This can be particularly difficult for patients who have made considerable changes to their eating habits and lifestyle but are still living with severe obesity.

Needing further treatment does not mean that the patient or their original surgery has failed. Obesity is a chronic, complex disease, and its management may need to change over time.

The American Society for Metabolic and Bariatric Surgery (ASMBS) recognises that further treatment may be appropriate when patients experience insufficient weight loss or weight recurrence following bariatric surgery.

For some patients, revisional bariatric surgery may be an option. One procedure that may be considered in carefully selected cases is Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S).

However, revising a previous gastric bypass to SADI-S is a complex operation and is not suitable for everyone.

Why Might Someone Need Further Surgery After Gastric Bypass?

Gastric bypass works by changing the size of the stomach and the way food passes through the digestive system. It also influences gut hormones involved in appetite, fullness and blood glucose regulation.

While many patients maintain meaningful weight loss over the long term, some may require further treatment.

There are several reasons why revisional surgery might be discussed.

Insufficient Weight Loss

Some patients lose a considerable amount of weight following gastric bypass but remain within a BMI range associated with severe obesity.

For example, someone who started with a particularly high BMI may have achieved substantial weight loss but still have obesity-related health concerns.

In these circumstances, further treatment may be considered to help address the remaining clinical risks.

Significant Weight Regain

Some weight regain can occur in the years following gastric bypass.

Changes in appetite regulation, metabolism, eating patterns, medication and the anatomy of the original bypass may all contribute.

Weight regain does not automatically mean that another operation is needed. A careful assessment is important to understand what has changed and whether medical, nutritional or surgical treatment would be most appropriate.

As outlined in the ASMBS statement on treatment options after bariatric surgery, treatment may include medication, endoscopic procedures or revisional surgery, depending on the patient’s circumstances.

Ongoing Obesity-Related Health Conditions

Weight loss is not the only measure of success following bariatric surgery.

Some patients may continue to experience conditions such as:

• Type 2 diabetes
• High blood pressure
• Obstructive sleep apnoea
• Joint pain and reduced mobility
• Other complications associated with severe obesity

Where significant obesity remains alongside these conditions, further treatment may be considered as part of an overall plan to improve long-term health.

What Is SADI-S and How Is It Different From Gastric Bypass?

SADI-S is a bariatric and metabolic procedure that combines a sleeve-shaped stomach with a bypass of part of the small intestine.

It works through changes in food intake, nutrient absorption and the hormonal signals involved in appetite and metabolism.

SADI-S is generally considered a more malabsorptive procedure than a standard Roux-en-Y gastric bypass, although the effects depend on the individual anatomy and surgical technique.

When a patient has already undergone gastric bypass, the operation is considerably more complex than performing SADI-S as a first bariatric procedure.

The surgeon must carefully assess the existing stomach and intestinal anatomy before determining whether reconstruction to a SADI-S configuration is technically possible and clinically appropriate.

Who Might Be Considered for Gastric Bypass to SADI-S Revisional Surgery?

There is no single BMI or weight regain threshold that automatically makes someone suitable for this type of revision.

However, certain circumstances may lead an experienced bariatric surgeon to consider whether it is an appropriate option.

Patients With Persistent Severe Obesity

Patients who continue to have a high BMI despite meaningful weight loss after gastric bypass may be considered for further assessment.

This may be particularly relevant where the remaining excess weight continues to affect mobility, metabolic health or quality of life.

The decision is based on more than BMI alone. The patient’s overall health, previous weight loss, surgical history and likely benefits and risks must all be considered.

Patients With Significant Weight Regain

For patients who have regained a substantial amount of weight, the first step is to understand why.

This may involve reviewing the original operation, examining the current anatomy and assessing nutritional, behavioural and medical factors.

If significant obesity persists and other treatment approaches have not provided sufficient benefit, revisional surgery may be discussed.

