Weight Loss Surgery
Bariatric and Metabolic Surgery
What causes obesity?
There are numerous causes including genetic, hormonal, metabolic, psychological and environmental factors. Everyone is different in the way their bodies digest, absorb, store and utilise food and energy expenditure differs with metabolism and physical activity. When an individuals energy intake exceeds their body’s requirements the excess is stored as fat. Excess fat is harmful to healthy tissues and leads to many health problems. The proportion of overweight and obese people has been increasing over time due to more sedentary careers, decreased physical activity, increasing food portion sizes and increased consumption of processed and fast foods.
Why have weight loss surgery?
Morbid obesity is a chronic condition. It is the second most common preventable cause of death in our society after smoking. Obesity causes many health problems including diabetes, high blood pressure, heart disease, stroke, sleep apnoea, arthritis, depression and even cancer. In morbidly obese patients various diets, exercise and prescribed medications are unlikely to reliably achieve and maintain significant weight loss over the long term.
Surgery is scientifically proven to be the most effective option in achieving sustained weight loss in morbidly obese patients. However surgery alone does NOT guarantee success. It still requires combination with a healthy diet and lifestyle to achieve optimal results.
How effective is weight loss surgery?
Studies show an average excess weight loss of 50-70% for groups of patients depending on the type of operation performed. Many reversible obesity-related health conditions will improve or be cured with this amount of weight loss. However, surgery alone does not guarantee success. For good results, you must also be prepared to follow healthy dietary and exercise principles and undergo regular medical follow-up.
Surgery is NOT a magic cure and should not be considered an easy option. The surgery can help restrict the amount you can eat and reduce hunger however to achieve good results you must also be prepared to:
- Eat 3 small meals a day
- Make sensible food and drink choices
- Eat slowly and stop when you are full
- Avoid eating when you are not hungry
- Exercise to your capacity
What types of weight loss surgery are there?
Weight loss operations are generally classified by either restricting food intake (restrictive) or preventing absorption of food (malabsorptive) or a combination of both.
Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Banding (LAGB) are both restrictive type procedures that can be safe, effective and suitable as first-line procedures for the majority of patients.
Roux-en-Y Gastric Bypass (RYGB) and Bilio-Pancreatic Diversion (BPD) are both restrictive and malabsorptive. They are both highly effective however being more complex the potential risks of surgery and complications are greater than for the restrictive procedures.
What will I be able to eat after surgery?
After the initial phases (4 weeks) you will be able to eat 3 small meals per day. You will be encouraged to make healthy choices and will be able to eat most foods. Attempts to overeat may cause discomfort and vomiting and may damage the gastric pouch or tube by overstretching which can reduce the effectiveness of the procedure. Excessive carbohydrate intake and drinking high calorie liquids (alcohol, soft drinks, milkshakes etc) will limit your weight loss and may result in weight regain.
With the gastric band, some foods including steak, chicken, white bread and rice are prone to blockage and should be avoided. Almost all foods are well tolerated after a sleeve gastrectomy but in small quantities.
Who should perform your surgery?
Surgery in morbidly obese patients can be challenging and technically demanding. Our Surgeons have undertaken 3 years of specific subspecialty training in “Upper Gastrointestinal Surgery” in addition to having a fellowship in “General Surgery.” They have experience in and offer a broad range of procedures for weight loss. In addition they regularly perform major operations for cancer and a variety of other complex advanced laparoscopic (keyhole) operations and endoscopic (telescope) procedures. They have extensive experience and a complete set of skills to manage both elective and emergency problems involving the oesophagus, stomach and intestines. Our Surgeons regularly attend scientific meetings and have visited other leading specialists in Australia and Overseas to keep up to date with the latest developments. Our Surgeons only operate in major tertiary hospitals including St John of God Murdoch, St John of God, Subiaco, Fiona Stanley* and Fremantle* Hospitals which have all the required resources to support this type of surgery. SJOG Murdoch has the only private Emergency Department in Perth and our Surgeons provide cross cover to ensure an expert is usually available in the event of any problems.
