Knowledge base

Questions and answers

FAQs

Which type of bariatric surgery is better?

There is no simple answer to this question. Just as one hairstyle does not suit all people, it is not possible to perform the same operation on all people who are obese. There are many reasons for this. 

 

Gender, age, concomitant diseases, past operations, the dietary habits of the patient etc. are decisive. Each time, the surgeon tries to ensure that the selected operation is ideally suited to the patient. This is by no means an easy choice as the number of variables is sometimes very long. 

 

We also try, of course, to take into account the preferences of the patients themselves as it is very important that the patient ‘believes’ in their operation. It is worth adding that all the operations we perform have similar effectiveness in treating obesity and none of them are objectively better than others.

How much does surgical treatment of obesity cost at the EuroMediCare Hospital in Wrocław?

Sleeve gastrectomy, gastric bypass and mini gastric bypass procedures cost PLN 22,900, whereas revision surgery (surgery performed after previous bariatric surgeries) – the so-called ‘re-do’ surgery – costs PLN 25,900. The above prices include both the surgical treatment, hospital care and the first follow-up visit one month after the surgery with the surgeon, dietician and psychologist. 

Additionally, we offer our patients a diagnostic-consultation package prior to surgical treatment, which costs 3,700 PLN. The diagnostic package in the hospital is not obligatory and the patient has the right to have the diagnostics done outside the hospital, with the exception of dietetic and psychological consultations, which must be done with us.

Choosing the package: surgical treatment + diagnostics, the prices are: PLN 25,900 for sleeve gastrectomy, gastric bypass and mini gastric bypass surgery, and PLN 28,900 for revision surgery.

I am struggling with obesity but am not yet considering surgical treatment. How can you help me?

You are welcome to come for a consultation with a clinical dietician. You will receive reliable and personalised advice on your nutrition as well as menu suggestions. 

 

Together with the dietician, you will specify the goal you want to achieve and you will be given the tools to do so. To help you find the motivation to fight your illness, meet with our psychologist.

 

You will learn more about yourself and the mistakes we all make when we are alone with a big problem. Remember that obesity is a disease that should be treated by specialists.

I am considering surgical treatment for obesity. Where do I start?

Start with a consultation with one of our surgeons. You will learn what bariatric surgery is, its benefits and risks, and the long-term benefits of successfully treating obesity.

 

Undergoing any surgical intervention is always a difficult decision that must be taken on the basis of rational arguments and not knowledge from internet forums where anyone can speak.

 

Remember that bariatric surgery is currently the most effective treatment for severe obesity.

Why was I advised to reduce my weight before surgery?

Weight loss before bariatric surgery may reduce the risk of complications during surgery and may speed up recovery after surgery.

 

The aim of the preoperative diet is to reduce the size of the liver and to build eating behaviours that play an important role in the surgical treatment of obesity.

 

Wouldn't it be better and safer if I opted for balloon treatment instead of surgery?

Safer – maybe yes. Better – not necessarily. You have probably wondered more than once why treatment by diet alone does not work in the case of obesity. It is mainly because even the best diet, applied as scrupulously as possible, is eventually abandoned. This leaves the patient with previous habits and mistakes, and leads to a new increase in body weight. 

 

It is very similar with a balloon. As long as it is in the stomach, it reduces the active volume of the stomach, allowing the intake of less food as long as it is not removed. Immediately afterwards, the patient is left alone with ‘their’ original stomach volume and the only ‘weapon’ that remains is again only a strong will. 

 

Therefore, treatment of obesity with a gastric balloon only makes sense in certain special situations and is always treated as a preliminary stage before the final surgical treatment. We most often resort to gastric balloon therapy either in very obese patients or in very sick patients (i.e., where the risk of surgical treatment is initially too high). Thanks to the application of balloon therapy, we are able to reduce the weight of these patients, as well as better control the diseases accompanying obesity through weight reduction. 

Performing surgery after initial weight reduction is, in such a situation, a natural next step in the comprehensive treatment of obesity.


It is a mistake to place a balloon in patients with an average, as for obese patients, body weight and a body mass index below 50 because such patients can usually be successfully operated on without intermediate stages.  

  

It should be remembered that after 6 months of balloon therapy, the gastric wall is always excessively thickened – which increases the risk of complications after subsequent surgical treatment. The benefits from balloon therapy should, therefore, be greater than the risk of complications resulting from its use. To sum up, a gastric balloon can be a great method of initial treatment of obesity, but usually not the final one.

I have heartburn. Which operation should I opt for?

When a patient suffers from gastro-oesophageal reflux – or, colloquially, ‘heartburn’ – the operation of choice is gastric bypass surgery. 

We avoid performing a gastrectomy in this situation because afterwards one of the most common side effects is precisely the creation or persistence of pre-existing gastro-oesophageal reflux. 

Losing a lot of weight after surgery definitely does not compensate for the reflux, which can make the everyday life of an already slim patient miserable. Sometimes reflux after gastric cuff resection requires further surgery.

How much time will I spend in hospital for surgical treatment?

