How do I know if I qualify for obesity surgery?
Surgery should never be rushed into and people should have made genuine attempts to lose weight by themselves through a combination of exercise and a well balanced diet. If patients have tried, and failed to lose weight then if their BMI is 40 or over then they may be candidates for surgery. Patients who have a BMI of 35 and over may also qualify, if they have significant obesity-related diseases which would be greatly improved by weight loss.
Will I have to undertake a pre-operative diet?
Generally we ask most of our patients to go on a diet for 2 weeks prior to surgery. Some of the smaller patients may not need to go on a diet at all, whilst our heavier patients may go on a diet for 8 weeks. The overall aim of the pre-op diet is to improve your health prior to surgery and hence reduce the chances of you developing complications. In terms of surgery, the patients who are technically the most difficult to operate on, are those who carry most of their weight in their abdomen. Patients with a lot of abdominal fat often have an enlarged liver, which sits directly on top of the stomach. The liver is lifted up during the operation, but if it is too enlarged and heavy it can be impossible to do this and the operation cannot be performed. For these reasons, if you are asked to undertake a pre-operative diet, is is important it is taken seriously to ensure the best possible outcome.
What is the best operation?
Despite what many people might tell you there is not one perfect operation to solve everyone's problem. All of the procedures have their advantages and disadvantages and most of them have a place when it comes to dealing with morbid obesity. It should be remembered that there is vast range of individuals who are classified as being morbidly obese ranging from the short 80kg diabetic to the 250kg super obese patient with multiple life threatening diseases. The choice between which operation for which patient takes into account many variables and should also considers the patients wishes.
How much weight will I lose?
Weight loss depends both on the operation performed and the willingness and ability of the patient to change their lifestyle and diet. All obesity procedures are tools be it very powerful ones for weight loss but at the end of the day if the individual does not change their lifestyle including diet and exercise the results can be disappointing. Overall procedures which restrict food intake such as gastric banding and sleeve gastrectomy will not produce as much weight loss as procedures such as gastric bypass which combine food restriction with malabsorption of food. Malabsorptive procedures also rely less on patient compliance because if fatty or food rich in sugar is consumed, less of the calories will be absorbed. On average patients undergoing banding can expect to lose 50 to 60% of their excess weight, whilst patients undergoing gastric bypass could expect to lose 60 to 70% of there excess weight. Patients having a sleeve gastrectomy fall between banding and bypass. Remember though that generally people are quoted averages with the reality being that some patients only lose 20 to 30% of their excess weight, whilst others might approach 100%.
Once I've lost the weight will it stay off and can I have my surgery reversed?
For all procedures most of the weight is lost in the first 2 years following surgery, although bypass patients generally lose their weight quicker than band patients. Patient's weights will then stay relatively constant for a few years. For all procedures after 5 years there may be some regain as the body adjusts to the surgery. Generally this is minor and may be in the order of 10%. Most procedures except sleeve gastrectomy can be reversed, although this is not something that should be contemplated unless there are complications. The majority of people who have their procedures reversed will regain their weight, for this reason if a procedure is reversed such as removal of a band they should be converted to an alternative procedure.
Will I feel Hungry?
The body has a great way of fighting weight loss during dieting by releasing hormones such as Ghrelin which stimulates the appetite centre in the brain, so that the more weight people lose the Hungrier they get. It is not surprising then that patients who have failed dieting have such a fear they will feel like they are starving. The beauty of procedures such as sleeve gastrectomy and gastric bypass is that they actually reduce those hormones so that people actually lose their appetite whilst losing weight. This loss of appetite is probably just as important in weight loss and maintenance as restriction and malabsorption of food.
I'm worried about the risks associated with surgery would it be safer to do nothing?
