That’s the wrong question.

The right question is: what does this patient need, at this stage of their disease?

Obesity is chronic, progressive, and heterogeneous. The era of picking a lane — medical or surgical — is over. The best outcomes come from building integrated pathways. Here’s how I think we could think about it clinically.

BMI 27–35: Early intervention, metabolic protection

This is where the newer incretin therapies have genuinely expanded our toolkit. For patients without advanced complications, GLP-1s can achieve meaningful weight loss and delay progression to T2DM, NAFLD, and OSA. The goal here is prevention — getting in early before the disease accumulates damage. Medication earns its place at this stage, and I use it.

BMI 35–45: The judgment zone

No dogma here. This is where clinical decision making meets outcome data.

I’ll consider GLP-1s alone when diabetes is mild or very recently diagnosed and the patient is highly adherent. Endoscopic options when they want a lower-risk bridge with 15% total body weight loss (TBWL). Surgery when there’s severe GERD, significant visceral fat, liver fibrosis, established diabetes or a poor response to medical therapy.

Often the sequence is: surgery for the durability that drugs alone haven’t matched long-term. HbA1c, reflux burden, functional status, and what the patient can realistically sustain for 20 years, cumulative cost of injectables — these also can drive the decision for surgery versus a trial of medication, not the BMI alone.

BMI 45+: Surgery anchors the pathway

The data here hasn’t changed, and it won’t be overturned by a few years of GLP-1 trial data. For severe obesity with end-organ damage — fatty liver disease, refractory T2DM, sleep apnoea, joint destruction — metabolic surgery delivers weight loss and disease remission at a magnitude we cannot replicate pharmacologically with medications available to date. Not yet. Possibly not ever, for this cohort.

That said, GLP-1s have earned a genuine role around surgery: shrinking the liver pre-operatively in very high BMI patients, reducing anaesthetic risk, and rescuing for weight regain long after the operation. They can extend what surgery starts. They don’t replace what surgery does.

What the best programs are building

Stratify by more than BMI — we need to stratify patients by metabolic burden, genetics, psychological readiness, and social context all matter. Sequence therapies deliberately and consider what the correct combinations are based on the stage of the disease. Follow patients for decades, not months. And put surgeons, physicians, dietitians, and psychologists in the same room, sharing the same data.

The tribalism between “medical” and “surgical” camps has cost patients. The win here is designing systems that deliver the right option, to the right patient, at the right moment in their disease trajectory.

That’s precision obesity care. And it needs surgeons to build it.

Your Health. We Care.

The post Knife and Needles appeared first on Blackrock WeightCare.

Loose or excess skin is a common and very normal part of major weight loss — but it is not something every patient experiences in the same way, and it does not mean that surgery has failed. Understanding why loose skin occurs, who is more likely to experience it, and what options exist can help patients make informed, confident decisions about their next steps.

Why Does Loose Skin Occur After Bariatric Surgery?

Skin is remarkably elastic, but it has limits. When the body carries excess weight for many years, the skin stretches to accommodate that weight. After bariatric surgery, weight loss often happens faster than the skin can adapt, particularly when large amounts of weight are lost.

Several factors influence whether loose skin develops:

• Amount of weight lost – greater weight loss often leads to more excess skin
  
• Age – skin elasticity naturally decreases over time
  
• Duration of obesity – the longer the skin has been stretched, the harder it is to retract
  
• Genetics – some people simply have more elastic skin than others
  
• Lifestyle factors – nutrition, hydration, exercise, and smoking history all play a role
  

Importantly, not everyone develops significant loose skin. Many patients experience only mild changes that settle over time, while others may notice loose skin in specific areas rather than all over.

Where Does Loose Skin Commonly Appear?

Loose skin tends to develop in areas where fat was previously stored in higher amounts, such as:

• Abdomen and lower belly
  
• Arms (often referred to as “bingo wings”)
  
• Thighs
  
• Breasts
  
• Neck and jawline
  

For some people, this is mostly a cosmetic concern. For others, excess skin can cause physical discomfort, including skin irritation, rashes, difficulty exercising, or challenges with clothing fit.

Managing Loose Skin Without Surgery

It is important to say clearly: many patients do not require plastic surgery.

Non-surgical approaches can help manage loose skin and improve comfort and appearance:

• Time – skin can continue to retract for 12–24 months after weight stabilises
  
• Strength training – building muscle can improve body shape and support the skin
  
• Good nutrition – adequate protein, vitamins, and hydration support skin health
  
• Skin care – while creams cannot remove loose skin, they may improve texture and comfort
  
• Compression garments – helpful for comfort, exercise, and clothing fit
  

For a large number of patients, these measures are sufficient, and no further treatment is needed.

When is Plastic Surgery Considered?

