What are the criteria for surgery (gastric sleeve, bypass or banding)?
The criteria have been very clearly defined by the France’s leading public healthcare authority, the Haute Autorité de Santé (HAS). Surgery is available to patients suffering from either morbid obesity (BMI >40) or severe obesity (BMI>35) with medical complications that are a result of their excess weight (arterial hypertension, cardiac problems, sleep apnoea, bone and joint pain, diabetes and high cholesterol). However, surgery is always a second-stage solution, offered after confirmation of the failure of carefully conducted medical and nutritional treatment over a period of at least six months, and the absence of any contraindication for surgery.
What are the differences between a sleeve and a bypass?
A gastric sleeve involves a reduction in the size of the stomach whereas a gastric bypass combines a reduction in the size of the stomach with a change in the intestinal pathway and the absorption of food. The two types of surgery have different side effects, produce a different quality of life and are not necessarily suitable for the same patients. It’s a complex issue and patients will be given comprehensive, detailed explanations during consultations.
What pre-operative procedures are there for gastric sleeve, bypass or banding surgery?
The procedures are both medical (two consultations with the surgeon, consultations with medical specialists and pre-operative medical examinations) and administrative (advance application for payment by France’s national health service). The procedures will be explained to you at your first consultation and you’ll be assisted throughout the process to avoid any stress or waste of time. The Professional background / Approach page provides more information.
Can I remove my gastric band and, if so, how?
Yes. If, after several years, you’re no longer satisfied with your gastric band (you suffer from discomfort when eating or the onset of complications such as reflux or oesophagitis, etc.), or if you don’t think you need it any more, it can be removed. This requires a surgical procedure but is almost always carried out by keyhole surgery, which is quite fast and has a quick recovery period (usual period of hospitalisation is 48 hours).
What’s a "Mini Gastric Bypass"?
A mini gastric bypass is a simplified bypass technique that requires only one suture instead of two for the conventional bypass. This procedure has only been available for the past few years and therefore its long-term results and risks are not yet known. It is only available in France, not in countries with severe obesity problems, such as the USA or Canada, for example. Contrary to what the name suggests (a "mini" bypass), it is not a more minor or less risky procedure than other, traditional, forms of bariatric surgery. Like the conventional sleeve and bypass, it is not reversible. The only advantage of this technique compared to the conventional bypass is that it is quicker for the surgeon. For the patient, it does not seem to have any additional benefits and there is a higher risk of biliary reflux and gastritis. Moreover, this procedure is neither recognised nor recommended by the HAS at the present time. For all these reasons, it is not usually done in our centre.
Can I become pregnant after the operation?
Yes. It is possible to become pregnant after being given a gastric sleeve, bypass or band. However, you’ll be advised to wait until the end of the period of rapid weight loss, i.e. a year after surgery, before trying to become pregnant. We also recommend that you undergo tests to confirm that you are not vitamin-deficient before planning a pregnancy.
I take the contraceptive pill. Will it still work normally after the operation?
Yes. Oral contraceptives remain effective after all types of surgery.
Is the surgery paid for by the national health service in France?
Yes. France’s national health service pays the “basic” rate for the surgery. As far as the co-payment or “gap” that you might be asked to pay, it may be fully or partially reimbursed by your private health insurance, depending on your level of cover.
Can I have the operation even if the national health service refuses to pay for it?
No. Agreement from the national health service is compulsory. In addition to the financial aspect, the fact that the national health service agrees to pay for the operation also guarantees that the surgery is appropriate for your condition and complies with professional recommendations.
I’m a smoker. Does that make any difference as far as the operation is concerned?
Yes. Smoking increases the number of complications (fistulas, respiratory complications, phlebitis). You will always be advised to stop smoking before the operation.
Is reconstructive surgery covered by the national health service?
There are several types of surgery that may be envisaged after weight loss. There are several types of surgery that may be needed after weight loss. Some of them are considered to be reconstructive and functional and are therefore covered by the national health service. One of these is the removal of the abdominal apron; another is the removal of excess skin on the limbs. However, cover will only be provided after an expert assessment and agreement on the part of the health service’s Medical Consultant. Other forms of surgery that are considered “cosmetic” (e.g. breast reduction or augmentation, procedures on the buttocks or face) are not paid for by the health service.
How should I choose the type of surgery?
It is really your surgeon who will suggest the most appropriate surgery for you. There are many things to take into consideration when choosing the surgery such as eating habits or medical history.
What should I do if I gain weight after the surgery?
There are several reasons for potential weight gain – difficulties in following nutritional advice, a return to bad eating habits, difficulty in exercising again, or mechanical reasons caused by the surgical implant. You should consult a member of the team (a surgeon or endocrinologist) who will diagnose the problem and prescribe the most appropriate treatment.
I have put on weight again after a failed gastric band. May I have a sleeve or a bypass?
Yes. The fitting of a sleeve or performance of a bypass are both feasible options (carried out quite frequently) for patients who already have gastric banding, but the surgery is slightly more difficult and there are more complications than in patients who have never been given a band.
Since the operation, I sometimes vomit. Is this normal?
No. Regardless of the type of surgery you have had, you shouldn’t be vomiting. Vomiting may be a sign that you are eating the wrong things or it may indicate a complication with your medical device. You should make an appointment so that your problem can be diagnosed and you can be given the appropriate treatment.
Do all patients lose the same weight with the same operation and can I know in advance how much weight I’ll lose?
No. Weight loss varies from one person to another. It is greater in patients who have more weight to lose at the outset (very high BMI) and in patients who successfully follow dietary advice and return to physical exercise.
How much does a gastric balloon cost?
Gastric balloons are not paid for by the national health service in France, which means that the patient has to pay all the expenses. Overall, the cost is approximately € 1,500. This includes the price of the balloon itself and the costs of the two endoscopies and two general anaesthetics (to install and remove the balloon).