This operation involves removing approximately 80% of the stomach, leaving a thin tube or sleeve (about the width of your thumb) which holds about 50-100mL of fluid (about ½ cup of tea). The ‘gut’ or digestive tract remains intact below the stomach. It works by restricting the volume of food you can eat. It also removes some stomach cells that produce a hormone that controls hunger, so patients often don’t feel as hungry afterwards. This has positive effects on diabetes and often patients can stop their medication after surgery. The operation takes about one hour and the hospital stay is 1 day.

Advantages: Sleeve gastrectomy is simpler than gastric bypass and has similar initial effects on diabetes. You will need to take vitamins for life afterwards.

Disadvantages: It may worsen severe acid reflux and is irreversible.

The gastric bypass is a more complicated procedure and involves the creation of a small pouch at the top of the stomach with staples. The remaining stomach stays in place. A section of intestine is ‘plumbed’ into this pouch so that the food bypasses the rest of the stomach and enters the intestine lower down. There are therefore two joins of the intestine inside. It works by limiting the amount you can eat at each mealtime but also by altering the hormone levels produced by the gut to improve diabetes and make you less hungry. The operation takes about one hour and the hospital stay is usually 1 day.

Advantages: It is very effective at weight loss and may be the best option in diabetes and acid reflux.

Disadvantages: The risks of surgery are higher than for simpler operations, it is essentially irreversible and you will need to take daily vitamin supplements for life after surgery.

The band consists of a silicone tube with a balloon device on one end and an inflation port on the other. It is fitted at the very top of the stomach with a small ‘inflation port’ underneath the skin on the left hand side of the tummy. It works by dimming the appetite and slowing your eating down. This, together with behavioral changes and mindful eating aims to result in lessening the volume of food you eat.  The tightness of the band can be adjusted by altering the volume of liquid within the band by a simple injection into the port. The operation takes less than an hour, although there is time taken in both putting you to sleep and waking you up afterwards so the overall time away from the ward is three to four  hours.

Advantages: The gastric band is the simplest and safest procedure. There are no permanent changes made to the stomach and it can be removed (although this would allow your weight to regain, so you should consider the operation as permanent).

Disadvantages: It may not work for everyone and up to ten per cent require further surgery, possibly as an emergency and it may not reduce appetite. You will need to attend hospital frequently for checks and adjustments initially.

North Bristol NHS Trust performs different types of weight loss operations of which all are keyhole (laparoscopic). This involves five small incisions (cuts) on the abdomen each usually less than one inch long. These allow the surgeon to introduce a small camera and fine instruments into the abdomen. The keyhole method allows for a quicker recovery and less chance of wound infection. While recovery is more rapid it must be remembered that you will have had major surgery.

Sometimes the operation can’t be performed using ‘keyhole surgery’, particularly if you have had previous surgery in the same area as there may be some scarring.  Before your surgery the surgeon will have discussed with you the possibility of having an open operation. Obviously there will be a larger wound with this sort of operation and it is likely that you will recover more slowly as a result.

To help the operation go well it is important that before you have surgery you follow a low fat, low carbohydrate, and low calorie food intake known as the ‘pre-operative liver shrinking diet’. This will be fully explained to you by the Bariatric Clinical Nurse Specialist pre-operatively and you will need to follow this for 14 days. Reducing your fat, carbohydrate and calorie intake results in the liver releasing it stores of energy, making it smaller. This helps the surgeon to see and be able to use the instruments more easily. Although you will lose weight it will not all be fat loss and you may find that you regain the lost weight after surgery.

The length of hospital stay will depend on the type of surgery but is usually 1 day for a Bypass or Sleeve Gastrectomy and a day case for Gastric bands or Intragastric Balloons.  Before discharge you will be reviewed by the surgical team, bariatric practitioner and dietitian. Occasionally if a larger procedure is performed, or there were difficulties during the operation, you may stay longer.

The majority of people report that pain after the operation is only moderate. A few people (approx. 1 in 10) complain of left shoulder pain. Movement and regular medication help, although as with many things time is often the best healer. Sickness is uncommon and is normally easy to control with medication.

Revision surgery

We also perform surgery on patients who have had problems following their initial weight loss surgery (either performed at NBT or elsewhere). These operations can be difficult, take longer and the complication rates are therefore higher.

We have strict criteria as to who is eligible for weight loss surgery. This not only depends on your weight, but also the presence of other health problems or psychological issues. Not everyone is suited to surgery as it means a complete change in lifestyle and some people find difficultly coping afterwards. Most of our patients however do very well and achieve good long term weight loss.

If your GP considers that you may be suitable for surgery they will refer you to us. You will then undergo detailed assessment with members of our team. This will include a nurse, dietician, and a surgeon. You may also be required to see a weight loss physician and psychologist. You may need to come back on a few occasions to address issues identified at that time or perform pre-operative tests. Once the team as a whole are happy that you are ready to go ahead with surgery we will add your name to the waiting list. This whole process can take a number of months. During the assessment, the types of operation will be discussed with you as not everyone is suited to each procedure.

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Access to and use of our website, www.nbt.nhs.uk and any related websites within the domain of www.nbt.nhs.uk is provided by North Bristol NHS Trust.

The website is owned by North Bristol NHS Trust and any use of the website is subject to these terms and conditions. North Bristol NHS Trust reserves the right to modify or revise these terms and conditions at any time by updating the text on this page.

The user warrants to North Bristol NHS Trust that they will only use the website according to these terms and conditions.

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North Bristol NHS Trust website provides medical information for use as information or for educational purposes only. We do not warrant that information we provide will meet your health or medical requirements. Please contact a health care professional if you are concerned about your health.

North Bristol NHS Trust website does not give medical advice in relation to any individual case or patient, nor does the North Bristol NHS Trust website provide online medical or diagnostic services.

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We want to make sure that information is accessible for everyone.

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The website allows you to easily change the text size to make it either larger or smaller via your browser settings. Some browsers will allow you to magnify the whole page. To change the text size, follow the instructions below:

Internet Explorer

• Click “View” to open the View menu or press “Alt” and “V”
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• Choose your preferred text size using your mouse or use the up and down arrow keys
• Click to select the text size or press “Enter”
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If your mouse has a scrolling wheel in the middle of the right and left click buttons, you can hold down the “Ctrl” key on the keyboard and scroll it up and down, the text size will increase and decrease. This works for both Internet Explorer and Firefox.

Accessibility in Windows
Windows also have a number of computer settings you can select to make your enjoyment of our website better. Go to Start > Settings > Control Panel > Accessibility Options. You can select options to alter your keyboard, display and mouse settings.

If you require information in another language or format please contact website@nbt.nhs.uk

To help provide a first class outpatient service we may remind you of your appointment through texts, automated messages or a phone call using the mobile phone number given to us by you or your GP surgery. 

Since we have introduced this service for patients, unattended appointments have been reduced on average by 40%.

Please be advised you will be asked to confirm your date of birth if receiving a reminder via automated call or a via an agent in order for us to give you details on which specialty you are attending. Calls may come from our provider, ERS Connect, who use the following numbers 0117 3270241 or 0117 3270242. Reminders sent by text will only include the date, time and location of your appointment.

Please inform us of any changes in your contact details so we can ensure you benefit from this service.

If you would like to opt out of this service please let us know by:

• Advising the clinic receptionist
• Calling the phone number on your outpatient letter
• Emailing outpatients.appointments@nbt.nhs.uk