Plastic or body-contouring surgery is not a requirement after bariatric surgery. It is a personal choice, considered only when:

• Weight has been stable for a sustained period (usually 12–18 months)
  
• Loose skin causes physical issues such as infections or mobility problems
  
• Excess skin significantly affects the quality of life or confidence
  
• The patient feels emotionally ready and well-informed 

Procedures such as tummy tuck, arm lift, thigh lift, or breast surgery can remove excess skin and improve comfort and body contour. For many patients, this represents the final step in a long health journey — not about perfection, but about feeling comfortable and confident in their body.

A Personal Decision, Made With the Right Support

Loose skin is not a failure, and addressing it is not about vanity. It is about well-being, comfort, and confidence. Some patients choose to proceed with plastic surgery, others do not — both choices are completely valid.

What matters most is having expert guidance, honest conversations, and access to experienced specialists who understand the full bariatric journey.

Completing Your Journey with Blackrock WeightCare

At Blackrock WeightCare, we understand that bariatric surgery does not end on the day of the operation. It is a journey that unfolds over time — physically, emotionally, and practically.

If you are approaching the later stages of your weight loss journey and would like to discuss loose skin, body changes, or whether plastic surgery may be appropriate for you, our team is here to help. We can guide you through your options, answer your questions, and support you in making the decision that feels right for you.

To explore your next steps, click to enquire with Blackrock WeightCare or call 01 255 2479. Our expert team is here to support you with clarity, confidence, and care.

Your Health. We Care.

The post Managing Loose Skin After Bariatric Surgery appeared first on Blackrock WeightCare.

Will the weight come back?

The honest answer is that weight regain can happen with both treatments. The difference lies in why it happens, how common it is, and how it is managed.

Understanding that difference matters before choosing your next step.

Why Weight Regain Happens After Injections

Medications such as Mounjaro and Ozempic work by regulating appetite hormones and slowing stomach emptying. While you are taking them, appetite is reduced and calorie intake falls.

The challenge is what happens when the medication stops.

These injections do not permanently change the anatomy of the digestive system. Once the medication is withdrawn:

• Appetite hormones gradually return to baseline
• Hunger increases
• Calorie intake rises
• Weight regain can occur

Clinical studies have shown that a significant proportion of weight lost on GLP-1 medications may be regained after stopping treatment if no structured long-term plan is in place.

This means injections need to be continued long term to maintain results. Medication is a lifelong treatment for a chronic disease. That carries a commitment to continuing the medications with clear cost implications and requires ongoing medical supervision.

Why Weight Regain Happens After Bariatric Surgery

Weight regain after surgery is different.

Procedures such as Gastric Sleeve and SADI-S permanently alter stomach size and, in some cases, nutrient absorption. They also create long-lasting hormonal changes that reduce hunger and improve insulin sensitivity.

However, surgery is not immune to weight regain.

Reasons may include:

• Gradual adaptation of the stomach over time
• High-calorie liquid intake
• Grazing behaviour
• Emotional eating
• Reduced follow-up engagement
• Lack of dietary structure

The key difference is that the anatomical and hormonal changes from surgery remain in place. This makes weight regain generally slower and often less dramatic than after stopping injections.

In most cases, surgery provides more durable long-term weight loss, particularly in patients with BMI over 45.

How Much Weight Regain Is Normal

After bariatric surgery, small amounts of weight regain several years later can be normal. The body stabilises after the initial weight loss phase. The goal is not zero regain. The goal is maintaining significant net weight loss and improvement in health.

After stopping injections, weight regain can be more rapid because the hormonal effect is removed entirely.

The pattern is different. The underlying biology explains why.

Which Offers More Durable Results

For patients with severe obesity, especially BMI above 40, bariatric surgery consistently shows stronger and more durable long-term outcomes compared to injections alone.

Injections can be effective for moderate obesity. They are valuable tools. But they do not currently match the long-term metabolic impact of surgery in higher BMI groups. That does not mean injections have no role. In some patients, they are appropriate as:

• A primary treatment
• A bridge before surgery
• Support in cases of mild post-surgical regain

For many patients the treatment of their obesity may involve both – often surgery now and medication later if ever required.

The decision depends on the individual.

What Happens if Weight Regain Occurs

At Blackrock WeightCare, weight regain is managed proactively.

This may include:

• Nutritional review
• Behavioural support
• Medical optimisation
• Use of medication where appropriate
• Consideration of revisional surgery in selected cases

Mr William Robb assesses each situation carefully. As an Upper GI and Robotic Bariatric Surgeon, he evaluates anatomical, metabolic and behavioural factors before recommending next steps.

The focus is always on long-term health, not short-term numbers.

The Bigger Question

The real question is not whether weight regain is possible. It is which treatment offers the most sustainable control of a chronic disease.

Obesity is a long term chronic disease. It requires a long-term plan and an ever evolving algorithm of care.

Injections require ongoing use to maintain effect. Surgery creates permanent anatomical and hormonal changes that support durability, particularly in higher BMI patients.

Neither is a quick fix. Both require commitment and follow-up.