Patients Who Are Medically and Nutritionally Suitable

Revisional surgery requires careful consideration of the patient’s nutritional health.

Gastric bypass already affects the absorption of certain nutrients. SADI-S can increase the risk of protein and micronutrient deficiencies, making nutritional assessment particularly important.

The ASMBS nutritional guidelines emphasise the importance of screening for nutritional deficiencies and maintaining appropriate supplementation and monitoring following bariatric surgery.

Patients need to be able to follow long-term dietary guidance, take prescribed supplements and attend regular follow-up appointments.

Existing deficiencies may need to be corrected before surgery can be considered.

Why Is Assessment Particularly Important Before Revisional Surgery?

Revisional bariatric surgery is generally more technically demanding than a first bariatric operation.

Scar tissue, altered anatomy and changes from the previous procedure can increase surgical complexity.

An international consensus on revisional bariatric surgery highlights the importance of careful patient selection, multidisciplinary assessment and appropriate investigations before further surgery.

Before recommending further surgery, the multidisciplinary team may arrange investigations such as an upper gastrointestinal endoscopy, imaging and blood tests.

The assessment will also consider:

• The type of gastric bypass originally performed
• Weight loss and weight regain history
• Current BMI and obesity-related health conditions
• Existing nutritional deficiencies
• Digestive symptoms and previous surgical complications
• The patient’s ability to maintain long-term follow-up

These findings help determine whether further surgery is appropriate and, if so, which procedure may offer the most suitable outcome.

What About Recovery and Long-Term Care?

Recovery following revisional surgery varies depending on the complexity of the operation and the patient’s overall health.

As with other bariatric procedures, patients follow a staged dietary progression after surgery. However, the nutritional requirements following SADI-S need particular attention.

Long-term care includes monitoring protein intake, vitamin and mineral levels, weight changes and general health.

At Blackrock WeightCare, we recognise the importance of continued support following surgery. You can read more about our approach to weight loss aftercare.

Considering Further Surgery After Gastric Bypass?

Having undergone gastric bypass does not necessarily mean that all surgical treatment options have been exhausted.

For patients who continue to live with severe obesity or have experienced significant weight regain, a specialist assessment can help establish whether further treatment may be beneficial.

At Blackrock WeightCare, Mr William Robb and our experienced multidisciplinary team assess patients considering revisional bariatric surgery, including complex cases where SADI-S may be an option.

Every patient’s circumstances are different, and any recommendation for further surgery follows a careful review of their previous operation, current health and long-term needs.

If you would like to discuss your options, contact Blackrock WeightCare on 01 255 2479 or send us an enquiry.

Your Health. We Care.

The post Gastric Bypass to SADI-S Who Might Be Suitable for Revisional Surgery? appeared first on Blackrock WeightCare.

It is understandable. Most people preparing for weight loss surgery are thinking about how much they will be able to eat, what foods they can have and how quickly they might lose weight. Drinking water does not tend to be high on the list of concerns.

Yet hydration is something we pay close attention to during recovery.

Having cared for bariatric patients for many years, I have seen that the difficulty is rarely that someone does not understand the importance of drinking. More often, they are simply adjusting to the fact that they cannot drink in the same way they did before.

The good news is that, with a few simple habits, it usually becomes much easier.

Why can something as simple as drinking suddenly feel different?

Following a gastric sleeve, gastric bypass or SADI-S, taking in a large amount of fluid quickly may no longer feel comfortable, particularly during the early stages of recovery.

Some patients also experience nausea or changes in appetite and thirst. Add in everything else you are learning about your postoperative diet, protein, medications and activity, and it is easy to fall behind with fluids without noticing.

Dehydration is something we take seriously in bariatric care. Research involving more than 250,000 patients undergoing sleeve gastrectomy or gastric bypass found that dehydration requiring treatment was associated with emergency department visits and hospital readmission. 

That does not mean hydration needs to become a source of worry. It means we want patients to understand it and establish good habits early.

