Bariatric Surgery, Obesity Surgery, Weight Loss Surgery

Weight Loss Surgery Procedures

Bariatric Surgeons first began to recognise 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, Bariatric Surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the years these procedures have been continually refined in order to improve results and minimise risks. Today's Bariatric Surgeons have access to a substantial body of clinical data to help them determine which weight loss surgery should be used and why.

We recommend you visit Dr David Joseph for a consultation to discuss your health and lifestyle goals and determine the best surgical option for you. He performs two of the most common bariatric surgery procedures to achieve successful weight loss results. 

There are two basic approaches that weight loss surgery takes to achieve change:

1. Restrictive procedures that decrease food intake. This includes Gastric Sleeve (Sleeve Gastrectomy).

2. Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool. This can also incorporate an element of restriction. This includes Gastric Bypass.
   

Gastric Sleeve Surgery (Sleeve Gastrectomy)

Gastric Sleeve surgery is performed as a laparoscopic (keyhole) surgical procedure. The procedure works by reducing the size of the stomach thereby restricting, or limiting, the amount of food that can be consumed. As a result of this reduced food and caloric intake weight loss occurs. In addition to reduced food intake, this surgical procedure also impacts and reduces the production “hunger” hormones.

During Gastric Sleeve surgery a few small laparoscopic (keyhole) incisions are made in order for the surgeon to access the stomach. The surgeon then creates a long narrow stomach with a smaller volume of 200-300 mL instead of the usual 1000-1300 mL. The excess portion of stomach is then removed from the body. Any food consumed following surgery will pass through the now smaller stomach the same way it would have prior to surgery and will then enter the small intestine via the normal end of the stomach.

Following surgery patients will become very satisfied with much smaller portions of food and feel full earlier. In addition, they will feel less hungry for at least 9-12 months due to the removal of the top portion of the stomach (fundus). This portion of the stomach produces a lot of the hormones that normally drive hunger (eg. Ghrelin). Nutrient absorption is essentially unchanged.

This procedure is the most commonly performed Bariatric Surgery providing a successful balance of long term sustained weight loss and a great quality of life. 

Pros
Gastric Sleeve patients experience excellent weight loss success and long term maintenance, they are also able to tolerate a normal range of food choices.

Diabetic patients with mild to moderately controlled blood sugars have seen positive results – very often reducing or ceasing diabetes medications.

Female patients with fertility concerns can improve their fertility following surgery as a result of weight loss. (please note: pregnancy is not advised in the first 6-12 months after bariatric surgery)

Cons
For a small percentage of patients, there can be some long term Vitamin B12 or Iron deficiencies.

Gastric Bypass Surgery (Single Loop Gastric Bypass, Roux-en-Y Gastric Bypass)

Gastric Bypass Surgery has performed for many years and can result in excellent long term sustained weight loss.

The procedure is performed using a laparoscopic (keyhole) incisions, the surgeon then creates a small portion of narrow stomach that is disconnected from the rest of the stomach. Some small intestine is then brought up to join the smaller and narrowed section of stomach allowing the ingested food to “bypass” the majority of the stomach, and the first 1-2 metres of small intestine.

There are 2 main types of Gastric Bypass performed, the Single Loop Gastric Bypass (also known as Omega Loop or Mini), and the Roux-en-Y Gastric Bypass. As a guide, the Single Loop procedure is more commonly used, while the Roux-en-Y might be preferred if patients suffer from severe reflux symptoms (heartburn).

Both the Single Loop and Roux-en-Y Gastric Bypass procedures work by combining both restrictive and malapsorptive methods.  As part of both procedures, the physical size of the stomach is reduced resulting in patients becoming fuller faster, while the “bypassing” of a section of the intestine means the absorbtion of restricted calories and nutrients consumed is reduced.

Pros
Gastric Bypass patients experience successful weight loss and long term maintenance.

This is an ideal procedure for patients with very poorly controlled Diabetes or Dyslipidaemia (high cholesterol).

Cons
There is a risk of medium to long term nutritional deficiencies. Patients will require vitamin and nutritional supplements.

Female fertility can improve following Gastric Bypass, but there may be a slightly increased risk of pre-term and underweight birth neonates.

Some patients may experience Dumping Syndrome or develop an intolerance to certain foods.

Revision Bariatric Surgery

In addition to Gastric Sleeve and Gastric Bypass, Dr Joseph also performs Revision Bariatric surgery for patients who have undergone a previous weight loss surgery procedure, most often Gastric Band or Gastric Sleeve.

The reasons to consider Revision surgery may include lack of weight loss, weight regain, significant reflux symptoms or other problems. The decision to consider Revision Surgery are quite complex and require detailed consultation

There are a number of Revision surgery options available. Following a Gastric Band or ESG, Gastric Sleeve or Gastric Bypass may be considered. Following a Gastric Sleeve a Gastric Bypass is the most commonly performed Revision procedure.

Dr Joseph has seen excellent results with the most commonly performed revision procedures.

The decision of what is best for the patient will likely require some investigative procedures to be conducted to look at the stomach prior to deciding on a surgical plan, of course the goal outcome will also direct the decision.

Weight Loss Surgery Pre and Post Operative Information

Weight Loss Surgery Pre Operative Care

All Weight Loss Surgery patients are required to commence an very low calorie Optifast based diet for a period of 2-3 weeks prior to surgery. During this period the patient’s diet will be restricted, with only certain additional foods allowed. There are no carbohydrates, sugars, fruits or juices etc. permitted during this Optifast period. The very low calorie pre-operative diet helps to remove stored fat in the liver.

During surgery, it is necessary to retract the liver. The reduction in fat stores in the lead up to surgery allows for this to be done safely without risk of damaging or tearing the liver during the procedure.

Some patients may note that they can lose 5-10% of their body weight during this period.

Weight Loss Surgery Post Operative Care

Wound Care
The small keyhole incisions are all closed with dissolving stitches which are all placed under the skin so that patients will never need to see them and the final incisions closed with a special surgical glue. Patients can bathe or shower as normal following surgery, however they should be patted dry afterwards.

The surgical glue will fall from the skin on its own 10-14 days after surgery and the incisions should have healed nicely by then.

Pain Management
Most patient’s post-operative discomfort has settled by the time of discharge from hospital. Some patients may however require a small amount of oral medication to help manage ongoing discomfort for a week or so. This can include Panadol, Panadeine Forte, Endone, or occasionally other medicines.

Other Medicines
Routine medications can be recommenced as directed in the post operative phase and any blood thinning agents that patients were previously taking will also be recommenced as directed by the medical team.

All patients will be directed to take a PPI (Proton Pump Inhibitor) such as Nexium, Somac or Losec for a certain period after surgery to reduce stomach acid production therefore providing a more optimal environment for internal joins to heal.

Weight Loss Surgery Post Operative Diet

Each patient will be given specific dietary advice based on their personal requirements, but the following are very brief recommended guidelines following surgery.

Week 1                 Liquid nourishment
Weeks 2 - 4         Pureed food
Week 4 +             Commencement of soft solid diet.

Detailed dietary information will be provided by the practice dietitian prior to surgery.

Weight Loss Surgery Recovery time

As a guide, patients will be in hospital for 2 nights, and depending on the work in which you are employed, will require anywhere from 3-14 days off work. Most patients can start walking within a few days, and more vigorous exercise within 3-4 weeks.

Do you have questions about Weight Loss Surgery or would like to schedule an appointment with Dr Joseph? Please call 9565 5514 to book your consultation.

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