CEBLS - Centre for Endoscopic, Bariatric & Laparoscopic Surgery
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Surgical Solution for Morbid Obesity

Weight-loss/Bariatric Surgery

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Q: How much experience does your bariatric surgeon have?

A: You will be seen by Mr Sufi - an experienced consultant bariatric surgeon with a long experience of performing these operations with good results.

Q: Is my surgeon trained in UK and a member of BOMSS (British Obesity and Metabolic Surgical Society)?

A: Yes, Mr Sufi has been a Fellow of the Royal College of Surgeons of England since 1996 and he is also a member of BOMSS.

Q: Is he also a member of ASMBS (American Society of Metabolic and Bariatric Surgery)?

A: Yes, he is also a member of ASMBS.

Q: Does Mr Sufi work in a NHS hospital recognised as a Centre of Excellence?

A: Yes, Mr Sufi leads bariatric surgery services in the NHS at North London Obesity Surgery Service (NLOSS) based at Whittington Hospital. Under his leadership NLOSS has achieved recognised as a Centre of Excellence. He has established similarly high quality care at Spire Bushey hospital.

Q: What type of weight loss surgeries does Mr Sufi perform (Shows overall skill level)?

A: Mr Sufi performs the whole range of bariatric surgical procedures including gastric balloon, POSE, Endobarrier, gastric plication, gastric bands, sleeve gastrectomy, gastric bypass, duodenal switch and revision bariatric surgery.

Q: Do I need a referral to make an appointment?

A: No – you can consult Mr Sufi directly if you are a self-paying patient. You can also be referred to him by your GP, especially if you are consulting for treatment other than bariatric surgery.

Q: What should I bring with me when I come for a scheduled office appointment?

A: Apart from information on your medical conditions, allergies, medications and previous operations, you should also bring

  1. Copies of blood results, x-rays, MRI's. CT scans, ECG etc. and any other relevant information
  2. Referral letter from GP, family physician or other doctor – if you are being referred.

Q: Is bariatric surgery covered by my private medical insurance?

A: No - all bariatric surgery services are self-pay. If you decide to proceed to surgery then your first consultation with Mr Sufi will be included in your package fee - otherwise, you will have to pay the hospital and consultation fees yourself.

Q: Are my medical records kept private and confidential?

A: Your medical file is handled with the utmost respect for your privacy. Our staffs are bound by strict confidentiality requirements as a condition of employment regarding your medical records. Ordinarily we will not release the contents of your medical file without your consent.

However, your consultant will normally write to your GP to ensure that he / she has full information in order  to look after your health in the future. If you object to this then you will have to provide this in writing.

Q: How can my general practitioner help me to obtain specialist medical care?

A: Before seeing Mr Sufi, you may want to talk to your general practitioner, who can discuss your condition with you and advise you on whether any other specialist care is appropriate. Your GP can help Mr Sufi to care for you better by providing relevant information about your health. Communicating with Mr Sufi will also enable your GP to care for you better during and after your specialist treatment.

Q: Based on my personal health and weight, what surgery do you recommend for me?

A: This will depend on the information which you provide to Mr Sufi at the time of consultation. Some people prefer less invasive procedures like a gastric balloon or a POSE (Primary Obesity Surgery Endolumenal). Others prefer procedures like a sleeve gastrectomy or gastric bypass, which are more likely to give a greater weight loss with a faster improvement of conditions like diabetes and high blood pressure.

Q: What should I expect during first visit?

A: During your initial visit, Mr Sufi will ask questions to ascertain your expectations and what is the best method to treat your obesity. He will explain to you any specific procedure you want, discuss the results you may expect and go over the risks.
If he considers that you have a higher risk than the general population then he may do a physical examination and ask you additional questions. He will decide what your appropriate treatment is and advise you.
If you accept his recommendation then he will arrange appropriate tests for you and suggest a date for your operation. He will discuss the liver shrinkage diet with you and arrange an appointment with your dietician before surgery.

He will also write to you and your GP.

Q: What pre-operative tests will be done?

