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Weight Loss Surgery FAQs

Pre-Surgery

Blood tests are required including a full blood count, electrolytes, and blood group and hold. An ECG (electrocardiogram or heart scan) will usually be performed on admission to hospital on the day of surgery. The anaesthetist will decide if any additional tests are required, e.g. sleep study, echocardiogram. Some patients will require a gastroscopy or barium swallow as part of their workup prior to surgery particularly if they suffer from significant acid reflux or have undergone bariatric surgery previously.

All patients are strongly advised to quit smoking for at least six weeks prior to surgery in order to minimise their operative risk.

Yes. Previous abdominal surgery inevitably leads to scar tissue or “adhesions” within the abdominal cavity. In most cases, laparoscopic surgery is still possible although the procedure is usually prolonged by the need to divide adhesions. In some circumstances, laparoscopic surgery may not be possible due to the severity of adhesions and the operation must then be carried out as an open operation, usually through a large midline incision, but this can often only be decided at the time of surgery. Recovery from surgery is slower following an open operation but the long-term outcomes are the same as for laparoscopic surgery.

Patients are advised to inform Mr Adam Cichowitz and the anaesthetist of any prior operations, especially those on the abdomen and pelvis. Operation reports from complicated or unusual past procedures are invaluable if available.

It can. Patients are advised to follow any preoperative instruction from their physician or the anaesthetist about managing their diabetes around the time of surgery. Almost everyone with Type 2 Diabetes experiences a dramatic improvement or even complete resolution after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.

Yes. Laparoscopic surgery is generally safer than open surgery performed through a large incision. Weight loss surgery leads to improvement in most problems related to heart disease including:

  • High blood pressure
  • Cholesterol
  • Lipid problems
  • Heart enlargement (heart failure)
  • Vascular and coronary artery disease

Patients need to advise Mr Adam Cichowitz and the anaesthetist about any heart conditions that they might have. Even those with atrial fibrillation, heart valve replacement, or previous stents or heart bypass surgery do very well. Patients on blood thinning medication of any type can expect special instructions just before and after surgery.

Yes. Patients will need to go onto a very low calorie diet (VLCD) for at least 2 to 3 weeks prior to surgery. This usually takes the form of Optifast or Optislim as a meal replacement therapy. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. This helps during the procedure and makes it safer.

As with any major surgery, weight loss surgery carries potential risks but for patients who meet the eligibility criteria the benefits often outweigh the risks but more importantly, the risks of NOT operating (e.g. heart attacks, unstable diabetes, strokes, premature death) nearly always outweigh the risks of operating.

Risks vary according to the surgical procedure (e.g. revision) and individual patient characteristic (e.g. smoker) and will be discussed in greater detail during the pre-operative assessment process. In general, risks can include:

  • Common (10-20%)
    • Bruising
    • Swelling
  • Uncommon (2-5%)
    • Wound infection
    • Lung or breathing problems
  • Rare (0.5-1%)
    • Blood clots
    • Leaks in the gastrointestinal system
    • Adverse reactions to anaesthesia
  • Very rare (~1 in 1000)
    • Internal bleeding
    • Organ injury

The overall rates of major complications associated with different bariatric procedures are:

  • Gastric band 0.5%
  • Sleeve gastrectomy 2%
  • Gastric bypass 4%

The mortality and complication rates associated with bariatric surgery are lower than those typically associated with gallbladder or hip replacement surgery.

Please phone or email North Eastern Surgery for more information on Bariatric Surgery. Bariatric surgery is only available at the Wangaratta Private Hospital and Albury-Wodonga Private Hospital. Private health insurance is strongly recommended to cover the costs associated with surgery but there may still be a “gap” depending on the procedure. Patients without private health insurance who choose to undergo bariatric surgery in a private hospital may be liable for large out of pocket costs. It is possible to fund any out of pocket costs from superannuation.

Under certain circumstances, reversal procedures (e.g. gastric band removal, reversal of vertical banded gastroplasty) may be undertaken in the public system at no cost to the patient apart from the initial outpatient consultation.

All post-operative consultations are free.

Post-Surgery

Most patients return to work within one to two weeks following surgery. Fatigue is common for several weeks so some patients find to easier to have half days or work every other day for a period of time before transitioning back to normal hours of work.

Patients are advised to avoid heavy lifting (>10 kg) and straining for about one month from the time of surgery. This may mean returning to work on light duties. Those patients who are unable to return to work on light duties may need to take one month off following surgery. A medical certificate can be provided on discharge from hospital for any time off work.

