Gastric Surgery

•  Introduction

•  Gastric Balloon

•  Laparoscopic Gastric Banding (Gastric Lap-Band)

•  Gastric Lap Band Refills & Adjustments

•  Laparoscopic Sleeve Gastrectomy

•  Roux-en-Y Gastric Bypass (RGB)

•  Short Limb Roux-en-Y Gastric Bypass (RGB)

•  When Considering Undergoing Obesity Surgery

•  How invasive is the surgery?

•  Which type of Obesity Surgery should I have?

•  Health Risks of Obesity

•  The Typical Program

•  Before Surgery

•  The Operation

•  Following Surgery

Obesity Surgery

With modern lifestyles, excessive weight is an increasingly common condition resulting in increased health risks and psychological, social and economic consequences.
Modern obesity surgery involves operations on the stomach, which are designed to permanently reduce food intake and thus result in loss of weight. These operations tend to produce a feeling of fullness so that the individual will have a reduced appetite and feel full with much less food.
Direct Healthcare International Limited are the only organisation in the world that offer a choice of all following types of Obesity Surgery:

Intra Gastric Balloon – Non Invasive Procedure  Adjustable Lap Banding - Laparoscopic Surgery  Mac Lean VBD - Open Surgery  Mac Lean VBD - Laparoscopic Surgery  Gastric Bypass - Open Surgery  Gastric Bypass - Laparoscopic Surgery  Short Limb Gastric Bypass- Laparoscopic Surgery

Gastric Balloon
This is a temporary restriction placed inside the stomach pouch, which reduces food intake. It is generally used in cases where the candidate has an unusually high BMI, in order to reduce the weight of the candidate to a safer level for them to undergo weight loss surgery safely. The balloon is inserted down the oesophegus while the patient is sedated. This is done as a day surgery procedure and takes about 30 min. The patient takes a few days to adjust to teh balloon and therefore will not return home for a few days.

Laparoscopic Gastric Band (Lap-Band) This is the weight loss surgery procedure everyone has heard about. The adjustable gastric banding method – although considered surgically less invasive is also the most ineffective surgery to have. In this surgery an adjustable silicon band is placed around the upper part of the stomach.

Long term many candidates will not succeed in maintaining their weight loss goals with the adjustable gastric band. The band requires strict aftercare and monitoring also dedication and commitment by the candidate. The band is adjusted by adding or removing fluid through a needle injected into a “port” that is situated just below the surface of the skin. The “port” (subcutaneous port) located just to the left of the navel and a bit lower down can be felt underneath the surface of the skin. It will sit comfortably in its place and won’t interfere or cause irritation. The fluid inflates the band surrounding the top of the stomach adjusting the amount of food the candidate is able to intake.

Gastric Lap Band Refills & Adjustments Please note that with Adjustable Gastric Lap Banding further adjustments to the lap-band are required; the first being 4 - 6 weeks after the band is fitted with approximately 3 further visits in the first year. Providing the candidate loses weight satisfactorily, further adjustments can normally be reduced to yearly adjustments. Adjustments can be quite costly so consider this additional cost before deciding to go ahead with this treatment. Please see our aftercare pages for more information.

Laparoscopic Sleeve Gastrectomy

Severely and morbidly obese patients seeking to loose weight successfully and keep their weight down have little option today than to seek a surgical weight loss solution. There is little doubt that the gastric bypass has proven to be the most successful of surgical interventions in the area of Bariatric surgery.

However this surgical solution is not without risks and it can be seen through statistics that the risks to the patient increase substantially when they candidate has a BMI of over 55.

The Laparoscopic Sleeve Gastrectomy is a solution that carries a low surgical risk factor and enables the patient to loose up to 80% of their excess body weight.

About 80% of the bariatric procedures performed are gastric bypass procedures. The other 20 percent are comprised of restrictive procedures, such as the laparoscopic adjustable gastric band. The Laparoscopic Sleeve Gastrectomy (LSG), a relative newcomer to bariatric surgery, is growing in popularity.

The Sleeve Gastrectomy is used as a staging procedure prior to a gastric bypass in very high risk patients. It has also been used as a primary, stand-alone procedure by some surgeons.