Forget the large glass. Think little and often

Patients sometimes tell me, “I just can’t get through that much water.”

My advice is not to look at the whole day’s fluid requirement as one big task.

You are not trying to drink a large glass at once. Small amounts, taken regularly across the day, are generally much easier to manage.

Your bariatric team will advise you on your individual fluid requirements. International bariatric guidance commonly refers to approximately 64 fluid ounces, or around 1.9 litres, per day, although individual requirements and postoperative plans can vary.

A few practical habits can make a real difference:

• Start your fluids early rather than trying to catch up later in the day.
• Keep your drink somewhere visible and within reach.
• Use a bottle with a known volume if that helps you keep track.
• Sip regularly rather than taking large drinks.
• Follow the guidance from your bariatric team about suitable fluids at each stage of recovery.

If you find plain water difficult to tolerate, let your bariatric team or dietitian know. There may be suitable alternatives depending on where you are in your postoperative plan.

You will need to rethink drinking with meals too

For many people, having a drink beside their meal is something they have done all their lives.

Following bariatric surgery, that habit needs to change.

BOMSS guidance recommends avoiding drinking with meals and leaving approximately 30 minutes between eating and drinking.

Initially, patients can find this one of the more awkward adjustments.

I usually reassure them that it becomes much more natural with time. What feels like a schedule during the first few weeks eventually becomes part of your normal routine.

Your body will usually give you a few clues

You do not need to become obsessed with measuring every millilitre you drink.

Instead, learn to recognise the signs that your intake may be falling behind.

A dry mouth, increasing thirst, headache, dizziness, unusual tiredness and urine that becomes noticeably darker or less frequent can all be signs that you need to pay attention to your hydration.

Vomiting or diarrhoea can increase the risk because you are losing fluids while potentially struggling to replace them.

I would much rather a patient contact us early because they are unsure than wait until they are feeling significantly unwell.

When is it more than just a difficult day?

There is an important difference between having a day when you have not quite reached your fluid goal and being unable to drink adequately.

Repeated vomiting, difficulty keeping fluids down, increasing difficulty swallowing or a significant drop in fluid intake should be discussed with your bariatric team.

Some days will require a little more attention

Warm weather, exercise, fever, vomiting and diarrhoea can all increase fluid losses.

Travel can catch people out too.

You may be walking more, sitting on a flight, spending time somewhere warmer or simply be out of your usual routine. If you are travelling after bariatric surgery, think about hydration before you leave rather than waiting until you become thirsty.

Eventually, you stop having to think about it so much

This is perhaps the reassurance I would most like to give someone preparing for bariatric surgery.

The early weeks involve a lot of learning.

Eating feels different. Drinking feels different. Your body is changing and you are trying to remember advice about nutrition, medication, activity and recovery.

It can feel like a lot at first.

But the patients I care for generally find that these new habits become increasingly normal. You learn what works for you. You recognise when you have not had enough to drink. And taking regular fluids becomes something you do without having to plan every sip.

The aim is not to be perfect. It is to understand your new body, build sensible habits and know when to ask for help.

At Blackrock WeightCare, we see bariatric surgery as much more than the operation itself. Preparing patients for the changes that come afterwards, and being there when questions arise, is an important part of bariatric care.

If you are considering bariatric surgery and would like to learn more about the treatment and ongoing support available at Blackrock WeightCare, complete the enquiry form here, or call us on 01 255 2479.

Your Health. We Care.

The post Why Hydration Can Be Harder After Bariatric Surgery and How to Stay on Top of It appeared first on Blackrock WeightCare.

Some people who have struggled with their weight for years are experiencing meaningful weight loss with tirzepatide. Their appetite may be easier to manage. Blood sugar control can improve. Everyday activities may become easier.

Then comes a question we hear increasingly often:

Will I have to take Mounjaro for the rest of my life to keep the weight off?