A: You will generally need to undergo blood tests and an ECG. If you have higher risks then you may also need an echocardiogram and sometimes a sleep study.

Q: When will I be admitted to hospital?

A: You will be admitted to hospital on the morning of your operation.

Q: When will I be discharged home from hospital?

A: You will usually be comfortable enough to go home from hospital on the morning after your operation. If you are undergoing a balloon or a POSE, then you will usually go home on the same day. Do not worry - if you have to stay longer in hospital due to medical reasons, then your package price will cover any reasonable fees.

Q: Will I be sick a lot after the operation?

A: Some patients after bariatric surgery may suffer from a short period of sickness (nausea and vomiting).
It is common to feel sick after a Gastric Balloon for 1-2 weeks after the procedure. You must take the anti-sickness medicines prescribed to you.

The LAP-BAND System limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation.

It is uncommon to feel sick for a period longer than a week after the other bariatric procedures. If you continue to feel sick then contact Mr Sufi’s secretary, bariatric nurse, dietician or Gade ward and a review will be arranged.

Q: How long will it take to recover after surgery?

A: It takes most patients about a week to return to work and a month to six weeks to resume strenuous exercise. Some patients return to work in a few days. In the case of open surgery or if there are complications, recovery may take longer.

Q: Does bariatric surgery limit any physical activity?

A: Bariatric surgery does not affect or hamper physical activity including aerobics, stretching and strenuous exercise. However, it is important to wait a few weeks before resuming strenuous physical activity to reduce the likelihood of poor wound healing or developing a hernia in your wound.

Q: In case of gastric bands, do I have to be careful with the access port just underneath my skin?

A: There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.

Q: How will my surgery be performed?

A: Mr Sufi performs gastric balloons and POSE endoscopically (through the mouth) and other surgery (gastric bands, sleeve gastrectomy, gastric bypass, duodenal switch and revision bariatric surgery) through a laparoscope. An endoscopic surgery has a quicker recovery time than laparoscopic surgery which in turn has a faster recovery than open surgery.

Q: Will I need a general anaesthetic?

A: Yes, all procedures except a gastric balloon will require a general anaesthetic. A balloon is introduced and removed with local anaesthetic and sedation.

Q: Will my procedure be performed by the consultant, or an assistant?

A: Mr Sufi, an experienced consultant, will perform your procedure, with the help of his assistants.

Q: Will my consultant be in the operation room during the entire procedure?

A: Yes, Mr Sufi will remain in the operation room during the entire procedure.

Q: Where will my surgery be performed?

A: Your operation will be performed at Spire Bushey Hospital in North London by a very experienced team.

Q: What changes will I be expected to make with regards to diet and exercise?

A: You will be expected to stick to a special liver shrinkage diet 2-4 weeks before your operation. This will make your operation safer and make it less likely that your surgeon experiences difficulty during the procedure.

After your operation we advise you to modify your diet as follows:

  • Restrict yourself to liquids for 2 weeks starting with sips of non-alcoholic, non-sugary and non-fizzy drinks immediately after your operation.
  • Then, restrict yourself to a soft moist/blended diet for a further 2 weeks
  • Slowly introduce soft diet after 4-6 weeks
  • Take lifelong vitamin and mineral supplements to avoid developing nutritional deficiency.

After you have recovered from your operation and resumed normal diet, we recommend the following general dietary advice:

  1. You should separate solids from liquids during your meals by at least half an hour.
  2. You should eat one small mouthful a minute and chew it well
  3. You should eat 3 meals including breakfast a day - your meals should consist of a maximum of 20 to 30 mouthfuls and taken over 20 to 30 minutes at least.
  4. You should avoid taking high energy foods (like fast food, crisps, chocolates, ice cream etc.) or drinks (like fruit juice, fizzy drinks or alcohol).
  5. You must stop eating as soon as you feel full and not eat if you are not hungry.
Q: How much weight will I lose?