Roux-en-Y Gastric Bypass (RGB) With a gastric bypass as with the MacLean the stomach is apportioned and a smaller pouch is created. In addition to this procedure a part of the intestine is bypassed reducing the level of food absorption. This means that the candidate has both a smaller stomach and a partial intestinal bypass. The candidate is hit with the “double whammy” of feeling full sooner and absorbs less of the food intake. The excluded and unused portion of stomach remains healthy and unchanged making the procedure reversible.

With the Roux-en-Y Gastric Bypass, people eat much more normally with little likelihood of vomiting. The quality of life is excellent and there is a good chance of reaching and staying at your ideal weight. Average weight loss with the Gastric Bypass is approximately 70% of the excess weight over 2 years. Once the ideal weight has been reached it remains stable. This is the most effective procedure for candidates with a high BMI.


Short Limb Roux-en-Y Gastric Bypass (RGB)
The short limb gastric bypass is similar to the gastric bypass. The difference is the amount of intestine bypassed is less than the gastric bypass. This enables the procedure to be carried out on those with a BMI of between 35 and 40. It is particularly suitable when the candidate has diabetes or a high possibility of contracting diabetes.

During a gastric bypass operation the surgeon does two basic things: (1) He reduces the size of the stomach. (2) The surgeon connects the remaining stomach pouch to the lower part of the small intestine (usually the lower section of the jejunum) bypassing the duodenum and a varying length but significant part of the jejunum (a total of up to five feet of small intestine)

The short limb version is less malabsorptive (smaller danger of nutritional deficiency) because the surgeon will remove only 3 – 4 feet (1 meter) of small intestine. The small intestine in adults is a long and narrow tube about 7 meters (23 feet) long. Malabsorptive means lack or problems associated with food absorption so “less malabsorptive” means the candidate can absorb more nutrients and vitamins carrying a lesser risk of complications postoperatively.

According to the Society of Bariatric Surgeons, Gastric Bypass Roux-en-Y is the “gold standard” procedure for weight loss surgery, it is a tried and tested operation to which all other weight loss procedures should be compared and is one of the most frequently performed weight loss procedures in the World. The short limb Gastric Bypass Roux-en-Y, is now considered by most weight loss surgeons, to be the preferred surgical procedure for the treatment of Morbid Obesity in most patients.

When Considering Undergoing Obesity Surgery
key success factors:
Records show clearly that there are key success factors to successful long-term weight loss. Success requires you to make the right choices from the outset and dedication from you, good aftercare, continued support of your surgeon, the treating body, and friends and family.

personal surgery choice:
So often the surgery choice is based on price and feelings as to the invasiveness of the surgery. The adjustable gastric lap band is usually the favoured option because it appears cheaper and less invasive. Statistically this is the least effective surgical solution, refills and aftercare are costly. Time and travel are required to reach a refill centre.

Surgery choice should be based on:

•  How much you desire to reach your ideal weight

•  Your BMI

•  The type of eating habits you have

•  Your physical makeup and medical history

•  Your considerations and how you feel about surgery

It is quite likely that there may be a conflict between your desire for long-term success in reaching your ideal weight and the dislike of a particular type of surgery. This is something you should consider carefully. You may need to decide which is more important to you! To help you make this awkward decision, speak to as many knowledgeable people as you can. Remember that good decisions are based on knowledge. Don’t just take one persons advice find out what people’s individual experiences are. Beware of organisations just directing you to their solution.

How invasive is the surgery?
All obesity surgery is invasive. All obesity surgery is reversible. Modern stomach reducing surgery where the stomach is reduced in size is both safe and reversible. The internal sealing system used is a multiple titanium stapling system where six tiny rows of staples are used to seal the area. The body naturally overgrows the area with it becoming part of your body as before the procedure. There is no discomfort afterwards.
Surgical skill – The treating consultant surgeon should be able to offer a full range of bariatric surgery. Some people are more suited to one type of surgery depending on their physical makeup and in particular their favoured diet. The surgeon should not just offer one solution. Direct Healthcare International’s Bariatric surgeon has undertaken over 8,000 successful Bariatric procedures. There is no Surgeon in the world as experienced or with such a success rate with performing Laparoscopic Gastric Surgery.
Aftercare and support – aftercare is a vital part of the total package, for success the candidate must have a good aftercare and support.
Direct Healthcare International’ has built up a comprehensive support team that will be able to assist you with any questions both before and after your surgery
There are risks associated with all types of surgery, if you are not sure that you are a suitable candidate please call us and ask one of our advisors to call you.

