Obesity left untreated can cause serious health problems over time. You can take action today. Discover your options.
Obesity left untreated can cause serious health problems over time. You can take action today. Discover your options.
All surgery involves some risk. Risks can be broken down into two groups, those related to surgery in general and those specific to the operation being performed. Risks of surgery in general include risks of anaesthetics, infections inside the abdomen and in the wound, lung problems, blood clots in the leg or lungs and, very rarely, death. If you have other health problems such as heart or lung problems, diabetes, smoking the general risks of surgery are increased.
When assessing the risks of surgery you must also consider and balance the risks of not having the surgery and remaining significantly overweight.
These will be discussed in detail with you prior to the operation by your surgeon.
The following are the commonest of the complications but please note that this is not a comprehensive list of possible complications but does cover most events.
Anaesthetic risks are extremely low because when you come to your operation any conditions which might increase your anaesthetic risk such as high blood pressure, diabetes or sleep apnoea will have been brought under control. All of our anaesthetists are experienced with dealing with the specific problems of patients with excess weight and have full access to all of the tests and information gathered during your preoperative assessment.
Although uncommon, bleeding can occur during an otherwise routine operation and could require blood transfusion and possibly abandoning the laparoscopic (keyhole) approach for a major incision in the abdomen. Occasionally, after a routine operation, bleeding can commence some hours after an operation and require a return to the operating theatre.
Again these are uncommon with laparoscopic surgery, but occasionally one of the small keyhole wounds can become infected and require antibiotics or drainage. Uncommonly, an infection inside the abdominal cavity or the chest can occur.
Although uncommon, during laparoscopic surgery it is possible to inadvertently damage another organ such as the spleen or the bowel. Normally this can be diagnosed and repaired during the operation but very rarely this damage may not be obvious until some hours or even days after the procedure and will then require appropriate management.
Rarely, it is not possible to complete an operation with keyhole surgery and a full abdominal incision may be necessary. This is more likely to be the case if you have had previous surgery on your stomach such as a gastric band or stomach stapling.
Blood clots to the legs or the lungs are a very serious complication. At LapSurgery we use the maximum protection against this occurring. Shortly before the operation you will be given a blood thinning injection and have stockings placed on your legs. A further device will also be placed on your legs which keeps pumping blood through your legs whilst you’re asleep to minimise the chance of a clot forming whilst you are on the operating table.
Using these precautions and the early mobilisation after the surgery that is possible with the keyhole operation, these complications have been uncommon in our patients.
Our operations are performed only in Private Hospitals. The costs of surgery can vary according to your particular private health cover. The out of pocket cost will depend on the operation performed and Medicare and Private Health cover rebates.
It may be possible to fund this out of pocket cost from your Superannuation.
We currently operate at Mulgrave Private Hospital, Peninsula Private Hospital, St John of God Hospital in Berwick and Knox Private Hospital.
Laparoscopic (keyhole) gastric bypass is considered the “gold standard” obesity operation by the majority of the world’s foremost bariatric (weight loss) surgeons. At LapSurgery we have been performing this procedure since 2009. It is particularly effective for patients with Type 2 diabetes.
There are several slightly different ways of performing a gastric bypass, at LapSurgery Australia we perform the most commonly used version referred to as a Roux-en-Y gastric bypass. Whilst it is a more complex operation than the sleeve gastrectomy or the gastric band, it can be performed with keyhole surgery.
At LapSurgery Australia we perform each of the three major types of weight loss surgery, the gastric band, the sleeve gastrectomy and the gastric bypass. In most cases we do not recommend the gastric banding so the choice lies between the sleeve gastrectomy and the gastric bypass. Studies comparing the two over five-year time frames show very similar degrees of weight loss.
However, patients with Type II diabetes and those with gastric reflux have better results with the gastric bypass. The choice of operation will be discussed with you very thoroughly, and in the end, we present the facts and you make the decision as to which form of surgery suits you best.