There is no single answer that applies to everyone. What we do know is that obesity is a chronic disease and, for many people, stopping an effective treatment can allow the biological drivers of weight gain to return.

That does not necessarily mean everybody who starts Mounjaro will remain on exactly the same medication or dose for life. It does mean that stopping treatment deserves more thought than simply reaching a particular number on the scales.

What happens when Mounjaro is stopped?

Mounjaro contains tirzepatide. It works on hormonal pathways involved in appetite, food intake and blood glucose regulation.

These effects are present while the medication is being taken. Stopping the medication does not permanently reset the body’s systems for regulating appetite and weight.

We have good clinical evidence showing what this can mean.

In the SURMOUNT-4 trial, people with obesity or overweight received tirzepatide for 36 weeks and achieved an average weight reduction of 20.9%. Participants were then assigned either to continue tirzepatide or switch to placebo for another year.

Those who continued treatment lost further weight. Those who stopped tirzepatide and switched to placebo experienced substantial weight regain.

This is important because it tells us that Mounjaro should not necessarily be viewed in the same way as a short course of antibiotics that is finished once the immediate problem improves.

Obesity usually requires a longer-term approach.

Weight regain does not mean the treatment failed

This point deserves particular attention.

Someone may take Mounjaro, lose a significant amount of weight and then regain some of that weight after stopping.

It can be very easy to interpret this as having gone backwards.

Clinically, that is not necessarily what has happened.

The medication was treating a chronic condition. Once treatment was withdrawn, some of the biological processes involved in that condition became more active again.

We see similar evidence with semaglutide. In an extension of the STEP 1 trial, participants regained around two-thirds of their previous weight loss during the year after semaglutide was stopped.

The lesson from these studies is not that weight-loss medication does not work.

In many patients, it works very well.

The more important lesson is that maintaining the benefit may require ongoing treatment.

Does that mean Mounjaro is a lifelong medication?

Potentially, for some people.

But “lifelong” can be an unhelpful way to think about the decision when somebody is only beginning treatment.

Obesity care can change over time.

A person may respond very well to medication and remain on it long term under medical supervision. Another may need a change in dose or medication. Someone else may stop because of side effects, cost, pregnancy planning or a change in their health.

There are also people living with more severe obesity for whom medication is helpful but does not provide enough improvement in obesity-related health conditions.

The more useful question is therefore:

What is my long-term treatment plan if Mounjaro is working for me?

That conversation should ideally happen before stopping rather than after weight regain has already occurred.

What if you have reached the weight you wanted?

Reaching a healthier weight does not necessarily mean that the underlying tendency towards obesity has disappeared.

This can feel counterintuitive.

We are accustomed to thinking that treatment should finish when the desired result has been achieved. Chronic diseases often work differently.

Blood pressure medication is not usually stopped simply because a person’s blood pressure has improved while taking it. The improvement may be evidence that the treatment is doing its job.

Obesity treatment can require similar long-term thinking.

Current European guidance describes obesity as a chronic, relapsing disease requiring sustained and personalised care. Long-term management should consider not only weight, but also conditions such as type 2 diabetes, cardiovascular disease, sleep apnoea, joint problems and quality of life.

What if you want to stop because of the cost?

This is particularly relevant in Ireland.

Many people are paying privately for weight-loss medication. A monthly expense that feels manageable for six months can look quite different when considered over several years.

Cost is therefore a legitimate part of the treatment conversation.

Stopping solely because the medication has “done its job”, without discussing what happens next, can leave somebody without a plan for maintaining the health improvements they have achieved.

Speak to the clinician managing your treatment before stopping. Depending on your circumstances, the discussion may include continued medical treatment, an alternative medication, nutritional and lifestyle support, or assessment for other obesity treatments.

When is it worth having a conversation about bariatric surgery?