Choosing the Right Path

If you are concerned about weight regain, whether after injections or surgery, the right step is expert assessment before making changes.

At Blackrock WeightCare, complex and high BMI patients are routinely assessed to determine the safest and most effective long-term strategy.

To know more, click here and fill the enquiry form or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post Weight Regain After Injections vs Bariatric Surgery: What is the Difference appeared first on Blackrock WeightCare.

But for some, once the weight has stabilised, a new concern emerges. Excess skin following significant weight loss can affect comfort, mobility and confidence. It can cause practical issues such as skin irritation, hygiene difficulties and challenges with clothing.

At Blackrock WeightCare, we believe care does not end when the weight comes down. That is why Body Contouring Surgery is now available for our patients following bariatric procedures, delivered within a structured, medically supervised pathway.

Why excess skin happens after bariatric surgery

Patients who undergo procedures such as Gastric Sleeve, Gastric Bypass or SADI-S often lose a substantial amount of weight, particularly those who begin their journey with a higher BMI. Skin that has been stretched for many years does not always retract fully after major weight loss.

This is especially true in patients who have undergone metabolic surgery for severe obesity. The abdomen is most commonly affected, though the upper arms, thighs and chest can also be areas of concern.

For some individuals, excess skin is primarily a cosmetic issue. For others, it becomes a functional problem. Recurrent rashes under skin folds, fungal infections, difficulty exercising, discomfort during movement and lower back strain are not uncommon. These concerns can affect quality of life and, in some cases, confidence in maintaining an active lifestyle.

When is the right time to consider body contouring

Body contouring is not rushed. In most cases, we advise that weight has been stable for some months. This allows the body to adjust fully and ensures the best possible surgical outcome.

Nutritional status must be optimised before any reconstructive procedure. Following bariatric surgery, careful monitoring of protein intake, iron levels, vitamin B12, folate and vitamin D is essential. For patients with a history of type 2 diabetes, blood glucose control must be stable.

Because our patients are already in structured follow-up, we are well placed to assess readiness safely and responsibly.

Surgical expertise you can trust

Body contouring after significant weight loss requires specialist experience. These procedures are different from standard cosmetic surgery. Patients who have undergone bariatric surgery have unique considerations, including nutritional status, weight stability, previous surgical history and areas of functional concern.

At Blackrock WeightCare, post-bariatric body contouring is performed by experienced Consultant Plastic, Reconstructive and Aesthetic Surgeons who specialise in surgery after major weight loss.

Ms Silvia Marino is a Consultant Plastic, Reconstructive and Aesthetic Surgeon with broad experience across Ireland and the UK. She has a particular interest in body contouring following bariatric surgery, with careful attention to patient safety, realistic expectations and balanced outcomes.

Mr Sergio Mitic brings extensive international training and experience in reconstructive and post-weight loss body contouring procedures. His approach focuses on restoring proportion, improving comfort and addressing functional concerns such as recurrent skin irritation or mobility limitation.

Both surgeons work closely with the multidisciplinary bariatric team. This collaboration ensures that each patient’s surgical history, weight loss progress and nutritional optimisation are fully understood before planning any contouring procedure.

It means decisions are not made in isolation. They are made with a full picture of the patient’s journey.

That continuity of care is important to us. Our goal is that no patient feels they are navigating the next stage of transformation alone.

A dedicated support pathway after body contouring surgery

At Blackrock WeightCare, we understand that body contouring after major weight loss is not just about the operation itself. Recovery matters just as much. Patients need reassurance, access to their surgical team and clear guidance as healing progresses. Wound problems can occur and patients need to be confident that they have access to wound care during their recovery.

Just as we provide structured follow-up after bariatric procedures, we have established a dedicated aftercare pathway for patients undergoing body contouring and skin removal surgery. This ensures that patients know exactly what to expect after their procedure and that support is readily available throughout recovery.

After surgery, follow-up is carefully organised to ensure each patient is reviewed appropriately. Two post-operative consultations with your plastic surgeon are scheduled as standard, allowing healing to be assessed and any concerns addressed. If you need more appointments – no problem and no further expense. Recovery is monitored individually, depending on the procedure performed and how you are progressing.

If additional reviews are required, including wound checks or dressing clinic support, these are arranged without additional professional fees. Patients also have access to specialist wound care services so that concerns such as swelling, fluid collections or infection concerns can be managed promptly and safely.

Care continues until your surgeon is satisfied that healing is complete and you are ready to be discharged from follow-up.

We believe patients feel more confident when they know support does not end once they leave the hospital after their operation. Clear communication, accessible clinical advice and planned follow-up remain central to how we care for those undergoing body contouring surgery at Blackrock WeightCare.

Common questions patients ask

Patients often ask whether body contouring is “necessary.” The answer depends on the individual. Some choose not to proceed and are comfortable as they are. Others find that excess skin limits exercise, affects clothing choices or causes ongoing irritation that impacts daily life.