The gastric bypass works in four different ways:
After Gastric Bypass surgery, food coming down the oesophagus enters the very small stomach remnant pouch. Food sits in this part of the stomach for a few minutes and stimulates the nerve endings in the top of the stomach. These nerve endings are there to tell the brain when the stomach is physically full. Of course, the stomach is nowhere near full but the brain doesn’t know that! As you will know from eating a very large meal and feeling your stomach is completely full, appetite is then turned off and this reduction of hunger is what makes it possible to eat much less food without the strong hunger that you get when you go on a strict diet.
As the capacity of the upper part of the stomach is only 30 to 60mL you simply can’t get a lot down! But don’t worry; you will get down quite enough to survive. Food passes reasonably quickly into the small bowel so as long as you eat slowly, enjoy your food and don’t rush it you should have no problems.
After food exits the small upper stomach it travels along the small bowel for about 1 ½ metres before it joins with the bypassed part of the small bowel. So in the one and a half metres of this limb there is food but fewer digestive enzymes. Food can’t be absorbed without digestive enzymes. So it’s not until around 2 metres along the small bowel until there is both food and digestive enzymes so that absorption can take place. That means that 2 metres or so of your small bowel no longer absorbs food.
Two of the major changes to the bowel with a gastric bypass are that, firstly, food no longer passes through the duodenum and, secondly, some partially absorbed foods enter the last part of the small bowel. Because of this, two substances known as incretins are produced in increased amounts by the small bowel.
These incretins have a profound positive effect on glucose absorption which, in combination with the weight loss, can either greatly improve diabetes control or in many cases put the diabetes into remission.
Our operations are performed only in Private Hospitals. These costs can vary according to your particular private health cover. It may be possible to fund this out of pocket cost from your Superannuation.
The major risk in the first two weeks is that the join of the small bowel to the stomach does not heal properly and gastric fluid leaks into the abdominal cavity causing peritonitis. This occurs in less than one in 100 operations in people who have not had previous gastric surgery. However, in people who have had a gastric band or a gastric stapling operation in the past the chance of a leak is higher and must be fully discussed with your surgeon before going ahead.
Should a leak occur, this is a very major complication which may well involve further surgery. This could include a major abdominal incision rather than keyhole surgery.
Hospital stay in this event could stretch into some weeks and involve a stay in the intensive care unit. Exactly how we deal with this complication can vary from person to person but, one way or another, the leak will seal and you should make a full recovery and still achieve very good results.
Narrowing of the join between the small bowel and the stomach.
Occasionally, the join between the upper part of the stomach and the small bowel can narrow down and cause difficulty swallowing. This is easily fixed with a gastroscopy and dilatation performed under sedation with only a couple of hours in the hospital. This usually only occurs in the first few weeks after the operation, not later on.
Dumping syndrome
Dumping syndrome is a possible side-effect of the gastric bypass surgery particularly in the first two or three months after the operation. Dumping syndrome is usually caused by eating a high fat or high sugar food. After eating, you may feel more mild symptoms like cold sweats or nausea or you may have a more severe reaction causing dizziness, diarrhoea or vomiting. The symptoms usually last a short time but you may experience symptoms of low blood sugar levels 1-3 hours after eating and need to eat a high carbohydrate food. If this is happening more than occasionally, keeping a food record and a visit to our dietitian should get things back to normal very quickly.
Internal Hernias
When we rearrange parts of the small bowel for the gastric bypass there are two places where we create a “hole” where part of the small bowel could get stuck. This can cause intermittent severe abdominal pain or even a complete blockage of the bowel. It is not always easy to diagnose and should always be considered if you have an episode of severe abdominal pain even some years after the operation. We are now very conscious of this possibility and part of every operation involves closing the two holes where the small bowel can get stuck. Even so there remains a small possibility that this could happen in the future. Surgery would probably be required and may not be able to be done with keyhole surgery. The chance of this happening is less than 5% for the rest of your life.
Ulcer at the join of the small bowel and the stomach pouch (Anastomotic Ulcer)
This is an uncommon condition and usually can be fixed with acid reducing tablets and some variation to diet.
