FREQUENTLY ASKED QUESTIONS
For Patients Considering Weight Loss Surgery
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:
- Relatively simple and potentially reversible procedure
- The gastric band is fully adjustable
- Most patients lose 50-60% of their excess weight
- Good documented evidence of reversal of type 2 diabetes, hypertension, sleep apnoea and improvements in fertility in women
- Most patients stay overnight in hospital Risks Specific to the Gastric Band
- The gastric band specific risks of slippage of the band and a small risk of erosion into the stomach.
- A small risk of problems with the access port.
Risk of food bolus getting stuck and an increase in reflux symptoms
- Most patients are discharged after an overnight stay
- Liquids are commenced after a swallow study (X Ray)
- For good long term success, patients are seen regularly in the clinic where the band is adjusted until a optimal stage is reached where the rate of weight loss is acceptable without being over restricted. Adjustments are more frequent in the first year.
- Some patients may not be suitable for a gastric band as they are not committed or able to attend the clinic regularly.
Our staff and dietitians will ensure you are well supported thru the follow up period.
Laparoscopic Gastric Bypass
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.
- Of the procedures commonly performed in Australia, studies show the Gastric Bypass to be the most effective at rapidly lowering weight. The bypass also has the best Excess Weight Loss(EWL) rates amongst most weight loss operations.
- For people with Type 2 Diabetes, the Gastric Bypass has the special ability to boost the body’s natural production of insulin from the pancreas.
- People suffering from significant reflux before surgery are likely to experience a reduction or cessation of their symptoms.
- Stomach ulcers and small bowel obstructions can be serious complications requiring additional surgery.
- If patients eat particularly fatty or sugary foods, they may temporarily experience the quite unpleasant symptoms of the ‘dumping syndrome’ associated with bloating and diarrhoea.
8 Golden Rules to Successful Weight Loss
- Patients should consume a minimum of 2- 2½ quarts (64-80 fluid ounces) of liquids per day. This should be done slowly and throughout the day. The easiest way to keep track of this is to purchase a 32-ounce water bottle and finish at least 2 bottles of liquids a day. Sip, Sip, sip..
- This amount should be increased by 10-20% when the weather is very hot and humid to prevent dehydration.
- In the first 30-45 days after surgery, avoid drinking more than 3-4 ounces of liquids (1/3 of a cup) in a 10-minute period to avoid vomiting. Avoid gulping any more than 1 ounce (shot glass size) at a time. Eventually, you may be able to drink more at a time.
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.
- Snacking between meals or “grazing” on small amounts of food throughout the day will sabotage your attempts at successful weight loss.
- If you “graze,” you will not lose an adequate amount of weight because you may consume too many calories.
- You will need to be the judge of your meals and snacks. Some patients need to have 5 mini-meals per day and that works for them. Since everyone is individual, there is no hard fast rule.
- 70%-75% of all calories consumed should be protein based (eggs, fish, lean meats, etc.; bacon is not a lean meat).
- Carbohydrates (bread, rice, pasta, potatoes, beans, etc.) should be only about 10%-20%, and fats (butter, cheese, etc.) only 5%-15% of the calories that you eat. If you must eat the carbs, opt for quality whole grains.
- A diet consisting of 600-800 calories and about 70 grams of protein should be your goal for at least the first 6-8 months. Caloric intake can increase as your stomach stretches.
- Swollen ankles, fatigue, hair loss, cracked nails, and defective healing and immunity are just some of the side effects of inadequate protein consumption (not to mention difficulty losing weight). Hair loss may also be due to hormonal changes but protein levels can be checked to be sure you are not developing a protein deficiency.
- Liquids should be avoided for a period of 15-30 minutes before and 30-45 minutes after eating solid food or meals.
- You must focus on eating enough protein to prevent malnutrition and hair loss. If you eat protein rich foods first at each meal, you will have little room left in your stomach for simple sugars.
- Sugar and other carbohydrates may slow your weight loss because they are so easily digested and absorbed. Vertical Gastroplasty/Gastrectomy patients who have early plateaus are most always consuming too many carbohydrates. Because the negative biofeedback of Dumping syndrome is not present with this operation, it is all too easy to start eating too much sugar and other carbohydrates. Eating protein first and when hungry will help to minimize the chance of consuming too many carbohydrates.
- Sugar, sugar alcohols and artificial sweeteners cause gas, bloating and diarrhea. VSG patients usually do not get dumping; however they may if they eat significant amounts of fat or sugar. If too much sugar is consumed, it may enter the intestines rapidly and travel through quickly. This may lead to gas, bloating and a mad dash for the bathroom.
- Avoid starchy foods such as rice, pasta, cereals, and mashed potatoes. Again, if you must eat them, opt for better choices of whole grains.
Do not “stuff” yourself. This may cause your stomach pouch to stretch.
- You will accelerate your weight loss and have a better chance of reaching your goal weight by establishing a good aerobic exercise program and making healthy dietary choices. In addition and more importantly, aerobic exercise strengthens the heart and makes you feel better. It can also help to suppress hunger.
- Lack of exercise may also limit the amount of weight loss.
- Occasionally, patients who exercise a great deal can experience a weight plateau due to increased muscle and lean body mass (like body-builders).
- Remember – muscle is denser than fat and thus weighs more. These patients often notice that they are losing inches and clothing sizes and should keep up the good work! Weight loss through exercise is the healthiest way to lose! Do not let the scale dictate your progress for you, how do your clothes feel, are you losing inches? These are the questions you should ask yourself.
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.”
Preparing For Surgery & What Follows After
As any surgical procedure, there are some pre-operative preparations to fulfill carefully.
The pre-operative preparatory instructions from your doctor will mainly include:
- Start Atkins diet for 2 weeks before the surgery to reduce the fat around your liver.
- Make sure to be on a regular intake of clear fluids 48 hours before surgery.
- You must cleanse your colon before surgery by taking regular laxatives as prescribed
- Stop any medication unless indicated and recommended by your doctor.
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:
- The risks of any general anaesthetic and operation.
- Wound infections at incision sites.
- Risk of bleeding or leakage from the site of bowel division or rejoining (anastomosis), depending on the nature of the procedure
- Hernias – a weakening of the abdominal wall.
- Development of gall bladder disease and/or gall stones – due to rapid weight loss.
- Blood clots in the legs and spreading to the lungs causing a serious condition called pulmonary embolism.
- Vitamin deficiencies – may be preventable by taking daily vitamin supplements. Periodic lab testing would be required.
- As with any surgical procedure, there is a risk of mortality.
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.
Sleeve or Tube Gastrectomy
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%.
- A good single stage operation for weight reduction for moderately obese patients.
- It does not require disconnecting or reconnecting intestines.
- The stomach is reduced but functions normally and almost every type of food can be consumed, though in small amounts.
- Many patients lose up to 60% of their excess body weight within six months of their Lap Sleeve Gastrectomy surgery.
- By removing most of the excess stomach volume, the Ghrelin hormone production is mostly eliminated and therefore the sensation of hunger is being reduced.
- It is a simpler surgery than gastric bypass
- There is no malabsorption as with Gastric bypass, minerals and vitamins are not necessary, this may be important though in older patients.
- There is no dumping syndrome but sugar substitutes may be better tolerated.
- No foreign device is inserted in the body as in gastric band.
- Can be converted into gastric bypass if required
- An internal infection from leakage of digestive juices into the body cavity.
- Risk of bleeding from the area of division of stomach
- It is irreversible operation
- Other surgical and anaesthetic risks common to a gastro intestinal operation