Mounjaro can be a very effective treatment for obesity, but continuing medication indefinitely may not be the right approach for everyone. Some people experience weight regain when treatment stops, while others may still be living with severe obesity or conditions such as type 2 diabetes, sleep apnoea or high blood pressure despite losing weight with medication.

At this point, it may be worth looking beyond the next prescription and considering what treatment could offer a more durable approach to obesity.

Bariatric surgery is one such option. Procedures including gastric sleeve, gastric bypass and SADI-S can achieve substantial, sustained weight loss and improvements in obesity-related health conditions. Surgery also requires long-term commitment, including changes to eating, nutritional supplementation where required and ongoing follow-up, so it is a decision that deserves proper consideration.

Taking Mounjaro does not prevent you from exploring bariatric surgery, and considering surgery does not mean that your previous treatment has failed. It may simply be the next conversation to have about managing obesity over the longer term.

At Blackrock WeightCare, Mr William Robb and the multidisciplinary bariatric team can assess your health, weight history and previous treatment and discuss whether bariatric surgery may be appropriate for you.

To arrange a consultation, call 01 255 2479 or complete the enquiry form here.

Your Health. We Care.

The post Do You Have to Stay on Mounjaro for Life to Keep the Weight Off? appeared first on Blackrock WeightCare.

Today, it is one of the most commonly discussed treatments for obesity. Conversations that once happened quietly behind closed doors are now taking place openly in GP surgeries, workplaces and family homes. More people are asking questions about bariatric surgery, weight loss injections and long-term obesity treatment than ever before.

This growing interest is not simply about losing weight. It reflects a broader shift in how obesity is understood.

For years, obesity was viewed primarily as a lifestyle issue. The advice was often straightforward: eat less, move more and try harder. While healthy eating and physical activity remain important, we now understand that obesity is a complex chronic disease influenced by genetics, hormones, metabolism, environment and psychological factors.

As that understanding has evolved, so too has the willingness of patients and healthcare professionals to consider treatments that go beyond traditional dieting.

One of those treatments is gastric sleeve surgery.

Ireland is Facing a Growing Obesity Challenge

The increasing popularity of gastric sleeve surgery cannot be separated from the reality of obesity in Ireland.

According to the latest Healthy Ireland data discussed in the Oireachtas, 21% of adults in Ireland are living with obesity, while a further 35% are classified as overweight. Together, that means more than half of the adult population is carrying excess weight.

The issue extends beyond adults. Research published by the HSE found that almost one in five primary school children in Ireland are living with overweight or obesity.

These figures matter because obesity is closely linked to a range of serious health conditions including:

• Type 2 diabetes
• High blood pressure
• Sleep apnoea
• Fatty liver disease
• Joint problems
• Heart disease
• Certain cancers

For many people, obesity becomes much more than a number on the scales. It begins to affect energy levels, mobility, confidence, relationships and long-term health.

As awareness of these risks grows, more people are seeking treatments that offer durable and meaningful results.

People are Beginning to Understand that Obesity is a Medical Condition

One of the biggest changes in recent years has been the way obesity is viewed by both patients and healthcare professionals.

Clinical guidelines in Ireland now recognise obesity as a chronic disease rather than simply a lifestyle issue. Experts increasingly acknowledge that many patients are fighting biological mechanisms that actively resist weight loss.

This shift is important.

When people understand that obesity is a medical condition, they become more open to medical treatments. Just as nobody would expect high blood pressure or asthma to be solved through willpower alone, obesity often requires specialist intervention.

For some patients, that intervention may involve weight loss medication. For others, it may involve bariatric surgery.

Increasingly, both approaches are being viewed as part of the same treatment pathway rather than competing alternatives.

Weight Loss Injections have Increased Awareness of Obesity Treatment

The rise of medications such as Ozempic and Mounjaro has generated enormous public interest in obesity treatment.

Many people who had never previously spoken to their GP about their weight are now doing so. This has helped reduce stigma and encouraged more conversations about obesity management.

