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.
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.
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.
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%.
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.
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.
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.
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 08 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.
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Dr Michael France
Mr Michael France is an Australian and Internationally trained general surgeon. He specialises in laparoscopic and minimally invasive surgery of the abdomen and gastrointestinal tract. His specialty interest is Obesity Surgery.
He was born and educated in New Zealand, completing his medical degree in Auckland New Zealand winning the Sir Carrick Robertson Prize for the highest overall marks in surgery.