Bariatric Surgery in Sydney
What is bariatric surgery?
Bariatric (weight loss or metabolic) surgery is a surgical procedure that is performed on the stomach and or the small bowel to restrict or reduce food intake so that fewer calories are available for absorption. The aim is to reduce body weight by helping patients eat less and not feel hungry.
Reduction in weight also significantly contributes to the improvement or resolution of some diseases. These diseases, known as metabolic disorders, include diabetes, high blood pressure (hypertension), high cholesterol, fertility, sleep apnoea, heart disease, stroke, arthritis, reflux, and fatty liver disease to mention a few.
Surgery also has many other health benefits. It reduces the risk of various cancers and, improves the immune system, life expectancy and quality of life.
Why did they need it and what did it take to get to this point?
Morbid obesity is a serious condition that can have a significant impact on an individual’s health and quality of life. It is often the result of a complex combination of factors, including genetics, environment, lifestyle, and underlying medical conditions.
Patients who need bariatric surgery typically have a long history of obesity and have been unable to achieve significant weight loss through traditional weight loss methods such as diet and exercise. They may have been struggling with their weight for a significant amount of time and have tried different diets and weight-loss programs without success.
Obesity can lead to a variety of health issues such as type 2 diabetes, high blood pressure, sleep apnoea, acid reflux, arthritis, and heart disease, as well as psychological issues such as depression and low self-esteem. They can also increase the risk of various cancers, Oesophageal (food pipe) cancer, Gastric (stomach) cancer, Gall bladder cancer, Breast cancer, Colon cancer, Prostate cancer, and Endometrial cancer. These health issues can be debilitating and significantly reduce the quality of life, making it difficult to work, be active with family and friends, and even perform daily activities.
What are the cancers that are affected by bariatric surgery? What are the cancers that are impacted by obesity? What are cancers where the risk of development is reduced by weight loss surgery?
Oesophageal (food pipe) cancer
Gall bladder cancer
Breast cancer
Colon cancer
Prostate cancer
Endometrial cancer
At what weight do you need bariatric surgery?
According to new guidelines published by the International Federation for the Surgery of Obesity and metabolic disorders (IFSO), any one over the BMI of 30 qualifies for bariatric surgery. This also takes into consideration a few other aspects such as the presence or absence of some health disorders and as a bridge to joint surgery, abdominal wall hernia surgery and transplant surgery
What are the types of bariatric surgery?
There are, largely speaking, two types of bariatric surgeries or procedures. They are restrictive, which restricts the amount of food (and so calories) that one can eat. Examples are a gastric band and gastric balloons. The other one is malabsorptive, which helps patients absorb less of what they eat and drink. All malabsorptive procedures are also to some extent restrictive as well. Examples are sleeve gastrectomy and bypass surgeries.
What are the disadvantages of bariatric surgery?
The disadvantages of any bariatric procedure depend on the procedure and how it has been utilised following the procedure.
The potential major complication rates vary from 1% to 10% depending on the kind of surgery. They include leaks, bleeding, internal hernia, and severe nutritional deficiencies. With regards to the outcome of surgery, some may lead to the development of reflux, insufficient weight loss or weight regain. It is important to utilise the advantages of the surgery along with a change in lifestyle to reap the best outcome.
Non-medical treatments, medical treatments?
Non-surgical ways of losing weight include dieting, exercising and weight loss medications. Weight loss medications are available in various forms (tablets and injections), both of which are aimed at reducing the hunger
How successful is bariatric surgery? What is the amount of weight loss with any bariatric surgery?
Success in terms of weight loss and resolution of medical conditions depends on the choice of surgery and associated lifestyle changes. It is successful in 80-90% of the patients.
Weight loss is talked I terms of the ‘percentage of excess weight loss’, compared to a person with a BMI of 25. Excess weight loss varies from procedure to procedure with an average excess weight loss of 60% from sleeve gastrectomy to 80% in bypass surgeries. The improvement of diabetes and other health conditions ranges from 30% to 80%.
Why you shouldn’t have weight loss surgery right away
There are a few reasons that you may not want to immediately have weight loss surgery. For one thing, weight loss surgery is not for everyone, and it is a long-term commitment. It’s important to remember that it can take years to see the full benefits of a weight loss surgery. When considering a weight loss surgery, it’s important to consider your readiness and the potential consequences of such a drastic change. If you are not ready to undergo such a dramatic change in your life, you should consider other options first. It is a tool that one can use well or misuse it.
Should teenagers consider weight loss surgery?
Bariatric surgery in a teenager is something that needs to be carefully considered. With the new IFSO guidelines, any teenagers who weighs more 120% of the 95th percentile for their age are eligible for bariatric surgery.
It is vital that adolescents and teenagers are treated by a multidisciplinary non-surgical team and have tried non-surgical methods for at least 6-12 months prior to considering surgical options. It is a life-long commitment and if other methods work, then surgery should be considered at a later stage. In terms of surgical options, a relatively less complex procedure that has lower complication rates (such as sleeve gastrectomy) should be considered.
Non-medical treatments for obesity
There are several non-surgical treatment options available for morbid obesity, including:
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- Lifestyle changes: This includes making changes to diet and exercise habits, such as reducing calorie intake, eating a healthy and balanced diet, and increasing physical activity. This can lead to weight loss and improve overall health.
- Behavioural therapy: This includes working with a therapist or counsellor to address emotional or psychological factors that may contribute to obesity, such as emotional eating or lack of motivation.
- Medications: Some medications, such as Olympic, Saxena and Byetta can help to reduce appetite and increase feelings of fullness, leading to weight loss.
