When most people in Australia think of weight loss surgery, they think of the laparoscopic gastric band (lap band). This is simply because it is the commonest procedure performed in Australia. The commonest procedure performed worldwide is the laparoscopic gastric bypass. The other operation performed in this practice is the laparoscopic sleeve gastrectomy.
By offering the three different types of operation, I can offer a tailored approach to your individual needs as opposed to the “one size fits all” approach of other surgeons who only offer the laparoscopic gastric band.
Weight loss surgery is commonly divided into two types of surgery, Restrictive and Malabsoptive. Restrictive procedures work by limiting the amount of food that you get in, thereby reducing your overall calorie intake. It should be remembered that restrictive operations do not affect your ability to absorb calories and therefore if you are able to get 5,000 calories in each day, you will absorb 5,000 calories and therefore not achieve the weight loss that you are aiming for.
The other types of procedures are malabsorptive procedures. These procedures also reduce the amount you get in but work mainly by impairing your ability to absorb the calories that you eat. These procedures certainly produce better weight loss than restrictive procedures but come with higher complication rates, in particular vitamin and nutrient deficiencies.
The Obesity Surgical Society of Australia and New Zealand (OSSANZ) has clearly stated that malabsorptive procedures are second-line procedures for those who have failed a restrictive procedure, and therefore, unless you have had a previous restrictive procedure, you will not be offered a malabsorptive procedure.
When you come for your initial consultation, I will explain the pros and cons of each of the three operations that I perform. If there is a particular medical reason that I think one of these operations would be best suited to you, I will inform you of this. Otherwise, I feel it is best for you to decide which of the operations you feel most comfortable undergoing. Each of the operations has its own pros and cons and its own risk profile.
You, as the patient, have to be comfortable with those pros and cons and risk profiles. Currently the laparoscopic gastric bypass is most commonly performed for diabetic patients and my other patients are split approximately 50/50 between the laparoscopic gastric band and the laparoscopic sleeve gastrectomy.
To ensure that you have plenty of time to consider your options and make sure all of your questions are answered, I have a structured programme of consultations with myself and with my dietitian, psychology and exercise physiology experts. This allows you time to ensure all your questions are answered before you decide which procedure you wish to proceed with.
Having decided which procedure you have decided to proceed with, the next step is to perform a gastroscopy. This involves a day stay in hospital and some light sedation. I examine the inside of your stomach for abnormalities that might impinge on your procedure and it also introduces you to my anaesthetists. My anaesthetists specialise in anaesthesia for weight loss surgery and are familiar with all the anaesthetic issues that this raises.
The day case gastroscopy allows them to perform a pre-operative anaesthetic assessment and they may, if necessary, request some additional investigations prior to surgery or recommend enhanced post-operative nursing care such as a high dependency bed. This is designed to facilitate an extra layer of safety for you, the patient, and minimise your intra-operative and post-operative risks.
I have devised a multidisciplinary team approach to weight loss surgery at the Brisbane Institute of Obesity Surgery. This involves pre-operative psychology, dietician and exercise physiology support, specialist anaesthetic support and programmed post-operative support, again from psychology, dietetics and exercise physiology.
This has been designed because various studies from around the world have demonstrated that patients who have their surgery within an environment such as this achieve better results. In addition, we have a patient support group that meets on a monthly basis at Brisbane Private Hospital.
The support group is free to attend and the hospital provides free car parking. This provides the opportunity for patients who are about to undergo or have undergone weight loss surgery to discuss their concerns, difficulties or lifestyle challenges. Again, access to a patient support group has been shown to enhance a patient’s weight loss outcomes.
In addition, we are striving to have guest speakers present at the patient support group on a regular basis. This list of guest speakers will include plastic surgeons discussing what can be done with excess skin after weight loss, chefs talking about tips on cooking, and fashion consultants advising on clothing after weight loss surgery.
If you are considering weight loss surgery, you may have family and friends or colleagues who advise you simply to diet and exercise, and that weight loss surgery is “the easy way out”. For the obese, diet and exercise does not work in the long term and certainly surgery is not the easy way out.
Myself and the team at BIOS act as your coaches and support to help you achieve the best possible outcome from your weight loss surgery but at the end of the day, you, as the individual, will have to do the hard work and have the commitment to succeed.