Why Choose Us?
"Quiz and question. It is your right and our obligation. Take your time to think and process information. If you are not quite sure then don’t proceed with surgery until or if you are. Make more appointments and discuss further but do not have a permanent and irreversible procedure unless you are sure about your surgeon and the procedure."
How to choose a bariatric surgeon?
You need to be confident, feel at ease and trust your surgeon and their abilities. Ethically and by law your surgeon is obliged to tell you the truth about their training, their abilities and their results. Similarly, they have to tell you as much as you want or need to know about the procedures and your options and the risks and plans for complications and redo surgery so that you can make an informed decision on how to proceed.
Why Choose Us?
Here are some facts about bariatric surgery and surgical training that may be of use to you:
Up to the late 1970s, and with the exception of an appendicectomy, the commonest general surgical emergency was an operation on the stomach or duodenum (1st part of the intestine) for perforated or bleeding ulcer disease. These operations were all performed by open surgery.
Elective operations on the stomach involving delicate dissection around the top part of the stomach and lower oesophagus and the nerves controlling acid were also very common. It was the availability of H2 antagonist medications (cimetidine and ranitidine) and later the PPI omeprazole, that controlled ulcer disease that changed all this. After this time the general surgeon’s exposure to the stomach became very rare. With the advent of laparoscopic surgery and sub-specialisation in the early 1990s, the exposure of the general surgeon to the stomach and oesophagus became even more limited.
Standard general surgical training in Australia is typically about 4-5 years.
Bariatric training in Australia is extremely limited as the majority of surgery occurs in private or in highly specialised units.
Bariatric surgery involves operating on obese individuals.
Obese individuals are the most difficult to operate upon especially in the upper abdomen because:
- The organs have fat coverings increasing difficulty of identifying important structures
- Access is reduced
- Fatty livers are enlarged and more prone to tearing and bleeding
- It is more difficult to see and control blood vessels in fatty tissue
- Complications in the stomach or lower oesophagus can not easily be dealt with by bringing out a bit of bowel to the outside (creating a stoma) like other areas of the bowel
- Complications can involve having to operate in the chest and rarely the neck
- Complications may involve multiple endoscopies and placement of drains, stents and plugs and special nasal tubes
- Obese individuals have more health issues (which is why we do the surgery!)
- Complications can involve prolonged stays in hospital and multiple complex procedures
- Complications may need transfer to a public hospital
- The best way to avoid complications is to be adequately trained and adequately supervised
- Operations should be planned and performed in a relaxed but organized environment
- Operations should be performed carefully and without time and other pressures
Upper GI training involves at least an additional two years of operating on the oesophagus, stomach, duodenum, liver, pancreas and spleen.
- It involved operating in the upper abdomen, chest and oesophagus.
- It involved massive open surgical operations and complex laparoscopic surgery of the stomach, their nerves, the oesophagus and its muscles.
- It involved extensive endoscopic experience both in diagnosis and therapeutic treatment of oesophagogastric conditions.
- It involved managing complications and emergencies of the oesophagus and stomach.
- It involved resecting parts or all of the stomach and oesophagus and stapling and suturing organs together in single and Roux en Y fashion.
- It also involved the management and surgery of bariatric patients.