Circle of Care - Institute of Weight Control
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FAQ's

Sleeve Gastrectomy

Can I be considered a candidate for surgery even though I have no health conditions (co-morbidities) related to my weight problem?

You may be considered a candidate for weight loss surgery if your BMI is in excess of 35 even though you present no co-morbidity symptoms.

What if I don't belong to a health fund?

The health fund waiting period for weight loss surgery (item number 30518) is 12 months as obesity is considered a pre-existing condition. However there may be other options available to you. For further information please contact us.

Will my hair fall out after having this operation?

Hair loss following weight loss surgery is common and usually due to the physiological stress resulting from shifting nutrients towards vital organs and away from the more cosmetic organs such as hair growth. It results from:

  1. Rapid weight loss
  2. Not eating enough protein or total calories
  3. Low iron, zinc or biotin intake
  4. Extended use of meal replacement shakes

To remedy this, take your multivitamin and mineral supplement. Eat foods high in protein at least 2 meals per day. High protein foods are often also high in iron and zinc, but not always. Aim for 60-80mg protein per day and the same of carbohydrate. If your iron stores are low, you may need an iron supplement. Oysters are the richest food source of zinc. 4 weeks after surgery limit meal replacement shakes and bars to 1 per day.

Will I have a lot of pain?

Usually there is minimal pain after surgery, every attempt is made to control pain to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Several drug options are used to help manage your post-surgery pain if required.

Is this cosmetic surgery?

NO, it definitely is not. Obesity is potentially a severe and a life threatening disease. It is recognised by health funds and Medicare. Item number 31575 is the item number that you should quote to your fund if you are considering this surgery.

How much weight can I expect to lose?

With your limited stomach capacity (75% of your stomach is removed in surgery) after the sleeve gastrectomy and provided you are following the program regarding eating and exercise then, we should expect that you should be able to lose a substantial amount of excess weight.

Do I need to take multivitamins?

Yes, our Nutritionist should have already gone through supplements in your first or second visit. Daily multivitamins are needed following sleeve gastrectomy.

Constipation

You will have less bowel movements after surgery because you will be eating less food. There is no need to be concerned nor to take anything for it if you are comfortable. “Not going” does not mean you are constipated.

Symptoms

  • A feeling of density or heaviness in the lower abdomen
  • Increased wind (this can happen post surgery for other reasons too)
  • Incomplete bowel motion
  • Pellet like stools that are difficult to pass, requiring more pressure

Untreated constipation can lead to:

  • Bad breath (different from the bad breath of rapid weight loss)
  • Nausea & reluctance to eat
  • Compaction – like you are sitting on a hard, dry mass
  • Blood in the toilet bowl due to excessive straining

Causes

  • Inadequate fluid intake – aim for 1500ml+ per day
  • Inadequate fibre intake – add a high fibre cereal (8g+ dietary fibre/100g)
  • Not enough exercise
  • Stress
  • Some medications

Treatment

It is prudent to treat constipation in the first 24 hours with 30ml prune juice twice per day. If that does not work, use a laxative. See your pharmacist or GP ASAP if symptoms have progressed or your treatment fails to work. There is little value on adding a bulking agent such as Benefibre or Metamucil or eating extra fibre if you are already blocked up. It will just sit on top.

Prevention

See causes and do the opposite. A bulking agent such as Benefibre can help things run smoothly. Take care with fibre supplements that swell as they may become uncomfortable soon after consuming. Useful products include All-Bran Fibre Toppers (2.5g/1.5 tbls) and Quaker Golden Apricot Fibre Bar (7.6g/30g bar).

When you are not eating much, the goal is a bowel movement every 2 or 3 days without straining and possibly less often on the fluid diet.

For more information:
www.medicinenet.com/constipation/article.htm

Can I speak to someone who has had the surgery?

Of course, we have many delightful patients who are happy to speak to you about their experience. Also see our facebook page for patients interactions and photos.

What information can you give me to help family and friends better understand this surgery?

We encourage a friend or family member accompany you on your consultation with the surgeon.

You may bring as many as you like to our information sessions.

Can I still dine out?