Another common concern is scarring. Body contouring does involve surgical scars, and this is discussed openly during consultation. The focus is always on balancing improved function and contour with realistic expectations.

Patients also ask about recovery time. This varies depending on the procedure performed and individual health factors. Detailed guidance is provided during assessment so that patients can plan appropriately.

What matters most is that the conversation happens in a supportive and informed environment.

Supporting long-term success after weight loss surgery

Maintaining weight loss requires continued physical activity, nutritional discipline and follow-up. When excess skin causes discomfort or limits movement, it can become a barrier to staying active.

By offering body contouring as part of our extended care pathway, we aim to support patients in sustaining the health improvements achieved through bariatric surgery. This includes improvements in diabetes, hypertension, sleep apnoea and overall cardiovascular risk. It also helps enabling exercise routine and removes barriers to a more active lifestyle.

Obesity treatment is not a single event. It is an ongoing process of restoring health, mobility and confidence.

For patients and GPs

If you have achieved significant weight loss after bariatric surgery but are now struggling with excess skin that feels uncomfortable, restrictive or difficult to manage, it is reasonable to seek advice. Many patients hesitate to raise the issue, unsure whether it is appropriate to ask. If it is affecting your comfort, mobility or confidence, it is worth discussing. Coming for an initial consultation allows you to be informed of your choices. Then you can make a decision you are comfortable with.

For GPs, patients who have done well metabolically may still present with ongoing functional concerns related to excess skin. Recurrent irritation, hygiene difficulties or limitation in activity can all impact long-term wellbeing. Assessment for body contouring may be appropriate in selected cases.

GPs can now refer directly to Blackrock WeightCare for body contouring assessment via Healthlink, in the same way as bariatric referrals. This allows continuity within a trusted service where the patient’s surgical history and weight loss journey are already understood.

At Blackrock WeightCare, our focus remains on providing complete and considered care. From bariatric surgery through to reconstructive options where appropriate, we aim to ensure that no patient feels their journey has been left unfinished.

If you would like to explore whether body contouring is right for you, you can submit an enquiry here or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post Body contouring now available for patients following bariatric surgery at Blackrock WeightCare appeared first on Blackrock WeightCare.

A common concern we hear is this – Do I need to lose weight with injections first before I can be considered for bariatric surgery?

In many cases, the answer is ‘No’.

You Do Not Always Need Injections Before Surgery

Patients with BMI above 45, and particularly those above 50, are sometimes told they must reduce weight before surgery is even discussed. This can lead to months or even years spent trying medications first.

At Blackrock WeightCare, we regularly assess and treat high BMI and complex cases. Surgery is not automatically ruled out because your BMI is high. In fact, procedures such as SADI-S are specifically designed for patients who require a stronger metabolic effect.

If surgery is clinically appropriate, it can be planned safely without asking you to invest time and money into injections first.

Each case is assessed on its own merits.

When Injections May Be Helpful

That said, weight loss injections can sometimes be useful.

They may help:

• Improve blood sugar control before surgery
• Reduce liver size
• Optimise medical conditions
• Support short-term weight reduction in selected cases

But this is strategic and individual. It is not a requirement for everyone.

Injections should never be viewed as a mandatory first step before surgical assessment.

High BMI Is Not an Automatic Barrier

Severe obesity often comes with additional conditions such as Type 2 diabetes, sleep apnoea, joint disease or cardiovascular risk. These patients need specialist input, not delay.

At Blackrock WeightCare, complex and high BMI patients are routinely assessed by Mr William Robb, an experienced Upper GI and Robotic Bariatric Surgeon. Careful evaluation determines:

• Whether surgery is safe now
• Whether optimisation is required first
• Which procedure offers the best long-term outcome

In many cases, metabolic surgery such as Gastric Sleeve or SADI-S provides more durable weight loss and stronger metabolic improvement than injections alone.

Why Expert Assessment Matters First

Starting injections without specialist advice can lead to:

• Modest short-term weight loss but no long-term plan
• Weight regain after stopping medication
• Delayed definitive treatment
• Additional financial cost

Obesity is a chronic disease. The treatment pathway should be planned properly from the outset.

An expert consultation allows you to understand:

• Whether injections are appropriate
• Whether surgery is the more effective option
• Whether a combined approach makes sense
• What is safest given your BMI and medical history

The right decision depends on your health, not on trends.

The Bottom Line

Weight loss injections can play a really positive role in obesity treatment. They are very useful tools in well selected and educated patients.

But you do not need to “prove yourself” with injections before being considered for surgery.

If you have a high BMI or complex medical history, the first step should always be specialist assessment. That way, you avoid unnecessary delay and move forward with a clear plan. Surgery and medication are very often complementary in the treatment of obesity – rather than it being the case of one or the other. 

If you would like to discuss your options, you can enquire here or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post Can Weight Loss Injections Help You Qualify for Surgery appeared first on Blackrock WeightCare.

