It’s been a few months since I last posted, but having just had the 2nd consultation (out of 4 total) on my trust's Tier 4 pathway I thought I’d share that experience just in case anyone else is searching for information regarding the NHS process (even though it seems to vary rather greatly between trusts).

My 1st Tier 4 appointment was on 31 May with one of the bariatric dieticians (via phone call). My 2nd appointment was with the bariatric nurse on 2 September (also phone call). Like the previous appointment, I reported my weight and had a medication review. Then we went through “What To Expect for Pre-Op/Surgery/Post-Op/Hospital-Stay/Aftercare”. I was also greatly relieved to find out that my trust gives a 5kg “cushion” of possible weight gain before surgery - they seem very compassionate and understanding given the long waiting times post-Tier-3 discharge and the difficulty in either losing or maintaining one's weight. I AM SO RELIEVED I COULD CRY. 🙌

Originally, this trust had a 6-9 month wait time from Tier 3 discharge to Tier 4 surgery, but since a few surrounding trusts lost funding for their bariatric services, this trust has taken up the additional patients, so the wait time from Tier 3 discharge to surgery is more like 2-3 years now.

We are hoping to have my last two appointments (in-person consultations with the anaesthetist and surgeon) before the end of the year. Once those appointments are done, the Tier 4 consultants will meet as part of the Multidisciplinary Team (MDT) review and decide whether or not I will be approved for surgery. And if approved, surgery is usually 1-2 months post-MDT meeting.

I won’t know who my surgeon is until I have the consultation - patients are assigned to whichever surgeon happens to be assigned to the bariatric clinic that day. Although I did find out that 4 out of the 5 surgeons in this department all perform robotic bariatric surgery via DaVinci, so that’s pretty cool.

Also, it’ll be the Milk Diet for the Liver Shrinking Diet. Good to know for the mental prep!

So far, my experience with the Tier 4 consultants and department secretary has been really, really good - I’ve always been met with kindness, encouragement, and compassion. Despite my own impatience, I’m so grateful for everyone I’ve encountered thus far and am looking forward to the next appointments!

Whelp. There we are. Hope this was helpful/insightful. We're getting there! 🫠

Congrats on making it this far! I had the milk diet for twelve weeks and I started it a week before my birthday and my friend's wedding so it was a real struggle! But it's going to be so worth it! I have no regrets. I have my one year post-op appointment on the 15th of October. Time really does fly. Im still nowhere near my goal and blind of worried as the weight hasn't really shifted much in two months, but even so I was a size 24 and now I'm a size 14. I can even shop in Primark and H&M now! I'm so happy for you! The NHS has so many hurdles but you made it this far!

On 9/15/2025 at 9:12 AM, NeonRaven8919 said:

Congrats on making it this far! I had the milk diet for twelve weeks and I started it a week before my birthday and my friend's wedding so it was a real struggle! But it's going to be so worth it! I have no regrets. I have my one year post-op appointment on the 15th of October. Time really does fly. Im still nowhere near my goal and blind of worried as the weight hasn't really shifted much in two months, but even so I was a size 24 and now I'm a size 14. I can even shop in Primark and H&M now! I'm so happy for you! The NHS has so many hurdles but you made it this far!

Hi, NeonRaven! Apologies for the massive delay in response to your reply! So, so much has happened since my last update - and as of most recently, I’ve just had my last two Tier-4 appointments this week! 🥳 I met my surgeon and my anaesthetist - both were exceptionally kind, compassionate, and patient with all my very numerous and specific questions, haha! I can’t give enough thanks for being able to have them as my physicians!

You are AMAZING for having successfully endured a TWELVE WEEK milk diet!! 👏👏 Wow!

During my surgeon's appointment, I have to admit that he did a most impressive and valiant job in trying to sell me the VSG; however, I was pretty staunch on wanting a bypass due to my history of diabetes and hypertension (both currently in remission, thankfully, though this is managed primarily through a massive carb/starch restriction). While he gave an extensively good list of “pros” for the sleeve, one of the “cons” that concerned me was the increased likelihood of regain and the need to be on lifelong GLP-1s. He said this would most likely become the normal course of treatment for sleeve patients in the future. Also, if one were to suffer GERD, then it would be a straightforward step to revision to RNY.

Prior to this appointment I had the OAGB (One Anastomosis Gastric Bypass or Mini Gastric Bypass) as my first choice, then changed it to RNY a few months ago when I had a gastroscopy and found some bile in my stomach (apparently that’s pretty normal…?) I was worried that the bile would rule me out of having the OAGB, but found out during this surgeon’s appointment that I shouldn’t have any issues with bile reflux - what RELIEF! So, I’ve requested the OAGB for my first choice as my surgeon feels the RNY would be too malabsorptive for me (he will do an 80cm BPL rather than the standard 100-200cm). After having all my questions answered and discussing the surgery options, I feel 100% confident and reassured in my surgeon and in going forward with the OAGB. 😊

At the end of our appointment, I was told I’m now on the waiting list for surgery! 🙌🥳🎉 (Although the MDT will happen sometime in the next 3 weeks.) He said surgery will most likely be within 4-6 months (though the anaesthetist said perhaps 3 months or sooner 🤞🤞). SO EXCITED! Pre-op assessment will be either in person or via phone with bariatric nurse about a month before surgery date.

Anyhoo, there we are!