Definitely Not. People with morbid obesity especially with comorbdities are walking time bombs. Studies comparing patients who have had surgery versus those managed with diet show a significant survival advantage for surgical patients. Yes there is an upfront risk but in the long term patients who choose to do nothing have much higher rates of premature death. If you need anymore motivation people who have lost weight have a quality of life, which is so much better than prior to their surgery that they are some of the happiest people I deal with.
How much does it cost?
Dr France will only operate on patients who have Private Health Insurance which covers their procedures. There will also be an out-of-pocket Copayment for the procedures, which will cover your surgery expenses and also the out of pocket gap for the Surgical Assistant. Please phone 8293 8109 for an estimate of this copayment. This payment will make it possible for all of your follow-up appointments to be bulk billed to medicare for two years following your procedure. The Anaesthetist may also charge a gap, so you will be given a contact number to ring to get an estimate of this cost when you book your surgery. If you have an excess or copayment as part of your health insurance policy, you will also be required to pay this to them prior to your procedure as part of your agreement with the fund.
All payments must be made in full prior to your surgery. All payments can be made directly to Dr France's office. Cash, EFTPOS, Credit Card (Visa and Mastercard) and Cheque are accepted. Payments can also be made over the phone with Visa and Mastercard. All consultations and surgeries will be billed directly to your health fund and medicare, please forward all Medicare Cheques as soon as possible after they arrive.
What is Laparoscopic Surgery?
Laparoscopic also known as keyhole surgery is performed through small incision's in the abdominal wall using special cylindrical ports through which instruments and a camera are passed. Carbon dioxide gas is used to inflate the abdominal cavity and create a space for the surgeon to work in all of which can be watched on a flat screen monitor. Amazing advances in technology now allow blood vessels to be sealed, pieces of bowel to be joined together, and organs to be removed through small keyhole size incisions.
Such have been the advances, that in the hands of a well trained laparoscopic surgeon most of the operations performed by traditional open techniques through large incisions can now be performed laparoscopically.
What are the advantages of laparoscopic surgery?
The most obvious advantage of laparoscopic surgery is much smaller incisions and hence less tissue disruption compared to open or traditional surgery. The benefits of this are clear and well proven in clinical trials, and include less pain and analgesic requirements, faster recovery and hence earlier return to both work and social activities including sports.
If you have a busy lifestyle and cant afford to take long periods of time away from work or other activities then a laparoscopic approach may save you significant amounts of time in terms of recovery. Obviously smaller incisions mean smaller scars and a much better cosmetic result.
Many of the complications associated with open surgery such as wound infections, bruising and hernias are greatly reduced if not eliminated by a laparoscopic approach. New research also suggest that traditional open surgery may suppress the immune system compared with laparoscopic surgery.
From a surgeons point of view there are many situations where a laparoscopic approach results in improved access and better visualization of areas of the body
Are there any disadvantages to laparoscopic surgery?
1. All surgery be it traditional open surgery or laparoscopic have associated risks or potential complications. Whist a laparoscopic approach may greatly reduce some of the risks associated with open surgery some of the risks associated with open surgery are still possible with a laparoscopic approach.
There are some risks, and complications which are specific to laparoscopic surgery which mainly relate to the gas used to create a working space for the surgeon to operate in. Gas may escape from the abdominal compartment mainly into the tissues under the skin.
This is normally more of a curiosity than a complication as it usually disappears within hours of the surgery. Gas also causes temporary stretching of the abdominal wall and diaphragm which may lead to some mild abdominal discomfort or referred pain in the shoulder region. All possible complications relating to your specific surgery will be discussed with you prior to your surgery.
2. From a surgeons point of view laparoscopic surgery greatly reduces tactile sense ie the ability to feel tissues, whilst in most instances this is not important in some situations a special port through which a hand can be placed maybe employed to eliminate this problem. Laparoscopic surgery for many operations is generally technically more difficult to perform than open surgery. For this reason if you are contemplating a laparoscopic approach you should make sure your surgeon, like Michael is well qualified and has specific training and experience in laparoscopic surgery.