SADI-S is one of the more powerful bariatric procedures available and is designed for people with severe obesity who need more than a standard sleeve alone.

What SADI-S Means in Practical Terms

SADI-S combines a sleeve gastrectomy with a bypass of part of the small intestine. The stomach is reduced in size, and food passes further down the intestine, which creates a strong metabolic effect.

This tends to result in:

• Greater overall weight loss in higher BMI patients
• Strong improvement in blood sugar control
• Reduction in cardiovascular risk factors
• Better long-term outcomes in patients with BMI above 45

The procedure is carried out by Mr William Robb using advanced robotic and minimally invasive surgical techniques, with a focus on precision and patient safety.

Who is it Suitable For

SADI-S is generally considered for:

• Patients with BMI over 45
• Severe obesity with significant metabolic disease
• Poorly controlled Type 2 diabetes
• Patients who require substantial and sustained weight loss

This is not a routine operation for lower BMI ranges. It is chosen carefully, based on clinical need and long-term goals.

What to Expect Before Surgery

The preparation is thorough. You can expect:

• A detailed surgical consultation
• Full medical assessment and blood tests
• Review of medications and current health conditions
• A structured pre-operative diet plan
• Clear explanation of risks and long-term responsibilities

An important part of the process is psychological evaluation. This is not a test to pass or fail. It is there to ensure you are emotionally prepared for the changes ahead. Surgery alters eating patterns, routines and coping mechanisms. Understanding your relationship with food, stress and lifestyle habits helps build a safer and more sustainable outcome.

This step is about support, not judgement.

What to Expect Around the Time of Surgery

SADI-S is carried out under general anaesthesia. Most patients stay in the hospital for 1-2 days.

After surgery, you can expect:

• Early mobilisation
• A gradual transition from liquids to soft foods
• Smaller portion sizes
• Rapid early weight loss
• Regular contact with the clinical team

The first few weeks require adjustment. Energy levels can fluctuate as your body adapts.

What to Expect in the Months After

Weight loss usually progresses steadily over 12 to 24 months. Many patients experience:

• Significant total body weight loss
• Improved diabetes control, sometimes with reduced medication
• Lower blood pressure
• Less joint pain
• Improved sleep quality
• Greater mobility

Results vary, but meaningful health improvement is the goal.

Because part of the intestine is bypassed, lifelong vitamin and mineral supplementation is required. Regular blood monitoring forms part of follow-up care. The structured aftercare programme at Blackrock WeightCare supports patients for the long term, not just the immediate post-operative period.

Accessing SADI-S Surgery in Ireland for High BMI Patients from Northern Ireland

Patients in Northern Ireland with very high BMI can face limited access to advanced bariatric procedures or long waiting times. Choosing treatment in Dublin at Blackrock WeightCare allows surgery and follow-up to take place within Ireland, with regular communication with your GP and ongoing monitoring close to home.

Many patients prefer this to travelling abroad, where long-term follow-up and nutritional supervision can be difficult to maintain.

SADI-S is a serious decision. It requires commitment and follow-through. It is also one of the most effective tools available for treating severe obesity and its related conditions.

If you would like to explore whether SADI-S is suitable for you, you can enquire through our website or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post What to Expect if You Are Considering SADI-S Surgery appeared first on Blackrock WeightCare.

Many people are simple told they should lose weight before having a hernia repaired. That advice is not given lightly. There are sound medical reasons behind it – but simply telling patients living with obesity to lose weight through diet and exercise so they can have a hernia repaired is not enough. They need a real treatment for the disease of obesity and that is where surgery is so effective.

Understanding why hernias are more common in severe obesity helps explain why treatment planning needs specialist input.

Why Severe Obesity Increases Hernia Risk

A hernia develops when tissue pushes through a weakened area of the abdominal wall. In patients with high BMI, several factors increase the likelihood of this happening.

Constant internal pressure
Excess intra-abdominal fat raises pressure inside the abdomen. Over time, this strains natural weak points such as the umbilicus or previous surgical scars.

Previous abdominal surgery
Patients with obesity are more likely to have had procedures such as gallbladder surgery or caesarean sections. Incisions can weaken the abdominal wall, leading to incisional hernias.

Reduced tissue strength
Obesity affects collagen and tissue quality. The abdominal wall may not hold sutures or mesh as effectively, increasing recurrence risk after repair.

This is why umbilical, ventral and incisional hernias are more common in patients with a high BMI.

Why Hernia Repair Alone Can Be Problematic

Repairing a hernia without addressing severe obesity often leads to:

• Higher recurrence rates
• Increased wound complications
• Greater infection risk
• Technical difficulty due to abdominal wall thickness

In some patients, repairing the hernia first may only provide temporary relief if abdominal pressure remains high.

That is where bariatric surgery can change the long-term outcome.

