Whilst laparoscopic gastric bypass in the USA has commonly been performed since the early 1990s, most gastric bypass procedures performed in Australia until the mid 2000s were through the traditional open technique. Whilst the open technique is at the end of the day the same very effective operation as performed through laparoscopic techniques many patients were put off because of the fear of a bigger open procedure with a longer recovery and opted instead for the laparoscopic gastric band.
When performed laparoscopically gastric bypass is one of the most technically challenging operations and demands skills that most general surgeons do not possess. Not surprisingly when performed by inexperienced surgeons the complication rates from laparoscopic gastric bypass are higher than those for laparoscopic gastric banding and hence perhaps wisely the reluctance for many surgeons to attempt such surgery laparoscopically.
During his training Mr France was fortunate enough to be involved in over 100 open gastric bypass operations with Mr Phillip Game, an Adelaide surgeon who has performed over 400 gastric bypass procedures. Seeing Mr Game’s excellent results and its obvious place in obesity surgery Mr France traveled to the USA where he spent 12 months in a laparoscopic fellowship. During this time he was trained by experienced surgeons in the art of laparoscopic gastric bypass and in doing so became one of the first surgeons in Australia to be formally trained in laparoscopic gastric bypass.
Another recent advance is 2-stage surgery for those patients who are at most risk of developing post-operative complications from any obesity procedure. These patients often have multiple life threatening diseases associated with obesity and also tend to be those who are classified as being super obese.
For high-risk patients Mr France prefers to initially perform a sleeve gastrectomy as a first step to allow patients to lose weight and hence reduce the risks a second stage gastric bypass. This approach has been proven in clinical trials to reduce complication rates whilst ultimately allowing a laparoscopic gastric bypass to be performed which many patients especially the super obese require to get effective weight loss.
Patients who have previously had a laparoscopic gastric band and had to have it removed or have not had sufficient weight loss maybe suitable for conversion to laparoscopic gastric bypass. This again maybe done as a staged procedure especially if the band is being removed at the same time.
Generally most patients will be asked to go on a pre-operative diet.