A: Obesity surgery is not a miracle cure, and the pounds won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Your main goal is to have sustained weight loss that prevents, improves, or resolves health problems connected with severe obesity.
Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. It depends on the procedure that you have chosen and your compliance with the recommended life-style changes. You can lose 20% with gastric balloon, 40% with POSE, 60% with band, 70% with sleeves and 80% with bypasses on average. You can lose 100% of your excess weight in certain circumstances and sometimes you may fail to lose weight. If you have chosen a band then your band needs to be in the right position, adjusted properly and you need to be committed to your new lifestyle and eating habits.

Q: How do the weight-loss results with the gastric band compare to those with the sleeve gastrectomy or a gastric bypass?

A: You are more likely to lose weight faster following a gastric bypass or a sleeve gastrectomy. However, in the long-term there may not be a big difference in the amount of weight lost, provided the gastric band is used appropriately. You should focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health.

How much weight can I expect to lose with POSE?

Worldwide, patients lose 43% of their excess weight on average. About 10% of patients may not lose weight - in my series the figure is 8%. A few of my patients have lost more than 60% of their excess weight.

Q: Do I have to visit clinic frequently after my operation?

A: The frequency of check-ups can vary. Most patients prefer to visit every 3-6 months. However, check-ups and band adjustments are a normal and a very important part of the gastric band follow-up. Most care package include bariatric support group and Mr Sufi highly recommends that you attend these – people who attend these meetings do better in the long term.

Q: How is the band adjusted?

A: A fine needle is passed through the skin into the access port to add or remove saline. This process most often takes only a few minutes. Most patients say it is nearly painless. Local anaesthesia may or may not be needed. Adjustments are usually done in an outpatient clinic or office. Sometimes adjustments can be carried out in the X-ray department. They are done there so the effect of the band adjustment can be clearly seen – sometimes it is also necessary to visualise the access port. When X-rays are used, your reproductive organs should be shielded.

Q: Is it true that the a gastric band seems "tighter" in the morning?

A: This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the band feels tighter during menstruation.

Q: Will I feel hungry or deprived after bariatric surgery?

A: It is common to lose hunger after bariatric surgery, but this effect is usually temporary. The effect is usually longer with gastric bypass and sleeve gastrectomy.
The gastric band makes you eat less and feel full in two ways - by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the gastric band is a tool to help you change your eating habits.

Q: Can the operation be reversed?

A: The gastric balloon and the Endobarrier are meant to be reversed, but all other procedures are intended for life. The gastric band is not meant to be removed but in certain circumstances it can be done - in most cases Mr Sufi can do this laparoscopically. The stomach generally returns to its original shape once the band is removed. It is not possible to reverse a sleeve gastrectomy, but the gastric sleeve can stretch over time – it can also be stretched with special balloon dilators. A gastric bypass is more difficult to reverse, but this can be done by an experienced surgeon. However, after the band removal or reversal of a bypass you may soon go back up to your original weight or even gain more.

Q: Will I need to take vitamin and mineral supplements?

A: Modern food is often rich in calories but poor in other nutrients. It's possible you may not get enough vitamins, iron and calcium from three small meals a day. Mr Sufi will advise your GP to evaluate whether you are getting enough vitamin B12, folic acid, iron and calcium at your regular check-ups. You should, except in gastric balloons, in most cases take multivitamins, iron and calcium.

Q: What about other medicines?

A: You should be able to take prescribed medicines. You may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck and make you sick. This is especially important after your band.
However, you may need fewer medicines for control of your diabetes, blood pressure, cholesterol following your operation. You should always ask Mr Sufi, your GP and your doctor who prescribed the drugs about this.
If you use contraceptive pills then these may not be effective – Mr Sufi advises you to use alternative methods for contraception.

Will my diabetes resolve after bariatric surgery?

Yes, if your diabetes is less than 10 years duration and treated with tablets alone then there is a high likelihood that your diabetes will resolve after your operation, especially after a gastric bypass or a duodenal switch. You can also obtain good control after POSE, gastric band or sleeve gastrectomy, depending an how much weight you lose.

Q: What if I go out to eat?

