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Bariatric surgery

Bariatric Weight Management web2

About the Service:

The Specialist Weight Management Service is a hospital-based Tier 3 service.  The dietitians are specially trained to address lifestyle change whilst considering the health problems associated with obesity.

The weight management team are here to provide help and support to people who are trying to reduce their weight.  We offer you personally tailored 12 months of support to help you to develop your skills and confidence so that you can manage your weight in the longer term.  These skills will benefit you regardless of whether you choose to have bariatric surgery or not.

Within the programme, we offer one-to-one and group appointments with dietitians.  Group sessions are fortnightly for 6 sessions, followed by 2 monthly sessions.  If you are not able to attend a group you will be seen monthly by a dietitian.

We ensure appropriate patients fully meet the criteria set out by the local service commissioners before referral, and that they are fully informed about what surgery involves through an education session.

When you have successfully completed the Tier 3 program you will either be referred back to the care of your local healthcare provider for continued support, or considered for weight loss surgery with our team of specialist surgeon.

 

Who Are We?

We are a friendly, approachable and experienced team who specialise in weight management. Our team is specially designed to fully support you with all aspects of weight loss.

Where Are We Based?

We deliver services in Worcestershire Royal Hospital.

Bariatric Service Information

You need to complete the Tier 3 program before you can be considered for bariatric surgery. This will help support you to make the necessary lifestyle changes that will enable you to manage your weight in the long term. Completing the weight management program allows you to show gradual, sustained weight loss (a minimum 5% weight loss). Losing weight before surgery will help lower the risk of complications.

Once you have completed the Tier 3 program you will need to attend the pre-surgery groups, 2 sessions in total. The groups provide you with information about bariatric surgery, the pre and post surgery diets and an opportunity for you to speak to someone who has already had surgery. If you still wish to proceed with bariatric surgery you will be made an appointment with the surgeon.

The aim of bariatric surgery is to help patients lose weight, keep the weight off long term and improve other health conditions such as diabetes.

All of our surgical treatments are performed laparascopically (keyhole). Performing the operation in this way removes the need for a large incision and means less pain, less scarring, and a much quicker recovery time. At present we offer the following procedures:

  • Roux – En- y / Gastric Bypass
  • Sleeve Gastrectomy

Operations

Sleeve Gastrectomy

The sleeve Gastrectomy removes part of the stomach to help with weight loss. The stomach is divided vertically from top to bottom, and the larger stomach section is then removed. This leaves a smaller gastric tube which is around 25-30% the size of your original stomach.

The Sleeve Gastrectomy encourages weight loss by reducing the amount of food you can eat and by reducing your appetite through complex hormonal mechanisms (not well understood). Your stomach will be around 70% smaller than before the surgery, meaning that the portion sizes that you are able to manage will be smaller. A Sleeve Gastrectomy is permanent and the alteration to your stomach is not reversible.

Unlike some other forms of bariatric surgery, a laparoscopic Sleeve Gastrectomy does not affect the valves or nerves in the stomach. This means that although the stomach is reduced, the stomach function largely remains intact.

Gastric bypass (Roux – En - y)

The gastric bypass combines restrictive and Malabsorptive techniques to produce weight loss:

Restrictive – the upper portion of the stomach is stapled to create a small ‘upper stomach’, or pouch about the size of a golf ball.

Malabsorptive – Most of the stomach is bypassed along with at least 150 cm of proximal small intestine, necessitating vitamin and mineral supplementation.

Neuro-hormonal component – the intestine is cut or divided. The lower portion of this division (the long roux limb) is then lifted and joined to the new stomach pouch. The free end of the intestine (the biliopancreatic limb) is then joined to the remaining portion of the gut forming a ‘Y’ shape. Once the restrictive component of the bypass decreases, different mechanisms will kick in to maintain weight loss.

Food eaten passes into the pouch, which becomes full with small quantities of food, meaning that you will feel full quicker. Food then bypasses the remainder of the stomach and passes through the newly created opening into the long roux limb. This ‘replumbing’ of the intestine results as well in a degree of malabsorption of food and calories, aiding further weight loss.

FAQ's

The Weight management service

Who can access the service?
People who have a Body Mass Index (BMI) of more than 40kg/m2 or a BMI between 35 and 40 who have and obesity-related condition that would be improved by weight loss.

Can I self-refer?
Unfortunately we are unable to accept self-referrals. We would require a referral letter from your GP or consultant physician.

What happens in my first appointment?
Your first appointment will be with one of our dietitians, and will take approximately 45 minutes. The aim of the first appointment is help us understand your weight history over time, and lifestyle factors and events that may have led to weight changes. We would then invite you to further individual appointments to focus on your weight, or invite you to our group programme.

Will you give me a diet plan to follow to help me lose weight?
We often find that people who access our service have tried many diets in the past which have not worked for them, and so the aim of our service will be to help you understand your weight history better. We will also explore any current habits and factors that are currently impacting on your weight.

If I see the psychologist for an assessment, will I be offered one to one therapy?
Unfortunately, our psychologist is unable to see anyone for individual therapy following an assessment, however she is offering group sessions in the Tier 3 weight management service. She also runs a post bariatric surgery support group.

Do I have to be interested in surgery to access the service?
No, many people attend the Tier 3 weight management service for dietetic support with weight management, and some people change their minds about surgery whilst in the service.

Bariatric surgery

How long will have to I wait before I can have bariatric surgery?
Generally there will be 12 months between your 1st appointment in the service, and the date of your surgery, however this timeline can vary. If you have lost 5% of your body weight by 6 months in the Tier 3 service, then you will be assessed by the surgery team.

