Patients after a sleeve gastrectomy can feel a little bit of heartburn for which they might need some medication to help control. After gastric bypass patients can feel a little bit of gassiness or bloating at times. But for the most part there really aren’t many significant long-term side effects.
We do strongly recommend, and almost require, that patients take vitamins after surgery, and we educate patients about that. We also monitor their vitamin levels with regular blood work after surgery. With careful monitoring, there’s very minimal as far as long-term problems that you can see.
Some of the vitamin levels if they go low or possibly even too high can have some clinical side effects, so we just want to make sure things are staying in the relatively normal range.
Some of the same tenets of weight maintenance and weight loss still hold true. Patients need to stay compliant by avoiding a diet high in carbohydrates and high in sugar. They should be a little bit more focused on protein as well as fiber.
Exercise is a strong component to weight maintenance in the long term. I find that the patients that are most organized with their diet and with their exercise regimen tend to be the most successful in the long term.
It does depend a little bit on the individual. It depends on their age when they first have the weight-loss surgery. It does depend a little bit on how much weight they lose.
Patients who are 150 or 200 pounds overweight will clearly have more excess skin than people who just need to lose about 70 or 80 pounds. Some of it is just how the individual looks at it. Some people are not bothered by it too much at all. Other people, they see it as somewhat of a detriment. But individually people make decisions about what they want to do with it. Obviously exercise and staying in shape will have a positive impact on that.
There is the option of plastic surgery or cosmetic surgery to remove some excess skin.
In some cases, plastic surgery will be medically indicated because if some of the excess skin is causing skin irritation, or rashes, or wound issues, it could be medically indicated. In other cases it could be purely cosmetic, but that is an option for patients.
In general, we want patients to wait at least a year, year and a half, to two years before they start exploring that.
Plastic surgeons will generally want to see weight stabilization for about six months or a year before they start pursuing excess skin removal. It will be a discussion they have with their plastic surgeon.
It can take about a year for the patient to get down to the weight that they want to get to. They need to show some stabilization of their weight to make sure the weight is not coming back, or maybe they’re not losing too much weight. Waiting this long is done to make sure that from a health standpoint they’re doing well.
It generally involves making incisions to remove the excess skin and some of the subcutaneous fatty tissue. It depends on what part of the body we’re talking about. But usually it’s an outpatient operation with a reasonable recovery time.
In the first four to six weeks, we want patients to start walking and to advance the time and length that they’re walking right away. After about six weeks, there’s really no restriction at all to physical activity.
We have patients who do kettlebell competitions, races, surfing, swimming, weight- lifting type sports. There’s really no restriction at all to physical activity and we encourage that as part of their weight-maintenance program.
Lightly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Takata discussing what to expect after weight-loss surgery.