Please note:

Losing a large amount of weight or losing weight quickly may increase the risk of Gallstones - however, this can be prevented by taking medication.

Anaemia, osteoporosis and other nutritional deficiencies can be prevented by taking vitamin and mineral intake supplements - especially vitamins B12 and D, calcium, foliate and iron. You will need to continue taking vitamin and mineral substances permanently.

Women of childbearing age should be aware that quick weight loss and nutritional deficiencies could harm a developing foetus. Therefore, if you are planning a family, it is best to avoid getting pregnant for the first 3 months after treatment. There is no reason why you should not bear children after 3 months have passed.

If you are taking contraception its effectiveness may be reduced after bariatric surgery, in addition the female becomes more fertile. Obesity surgery can significantly improve any reproductive problems.

Selection Criteria for Obesity Surgery should be:

•  Aged between 18 and 55 years

•  Have their weight remain stable for the last 5 years

•  Are unable to lose weight through diet or other methods

•  Have an absence of glandular diseases such as hypothyroidism

•  Are not dependent on alcohol or drugs

•  Have a BMI (Body Mass Index) of over 30

Which type of Obesity Surgery should I have?

Health Risks of Obesity
Being severely overweight increases your risk of developing severe medical conditions such as osteoarthritis, rheumatoid arthritis, several cancers, carpal tunnel syndrome, gallbladder disease, gastroesophageal reflux disease, gout, hypertension, deep vein thrombosis, infertility, liver disease, low back pain, obstetric and gynaecological complications, impotence, cellulitis, asthma, sleep apnea, stroke, pancreatitis, type 2 diabetes, and urinary stress incontinence and the chances of dying from cardiovascular disease. (The death rate for morbidly obese men 23-34 years old is increased twelve fold.)

Obesity can cause or worsen depression; low self-esteem and other psychological difficulties attributed to feeling discriminated against, insulted and ridiculed by others.

The Typical Program
Adjustable Laparoscopic Banding
Day 1 - Arrival and 14.00pm consultation with the surgeon + nutritionist
Day 2 - Surgery + overnight stay in hospital
Day 3 - Discharge from hospital to patient's accommodation
Day 4 - Our nurse will visit you in your accommodation
Day 5 - Post operative check and departure

Mac Lean, Gastric Bypass Open & Laparoscopic
Day 1 - Arrival and 14.00pm consultation with the surgeon + nutritionist
Day 2 - Surgery + overnight stay in hospital
Day 3 - Stay in hospital
Day 4 - Stay in hospital
Day 5 - Discharge from hospital to patient's accommodation
Day 6 - Stay in hotel
Day 7 - Our nurse will visit you in your accommodation
Day 8 - Post operative check and departure

Please remember that you are undergoing major surgery and for the week after surgery you may feel some discomfort, be swollen and experience some pain, so coming with a companion is a good idea.

Before Surgery
You will have a consultation with the treating surgeon and a clinical examination as well as preoperative screening, blood tests, imaging studies, and a gastroscopy. The surgeon will discuss together with you the most suited surgery and options with you. Please avoid any last minute weight gains prior to surgery; if you are able to reduce your weight slightly prior to surgery this reduces any subsequent surgical risks.

The Operation
Surgery is performed under general anaesthesia. Hospital stay is normally between 3 – 5 days, depending on the type of surgery. The surgery is performed in one of Belgium's leading university hospitals by a world-leading highly skilled bariatric surgeon with considerable experience in all varieties of gastric obesity surgery.

Following Surgery
Following your surgery for a few days you will be on a soft food diet. Please see our dietary section for further information. Following surgery, certain nutrients are not absorbed as well - in particular, these may be fat, soluble vitamins, such as vitamin A, B12, D and K, iron and calcium. Taking multivitamins with minerals as well as extra iron, and calcium resolves these deficiencies. After surgery, it is possible to develop lactose intolerance. This means milk or milk products such as cheese may cause diarrhoea. Avoiding these foods or using Lactaid can relieve this. For more detailed nutrition information, please see our nutritional advice section and our questions & answer section.

Why not give us a call?
if you have any further questions Why not give us a call, email or write to us and ask one of our specialists to give you a call at a time that is convenient to you.