Why do I have to lose weight before bariatric surgery?
If you are able to lose 5% of your body weight before surgery, we find that the risk of complications from surgery is reduced. It also helps to show that you are able to lose weight and make lifestyle changes in order to get the most out of your surgery.

When I have had surgery, when will I have follow-up and how long does this last?
You will be reviewed on the ward after your surgery. You will be seen in clinic 3 weeks after the operation by a Nurse and Dietitian, and then every 3 months or so for 2 years. If you have a problem, you can be seen more often.

How much weight on average do people lose after surgery?
People who have a Sleeve Gastrectomy typically lose 60% of their excess weight (weight that they can above a Body Mass Index of 25kg/m2). People who have a Gastric Bypass usually lose about 70% of their excess weight. Weight loss varies from person to person, and will depend on their eating habits and the amount of activity that they do.

What are the risks of Bariatric Surgery?
Any operation has risks. A bleed, blood clot, wound infection or leak as a result of the surgery carries a risk of 1 in 50 people. In the long term, people might experience dumping syndrome (food entering the gut too quickly and causing symptoms such as shaking, sweating, fatigue and nausea), reflux, or stomach pain.

Will I need to take vitamins and minerals after the surgery?
Yes, after the surgery you will need to take multi-vitamins and minerals every day for the rest of your life, for which you will be advised. You will also have to have a Vitamin B12 injection every three months for the rest of your life.

 

Testimonials

Testimonial 1

Dear *****

I am writing after completion of a Gastric Sleeve procedure in late December 2017, as you are aware this procedure is for weight loss and within this letter I have to compliment the Trust on firstly offering this type of procedure but also for the standards of care given, I highlight the professionalism, compassion and friendliness from all the staff I came into contact with across the Trust.

I have been over weight since I was 15 years old and I have tried everything including different diets, over the counter Diet pills, and other “Fads” to try and lose weight, some with short term limited success. I really had nowhere to turn and and I was very despondent with my weight controlling my everyday life.

Once I met ******* she gave me a massive amount of information and encouragement. I was seen by ******** (Con surgeon) and everything explained thoroughly, after a short while a slot was given at short notice for surgery on the 29th December 2017. The pre surgery Liver shrinking Diet over Christmas was a Challenge but surgery went ahead and went reasonably smoothly. My weight loss has been an extraordinary part of my life since the procedure and I am convinced this will massively reduced my chances of getting diabetes and the associated risks plus many other serious longer term issues associated with Obesity. I have no hesitation in stating that this procedure will ultimately extend my life expectancy.

Weight Stats:

Worst Weight before GP referral: 154kg (24.2 stone)
Day of surgery: 133kg (20.9 stone)
Today: 112kg (17.6 stone)
Height: 185.9cm (6ft 1)

The WRH staff are in my opinion outstanding from ****** and his team. I hope my gratitude to all concerned is covered. I am realistic that I still need to focus on my diet for the rest of my life and the surgery is a tool to help me do this along with support from the Trust. Next stop 100kg!!

Testimonial 2

Dear *****,

Thank you all for the journey you have helped me embark and for being by my side as I continue on it’s path. Your knowledge and encouragement have really helped me get to where I am today. *****, thank you for recognising my desire and need to go forward with the operation as soon as possible and for helping this to happen. *****, You have been a reassurance and a wealth of knowledge of helping cure the side effects I was feeling. I look forward to continuing my journey with you all and know that with your guidance, and my desire, that I will succeed.

Useful Links

Referral information

Referral information:

Please send a letter or email to:

Specialist Weight Management Dietitians
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Telephone: 01905 760742 (answer phone)

Address:

Worcestershire Acute Hospitals NHS Trust
Worcestershire Royal Hospital
First Floor, Aconbury West
Worcester, WR5 1DD

Referral Criteria

In order to be referred through to the Worcestershire Specialist Tier 3 Weight Management Team you must fit the following criteria. If you are unsure if you fit the criteria, talk to your GP and they will be able to talk you through the criteria.

  • Registered with a Worcestershire GP
  • Aged at least 18 years
  • BMI >40 kg/m2 with or without obesity related co morbidities
  • BMI >35 kg/m2 with at least one obesity related co morbidity

For the purposes of this service, specific obesity-related co-morbidities are:

  • Diabetes
  • Obstructive sleep apnoea
  • Obesity hypoventilation syndrome
  • Polycystic ovarian syndrome
  • Ischaemic heart disease
  • Difficult to control hypertension
  • Difficult to control dyslipidaemia
  • Non-alcoholic fatty liver disease
  • Chronic joint pain (e.g due to osteoarthritis)
  • Infertility (after exclusion of other causes)
  • Psychological problems such as depression related to obesity.

Patients with other medical conditions (not necessarily caused by obesity) that are likely to benefit from weight loss may also be accepted. Examples include patients awaiting major surgery where weight loss is recommended prior to surgery, patients with organ failure (e.g kidney, heart) awaiting transplantation; severe asthma, corticosteroid-induced weight gain; other drug-induced obesity (eg anticonvulsants).

Please note that this list is not exhaustive and each case will be considered on individual merits.

Click here to find out your Body mass index (BMI)

Referral information for patients

Referrals cannot be taken directly and must come from your General Practitioner (GP).

Contact Us

If you would like to contact the team please use the details below.

Specialist Weight Management Dietitians

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Telephone: 01905 760742 (answer phone)

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