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Chrysalis Clinic Health
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Patient Experience
Weight (kg)
Height (cm)

expectations of surgery

The whole idea of bariatric surgery is to help morbidly obese patients to change their eating behaviour, so that they will eat considerably less than they have done in the past. The main reason that people become morbidly obese is that they have, for many years (in many cases, most of their lives) been eating more than what their bodies have required. In order to lose weight you have to eat less than your body needs and increase your energy expenditure by exercising more. You have to build up a deficit that will then be met by mobilising your fat stores.

Results of bariatric surgery
Results are measured by way of percentage of excess weight lost (%EWL).

Knowing your height, we calculate what your weight should be to have a BMI of 25. That weight is subtracted from your weight at presentation to determine your excess weight and after treatment the percentage reduction of your excess weight is calculated.
After all the various types of bariatric operations, weight loss is progressive up to about 18 months, after which weight stabilises and after several years may increase a little. So, after reaching your weight nadir (lowest point), usually after about 18 months, you may start to gradually regain a little weight and the extent of that regain is related to the type of operation that you have.
On average, adjustable gastric bands achieve around 50% EWL, RYGBP achieves 75-80% EWL and BPD achieves 80-90% EWL.
Weight regain is more of a problem after the purely restrictive operations, viz. adjustable gastric band or vertical banded gastroplasty. Weight regain is least after biliopancreatic diversion (malabsorptive) operations. Sleeve gastrectomy is still quite a new introduction to the surgical armamentarium, so data are limited about long-term weight reduction, but as this is essentially a restrictive type of operation, one would expect long-term outcomes them to be similar to those of adjustable bands.

One of the mechanisms of action of the RYGBP is to reduce grehlin production by the stomach. This hormone stimulates the appetite centre of the brain,so with reduced grehlin, appetite decreases.

Diet after Roux-en-Y Gastric Bypass:

During this delicate period your tiny gastric pouch is being held together by small metal staples. Any over distension of the gastric pouch can disrupt the staple line with leakage, sepsis (infection) and possible death. Therefore, you are only allowed to consume liquids and purées. Remember that you need to get in two litres of water per day as well as enough nutrients in liquid form. At this stage it is preferable to take your water and nutrients separately, at different times.

Your staple lines will be strengthening by now so you can slowly progress onto finely minced and mashed food.

If all is well at this stage you can start taking solid food.

However, you must remember that you no longer have a stomach to churn your food into a paste and you no longer have a pylorus to regulate what leaves your stomach to enter the intestine. Food that is not thoroughly chewed can pass into the intestine in its unchewed form and impact in it, causing a bowel obstruction. This applies especially to food that has a high content of indigestible fibre (ask your dietician about this) or dried food that might swell after absorbing fluid from the intestinal juices (e.g. dried fruit and biltong).

You have to understand that the whole idea of the surgery is to force you to eat much less than you were accustomed to eating before surgery. We are assisting you to completely change your eating behaviour. Your portions must be very small. To get enough essential nutrients you will have to take 5-6 of these tiny meals per day instead of the customary three.

You must eat slowly
You must chew very thoroughly before swallowing.