Can Hernia Repair Be Done During Bariatric Surgery

In selected cases, yes. The decision depends on:

• The size and type of hernia
• Whether it is symptomatic
• Risk of bowel obstruction
• Overall BMI and medical condition

Small hernias can sometimes be repaired at the same time as a bariatric procedure such as Gastric Sleeve, Gastric Bypass or SADI-S. Very often however they are repaired at a later date when there has been significant weight loss and the repair is then likely to be more robust and enduring.

Larger or complex abdominal wall defects may be better treated in stages. In these cases, weight loss surgery is performed first. Once weight has reduced and surgical risk is lower, hernia repair can follow under safer conditions.

There is no standard rule. 

The Importance of Specialist Assessment

This is where experience matters.

Mr William Robb is an Upper GI Surgeon and Robotic Bariatric Surgeon with extensive experience in complex abdominal surgery. His background in upper gastrointestinal surgery means he regularly manages conditions involving the stomach, oesophagus and abdominal wall, alongside bariatric procedures.

At Blackrock WeightCare, assessment involves:

• Careful physical examination
• Imaging where needed
• Review of previous surgical history
• Evaluation of metabolic health and BMI
• Discussion of the safest sequencing of procedures

Robotic surgical techniques are used where appropriate, particularly in higher BMI patients. Robotic assistance allows greater precision and improved visualisation inside the abdomen, which can be especially helpful when managing both bariatric surgery and hernia repair in the same setting.

The key decision is not simply whether surgery can be combined. It is whether it should be combined in your specific case.

What Patients Can Expect

If you are being assessed for both severe obesity and a hernia, you can expect:

• A detailed consultation
• Honest discussion about risks and benefits
• Clear explanation of whether a combined or staged approach is safer
• Structured preparation before surgery
• Long-term follow-up after bariatric treatment

If a combined procedure is appropriate, both issues are addressed in one surgical setting. If staging is safer, you will understand why and what the timeline looks like.

Why Treating Obesity Improves Hernia Outcomes

Sustained weight loss reduces abdominal pressure. This improves healing, lowers recurrence risk and makes future abdominal surgery safer.

In many patients, addressing obesity first creates better long-term results for hernia repair.

Managing hernias in the setting of severe obesity requires careful judgment. A specialist assessment at Blackrock WeightCare ensures the decision is based on safety, surgical expertise and long-term outcome.

If you would like to discuss your case, you can click to enquire here or speak directly with our team on 01 255 2479.

Your Health. We Care.

The post Why Hernias Are More Common in Severe Obesity and Can They Be Repaired During Bariatric Surgery appeared first on Blackrock WeightCare.

Obesity affects nearly every area of medicine. We work closely with GPs, Endocrinologists, Women’s Health practitioners, Orthopaedic surgeons and other specialists who are supporting patients with weight related illness. 

Many are caring for individuals with Type 2 diabetes, PCOS, infertility, fatty liver disease, joint degeneration, sleep apnoea and cardiovascular risk. In many cases, simply treating obesity appropriately is central to improving long term outcomes.

Bariatric surgery can support that goal.

Who is Eligible

In general, patients may be considered for bariatric surgery if they have:

• A BMI of 40 or above
• A BMI of 35 or above with obesity related medical conditions such as Type 2 diabetes, hypertension or sleep apnoea

Patients with higher BMI and more complex medical needs can also be assessed, including those who may have been declined surgery elsewhere. We have particular experience managing very high BMI cases safely.

Supporting Specialists Across Disciplines

Referrals are welcome from:

• GPs managing chronic disease in the community
• Endocrinologists seeking better metabolic control for patients with poorly controlled diabetes
• Women’s Health clinicians supporting patients with PCOS, fertility challenges and cancer risk
• Orthopaedic surgeons whose patients require weight reduction before joint replacement
• Physicians managing obesity related cardiovascular, respiratory disease and renal disease amongst others

Our aim is to work alongside the referring clinician. Patients return to their own doctor for ongoing care with a clear aftercare plan in place.

Care in Ireland with Insurance Cover

Many patients in Ireland are insured for bariatric surgery through their private health insurance, subject to policy approval. Having surgery with Blackrock WeightCare allows patients to receive treatment at home in Ireland, close to family and their usual medical team.

Travelling abroad for surgery can seem attractive at first, but continuity of care, structured follow up and access to your own GP and specialists are critical for long term success.

All procedures are performed by Mr William Robb. We provide:

• Gastric Sleeve
• Gastric Bypass
• Gastric Band Removal and conversion to Bypass or Sleeve
• SADI-S for patients with higher BMI and complex metabolic disease

Healthlink referral ensures a secure and straightforward pathway for assessment.

If you would like to refer a patient, please look for Blackrock WeightCare via Healthlink.

For further information about Blackrock WeightCare, please click here or contact our team on 01 255 2479.

Your Health. We Care.

The post Making Referrals from General Practice for Bariatric Surgery Easier – Direct Referral to Blackrock WeightCare Now Available via Healthlink appeared first on Blackrock WeightCare.

