FAQs

Effects of obesity

Obesity and overweight puts individuals at risk for many chronic diseases (many potentially fatal) and increases health care costs.

• Obesity-related medical conditions include :-

1. Diabetes
   1. Type 2 diabetes is a common and serious comorbid disease of obesity. About 85% of type 2 diabetics are obese and the increased risk of becoming diabetic is estimated to be 93x for women and 42x for men who are severely obese.
   2. Bariatric surgery can improve or cure type 2 diabetes.
2. High blood pressure
   1. It is common in obesity. If untreated, it can cause irreversible damage to heart, kidneys, brain and blood vessels.
3. High blood cholesterol level
4. Sleep apnoea
5. Fatty liver
6. Back and lower limb osteoarthritis
7. Gastro-oesophageal reflux disease or heartburn
8. Polycystic Ovarian Syndrome
9. Infertility/ irregular menstruation
10. Cancer risk
11. Depression
12. Impaired self-esteem and low quality of life

Obesity can be treated by surgical and/or non surgical methods.

Non-surgical methods such as dieting, medications, exercise or combinations thereof achieve weight loss that is often modest and difficult to sustain.

Surgery is a proven, effective and safe method that can deliver sustained weight loss when non-surgical treatment has failed.

It is important to remember that obesity surgery is NOT cosmetic surgery.

It does not cure obesity and will only be successful if accompanied by a lifelong commitment to healthy eating habits and exercise.

There is no perfect surgical solution to obesity. The 3 main proven weight loss operations are gastric banding, sleeve gastrectomy and gastric bypass.

Each technique has its risks, strengths and weaknesses and is only a tool that enables one to lose weight with healthy food choices and exercise.

Gastric Banding

Using laparoscopic (key-hole) surgery, a silicone band is placed around the top of the stomach, just below the junction between the food pipe (esophagus) and the stomach. The inner lining of the band is a balloon which is connected by tubing to a reservoir which is secured under the skin on the abdominal wall. A special non-coring needle is used to inject fluid (saline) to tighten or loosen the band around the stomach. This limits the portion size one can eat.  Hi calorie fluids however will still pass through the band without any restriction and can therefore jeopardize weight loss if one does not make the appropriate food choices.

(Read more)….

Sleeve Gastrectomy

Sleeve gastrectomy is usually performed by laparoscopic (key-hole) surgery and involves removing about 80% of the stomach leaving a small volume “sleeve” of stomach. It reduces the amount one can eat and importantly the portion of stomach removed produces a hormone called Ghrelin that regulates appetite. Hence most patients do not feel as hungry and this helps with achieve weight loss.

(Read more)….

Gastric bypass

Roux en Y gastric bypass or gastric bypass is an established surgical treatment for morbid obesity. This is usually performed with laparoscopic or “key-hole” surgery. It involves partitioning the stomach into a small pouch and re-arranging part of the small bowel. The small stomach pouch, about the size of one’s thumb, is fashioned with a surgical stapler and separated from he remainder of stomach. The upper half of small bowel is sectioned and re-arranged into 2 limbs – Roux or the ‘food’ limb and biliopancreatic or “ digestive enzyme” limb. The “food” limb is then connected to the small stomach pouch to restore the continuity of gut and the “digestive enzyme” limb connected to the “food” limb downstream to allow digestion of food and absorption of nutrients in the “common” limb. With gastric bypass, patients feel full and satisfied with a small portion of food. In addition, the re-arrangement of the small bowel triggers hormonal changes that suppresses hunger and improves diabetes.

(Read more)…

Gastric band, Sleeve gastrectomy and Gastric bypass surgeries are offered at UniHill Specialist Centre.

While they are all proven to be effective, some patients may be more suited to one than another.

Our surgeons can talk you through the pros and cons of each procedure and assist you with making an informed decision on surgical choice.

Not infrequently, patients have already decided on the type of surgery when they see our surgeons.

Our surgeons will discuss with you to determine if your choice is appropriate based on your BMI, medical comorbidities, dietary habits and geographical location.

Non surgical or medical methods of treating obesity include dieting, counseling, medications and/or exercise. These methods can deliver modest degrees of weight loss which are often difficult to sustain – leading to yo-yoing of weight and in the long term may lead to a lot of frustrations, a sense of failure and contributes to a great deal of anxiety about weight loss.

Rather than dismissing these options, non surgical methods are often used to support and  reinforce surgical treatment.

Surgical treatment will not be successful on its own without the support of a healthy diet and appropriate amount of exercise.

The key to success is the ability to integrate all aspects of treatment (multidisciplinary approach) to achieve the one ultimate goal of safe and sustained weight loss.

Selection for surgery is based on a multidisciplinary assessment programme which includes a consultation with a surgeon, a physician, a dietitian and a clinical psychologist if appropriate.

Criteria that need to be fulfilled include:-

• BMI > 40 or BMI > 35 with obesity related medical conditions  (link to obesity related medical conditions)
•   Age >18 and previous failed attempt (>6 months ) to lose weight via medical means
• A full and complete understanding of the nature, mechanism and risks of the surgery
• Absence of uncontrolled psychological problems
• Absence of active drug and /or alcohol problems
• A commitment to a healthy and appropriate diet, exercise and long term followup

We are a specialist clinic and therefore will require a letter of referral from your local doctor/ general practitioner.