Interestingly, the popularity of weight loss injections has also increased awareness of bariatric surgery.

Patients are becoming more informed about the different treatment options available. They are learning that obesity treatment exists on a spectrum, ranging from lifestyle support and medication to procedures such as gastric sleeve surgery, gastric bypass and SADI-S.

Rather than replacing surgery, these medications have often acted as a gateway to broader discussions about long-term obesity care.

Gastric Sleeve Surgery Offers Long-Term Results

Another reason gastric sleeve surgery is becoming more popular is that patients are increasingly focused on long-term outcomes.

Most people seeking obesity treatment have already tried multiple diets. Many have experienced the frustration of losing weight only to regain it months or years later.

What attracts many patients to gastric sleeve surgery is its ability to produce significant and sustained weight loss.

The procedure works by removing a large portion of the stomach, creating a smaller sleeve-shaped stomach. While this reduces the amount of food that can be consumed, it also affects hormones involved in hunger and appetite regulation.

Patients often report that the constant battle with hunger becomes easier to manage after surgery.

Importantly, the benefits extend beyond weight loss. Gastric sleeve surgery has been shown to improve or even resolve many obesity-related conditions, particularly type 2 diabetes, hypertension and sleep apnoea.

For patients who have spent years managing multiple health conditions, this can be life-changing.

Advances in Surgical Technology have Improved Confidence

Modern bariatric surgery looks very different from the procedures performed decades ago.

Minimally invasive techniques have transformed patient experience. Smaller incisions, reduced pain and faster recovery times have made surgery more accessible and less intimidating.

The development of robotic bariatric surgery has taken this even further.

Robotic technology allows surgeons to operate with enhanced precision and control, which can be particularly beneficial in patients with severe obesity or complex anatomy.

Blackrock WeightCare has seen firsthand how advances in surgical technology continue to improve patient outcomes and recovery.

More GPs are Referring Patients Earlier

There has also been a noticeable change within primary care.

Many GPs now recognise that waiting until obesity-related complications become severe may not be in the patient’s best interests.

Instead, referral for bariatric assessment is increasingly being considered earlier, particularly for patients with:

• Type 2 diabetes
• Sleep apnoea
• Hypertension
• Severe obesity
• Repeated unsuccessful attempts at weight loss

This does not mean every referred patient will undergo surgery. It simply means they have the opportunity to discuss all available treatment options with a specialist team.

Earlier conversations often lead to better outcomes.

The Conversation around Bariatric Surgery is Changing

Perhaps the biggest reason gastric sleeve surgery is becoming more popular in Ireland is that the conversation itself has changed.

Patients are no longer asking whether obesity deserves treatment.

They are asking which treatment is most appropriate for their situation.

Healthcare policy is evolving too. Recent discussions around a new National Obesity Strategy and continued efforts to expand obesity services reflect growing recognition that obesity requires structured medical care and long-term support.

The focus is gradually moving away from blame and towards treatment.

That is good news for patients.

Looking Beyond Weight Loss

For many people considering gastric sleeve surgery, the goal is not simply to lose weight.

It is to walk without pain.

To reduce diabetes medication.

To sleep better.

To play with children or grandchildren without becoming exhausted.

To improve health, mobility and quality of life.

Those are the outcomes that matter most.

At Blackrock WeightCare, based at Blackrock Clinic, we understand that every patient’s journey is different. Some patients may benefit from medical weight management, while others may be suitable for gastric sleeve surgery, gastric bypass or SADI-S. The most important step is understanding your options and receiving advice tailored to your individual health needs.

If you would like to learn more about gastric sleeve surgery in Ireland or discuss whether bariatric surgery may be right for you, our team is here to help.

Speak with our team directly on 01 255 2479.

Your Health. We Care.

The post Why Gastric Sleeve Surgery is Becoming More Popular in Ireland appeared first on Blackrock WeightCare.