How was your one-year post-op appointment??? I hope all went well and that your stall has passed. 💕

Fantastic news that you are on the waiting list for the surgery now! And well done for standing up for what type of surgery you want! Admittedly, I am a bit scared of the lower weight loss and the higher chance of weight gain on the future, but my mother had complications with the bypass (I don't actually know if it was RNY or not, but it was 2008 so I'm assuming it woild have been) and those complications resulted on her passing away in 2023. But there are a lot of long term success stories with the VSG as well and I'm determined to be one of them.

The one year post op was great! I actually was excited to see the surgeon and I was excited by the fact I took up less than half of the bariatric size chair in the waiting room (little victories) i told him I was a completely different person than I was the year before and he was really please that I'd lost over 60% of my excess weight already. He did tell I could easily lose a few more kilos as well.

Keep us all posted on how things goo for you! I can't wait to aee tour one year post op as well!

I seriously commend your commitment to getting your surgery. I thought 6 months was a long time. I think that all of this will have to help your success in the long run. The mental prep is just as big as the surgery itself.

On 12/20/2025 at 9:04 AM, NeonRaven8919 said:

Fantastic news that you are on the waiting list for the surgery now! And well done for standing up for what type of surgery you want! Admittedly, I am a bit scared of the lower weight loss and the higher chance of weight gain on the future, but my mother had complications with the bypass (I don't actually know if it was RNY or not, but it was 2008 so I'm assuming it woild have been) and those complications resulted on her passing away in 2023. But there are a lot of long term success stories with the VSG as well and I'm determined to be one of them.

The one year post op was great! I actually was excited to see the surgeon and I was excited by the fact I took up less than half of the bariatric size chair in the waiting room (little victories) i told him I was a completely different person than I was the year before and he was really please that I'd lost over 60% of my excess weight already. He did tell I could easily lose a few more kilos as well.

Keep us all posted on how things goo for you! I can't wait to aee tour one year post op as well!

Awww, I love hearing your good news from your appointment! 🥰🎉 This gives me great hope and encouragement!

I have to admit, I do have a teeny-tiny bit of apprehension for the OAGB since it seems at least here in the UK (and perhaps other parts of the world) that it’s not totally standardised when it comes to technique and method. I wish I could know exactly what’s happening under the knife, so to say. But I suppose this is where trust comes in between patient and surgeon, and that’s what I’ll have to rely on. 🤞🤞

Seeing and reading about so many VSGers' success gives me incredible hope as well, and I remind myself that we're all given a tool to work with, and that tool in the long run won’t work to the best of its potential by itself - it’s what we make of it that matters most, right? So, we shall give it our best!

I am so, so deeply sorry to hear about your mother and that she suffered complications from her bypass that resulted in her passing. 💔 Last month, I lost both of my parents, though from separate unrelated health conditions… if either of them had been through something I was medically considering, I think I would be extra cautious about that as well. Please be assured of my thoughts and prayers for you and your family - and for your continued success with the VSG, especially with this new year! ❤️‍🩹

Edited January 4Jan 4 by Bari_Hopeful
Formatting fix.

On 12/26/2025 at 7:09 PM, ShoppGirl said:

I seriously commend your commitment to getting your surgery. I thought 6 months was a long time. I think that all of this will have to help your success in the long run. The mental prep is just as big as the surgery itself.

Thank you so much, @ShoppGirl! Perhaps it’s commitment mixed in with a good sprinkling of desperation? 😅 Being reliant on the NHS definitely makes me feel like this is my “only chance” to really help myself get healthier. And I’m super-grateful that once I have the surgery, our bariatric team offers support (both nutritional and psychological) for the first two years post-op as and when requested. I think that will be a great help!

Whelp, to my utter shock and pleasant surprise, I received The Call yesterday - giving me my pre-op and surgery dates! 😮

My surgery (One Anastomosis Gastric Bypass aka Mini-Bypass) will be on 19 March! 🥳🎉 Two weeks from today! I still nearly can’t believe it… I’ve started the LRD Milk Diet today, and am grateful it’s so simple and requires minimal brain power for me to spend thinking about. 😅

Here’s hoping for the best! 🤞🤞

Surgery happened on 19th March - the only unexpected thing about all of it was arriving to go over surgical consent with my surgeon to find out my expected surgeon was out of the country…! So, I was given two options: 1) Reschedule when the expected surgeon is back, or 2) have the operation with the surgeon present.

Granted, I trust all the surgeons on that bariatric team, so I was perfectly happy to have the surgeon who was on duty that day - but I did want to know his specific procedure of doing the OAGB/MGB especially as I still felt a tad cheated by my original surgeon’s planned measurements.

Based on my BMI this surgeon said he would do a 125cm biliopancreatic limb with a long (12-15cm) and narrow (34 French bougie) pouch. (As opposed to a shorter 80cm bp limb, a shorter and wider pouch which would stop at the crow's foot and be an approximate 40 French bougie in width.) I was beyond thrilled and relieved to hear this! And so far, he’s never had any patients suffer from reflux or needing revisions. 🤞🤞

Later on in my room (shared with five other ladies), I overheard one of the ladies talking to another about her surgery - she had come for a revision to RNY from an OAGB done by my originally expected surgeon because of severe reflux. I feel like a dodged a bullet and won the lottery all in one go!

And so far, I’m feeling pretty darn good on this Day 2 Post-op. So much to be grateful for! 🙌🥳💕