Bariatric surgery helps patients lose weight by changing the digestive system, but it also changes something deeper: the relationship with food.

At Blackrock WeightCare, we often tell patients that surgery is a powerful tool, but learning how to live with that tool is an important part of the journey. Understanding how eating habits and feelings around food evolve after surgery can help patients approach this change with confidence.

Food Becomes about Nourishment, Not Just Quantity

Before surgery, many patients feel that food is constantly on their mind. Large portions, frequent snacking, or emotional eating may have developed over time.

After bariatric surgery, the stomach becomes much smaller. Because of this, patients naturally eat smaller portions.

Meals become less about quantity and more about quality and nourishment.

Patients often begin to think differently about what they eat. Instead of asking, “How much can I eat?” the question becomes, “What will help my body feel satisfied and energised?”

This shift does not happen overnight, but over time, many patients feel they develop a more balanced and mindful approach to food.

Eating Slower Becomes Important

After surgery, eating too quickly can cause discomfort. This is because the stomach pouch fills more quickly than before.

Patients learn to eat slowly, chew carefully, and pay attention to the signals their body sends.

For many people, this slower approach to eating becomes a positive change. Meals become more intentional and less rushed. It also allows patients to recognise the feeling of fullness more easily.

Hunger Feels Different

Another change many patients notice is that hunger feels different after surgery.

Hormonal changes that occur after procedures such as gastric sleeve or gastric bypass often reduce the intensity of hunger signals.

This does not mean that patients never feel hungry again. Rather, hunger often becomes more predictable and manageable. Patients may find they feel satisfied with smaller meals and do not experience the same strong cravings they once did.

Emotional Eating May Still Need Attention

While surgery changes the digestive system, it does not remove emotions.

Some patients realise that certain eating habits were linked to stress, boredom, or emotional comfort. Recognising these patterns is an important step in building a healthier relationship with food.

This is why bariatric care includes more than surgery. It involves education, support, and follow-up care to help patients develop long-term habits that support their health.

At Blackrock WeightCare, we encourage patients to stay connected with the team of experienced dietitians if they notice challenges around food choices or emotional eating.

Food Preferences May Change

It is quite common for patients to notice changes in taste or food preferences after surgery.

Foods that once felt appealing may feel too heavy or uncomfortable, while other foods become easier to enjoy. Many patients find themselves naturally leaning toward foods that are higher in protein and easier to digest.

This shift can help reinforce healthier eating habits over time.

Social Situations Around Food Can Feel Different

Food is often part of social life. Family gatherings, celebrations and eating out with friends are important parts of everyday living.

After bariatric surgery, patients may initially feel uncertain about these situations. Smaller portions or slower eating can feel different from what others expect.

With time, most patients find their own comfortable way of navigating these moments. Many discover that social events are still enjoyable, even if food plays a smaller role than before.

The Importance of Support and Aftercare

Changing your relationship with food is not something that happens in a few weeks. It develops gradually over months and years.

There may be periods where patients feel confident and in control, and other moments where they need reassurance or guidance.

This is why ongoing aftercare is such an important part of bariatric treatment.

At Blackrock WeightCare, our Aftercare Programme helps patients:

• Understand how their eating habits are evolving
• Maintain balanced nutrition after surgery
• Navigate plateaus or challenges
• Stay motivated in the long term 

Having professional guidance available makes the journey easier and helps patients build habits that support lasting success.

A New Relationship With Food

Bariatric surgery does not take food away from your life. Instead, it often helps patients rebuild a healthier and more balanced relationship with it.

Food becomes less about overeating or constant hunger and more about nourishment, energy, and wellbeing. For many patients, this shift is one of the most meaningful parts of the journey.

If you are considering bariatric surgery or would like to learn more about the support available before and after surgery, the team at Blackrock WeightCare is here to help.

You can make an enquiry here or call 01 255 2479 to arrange a consultation.

Your Health. We Care.

The post How Bariatric Surgery Changes Your Relationship with Food appeared first on Blackrock WeightCare.

But for some people, things can change again years later.

They may notice that the weight starts creeping back. They don’t feel as full as they once did. Meals that used to satisfy them suddenly seem too small. Some patients also begin experiencing unpleasant symptoms of dumping syndrome.

It can be confusing and upsetting. Many people wonder if they have somehow caused the problem themselves.

Often, that isn’t the case at all.

In many situations, the reason is anatomical. The body changes over time, even after successful surgery.

To help explain what happens and what options may exist, we spoke with Mr Achille Mastrosimone, Consultant General and Upper GI Surgeon, who specialises in advanced endoscopic treatments for bariatric patients.

Interview with Mr Achille Mastrosimone

What is TORe?

Mr Mastrosimone: TORe stands for Transoral Outlet Reduction. It is an incisionless endoscopic procedure designed for patients who previously had a Roux-en-Y gastric bypass and later develop problems such as dumping syndrome or weight regain.

