Weight loss after gastric bypass surgery can be attributed to several mechanisms. The smaller stomach pouch significantly reduces its volume, leading to a quicker sensation of fullness and reduced food intake. Additionally, as food bypasses the duodenum and transitions directly from the stomach pouch to the small intestine, there is an increase in "incretin" hormones. These hormones not only enhance the feeling of satiety but also improve the regulation of sugar metabolism, offering direct benefits for managing type 2 diabetes.

Another contributing factor is malabsorption, as food only mixes with digestive juices after traveling 120 cm into the small intestine. This delay reduces the absorption of fats and sugars, leading to fewer calories being absorbed. Furthermore, the procedure alters the composition and distribution of gut bacteria (microbiome), which also plays a role in promoting weight loss.

• Patients are usually referred by their GP or a specialist to a bariatric surgery clinic.

• A comprehensive assessment is conducted to determine eligibility, including medical history, weight history, and underlying health conditions.

• Patients must meet specific NHS or private criteria, such as having a BMI of 40+ or 35+ with obesity-related health issues.

• Once deemed suitable, patients undergo a series of pre-operative tests, including blood tests, imaging (e.g., X-rays or ultrasounds), and • possibly an endoscopy.

• A consultation with a multidisciplinary team, including a surgeon, anaesthetist, dietitian, and psychologist, helps ensure the patient is physically and mentally prepared for surgery.

• Patients are provided with a pre-operative diet plan (usually a low-calorie liquid diet) to reduce liver size and facilitate surgery.

• Admission typically occurs on the day of surgery. Patients are required to fast as instructed (usually from midnight before surgery).

• They are checked in by hospital staff and prepared for the procedure, which includes confirming personal details, conducting baseline observations (e.g., blood pressure, heart rate), and finalising consent forms.

• The procedure is performed under general anaesthesia, lasting 2-3 hours.

• Minimally invasive techniques, such as laparoscopic (keyhole) surgery or robotic-assisted surgery, are commonly used.

On the first day after surgery, a light diet will be introduced, and early mobilisation is encouraged to reduce the risk of respiratory complications and prevent blood clots in the legs or lungs. Adequate pain relief will be provided to ensure comfort. During your stay, a dietitian will offer detailed nutritional guidance for the initial weeks following the procedure.

If blood tests and a clinical examination indicate satisfactory recovery, most patients are discharged the day after surgery. A follow-up wound check with your general practitioner is arranged for one week later. The incisions are closed with self-dissolving sutures placed within the wound, so no stitches will need to be removed.

The dietitian will provide a comprehensive explanation of the dietary guidelines to follow both before the procedure and during your hospital stay.

In the initial weeks following surgery, it is important to remain mobile by walking regularly and resuming daily activities as much as possible, while staying mindful of any discomfort or pain. However, strenuous physical activities should be avoided until after your first follow-up consultation with the surgeon, which typically occurs three weeks after the procedure.

Short-term complications:

Wound infection or abscess.

Leakage or bleeding at the junction between the stomach and small intestine (anastomotic leakage).

Blood clots in the legs or lungs (deep vein thrombosis or pulmonary embolism).

Long-term complications:

Temporary hair loss due to rapid weight loss, which is reversible.

Fatigue, particularly during the period of rapid weight loss.

Incisional hernia, though the risk is reduced with laparoscopic surgery.

Vitamin deficiencies requiring ongoing supplementation.

Dumping syndrome, which can cause nausea, diarrhoea, and abdominal cramping after eating.

Bowel obstruction caused by internal herniation, where a section of the small intestine becomes trapped through an opening in the intestinal membrane. Symptoms include abdominal pain, especially after meals. The risk of internal herniation ranges from 1.4% to 10% of gastric bypass patients and is typically treatable with laparoscopic surgery.

Several factors contribute to the weight loss achieved after a sleeve gastrectomy:

The significantly reduced stomach volume leads to an earlier sensation of fullness, helping to control portion sizes and overall food intake.

Faster gastric emptying stimulates the release of incretin hormones, which enhance feelings of satiety. These hormones also play a key role in improving type 2 diabetes by better regulating blood sugar levels.

The part of the stomach removed during the procedure contains most of the cells responsible for producing ghrelin, an appetite-stimulating hormone. With this reduction, appetite decreases, supporting sustained weight loss.

The surgery also alters the gut microbiome, changing the balance and concentration of gut bacteria. These changes have an additional influence on metabolism and weight loss.

• Patients are usually referred by their GP or a specialist to a bariatric surgery clinic.

• A comprehensive assessment is conducted to determine eligibility, including medical history, weight history, and underlying health conditions.

• Patients must meet specific NHS or private criteria, such as having a BMI of 40+ or 35+ with obesity-related health issues.

• Once deemed suitable, patients undergo a series of pre-operative tests, including blood tests, imaging (e.g., X-rays or ultrasounds), and • possibly an endoscopy.

• A consultation with a multidisciplinary team, including a surgeon, anaesthetist, dietitian, and psychologist, helps ensure the patient is physically and mentally prepared for surgery.

• Patients are provided with a pre-operative diet plan (usually a low-calorie liquid diet) to reduce liver size and facilitate surgery.

• Admission typically occurs on the day of surgery. Patients are required to fast as instructed (usually from midnight before surgery).

• They are checked in by hospital staff and prepared for the procedure, which includes confirming personal details, conducting baseline observations (e.g., blood pressure, heart rate), and finalising consent forms.

• The procedure is performed under general anaesthesia, lasting 2-3 hours.

• Laparoscopic (keyhole) or robotic-assisted surgery is used to remove approximately 75% of the stomach, leaving a smaller, sleeve-shaped stomach.

On the first day after surgery, a light diet will be introduced, and early mobilisation is encouraged to reduce the risk of respiratory complications and prevent blood clots in the legs or lungs. Adequate pain relief will be provided to ensure comfort. During your stay, a dietitian will offer detailed nutritional guidance for the initial weeks following the procedure.

If blood tests and a clinical examination indicate satisfactory recovery, most patients are discharged the day after surgery. A follow-up wound check with your general practitioner is arranged for one week later. The incisions are closed with self-dissolving sutures placed within the wound, so no stitches will need to be removed.

The dietitian will provide a comprehensive explanation of the dietary guidelines to follow both before the procedure and during your hospital stay.

In the initial weeks following surgery, it is important to remain mobile by walking regularly and resuming daily activities as much as possible, while staying mindful of any discomfort or pain. However, strenuous physical activities should be avoided until after your first follow-up consultation with the surgeon, which typically occurs three weeks after the procedure.

Short-term Complications

In the immediate post-operative period, the following complications may arise:

Infection at the surgical wound or the development of a wound abscess.

Leakage or bleeding along the staple line, where the stomach was surgically divided.

Blood clots in the legs or lungs, such as deep vein thrombosis or pulmonary embolism.

Long-term Complications

In the longer term, patients may experience:

Gastroesophageal reflux.

Temporary hair loss, which is associated with rapid weight loss and is reversible.

Fatigue, primarily during periods of significant weight loss.

Incisional hernia, with a reduced risk due to the use of laparoscopic techniques.

Vitamin deficiencies that require ongoing supplementation.

Dumping syndrome, which can cause symptoms such as nausea, dizziness, and diarrhoea following meals.

The sleeve gastrectomy is an irreversible procedure.

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