According to the saying “haste makes waste”, a stay in hospital, when a patient is treated surgically, must take several days. This is usually as follows:

 

Day 1 - The day you are admitted to hospital. Admission usually takes place around midday. The patient has blood drawn for tests that need to be done before the operation. He or she meets the anaesthesiologist as well as the surgeon who will operate on the next day. This is the time to ask all questions that remain unanswered and give consent for the surgical treatment.

 

Day 2 - The so-called ‘day zero’ for the surgeon – on this day, the patient is operated on. We start the operation in the morning. Unfortunately, all patients cannot be operated on at the same time; therefore, some of you will be stressed before the operation only for a little while in the morning and some of you for a little longer. After the operation, you will normally be taken to the recovery room, where you will remain until the following morning.

Day 3 - The first post-operative day – on this day, in the morning, the patient has blood drawn again for tests. This allows for a more complete assessment of the patient's condition after the operation. After a positive assessment by the surgeon, with normal blood tests, the patient can start drinking water on this day. On this day, patients can leave their own bed without any problems and walk in the hospital corridors and, in good weather, also in the green areas in front of the hospital.

 

Day 4 - the second postoperative day – similar to the day before, blood is taken for examination. After the medical examination and with normal blood tests, the patient starts oral nutrition. Natural yoghurt goes first! Patients say that it is delicious ;) This day is the discharge day for some of our patients. After a final check of wounds and making sure that the patient can manage on their own without medical and nursing care, patients are discharged from the hospital to go home.

 

Day 5 - the third post-operative day – on this day, practically 100% of bariatric patients demand that they should leave the hospital as, in the absence of any significant complaints, they no longer have the slightest doubt that a further stay in the hospital ward is more of a hotel stay than a therapeutic one.

When will I return to full fitness?

The recovery process itself is quite short. Most patients return to normal functioning within a month. Walking and normal household activities are possible right after leaving the hospital.  Longer walks or swimming classes will be possible after about 4 weeks. 

When it comes to more strenuous physical exercises, we recommend waiting for 3 months after the operation. This is the amount of time it takes for the fascia – the strongest of the abdominal layers that protects us against the formation of a hernia – to fully heal.

Do scars remain after bariatric surgery?

All surgeries are performed using the laparoscopic technique, which means that – in most cases – we make 5 incisions on the abdomen, about 1-1.5cm long, in order to introduce tools. The wounds are closed with a cosmetic suture. 

 

We care very much about aesthetics and are aware that this is an important issue for most of our patients. After all, 5 transverse lines remain on the abdomen – which, after a few months, are hardly visible and do not constitute a serious aesthetic defect.

What is the patient's care like after leaving hospital?

Above all, we remain at the patient's disposal throughout the recovery period. We encourage you to contact us by e-mail or telephone if you have any questions or problems. The first follow-up visit takes place one month after the operation and includes a check-up with the surgeon, dietician and psychologist.  

 

The patient should bring current blood test results to the check-up. The purpose of the visit is to monitor the recovery process, assess vitamin supplementation and expand the diet under the guidance of a dietician. Check-ups are recommended every 3 months for the first year after surgery.

What is the size of my new stomach?

The size of the stomach depends on the type of surgical procedure. Immediately after bariatric surgery, it ranges from 50 to 150ml, which is approximately the volume of a shot glass to a half cup.

Will I be able to take medication after the procedure?

Small tablets can be taken before treatment. Larger medicines may be broken or crushed, although this is usually not necessary. Contact your health care provider to obtain information on the administration of medication.

When can I return to work?

You can return to work as soon as you feel well enough. Usually, 2-6 weeks for most office work and 6-8 weeks for manual work. Remember that your readiness to return to work is not only determined by your physical and mental wellbeing, but also by your ability to take care of your meals.

What is a bariatric plate?

A bariatric plate is a graphical form showing dietary recommendations after surgery. The main and most important part of each portion of food should be foods that are sources of protein, followed by vegetables and, lastly, sources of carbohydrates.

Why is fluid important?

It is important that your fluid intake is around 1500ml or more per day. This will help to keep your body adequately hydrated. Take small sips throughout the day. Fluids should be calorie-free, caffeine-free and gas-free. Remember to keep a 30-minute interval before and after meals.

Is it necessary to take vitamins after the surgery?

A definite cost associated with bariatric surgery is the need to take vitamins and micro and macro elements such as iron for (virtually) the rest of your life. Vitamins are substances that are necessary for maintaining proper health. Unfortunately, our body cannot synthesise them on its own. Therefore, it is necessary to supplement them. Adequate amounts of vitamins only reach our body if we eat a healthy and balanced diet.

Unfortunately, after bariatric treatment, the amount of food taken in by the patient is so small that it is impossible to provide the necessary amount of vitamins in the small volume of food eaten.  It is, therefore, necessary to supplement vitamins in the form of vitamin preparations. This is the only way in which it is possible to provide our body with an adequate amount of vitamins.

Why is protein so important?

Protein is essential after bariatric surgery to promote healing and preserve muscle mass. Following a protein diet plan is important in the bariatric patient's recovery process. Remember to eat your protein sources first!

What should I do if I feel nauseous?