Patients are encouraged to begin walking immediately after surgery. Initially this will involve gentle, short walks in hospital. Activity levels should be increased gradually over a period of several weeks following surgery. Cardio activities (e.g. jogging, cycling, treadmill) can generally be commenced after two weeks but hard physical and resistance activities (e.g. weights) should be deferred for at least one month from the time of surgery. Swimming should be avoided until all wounds have healed over (usually by two weeks).

Most women are much more fertile after surgery even with modest weight loss. The oral contraceptive pill (OCP) does NOT work as well in heavy patients. For this reason, having an IUD or using condoms is needed.

Most groups recommend waiting 12-18 months after surgery before getting pregnant to ensure that adequate nutrition can be maintained in both mother and baby.

After weight loss surgery, there is much less risk of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There are also fewer miscarriages and stillbirths than in heavy women who have not had surgery and weight loss.

Children born after their mother’s weight loss surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during foetal growth. There is also less risk of needing a caesarean section.

Most patients have some loose or sagging skin, but it is often more temporary than expected. Patient notice a lot of change between 6 and 12 months after surgery. Individual appearance depends upon several things, including how much weight is lost, age, genetics, level of fitness and exercise and smoking status. Generally, loose skin is well-hidden by clothing. Many patients wear compression garments to help with appearance.

Some patients will choose to have plastic surgery to remove excess skin. Most surgeons recommend waiting at least 12 to 18 months. Plastic surgery for removal of excess abdominal skin (“tummy tuck” or abdominoplasty) is often covered by insurance for reasons of moisture, hygiene and rash issues.

Mr Adam Cichowitz will consider performing an abdominoplasty if excess abdominal skin remains a problem after a patient’s weight has been stable for at least 6 months and they are at least 12 months down the track from their weight loss surgery. Arms and other areas will require referral to a plastic surgeon and may not be covered by private health insurance if they are considered “purely” cosmetic.

Some hair loss is common between 3 and 6 months following surgery. The reasons for this are not fully understood. Even with taking all the recommended supplements, hair loss will be noticed until the follicles come back. Hair loss is always temporary and hair re-growth can be expected from about 6 months.

A double-dose of an over-the-counter multivitamin will be required for at least 6 months following surgery. Certain patients may benefit from taking additional vitamins and minerals depending on their medical history and the procedure, e.g. iron, calcium, vitamin D, vitamin B12. Vitamin and mineral levels should be checked as required and when considering whether or not to cease any supplements (usually between 6 and 12 months when weight loss has stabilised).

No and Yes.

Most people think of a “diet” as a plan that leaves them hungry. That is not the way people feel after surgery. Eventually, most patients get some form of appetite back 6-12 months after surgery but their appetite is much weaker and easier to satisfy than before. This does not mean being able to eat whatever and whenever. Healthier food choices are important for best results, but most patients still enjoy tasty food, and even “treats”.

Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Sometimes exercise is difficult, but if it becomes a punishing, never-ending battle, then it becomes much harder to maintain in the long term. There is no “one-size-fits-all” plan. Patients eventually find a variety of activities that suit them but can expect to learn and change along the way.

For many patients (and normal weight people, too) exercise is more important for regular stress control, and for appetite control, than simply burning off calories. As we age, inactivity can lead to being frail or fragile, which is quite dangerous to overall health. Healthy bones and avoiding muscle loss partly depends on doing weekly weight bearing (including walking) or muscle resistance (weights or similar) exercise.

Almost everyone is able to find some activity to “count” as moderate exercise, even those who are partially paralysed, or who have arthritis or joint replacement or back pain. Joint pains always improve with weight loss and exercise becomes much easier.

With weight loss, many health problems tend to improve or can even be cured! Patients can often reduce or eliminate many medications they take for high blood pressure, heart disease, arthritis, cholesterol, and diabetes. The is best done under the supervision of their physician or general practitioner who normally monitors these health issues.

Weight loss is greatest in the early stages after surgery but it cannot continue forever and patients can rest assured that they will not shrink away to nothing! The human body is very good at adapting over time. Weight loss gradually slows down and usually reaches a plateau between 6 and 12 months after surgery. Rather than a problem with the surgery or the stomach “stretching”, this is a normal response of the body when the mechanisms for maintaining weight (e.g. appetite, energy expenditure) come into balance. During this time it is important to develop healthy eating and lifestyle habits to ensure long term success.