Weight gain
Unfortunately, a small number of patients will either not lose the expected amount of weight or will, at a later date, put some of the weight back on. It is vital that you understand that the bypass is a tool to help keep your weight down. It is not a procedure which can protect you forever from gaining weight. You must realise that you have a genetic predisposition to weight gain and that long-term attention to the principles of healthy diet, exercise and lifestyle are essential to maintain your weight loss results. Long-term follow-up, which we provide at LapSurgery Australia, is absolutely essential to your long-term success. If there you see any significant weight gain you must see us immediately so that we can help you. Unfortunately, some people feel they have failed if their weight starts to increase and feel too embarrassed to come back and see us. The more weight you put on before seeking help, the more difficult it will be to reverse. We will never make you feel embarrassed about any weight gain; we are here to help you.
Vitamin deficiency
Following weight loss surgery each patient has the potential of vitamin deficiency and so LapSurgery Australia recommend to all patients that they take daily multivitamins in order to reduce the risks of other medical conditions such as osteoporosis, thiamine deficiency and other conditions. More information is given to patients at the time of consultation.
The intragastric balloon is designed to be inserted into the stomach and inflated to a volume which will restrict the amount you can eat and reduce hunger.
We are proud to offer our extensive experience with weight loss to patients requiring the intragastric balloon.
The intragastric balloon is not a permanent solution as it may only be inserted for a limited time.
Our team offer a multidisciplinary approach to helping you achieve your weight loss goals. After obtaining a referral from your General Practitioner, you will attend an initial consultation with your surgeon. You will also see our dietitian prior to the intragastric balloon being inserted and at least twice before the balloon is removed.
1. Long term maintenance of weight loss
2. Possible control or remission of serious illness associated with obesity including:
3. Improved quality of life, being able to stop dieting
4. Ability to participate in family activities eg. swimming, playing sport, chasing the kids
5. Ability to purchase clothes in mainstream shops
Our operations are performed only in Private Hospitals. These costs can vary according to your particular private health cover.
Some patients may not be able to tolerate the presence of the balloon and may request its removal in the first 2-3 weeks. There is no refund of costs in this situation.
If the balloon were to develop a leak, it can deflate and block the intestines. This is rare but a very major problem requiring abdominal surgery. Deflation of the balloon prior to 6 months of it being in place is exceptionally rare but becomes more likely after six months which is why we insist the balloon is removed after six months.
LapSurgery Australia’s surgeons are fully trained in the techniques of insertion of the intragastric balloon and such an injury is judged extremely unlikely but nevertheless possible.
Whilst this ceases after a few days for most people, a small number of people may experience ongoing symptoms requiring the balloon to be removed.
Some patients will experience quite severe heartburn. In most cases this will be controlled with appropriate medication.
A variety of other possible complications are possible but very rare. For a complete list of possible complications please contact us.
A small percentage of patients may not achieve any significant weight loss and some patients may not be able to maintain the weight loss that is achieved at the time the balloon is removed.
For years before your operation you have fought your excess weight despite every effort. The reason for this is that significant excess weight is a disease. A chronic disease which cannot be cured by diet and exercise.
Your operation has now given you the ability to control your weight in a way you never could before. However, your operation is just the beginning of the journey of long-term success in controlling your weight.
Follow-up is essential to achieving the weight loss you want and maintaining that weight loss in the long-term.
In the first year after operation we have a specific program in which you will be seen by your surgeon, nurse and dietitian for multiple appointments. We will be supervising your weight loss and issuing guidance and help during this time. It is vital that you attend all your appointments, particularly your dietitian appointments.
At 12 months (6 months for bypass patients) from your surgery you will see one of our physicians, with results of your blood tests, who will advise you on any medical problems or vitamin deficiencies and arrange to treat these if necessary. Thereafter we will call for you every year and offer blood tests and an appointment with one of our physicians to check your overall health and well-being.
