Where to Begin
If you are considering weightloss sugery, I highly recommend you make an appointment with me at the Epworth Centre for Bariatric Surgery where I can assess severity of your problem and work out a suitable treatment.. Alternatively you can attend one of our free information seminars.
For an appointment or details of our next information evening please contact us on (03) 9421 1166
Choosing Surgery
Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure.
The goal is to live better, healthier and longer.
That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician.
At the Epworth Centre for Bariatric Surgery a qualified surgeon will answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. As part of our routine evaluation for weight loss surgery you will consult with a dietician/nutritionist, psychologist and physician to assess your suitability for surgery. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.
It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples.
To help patients achieve their goals and deal with the changes surgery and weight loss can bring, The Epworth Centre for Bariatric Surgery offers follow-up care that includes support groups, dieticians and other forms of continuing education.
Ultimately, the decision to have the procedure is entirely up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications.
This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.
The Adjustable Gastric Band
The Swedish Adjustable Gastric Band (SAGB) was developed in Sweden in 1985 and has been available globally since 1996. The procedure is a purely restrictive surgical procedure in which a low pressure soft band is placed around the upper most part of the stomach 'like putting a belt around the stomach'.
The SAGB forms the stomach into two sections, with a small opening between the sections allowing food to pass through. Food collects quickly in the small upper section causing most patients to feel full faster and eat less.
How Surgery Loses Weight
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Surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient's stomach and intestine.
After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients.
Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today's bariatric surgeons have access to a substantial body of clinical data to help them determine which surgeries should be used and why.
Today, the American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:
- Restrictive procedures that decrease food intake.
- Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Restrictive Procedures
Malabsorptive Procedures that Alter Digestion
Restrictive Procedures
The theory is simple. When you feel full, you are more likely to have reduced feelings of hunger and will no longer feel deprived. The result is that you are likely to eat less.
Restrictive weight loss surgery works by reducing the amount of food consumed at one time. It does not, however, interfere with the normal absorption (digestion) of food. In a restrictive procedure, the surgeon creates a smaller upper stomach pouch. The pouch, with a capacity of approximately 15 to 30 ml, connects to the rest of the stomach through an outlet known as a "stoma." In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss.
During recovery, patients must adhere to the strict specific dietary guidelines and restrictions their surgeon prescribes. While these guidelines may vary from one surgeon to the next, it is important for each patient to follow the surgeon's guidelines.
When the time comes to resume eating "regular" food, the patient must learn to adapt to a new way of eating. At each meal, they are restricted to consuming approximately 1/2 to a full cup of food before feeling uncomfortably full.
Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can stretch the stomach pouch and/or the stoma outlet and defeat the purpose of the surgery.
The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids.
Failure to achieve the expected level of weight loss is usually the result of a patient failing to comply with the recommended dietary and behavior modifications, such as increased exercise and regular support group attendance.
Malabsorptive Procedures that Alter Digestion
It can be said that some of the restrictive approaches discussed above have not always achieved the excess weight loss surgeons and patients anticipated. For this reason, procedures that alter digestion, known as malabsorptive procedures, were developed to work in conjunction with restrictive approaches.
Some of these techniques involve a bypass of the small intestine, thus limiting the absorption of calories.
On balance, malabsorptive or malabsorptive/restrictive procedures have resulted in an overall increase in the loss of excess weight.. Malabsorptive techniques carry a higher risk of complications and mortality compared to laparoscopic banding surgery.
Basically, weight loss operations fall into three categories:
- Restrictive procedures make the stomach smaller to limit the amount of food intake.
- Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories.
- Combination operations take advantage of both restriction and malabsorption.
How effective is Surgery
The actual weight a patient will lose after the procedure is dependent on several factors. These include:
- Patient's age
- Weight before surgery
- Overall condition of patient's health
- Surgical procedure
- Ability to exercise
- Commitment to maintaining dietary guidelines and other follow-up care
- Motivation of patient and cooperation of their family, friends and associates
In general, weight loss surgery success is defined as achieving loss of 50% or more of excess body weight and maintaining that level for at least five years. Clinical data will vary for each of the different procedures mentioned on this site. Results may also vary by surgeon. Ask your doctor for the clinical data stating their results of the procedure they are recommending.
Clinical studies show that, following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Patients may lose 30 to 50% of their excess weight in the first six months and 77% of excess weight as early as 12 months after surgery. Another study showed that patients can maintain a 50-60% loss of excess weight 10-14 years after surgery.
Patients with higher initial BMIs tend to lose more total weight. Patients with lower initial BMIs will lose a greater percentage of their excess weight and will more likely come closer to their ideal body weight.
Patients with Type 2 Diabetes tend to show less overall excess weight loss than patients without Type 2 Diabetes. The surgery has been found to be effective in improving and controlling many obesity-related health conditions.
In a study of 500 patients, 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) improved or resolved following surgery.
For example, many patients with Type 2 Diabetes, while showing less overall excess weight loss, have demonstrated excellent resolution of their diabetic condition, to the point of having little or no need for continuing medication.
Preparations for Surgery
Weight loss surgery is like other major surgeries. The best preparation is to understand the risks and potential benefits and to closely follow your doctor's instructions.
To physically prepare yourself, strictly follow your doctor's guidelines. These usually include, but are not limited to:
- Optifast diet for 10 days prior to surgery
- Stop smoking 6 weeks prior to surgery
- Be certain to follow you surgeon’s instructions regarding any medication you may be taking to control other health conditions
- Expect to stay at least 1 night in
hospital.
- If you special equipment for sleep apnoea, please bring your machine to hospital
Life After Surgery
The following identifies areas that will be important for patients to follow after weight loss surgery. 
Diet
Going Back to Work
Birth Control & Pregnancy
Long-Term Follow-Up
Support Groups
Diet
The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their weight loss surgery.
It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of procedure.
What is most important is that you adhere strictly to your surgeon's recommended guidelines. The following are some of the generally accepted dietary guidelines a weight loss surgery patient may encounter:
- When you start eating solid food it is essential that you chew thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
- Don't drink fluids while eating. They will make you feel full before you have consumed enough food.
- Omit desserts and other items with sugar listed as one of the first three ingredients.
- Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
- Avoid alcohol.
- Limit snacking between meals.
Going Back to Work
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.
Birth Control & Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.
Long-Term Follow-Up
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed, and then every one to two years.
Support Groups
The widespread use of support groups has provided weight loss surgery patients with an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.
Risks and Complications
of Bariatric Surgery
Surgery should not be considered until you and your doctor have evaluated all other options.
As with all surgeries, there are risks associated with this procedure. If complications occur during the operation, your doctor may choose to perform open surgery.
Your doctor must determine if you are an appropriate surgical candidate.
Indication
Weight loss surgery is typically reserved for those patients with a Body Mass Index (BMI) of 40 or higher.
In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).
Important Considerations
Surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:
- These procedures are in no way to be considered as cosmetic surgery.
- The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
- A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
- The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise.
- Problems may arise after surgery that may require reoperating.
Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.
Complications and Risks
As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor.
Possible risks include, but are not limited to:
- Bleeding*
- Complications due to anaesthesia and medications
- Deep vein thrombosis
- Infections
- Pulmonary problems
- Spleen injury*
- Conversion to open surgery
- Perforation of the stomach
Band Specific Problems such as
- Band Slippage
- Band Erosion/Migration
- Mechanical Failure
- Mechanical failure of banding device requiring replacement
*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.
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