3 Things To Know About Obesity Surgery

Transcription

1 3 Things To Know About Obesity Surgery Dr Jon Armstrong 1st Edition

2 Introduction Am I A Candidate? What Are The Options? How Does It Work?... 6 Conclusion... 9 Follow me here... 10

3 Introduction I have been performing weight loss surgery since 2005 and have completed over 2000 procedures. When I was in my training as a surgeon, there seemed to be a real gap in Australia in the services provided to overweight patients. Obesity or bariatric, surgery is often life-saving and a life-altering procedure to undergo. For me, training in this field has turned out to be a great pathway to go down. Bariatric surgery can be challenging to perform but can be done safely with excellent results. It is great to be able to help out our patients and follow their progress. It is also a pleasure to work with such a great team at Advance Surgical. Whatever your personal situation, please bear in mind that this ebook and the content on our website do not replace the individual, customised advice you will get from your health practitioner. We intend to give you as much educational information as possible, to be familiar with the conditions and treatments in our speciality clinic.

4 1. Am I A Candidate? If you are between the age of 18 and 70 and have been battling significant weight issues, you may be a candidate for weight loss surgery or bariatric surgery. We know that patients who have a BMI of over 35 (you can work it out on our website) are going to find it difficult to get sustained weight loss with diet and exercise. In fact, if you have a BMI of over 35 you have a 2% chance of weight loss at 5 years. Most people will tend to yo-yo with diets and in fact, may slowly put on weight. Noone wants to have an operation for this sort of thing, but the evidence is that bariatric surgery works and ensures long-term weight loss. Of course, there are risks. Generally, the risks associated with a very high BMI are probably higher than the risks of the surgery. So it might be a good time to consider surgery. If you are very overweight, you may already have picked up some health problems or comorbidities. You may have joint issues, hypertension, diabetes, high cholesterol, fertility problems, depression or body image issues. There are also some cancers that are more common in obesity. Many of these co-morbidities would be expected to improve or perhaps resolve with weight loss surgery.

5 2. What Are The Options? Surgeons have been performing weight loss surgery since the 1950s. In that era, the surgery required large, open incisions and a long recovery time and it had a moderately high complication rate. Nearly all bariatric surgery is now keyhole or laparoscopic surgery. There are two types of operations. Restrictive operations to decrease food intake and often to promote a feeling of fullness (satiety) after meals. Malabsorptive procedures reduce the absorption of calories, proteins and other nutrients. Right now in Australia, there are 3 choices. The gastric band, sleeve gastrectomy, and gastric bypass.

6 3. How Does It Work? Gastric band surgery We rarely perform gastric band surgery now. It was all the rage 5-10 years ago. It was a fairly safe operation. A silicon ring containing a fluid reservoir was placed around the stomach. The amount of fluid in the reservoir was adjusted with a port under the skin. A tight band will massively reduce the portions that can be eaten. It is a restrictive operation that results in variable appetite reduction. Patients have variable weight loss and fairly reasonable resolution of their co-morbidities such as diabetes and hypertension. The problem for many people with bands is that they may have fairly poor quality eating and not be able to eat certain healthy foods. Calorie-rich liquids can nearly always go down. Regular adjustments are also needed to make the band work well. Mechanical problems with the band can occur after a few years. The problems can lead to reflux, vomiting and blockages. We now know that after 10 years, 80% of bands will need to be surgically repositioned or removed altogether. Most patients will have fairly rapid weight regain after the band is removed. For most patients, we would not be recommending gastric bands.

7 Sleeve Gastrectomy Patients like the procedure of sleeve gastrectomy, and it is not particularly complicated to perform. It is, however, a permanent procedure as a part of the stomach is removed. It is also a restrictive procedure. You would lose weight because you can only eat an entree sized portion. The other reason for weight loss is a significant reduction in appetite that most patients notice straight away. The stomach makes a number of appetite hormones. The hormones are reduced when a measurable portion of the stomach is taken out. Sleeve gastrectomy is a fairly predictable operation. We would expect most patients will lose 70%-80% of their excess weight after this procedure over about a year. Weight loss occurs with good quality eating after about 8 weeks on a soft diet. There is a substantial recovery from many co-morbidities. About 70% of diabetics will be in remission from their diabetes and off their medications. Sleeve gastrectomy is the most common procedure that we are performing. The risks with sleeve gastrectomy are a small chance of a leak (roughly 1% risk) from the staple line. It is a big issue. It can require multiple procedures to fix it, and a prolonged period of hospitalisation. There is a risk of weight regain long-term if patients are eating calorie-rich foods. Nutritional deficiencies are fortunately rare. Some patients may develop reflux symptoms postoperatively.

8 Gastric Bypass There are various types of gastric bypass. It is a more complicated procedure and takes longer to perform. It is a mixture of a restrictive and a malabsorptive procedure. The stomach is divided in two so that you can only eat small portions. Then a loop of bowel is brought up to the smaller stomach to drain it. The food then passes down through a shorter length of bowel and calories are not so well absorbed. Patients can expect to lose a lot of weight with a gastric bypass, often more than with a sleeve gastrectomy. It is a very 'tried and tested' procedure and has been around the longest. Again it is very predictable. Many diabetic patients would be expected to be in remission from their diabetes, and the can expect to lose about 70% of their excess weight. Bypass is a useful procedure to consider for very high weight patients (BMI 50 plus), and diabetics. It can also be a useful procedure for patients who already have reflux. We also use bypass for patients who have had bands before and who cannot have sleeves for technical reasons. The risks with bypass are a leak (roughly 1%). In the early postoperative period, there can be abdominal cramps when eating calories (dumping). There is a slightly higher risk of nutritional deficiencies such as iron or Vitamin B12 deficiency, and patients need longterm follow up.

9 Conclusion Weight loss surgery encompasses many procedures. If you are interested, we tailor the surgery to your needs. I hope that this information has been helpful to you. There is much more to discuss, and we have more information on our website. Tap into our knowledge and learn more about the conditions we treat, and the treatments we offer. If you have any questions, don t hesitate to contact us using the forms on our website. Dr Jon Armstrong Advance Surgical

10 Follow me here Advance Surgical Suite 8/85 Monash Ave Nedlands, WA,