First of all, analyse your eating behaviour. You might be eating too much and/or too quickly. An important part of your management after bariatric surgery is to keep a food diary to see if the discomfort you are experiencing is linked to the food items. If nausea recurs, discuss this with your dietician or bariatric surgeon.

What should I do if I vomit?

Vomiting is not uncommon but it can be controlled. If it does occur, there are aspects to look out for. Do you eat your meals too quickly? Pay attention to the texture of the food. Are your meals too dry? Make sure that the meat you eat is moist.

Meat is a product that requires a lot of effort on the part of the digestive part to digest, so grind or blend it. If you still cannot tolerate it, refrain from eating meat for a few weeks and try again at a later date. Do you chew your food well? Enjoy, feel and taste every bite. Remember to drink liquids separately. Do not eat and drink at the same time.

 

Wait about 30 minutes before and after a meal before drinking fluids. Fluids increase the feeling of overeating, and this can cause restlessness – resulting in a feeling of needing to vomit. If vomiting persists, discuss this with your dietician or bariatric surgeon.

What should I do if I have a problem with constipation?

You may need to increase your fibre and fluid intake. A food diary will help determine how much you are actually drinking. Adding fibre may help. The consistency of your meals and physical activity may also affect the quantity and quality of your bowel movements. Consult your surgeon or dietician about your condition.

What should I do if I have gas and bloating? What do I do if I have diarrhoea?

Some patients may experience diarrhoea after bariatric surgery due to the sugar found in dairy products (i.e., lactose). If a patient – after surgical treatment for obesity – cannot tolerate dairy sugar, this can result in cramps, bloating and/or diarrhoea. It is worth introducing lactose-free products or soya products. 

Also, make sure that meals are not too large or eaten too quickly. Eat more slowly, take small bites and chew thoroughly

What can cause chest tightness (either during or immediately after a meal)?

For a bariatric patient, pressure while eating is usually a warning sign that they are making dietary mistakes. This could be overeating or eating too fast. Celebrate your meals. Remember that you should take about 20 minutes to eat a prepared portion.

Make sure your food preparation methods and meal consistency are appropriate for the stage of dietary management you are in.

What is the dumping syndrome?

Symptoms such as nausea, vomiting, sweating, bloating, diarrhoea that usually occur after eating high fat or sugary foods. Symptoms usually last about half an hour. Not every bariatric patient experiences dumping. 

To avoid it, choose foods that contain 14 grams or fewer of sugar per serving and 3-5 grams or fewer of fat per serving. Bariatric surgery patients should read product labels and pay attention to nutritional content.

Why do I lose my hair after bariatric surgery?

Sometimes after bariatric surgery, a patient will complain of hair loss. This may be related to an insufficient supply of protein and/or vitamins. This is a common body response to rapid weight loss. Hair loss is usually not permanent and subsides after 3-6 months. Discuss this with your dietician, who will make recommendations for protein amounts and possible vitamin and mineral supplementation.

What to do if weight reduction slows down?

Weight loss can be variable. Everyone loses weight at different rates, so please do not compare yourself to other bariatric patients. If you experience a period of arrested weight loss (no reduction for more than 2 weeks), continue with dietary recommendations and physical activity.  

You may need to adjust your diet or exercise to get the reduction moving again.  If the stagnation stage lasts longer than 4 weeks, contact your dietician.

How much weight should I lose after bariatric surgery?

Among bariatric patients, weight loss is variable. The reduction depends on many factors, including exercise, food choices, calorie intake, initial weight, age, gender and adherence to dietary guidelines.

How soon after the operation will I be able to get pregnant?

It is said that “man proposes, God disposes”, but it is definitely better if pregnancy after bariatric surgery is planned. Ideally, a woman (after bariatric surgery) should not become pregnant until two years after the operation. The minimum period between the operation and conceiving a child is twelve months. 

During the first year after surgery, the body goes through something of a 'metabolic storm'. Vitamin, micro- and macro-element deficiencies can occur during this period. From the point of view of becoming pregnant, this is an extremely unfavourable situation.

When will I be able to have a surgical correction of my skin after bariatric surgery?

Everyone wants to look nice! On the other hand, “all that is delayed is not lost”! In the first year after bariatric surgery, patients go through a physiologically difficult period.  They are at risk – even if subjectively they feel very well – of deficits in protein, vitamins and micro- and macroelements. For this reason, the performance of major surgical procedures, which definitely include corrective body surgery, is dangerous during this period. 

The risk of postoperative wound infection and widespread problems with extensive wound healing is much higher. The second reason not to rush is related to weight loss during this period. It does not make any sense to perform corrective surgery if, in the subsequent months after the operation, body weight continues to decrease. To sum up, no earlier than one year after bariatric surgery and after at least a 3-month period of weight stabilisation.

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The BMI (Body Mass Index) calculator is a quick and convenient method to calculate your own body mass index. This index is used to determine the severity of obesity as well as to assess the risk of developing diseases associated with excessive body weight. The higher the degree of obesity, the higher the risk of obesity complications is, unfortunately.

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Rafał Mulek - ZnanyLekarz.pl

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Collegium Medicum UMK w Bydgoszczy Uniwersytet SWPS w Warszawie

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