking supplements as instructed

GENERAL GUIDELINES

Your body digests food by breaking it down with acids and juices on its journey from mouth to stomach and then through the small intestine. In the process, calories, nutrients and minerals are absorbed into the bloodstream to power the body. Becoming obese interferes with the signal of having "had enough" and people carry on eating. The spare energy is converted into fat and stored. Surgery can either restrict food intake or by-pass part of the digestive system.

RESTRICTIVE

Restrictive operations work by reducing the stomach and thus inhibiting hunger. This does not interfere with normal digestion or alter your anatomy so recovery is quicker. The surgeon creates a small pouch at the top of the stomach where food enters. It can store about an ounce of food but may later stretch to two or three ounces. The outlet of the pouch, being only about half an inch in diameter, delays the outflow of food causing a feeling of fullness. You will no longer be able to eat large portions at one time.

RESTRICTIVE/MALABSORPTIVE

Malabsorptive surgery prevents your digestive system from processing a proportion of the calories of the food you eat. The food is separated from digestive juices to leave only a short section of the small intestine to absorb nutrients. Operations which combine malabsorption and restriction are the most common. They ration both food intake and the amount of calories and nutrients the digestion takes in. To perform both kinds of operations we nearly always use laparoscopic (keyhole surgery) techniques. The surgeon makes several small incisions through which slender instruments are passed, creating less tissue damage than a large incision.

NORMAL DIGESTIVE ANATOMY

Having been partly digested by the stomach, food passes through the duodenum, where it is processed by juices from the pancreas. Nutrients continue to be extracted by the jejunum and ileum, the remaining sections of the 20 foot long small intestine.

ADJUSTABLE GASTRIC BANDING

A hollow silicone rubber band is placed around the stomach near the top end, leaving only a narrow passage into the rest of the stomach. This is inflated using a solution through a tube connected to an access port placed under the skin. This can be adjusted over time to change the size of the passage. The procedure is known as adjustable gastric banding surgery.

This is easier to perform and generally safer than malabsorptive operations, but weight loss tends to be smaller.

Patients who maintain the necessary changes in eating habits after the operation can lose over 50-60 per cent of their excess weight in under two years.

ROUX-EN-Y GASTRIC BYPASS (RGB)

This is easily the most common and successful combined procedure at Abbey Sefton Hospital and across the UK. The surgeon creates a small stomach pouch to restrict food intake then attaches the pouch to a Y shaped section of the small intestine so food by-passes the lower stomach, the duodenum and the first portion of the jejunum. This reduces the amount of calories and nutrients the body absorbs. Taking away the pyloric valve may cause a side effect of dumping syndrome.

The Laparoscopic Gastric Bypass and Duodenal Switch work through a combination of restriction and malabsorption. The Gastric Bypass mainly works through restriction of portion size, whereas the Duodenal Switch works mainly through malabsorption

DUODENAL SWITCH (DS)

In this more complicated combined operation, the lower portion of the stomach is removed. The duodenal switch leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

The portion of the small intestine connected to large intestine is attached to the short duodenal segment next to the stomach.

The remaining segment of the duodenum connected to the pancreas and gallbladder is attached to this limb closer to the large intestine. Where contents from these two segments mix is called the common channel, which deposits into the large intestine.

FIRST STAGE FOR A TWO STAGE PROCEDURE (SLEEVE GASTRECTOMY)

Research has shown that for patients with a BMI of 60+ there is a significant decrease in operative mortality if the RGB or DS is carried out in two stages. This is particularly true for male patients and those with extensive co-morbidities. The sleeve gastrectomy does not involve a bypassing of the intestines. It is said to produce weight loss simply through the reduced volume of the stomach.

The sleeve gastrectomy is an operation in which the left side of the stomach is surgically removed. This results in a new stomach which is roughly the size and shape of a banana. Since this operation does not involve any "rerouting" or reconnecting of the intestines, it is a simpler operation than the gastric bypass or the duodenal switch. Alternatively, the patient can be given a Gastric Band until sufficient weight loss has taken place for the second stage to be completed. This procedure is usually done laparoscopically.