In general, we will not see you regularly after the first year unless there are problems.
Your weight problem is a chronic disease and sometimes, despite your very best efforts, the weight starts going up. The key to stopping this from getting out of hand is to get back to us by making an appointment to see your surgeon as soon as you feel your weight is out of control.
We can help. The cause of weight regain is rarely due to a single factor. The reasons are nearly always complex and can be related to all sorts of issues which may be; psychological, related to food cravings, excess alcohol consumption and in rare instances there may be something wrong with your operation. We have a formal weight regain clinic where we fully assess all factors related to the weight regain and help you to overcome these. Sometimes it’s a simple matter of altering the diet, at other times problems such as food cravings or excess alcohol consumption may need the help of our psychologist.
We now have a new generation of drugs which have come out in the last few years which can be extremely effective in getting your weight back under control.
At LapSurgery we have a special interest in helping those who have had a previous operation for weight control which hasn’t worked as you had hoped or is giving you other problems. We offer our expertise to our own patients and also to those who have had operations with other surgeons.
What we can do depends a lot on what the previous operation has been. You should be aware, at the outset, that a further procedure is not to be entered into without very careful assessment by us and the understanding that such a procedure carries risks which may be greater than those of the initial operation.
In most cases we can offer you an alternative procedure. The option of a gastric banding procedure has been used in this situation, but in general we have not found this approach to be effective. Our advice, and that of the majority of international experts in the field, is the conversion of your stapling procedure into a gastric bypass. This is a very major operation in someone who has had previous abdominal surgery and may not be able to be performed by keyhole (laparoscopic) technique.
The risks of complications from this procedure are greater than for the same operation done where there has not been previous surgery and this will be discussed with you in full at your consultation.
The majority of patients who have had their gastric stapling converted have had very significant weight loss and a much improved quality of life.
We understand that everyone is different and we advise you to discuss your options with a Surgeon.
We have performed around 4,000 gastric banding operations and we know that some patients don’t achieve a satisfactory long term result. We have significant experience in helping patients in this situation.
As a first step we would always check to see if the Band can be made to work. This involves a consultation with one of our surgeons and assessment by our dietitian and counsellor. Tests including X-Ray and gastroscopy may be required.
If the Band cannot be made to work, then we will discuss alternatives such as newer medications, or in some cases further surgery.
We understand that everyone is different and we advise discussion of your options with one of our Surgeons.
First, don’t be embarrassed to seek help! A sleeve gastrectomy is a powerful weight loss tool, but it isn’t a magic bullet. A consultation with a bariatric surgeon is essential, to work out if there are anatomic reasons for the lack of weight loss or weight regain. From there, a number of strategies can be advised, including revision surgery if appropriate. The human body has a number of powerful mechanisms to protect against weight loss, and we can provide a multidisciplinary approach to best tackle this problem.
If you are already one of LapSurgery Australia patients, you will need only to have a current referral from your General Practitioner. If you are not a LapSurgery patient already, you will need a referral from your General Practitioner and, if at all possible, you should ask the surgeon who performed your previous operation to provide you or us with a summary of the procedure performed.
As we do not work in the public hospital system you will need to have, or to be prepared to take out, appropriate private health insurance. We will not perform these types of weight loss procedures on patients without suitable private health insurance as your hospital stay can be prolonged, further procedures may be needed and often a period in the intensive care unit may be required. This can involve very significant and unpredictable costs along with considerable stress to you and your family.
Revisional bariatric (weight loss) procedures are complex and time consuming. At LapSurgery we have the experience, expertise and multidisciplinary setup and staffing to perform these types of procedures.
Although some of the hospital costs will be covered with your private health insurance, there will be significant out of pocket (OOP) costs if your previous weight loss procedure has not been performed by us. Discounts apply to those who have had previous procedures performed by LapSurgery surgeons.
For patients of LapSurgery Australia who have had previous weight loss surgery please speak to our staff regarding your out of pocket costs as these will vary depending on what type of surgery you have had previously.
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