Medical Weight Loss
Our Weight Loss Team consists of medical/surgical specialists, a specialist dietitian, a bariatric nurse specialist and a bariatric clinical psychologist. We offer bespoke packages for any weight loss goal.
In our consultations we aim to explore the physiology of weight gain/loss and give a full assessment of the individual and their needs as a patient.
Surgical Weight Loss
Thames Valley Weight Loss Surgeons are James Ramus MD FRCS, Marianne Sampson MA FRCS and Gregory Jones BSc FRCS (Gen). All are consultant Bariatric and specialist UGI surgeons based at the Royal Berkshire Hospital, Reading which is the regional centre for provision of bariatric services.
A gastric band is an adjustable silicon device that is placed surgically around the top of the stomach. The band is attached to a piece of tubing that is connected to a small port. The port can be accessed with a needle and water can be injected into the band to alter the tightness of the band.
The procedure to place the gastric band is performed under a general anaesthetic and is normally performed laparoscopically (’keyhole surgery’) usually involving a one night stay in hospital.
The idea of the band is to encourage an eating pattern that allows small portions of food to pass into the part of the stomach above the band (‘the so called ‘pouch’) which will then pass into the rest of the stomach causing a small stretch of the part of the stomach that is in contact with the band. This ‘stretch’ of the stomach sends signals to the brain that induces ‘satiety’ – ie. tells you that you are full up.
Patients will then tend to feel full quicker and therefore eat less than they did before. On average patients will lose 40-50% of their excess weight over a 2 year period.
Risks specific to gastric banding
|infection||as with any prosthetic device, there is a risk they can become infected. This can occur in the port, the tubing or in the band itself and can sometimes mean these parts have to be removed.|
|band slippage||it is possible for the band to slip further down the stomach and sometimes (rarely) this can cause a blockage which will require removal of the band.|
We offer a full package of care for all patients undergoing gastric band surgery including all band adjustments for the first year, annual phone follow-up and extended follow-up packages if requested.
Gastric banding – a video introduction
The gastric bypass is an operation that reduces the size of the stomach and creates a new join between the new stomach ‘pouch’ and the small bowel. Not only does this decrease the capacity of the stomach but it also allows food to enter a part of the digestive tract (the small bowel) much quicker than before. This induces a change in a number of important digestive hormones that control hunger and satiety (‘fullness’) and also effects the way cells respond to insulin. The result is that patients do not feel hungry as much as before, they feel fuller quicker and they maintain much better control of their blood sugars (often reversing the effects of diabetes).
Like the gastric band, the procedure is performed under general anaesthetic normally using laparoscopic techniques. The size and position of the surgical incisions are almost identical to the gastric band operation but it is longer procedure requiring specialist laparoscopic stapling devices that divide and join sections of bowel together. Patients generally stay in hospital for 2 to 3 nights.
Patients will typically lose around 60-70% of their excess weight over a 2 year period, often with a ‘rapid weight loss’ period for the first 6 months post-operatively.
All obesity-related medical conditions improve after the surgery but perhaps most strikingly it is the resolution of diabetes that has the most beneficial impact.
|Anastomotic leak||there is a risk that where the parts of stomach and bowel have been joined together, if the join doesn’t heal up properly, a leak may develop. The risk of this is thankfully fairly low with recent evidence suggesting that this may occur in less than 1% of patients.|
|Internal hernia||as the new joins between sections of bowel have been created, this can leave ‘gaps’ between loops of bowel. Although most surgeons will routinely close up these gaps with stitches during the procedure, in a small percentage of patients these gaps may reopen as they lose weight and allow other parts of bowel to herniate through. This is something that often does not occur for several months after the procedure, but can normally be managed with another laparoscopic procedure to re-close the gaps if necessary.|
|Deep vein thrombosis (DVT) and pulmonary embolus (PE)||Blood clots in the legs (DVTs) that can pass into the lungs (PEs) are risks for all major surgical procedures but patients with high BMIs who undergo long operations are at higher risk for this. We advise all patients who have bypass procedure to mobilise as quickly as possible after the operation and prescribe them with regular blood thinning injection (for up to 2 weeks after the procedure) to try and prevent this.|
We offer a full package of care for all patients undergoing gastric bypass surgery including full pre-operative assessment and regular post-operative follow-up from the whole team for the first year. Annual phone follow-up and extended packages are available after this time.
Gastric bypass – a video introduction
During a sleeve gastrectomy a large portion of the stomach is stapled and removed, leaving behind a stomach ‘tube’ (rather than a normal ‘sac’ shaped stomach). This has a number of effects not only due to the decreased capacity of the stomach but also as this allows faster transit of food into the small bowel (similar to, but not quite as effective, as the gastric bypass).
Patients will generally stay in hospital for 2 to 3 nights and will typically lose between 50-60% of their excess weight over a 2 year period.
Specific risks of sleeve gastrectomy
|Gastric staple line leakage||there is a risk of leakage along the long gastric staple line (particularly at the top end). This has been reported in up to 7% of patients.|
|Acid reflux||This can be a problem post-operatively and most surgeons would not recommend a sleeve gastrectomy in patients with a preoperative history of reflux.|
We offer a full package of care for all patients undergoing sleeve gastrectomy including full pre-operative assessment and regular post-operative follow-up from the whole team for the first year. Annual phone follow-up and extended packages are available after this time.
Sleeve gastrectomy – a video introduction
The gastric balloon is a soft silicon expandable device that is placed into the stomach and then inflated with water to a desired volume (usually between 500-700 mls). This causes a feeling of fullness in the stomach that encourages patients to eat less and hence, lose weight.
It is usually either performed under sedation or a light general anaesthetic and is placed endoscopically (using an endoscope passed into the mouth). Most balloons are licensed to stay in for 6 months and therefore need to be removed (endoscopically) after this period.
Patients typically lose up to 30% of their excess weight over this period. The procedure is generally used to achieve a degree of weight loss in patients planned for a more definitive procedure (such as a gastric band or bypass) but who would benefit from some initial weight loss to make further surgery safer. Some patients may benefit from the gastric balloon as a means to ‘kick start’ a change in dietary habit that will help with longer term ‘non-surgical’ weight loss.
Specific risks of gastric balloon
|Nausea and vomiting||It is not uncommon for patients to experience a degree of sickness for the first few days after the procedure. For most patients this settles, but in some patients early removal of the balloon may become necessary.|
|Perforation of the balloon||Very rarely the balloon may develop a leak which will allow it to become deflated. The water in the balloon has a (safe) blue dye added which will be absorbed if the balloon leaks and become evident in the patients urine.|
Our private service offers a complete package of care for all patients requesting a gastric balloon. This includes preoperative consultations and assessment from the full weight loss team with regular post-operative follow-up appointments for the 6 month duration of the balloon.
"The whole experience has been amazing from start to finish and I can confidently say I would do it all over again. Thankfully, I am much healthier / happier / slimmer / not diabetic / no sleep apnoea / and a healthier BMI. I love going clothes shopping and no longer feel like the old granny who has to walk miles and sit in changing rooms watching my daughter try on clothes (for hours !!!) I cannot believe how well I feel now... As I said before thank you to everyone involved, you’re the best."Gastric bypass, 76.3% Excess weight loss at 1 year