Obesity is a chronic and progressive disease that can affect multiple organs in the body. People with morbid obesity are at great medical risk of disability or premature death. 10% or 2 million Australians are suffering from morbid obesity.
At the top of the list of obesity related co-morbidities are adult onset diabetes, or Type 2 diabetes, and high blood pressure. High blood pressure caused by morbid obesity can contribute to heart attacks, congestive heart failure and stroke. Health concerns such as sleep apnoea, asthma, low-back pain, infertility in women and severe acid reflux (GERD) are also a result of increased weight.
Significant weight loss can often ease these conditions or reverse them completely.
Obesity is very difficult to treat. Many patients have tried multiple diets, medications and exercise regimes with results that did not last. Surgery to promote weight loss by restricting food intake is an option for morbidly obese patients that have been unsuccessful with other weight loss treatments.
Eligible patients for weight loss surgery would usually have a body mass index, or BMI, of 35, or greater, however each patient is evaluated individually depending on medical co-morbidities.
You can work out your BMI by dividing your weight in kilograms by your height in meters squared. Alternatively visit our website at www.melbournegastrosurgery.com.au where there is an easy to use BMI calculator.
At Melbourne Gastro Surgery we offer the following three options for Surgical Weight Loss:
The following is general information on these procedures. Please note that it does not take into consideration your specific circumstances.
Laparoscopic Adjustable Gastric Banding or Lap Band Surgery
Laparoscopic Adjustable Gastric Band (LAGB) or Lap Banding surgery is a popular option for weight loss surgery. This is a keyhole procedure requiring a short hospital stay and the insertion of a silicon ring around the upper stomach. This holds up the passage of food and creates a small pouch above it restricting portion size.
There is also a profound effect in reducing hunger which is not yet fully understood. Several weeks after insertion, the band is filled with saline by an injection through the skin on the abdomen into a chamber which connects via a tube with the band. This places extra pressure on the stomach and starts the process of dietary restriction and weight loss.
Advantages Specific to the Gastric Band:
Risk of food bolus getting stuck and an increase in reflux symptoms
Our staff and dietitians will ensure you are well supported thru the follow up period.
Roux-en-Y Gastric Bypass involves forming a small stomach pouch (about the size of a person’s thumb) which is created using a surgical stapler.
The small stomach pouch restricts food intake by allowing only a small amount of food to be eaten at one time. Next, the small bowel is divided about two feet from the stomach. One end of the small intestine is brought up and attached to the stomach pouch (the gastrojejunostomy).
The other end of the small intestine, still connected to the now non-functional stomach remnant, is reconnected to the intestinal tract (the jejunojejunostomy). As the name “gastric bypass” implies, following the surgical procedure, food is now routed past most of the stomach and the first part of the small intestine.
In addition to restricting food intake, gastric bypass reduces nutrient absorption.
Some patients need to eat more often 5-6 small mini-meals to get their protein in, you will just need to adjust according to your own needs.
Do not “stuff” yourself. This may cause your stomach pouch to stretch.
The most difficult (and most important) time after surgery is the first 3-6 months. This is also the most important time because the habits that you develop in this period will be the ones that you will probably adopt for the rest of your life.
In the first months after surgery, you are relearning how much you can eat (portion size as well as “bite” size), how well you have to chew, and what you can eat without developing problems.
Although everyone is different, usually by the sixth month patients are eating most regular (healthy) foods – but in much smaller portions than they did before surgery. There will definitely be foods that you will never want to eat again because they will cause some type of “intestinal distress.”
As any surgical procedure, there are some pre-operative preparations to fulfill carefully.
The pre-operative preparatory instructions from your doctor will mainly include:
Stop any herbal medication and over the counter medications for headache or allergy or other similar conditions 7 days before the surgery.
Studies show that patients who commit to eating healthy food, take nutritional supplements and have routine blood work for monitoring purposes have the best long-term results.
Surgery gives patients the physical tool to assist with weight loss. Patients must be committed to making the emotional and physical changes necessary after weight loss surgery. This commitment will ensure successful weight loss and long-term weight maintenance.
Lack of exercise, poorly balanced meals, constant grazing, eating processed carbohydrates and drinking sweet drinks are some of the most common preventable causes of failure to achieve adequate weight loss and maintain it.
Weight loss surgery, as with any major surgery has risks, of which you should be made aware. These may include:
You will be instructed to change your diet and eating habits. Drink more water (about 8 cups of water per day) and increase this amount 10-20% if you are exercising. You MUST not drink water or fluids with solid food.
Regarding your meals, the first couple of months will be the hardest times, as you have to adapt to your new stomach size. You must chew food well and eat smaller amount of food within longer meal time (30-45 minutes for meal).
You must stop eating once you feel full. You should have 3 meals per day but the most important thing is to reduce fats and carbohydrates and make the main nutrient of your diet protein.
Now that you’ve taken your decision for obesity surgery here are some important guidelines to follow. The greatest weight loss will occur within the first six months. It will start to slow after that, but can continue for a total of 12-18 months.
You may intermittently have plateaus in your weight loss for up to a month. This is usually an indication that you are eating too many carbohydrates or calories and/or not exercising enough. Take this as a sign to re-examine your eating and exercise habits. Most patients’ weight will plateau after 8-12 months view success stories…(Link coming soon).
After this time, additional weight loss may be difficult. Weight regain may also occur if too many calories are consumed, exercise is discontinued or old habits, such as grazing, snacking, or poor eating habits return.
The sleeve gastrectomy is a key hole surgery only on the stomach (it is only a restrictive procedure) and does not involve any surgery on the intestine (which would make it malabsorptive). Sleeve gastrectomy has also been called tube gastrectomy and vertical sleeve gastrectomy.
It basically consists of converting a stomach that looked like a pouch into a long tube; therefore the name ‘Sleeve’
The sleeve gastrectomy (SG) removes three-quarters of the stomach, which provides for quicker satiety (sense of fullness) and decreased appetite. The smaller stomach sleeve restricts food intake by allowing only a small amount of food to be eaten at one time.
The valve at the outlet of the stomach remains, this provides for the normal process of stomach emptying to continue which allows for the feeling of fullness.
SG has been utilised in the treatment of obesity since 2003. There are no new connections made between the stomach and small intestine in this procedure. There is no rerouting of the intestine. There is no malabsorption or dumping syndrome.
The Sleeve Gastrectomy is believed to have an advantage over the Adjustable Gastric Band due to removal of the part of the stomach that produces the hormone (Ghrelin) that controls the desire to eat. The potential complications of the operation on average are typically less than 1.5%.