The procedure is performed using a flexible endoscope that is passed through the mouth, so there are no external cuts or abdominal incisions.

After gastric bypass surgery, the stomach pouch connects to the small intestine through a small opening called the gastrojejunal anastomosis, often referred to as the outlet.

Over time this outlet can stretch. When that happens, food moves through the stomach more quickly and the feeling of fullness becomes weaker.

During TORe, we place sutures around this outlet using a specialised endoscopic suturing device. This reduces its size again, which helps slow gastric emptying and restore restriction.

In some cases, if the gastric pouch has also stretched, we can reduce its size endoscopically at the same time.

Why does gastric bypass sometimes stop working as well over time?

Mr Mastrosimone: Weight regain after gastric bypass is usually multifactorial. There are often several contributing factors, including physiological adaptations, behavioural changes, and, in some patients, significant anatomical changes.

In some patients, over time, the outlet between the stomach pouch and the small intestine can widen, and the pouch itself may stretch slightly. When that happens, the restrictive effect of the operation becomes less effective.

As a result, food can pass through the pouch more quickly, patients may feel hungry again sooner after eating, and portion sizes may gradually increase. This can contribute to weight regain.

It is important to stress that these changes can be mechanical and are not simply a question of behaviour. They may occur even when a patient is doing everything right.

Is dumping syndrome one of the main reasons people consider TORe?

Mr Mastrosimone: Yes, very often. In fact, in my experience the strongest indication for TORe is dumping syndrome.

Dumping syndrome occurs when food moves too quickly from the stomach pouch into the small intestine. Patients may experience symptoms such as sweating, dizziness, nausea, palpitations, diarrhoea or low blood sugar after eating.

By reducing the diameter of the outlet, TORe slows gastric emptying. This can significantly improve these symptoms and help patients feel more comfortable after meals.

How do you decide if someone is suitable for the procedure?

Mr Mastrosimone:  The first step is a careful assessment of the anatomy. Before recommending TORe, I perform an OGD, also known as a gastroscopy. This is a procedure that uses a small camera to look inside the stomach. It allows me to measure the opening and assess the size and length of the stomach pouch.

This evaluation is essential because TORe works best when the outlet is enlarged. Patients with an outlet diameter of 2.5 cm or more tend to benefit the most, and results are often even better when the outlet is greater than 3 cm.

If the pouch is also significantly enlarged, we may perform an endoscopic pouch revision at the same time as the outlet reduction.

This ensures that the procedure is tailored to each patient’s anatomy.

What happens during the procedure itself?

Mr Mastrosimone: The procedure takes place in theatre under general anaesthetic, which means the patient will be asleep throughout. The anaesthetist will give the anaesthetic and monitor the patient carefully.

We start by performing an OGD (gastroscopy) to reassess the size and length of the stomach pouch. If appropriate to proceed, we then treat the inner lining of the join between the stomach and bowel (the anastomosis) using a special heat probe called APC.

 After this, a specialised stitching device attached to the endoscope is used to place stitches around the outlet. These stitches make the opening smaller, which helps food stay in the stomach pouch for longer and move through more slowly.

The procedure usually takes about 60 to 90 minutes.

As there are no cuts on the outside of the body, recovery is usually quicker than with revisional surgery.

How does TORe compare with revisional bariatric surgery?

Mr Mastrosimone: Revisional surgery can be quite complex. Surgeons often have to deal with scar tissue and may need to reconstruct parts of the bypass.

TORe is much less invasive because it’s done endoscopically. There are no abdominal incisions, and the recovery is usually faster. The risk of complications is also generally lower.

For some patients, TORe can delay or even avoid the need for major revisional surgery.

What should patients expect after the procedure?

Mr Mastrosimone: Most people recover well after the procedure and only have mild symptoms. It is quite common to have a sore throat or some temporary bloating. Mild abdominal discomfort can also occur, but this is usually well controlled with common painkillers.

Many patients go home the same day or after a short overnight stay.

Normal activities can usually be resumed within a few days.

As with any bariatric treatment, the best results happen when the procedure is combined with ongoing dietary and multidisciplinary support.

Understanding the Next Step

Weight regain after gastric bypass can feel discouraging, but it is not unusual. Obesity is a chronic condition, and treatment sometimes needs to evolve over time.

For patients who develop dumping syndrome, loss of restriction or anatomical changes after gastric bypass, TORe may offer a minimally invasive way to address the underlying issue.

At Blackrock WeightCare, careful assessment is always the first step. A detailed consultation and endoscopic evaluation help determine whether TORe is the right option for each individual patient.

If you have had gastric bypass surgery and are experiencing weight regain or dumping syndrome, you can make an enquiry here or call 01 255 2479 to arrange an assessment with the team at Blackrock WeightCare.

Your Health. We Care.

The post TORe after Gastric Bypass: A Conversation about Dumping Syndrome and Weight Regain appeared first on Blackrock WeightCare.