A: Order only a small amount of food, such as an appetizer. Eat slowly. Avoid fizzy drinks. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.

Q: What about alcohol?

A: Alcohol has a high number of calories. It also breaks down vitamins. If you drink alcohol regularly then you may not lose weight. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss. However, following a gastric bypass operation, the alcohol may be absorbed very fast in to your body and therefore you may get drunk quickly.

Q: Can I eat anything in moderation?

A: After your stomach has healed, which is usually 4 weeks after your operation, you may eat most foods that don't cause you discomfort. However, because you can only eat a little, it is important to include foods full of important vitamins and nutrients such as those recommended in our booklets and as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of bariatric surgery may be greatly reduced or cancelled.

Q: Will I suffer from constipation?

A: There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fibre. This should not cause you severe problems. Our information leaflets on eating after your operation will advise you on ways to avoid constipation and deal with it. If difficulties do arise, let us know as soon as possible

Q: Will I need plastic surgery for the surplus skin when I have lost a lot of weight?

A: That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mould itself around the new body tissue, especially if you keep fit by performing regular exercise. You should give the skin the time it needs to adjust before you decide to have more surgery.

Q: What will happen if I become ill?

A: This is usually not a problem. One of the major advantages of the gastric band is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. Sometimes, if the band cannot be loosened enough, it may have to be removed.

Q: What about pregnancy?

A: Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. It is better to avoid pregnancy in the first year after bariatric surgery as otherwise your weight loss may be less than expected – in addition you baby may be harmed.
If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band may be made tighter again, and you can resume losing weight.

Do you have a dietician available to patients?

A: Yes, you will have a dedicated dietician, either Miss Lucy Jones or Mrs Gill Cuffaro.

Q: Do you have a psychologist available to patients?

A: Yes, we can recommend an experienced psychiatrist.

Q: Do you have a support group for patients?

Yes, your care package will include a year’s subscription to the support group at Spire.

Q: Do you have someone I can call if I have a question during non-office hours?

A: Yes, you may contact the bariatric nurse at Spire Bushey or Gade ward.

Q: Do you have a high complication rate?

A: No, Mr Sufi’s complication rates are low.

Q: What type of balloon do you use?

A: Mr Sufi generally uses an Allergan Bioenterics gastric balloon.

Q: What type of band do you use?

A: We use an Allergan Lap-band gastric band.

Q: Are you certified with that type of band?

A: Yes, Mr Sufi is certified with Lap-band and also other bands, but he prefers to use the Lap-band.

Q: Regarding lap band surgery, what is rate of infections? (should be less than 1%)

A: Mr Sufi’s band infection rate is less than 1%.

Q: Regarding lap band surgery, what are your slip statistics? (should be less than 3%) .

A: Mr Sufi’s band slip rate is less than 3%.

Q: Regarding lap band surgery, what are your erosion statistics? (should be less than 1.3%)

A: Mr Sufi’s band erosion rate is less than 1%.

Q: Regarding lap band surgery, are adjustments (fills / defills) included in post-op care? If not, what is the cost for an adjustment? (many doctors provide fills for the first year if they perform the surgery)

A: Yes, adjustments are included in the first year. After this, you can easily obtain further support for a small fee.

Q: Do you have patients who are willing to share their experiences with me?

A: Yes, please contact Barbara Morris (secretary) for names and contact details of other patients. She can also arrange a visit to the bariatric support group meeting run at Spire Bushey hospital.

Q: What is your experience in performing POSE?

A: Mr Sufi has performed the most POSE procedures in the UK.

Q: What is your complication rate with POSE?

A: Mr Sufi’s complication rate after POSE is low. One of his higher risk patients bled and required a blood transfusion – he recovered fully and was discharged home on the following day.

Q: Do you have an insurance and/or finance available to patients?

A: Our packages are usually self-pay, but Spire Bushey can arrange finance for you if you qualify – please contact Mrs Sam Lane on 020 8901 5505 to discuss terms and conditions if you require finance. Unfortunately, private insurance does not cover bariatric surgical procedures.



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