* Unfortunately weight loss surgery is not currently supported or funded by the Health Department at Fiona Stanley and Fremantle Hospitals so we are unable to offer procedures to public patients.
How much does it cost?
How soon can I have the surgery?
After your initial visit to the surgeon you will need to complete a comprehensive preoperative assessment to ensure you are well prepared and to minimise any potential risks of surgery.
We will arrange for you to see our bariatric physician, dietician, have blood tests, and undergo gastroscopy:
- The bariatric physician is a primary care practitioner who will assess your general health and any medical conditions. Routine fasting blood tests are reviewed and other specific investigations and referrals to specialists may be arranged as required to ensure the anaesthetic and surgery can be performed safely eg heart tests, sleep studies.
- The dietician will discuss the changes required after surgery including the liquid, pureed and soft dietary phases and the required vitamin and mineral supplementation. They will help you improve your food choices, slow the speed of eating, select smaller portions and avoid common problems after surgery including dehydration, constipation and low energy levels.
- Your surgeon will perform a gastroscopy and examine the stomach to look for a hiatus hernia, signs of reflux, ulcers, inflammation and Helicobacter pylori# which require initial treatment and/or may change the way an operation needs to be performed.
# Helicobacter pylori is a bacteria that is known to cause stomach ulcers, inflammation and even cancer. It can be treated with a combination of antibiotics and acid lowering medication.
After the assessment, you will have a follow-up visit with your surgeon to discuss the results and the operation in more detail. If all your questions have been answered, you understand the surgery including the benefits and potential risks and you are ready to proceed then we will make arrangements for the procedure. In routine cases, it usually takes about 4-6 weeks from initial visit until the surgery.
Do I have to take “Optifast” before the surgery?
Optifast is a very low calorie diet (VLCD) that comes in a variety of forms (shakes, bars, soups, desserts) and flavours. It contains all the essential nutritional requirements to completely replace other food but with far less calories. It is highly effective in decreasing the size of an enlarged fatty liver that can prevent your surgeon accessing the stomach to successfully perform your procedure. A massively enlarged fatty liver increases the risks with surgery and in some cases the surgery may be abandoned if the upper stomach can not be safely accessed. Your surgeon and dietician will advise if optifast is required based on your weight, fat distribution, comorbidities (metabolic syndrome) and blood tests.
Do I have to quit smoking?
Smoking is the leading cause of preventable deaths in our society. The health benefit gained from smoking cessation is even greater than from losing excess weight. In addition, smoking considerably increases the risks of the anaesthetic and surgery including infections, lung complications, blood clots and impairs tissue healing. For this reason, we insist that you quit smoking at least 3 months before we can consider you for obesity surgery. We recommend you speak with your usual GP, Pharmacist or call the Quitline on 131 848 to discuss your options.
- It is desirable to begin losing (or at least maintain your weight) prior to surgery to decrease the risks involved and improve your recovery.
- You will need to follow the advice of the assessing team. In some cases additional tests or consultations may be required to minimise the risks and ensure you are well prepared for a successful outcome.
- If you gain weight whilst being assessed for surgery or fail to attend the required consultations your procedure may be postponed or cancelled.
Please check that you are ready to proceed?
- You must have Private Health Insurance with full hospital cover. Please check with your Health Fund that your policy covers you for weight loss surgery.
- You must be a non-smoker or have quit smoking at least 3 months before any surgery can be performed. See your GP if you require assistance.
- You must be prepared to complete our comprehensive pre-operative assessment and follow the recommendations of our team.
- You must be prepared to make changes to your lifestyle including making healthy dietary choices.
If you are ready to make this important life changing decision please phone our office for an appointment on 6189 2500.
At the initial consultation, we will:
- discuss the surgical options and the requirements for success
- commence our comprehensive assessment process
- answer any other questions you may have and begin your pathway to a better health and lifestyle.