Our multidisciplinary approach to your care begins with an initial consultation with a bariatric surgeon who will carefully assess your suitability for surgery and discuss the strengths, weaknesses and risks of each procedure to help you make an informed decision.

If surgery is deemed a suitable option for you, our bariatric physician will meet you to determine and ensure your fitness for surgery, following which you will meet our practice dietitian.

Dietary input is essential to your long term success and our dietitian will be a very valuable source of information for you along the way and also in the future.

Some routine blood tests and a Chest Xray will be required as part of your preoperative assessment and there may be additional tests as deemed appropriate by our bariatric physician/practice dietitian.

A Clinical Psychologist is also available if required.

Once your fitness for surgery is ascertained and choice of operation decided upon, a date for surgery is given to you.

Preparation for surgery

A VLCD (Very Low Calorie Diet; OPTIFAST ) is usually commenced 2 weeks prior to surgery.

This can be quite challenging but it is very important to adhere to it as it will help to shrink your liver to make surgery safer and improve recovery.

How long should I fast before surgery?

You can have Optifast up to 4 hours before surgery and water up to 2 hours before surgery.

How long is the surgery?

•  Gastric band                ~1 hour
• Gastric sleeve              ~1.5-2 hours
• Gastric bypass           ~2.5hours, may be up to 6 hours in revision cases

How long is my stay in hospital?

Your length of stay in hospital depends on the type of surgery you have.

In summary:-

• Gastric band                 1 day
• Gastric sleeve             3-4 days
• Gastric bypass           4-5 days

A check Xray ( gastrograffin swallow ) is performed the day after surgery.

You will be commenced on the appropriate post op bariatric diet as advised by our dietitian. (link to Stage 1 and 2 diet). Once you are comfortable and are tolerating this diet you may be discharged to continue your recovery in the comfort of your own home.

Can I take my tablets after surgery?

In the first 4 weeks after surgery, please crush big tablets or choose liquid version of medications to prevent them getting caught in stomach.

When can I drive after surgery?

You cannot drive while taking opiate painkillers.

Talk to your GP and get a referral letter listing all your medical conditions and medications

Check with your private health funds to confirm your eligibility for weight-loss surgery. You can quote these item numbers :-

• Gastric band         31569,
• Gastric sleeve       31575,
• Gastric bypass      31572.

Call UniHill Specialist Centre on 03 94667338 to make an appointment with our surgeons and also complete weight-loss surgery screening questionnaire (link to this file).

Loose or excess skin after weight loss surgery is relatively common. Excess skin often occurs on the abdomen, upper arms and thighs.  There are a couple of factors that can predict whether or not you will be at risk of excess skin.

In general the younger you are, the more elasticity there is in your skin and the more likely your skin will recover from  changes in body shape.

Rapid weight loss may also lead to excess skin because the skin has less time to recover from the rapid change in body shape and size.

Exercise and certain workouts can sometimes minimize the amount of loose or excess skin postoperatively by shaping and toning your muscles.

Excess skin can lead to skin infections, rashes, may interfere with personal hygiene or be cosmetically unacceptable. If this occurs, please speak to your surgeon who will be able to coordinate and recommend a plastic surgeon who is best able to deal with your situation. This surgery is best performed once your weight loss has stabilized – usually 12-18 months after surgery.

Pregnancy is safe after weight loss surgery but we would recommend you postpone your pregnancy plans for at least a year after surgery or until your weight is stable.

Weight loss surgery should only be considered when all non surgical options have been evaluated and explored. As with all surgeries, weight loss surgery has its associated risks.

General risks include but are not limited to:-

• Risks of anaesthesia and medications
• Bleeding
• Infection
• Deep venous thrombosis ( blood clots in the leg veins)
• Pulmonary embolus  ( blood clots in the lung)
• Lung infection
• Failure to lose weight

Each type of weight loss surgery has its own unique risk profile:-

Risks associated with Gastric Banding include:-

• Band slippage
• Band erosion
• Gastric band and tubing leaks………….. Read more 

Risks associated with Sleeve gastrectomy include:

• Staple line leak
• Staple line bleeding
• Stricture………………………………….Read more 

Risks associated with Gastric Bypass include:-

• Staple line leak
• Staple line bleeding
• Nutritional deficiency
• Internal hernia……………………….Read more 

Rarely if a complication occurs during the operation, your surgeon may decide to convert the operation from laparoscopic ( key hole ) to open surgery to be able to deal with the complication more effectively.

We strongly advise our patients to subscribe to private health insurance.

With the appropriate private insurance cover, operating theatre costs and bed costs will be covered. However, there will be an out of pocket charge depending on the type of weight loss surgery. This covers the professional fees of the surgeon, anaesthetist and assistant.

Post operative review visits  and gastric band adjustments will attract a small  fee.

Please contact us on 9466 7338 to obtain a quote for your particular type of surgery and level of insurance cover.