- Meal replacements: This includes using meal replacement shakes, bars, or soups to replace some or all of your meals. This can help to reduce calorie intake and make it easier to stick to a diet plan.
- Interventional weight loss programs: This includes weight loss programs that provide support and guidance from a team of healthcare professionals such as dietitians, exercise specialists, and behavioural therapists to help individuals lose weight and improve their overall health.
It’s important to note that non-surgical treatments for morbid obesity often require a long-term commitment and may not be as effective as bariatric surgery. It’s also important to remember that non-surgical treatments are not suitable for everyone, and it’s important to consult with a doctor or a specialist in obesity to determine the best treatment options for you. see also our blog post on Mastering success habits in weight loss surgery
Bariatric surgery journey, aftercare and follow up
Bariatric surgery is something that needs careful consideration. Ideally, you should have tried non-surgical methods and achieved some results, even if it was temporary. This gives you the best chance for success following surgery. Spend some time understanding the weight loss journey including what lifestyle adjustments you need to do after the surgery and what you really want to achieve out of the surgery. This allows you to take full advantage of the procedure to achieve the best and long-term outcome
On your first consultation discuss, with your surgeon, various surgical options and the rationale behind any proposed type of surgery. Also, ask and understand the potential complications with each one of them, you can also attend our Weight loss program or exclusive webinar!
Ideally, prior to surgery, you should have consultations with a dietician and psychologist. They are part of the multidisciplinary team vital for a good outcome. Sometimes, depending on the health conditions you may also have to meet an endocrinologist, cardiologist, respiratory physician and anaesthetist.
Following surgery, expect to spend one or two nights in the hospital. If everything goes as planned you tend to go home on a liquid diet, which continues for about two weeks. This will be upgraded slowly, under the supervision of the dietician to a soft and normal diet over the next few weeks.
Most surgical teams would follow you, along with the dietician, for 2-3 years. This period is very important since the weight loss is maximum during the first 12-24 months. But at the same time, weight regain commonly starts around 2-3 years following surgery and additional intervention, such as medical therapy may be beneficial at this stage.
Bypass surgery in Sydney NSW
What are the kinds of bypass surgeries that are commonly performed?
The most common type of bypass surgeries is Roux-en-Y (RnY) bypass and single anastomosis bypass (OABG) or mini gastric bypass (MGB). There are types of bypasses which are less common in Australia which include Single anastomosis duodenal-ileal (SADI) bypass and Biliopancreatic diversion (BPD) procedure.
What is bypass surgery?
Bypass surgery is where a part of the intestine is bypassed by dividing the bowel and rejoining at a different spot to allow for malabsorption. The bypassed part of the bowel does not absorb any calories leading to weight loss.
Bypass operations are selected and tailored to individual patients depending on their health condition and weight. Some of the factors that are considered while selecting a bypass operation include weight, body mass index, reflux and the presence or absence of other health conditions such as diabetes, high blood pressure and high cholesterol.
Who needs bypass surgery?
Gastrointestinal (GI) bypass is a bariatric surgery and is typically recommended for morbidly obese patients who have been unable to achieve weight loss through other methods, such as diet and exercise.
Bariatric surgery is usually recommended, according to new international guidelines for patients who have a body mass index (BMI) of 35 or higher, or a BMI of 30 or higher with one or more obesity-related conditions such as type 2 diabetes, high blood pressure, or sleep apnoea
It’s also important to note that bariatric surgery is not a quick fix and it requires a commitment to long-term lifestyle changes such as healthy eating, regular exercise and follow-up care with a multidisciplinary team including a dietitian, a psychologist, and an endocrinologist.
The kind of bariatric operation (sleeve or bypass) depends on a few patient-related factors and they need to be discussed in detail with the surgeon. It is important to discuss the benefits and risks of the surgery with your doctor and to have a clear understanding of the procedure, the recovery process, and the lifestyle changes that will be necessary after the surgery to achieve successful weight loss and maintain weight loss in the long term.
How serious is bypass surgery? Is Bypass Surgery major surgery?
Bariatric surgery is a major surgery. There are several potential major complications that vary from 1 – 10% depending on the kind of surgery. They include leaks, bleeding, internal hernia, and severe nutritional deficiencies. With regards to the outcome of surgery, some may lead to the development of reflux, insufficient weight loss or weight regain. It is important to utilise the advantages of the surgery along with a change in lifestyle to reap the best outcome.
What is the life expectancy after the bypass?
Life expectancy improves significantly following weight loss surgery as long as there are no major complications. A patient can expect a life expectancy of any other average individual in the population following a successful bariatric procedure.
What does a sleeve gastrectomy do? What is involved in sleeve gastrectomy?
Sleeve gastrectomy is a surgical procedure that involves cutting out 75-80% of the stomach, thereby reducing the size and volume of the stomach. This helps patients to feel less hungry and eat less leading to weight loss. The weight loss is gradual and over 12-24 months. Average excess weight loss is about 60% in 2 years.
Which is the most common complication after sleeve gastrectomy?
Sleeve gastrectomy, like any other bariatric surgery, is a major procedure. Although it is less complex and carries lower complication rates, it needs to be considered with a proper understanding of what is involved and what is the role of the patient in the weight loss journey.
Complication rates following sleeve gastrectomy range from 1-5%. Leaks from the staple line are the worst complication and rates are 1-2%. The most common complications of sleeve gastrectomy are minor and gastrointestinal such as nausea, swallowing difficulty initially, diarrhoea and constipation.