Meal sizes should be kept to entrée size due to your limited capacity now. Eat slowly! Maybe if you are going out to dinner at a friend's house, maybe advise them that you can only eat a small amount of food to save any embarrassment. Social eating will be harder initially after the sleeve.

What about alcohol?

Alcohol is high in calorie content and is therefore not recommended. There are some health advantages with modest alcohol intake, particularly wine. Occasionally a glass of wine is not really going to compromise your outcome, just try to avoid this occurring more than once a week.

Will I need plastic surgery for excess skin after losing all my weight?

A quarter of our patients need to get some help with excess skin folds. Removal of the abdominal apron is the most common. Plastic surgery is not usually considered for some months after reaching your goal weight. The skin usually has enough elasticity in the skin to take up the slack, and this is assessed before considering reconstructive surgery.

We have specialist plastic surgeons available that has expertise in body contouring required after massive weight loss.

What about follow up care after I have finished my Circle of Care Program?

Patients who have a sleeve gastrectomy are required to be followed up every six to twelve months, for the rest of your life. Regular blood tests and xrays will be required as part of your routine follow up. We will place you on a recall system to remind you.

'Keyhole' or Laparoscopic Surgical Procedure

Laparoscopic Sleeve Gastrectomy is done with minimally invasive 'keyhole' surgery. This means there is:

  • Less pain and discomfort
  • Fewer complications
  • Shorter hospital stay
  • Earlier return to normal activities

Other laparoscopic procedures performed by our surgeons include:

  • Gallstone surgery (cholecystectomy)
  • Hernia repair
  • Anti-reflux surgery
  • Gastric Banding

What are the risks?

Although the weight loss surgery procedures are minimally invasive 'keyhole' surgery, there are still risks and complications, especially if the patient suffers from a pre-existing illness, such as diabetes.

When considering surgery, it is important to realise that the potential benefits of weight control surgery outweigh the risks.

Some of risks and complications of laparoscopic sleeve gastrectomy surgery are:

  • Anaesthetic risks: Anaesthesia is a long-practised and very safe technique. The risk of dying under anaesthetic is very low, about 1 in 40,000.
  • Infections are uncommon: All patients are given antibiotics during the operation. Infections may develop around the wounds or at the access port. This would require the patient to remain in hospital longer and have ongoing antibiotic treatment.
  • Surgical complications may include perforation of the stomach, bleeding, infection and slow healing of wounds. 
  • Stomach pouch dilatation: Over-eating may stretch the small stomach pouch making it less effective.
  • Gallstones: Weight loss may predispose to gallstone formation.
  • Nutritional deficiencies are uncommon.
  • Leakage: The sleeve has a 1-2% rate of bleeding and leakage.
  • Deep Venous Thrombosis and pulmonary embolism: Blood clots may develop in the leg veins, which may travel to the lungs, thus causing death. The risk of pulmonary embolism/blood clot is 3:1000. 
  • Death: The risk of dying during the operation is about 1 in 300. 

Supplementation

Because of changes to gastric function caused by The Sleeve, you will need to take a multivitamin and mineral supplement and calcium tablets daily for the rest of your life. Other vitamins and minerals may become depleted and require supplementation such as iron and vitamin B12. Regular blood tests will help determine this.

Potential Benefits and Results

'Success', following weight loss surgery, is measured in terms of:

  • Weight loss as a percentage of excess weight loss (%EWL) - e.g., a female who is 120kg before surgery (whose ideal weight is 60kg), has 60kg of excess weight. If she loses 40kg, then she has lost 66% of her excess weight.
  • Improvement and restoration of health to individuals suffering from obesity.

Studies have shown that following sleeve gastrectomy patients can expect:

  • An average of 50 - 70% excess weight loss gradually over 1 to 2 years.
  • Maintaining weight loss over the medium term, but no studies exist that span over 10 years.
  • Improvement in health, especially in relation to obesity-related diseases such as hypertension, diabetes, lipid disorders, asthma, sleep apnoea and arthritis.
  • Mortality risk reduced
  • Mobility and endurance levels improved
  • Self esteem and self confidence improved
  • Significant improvement in quality of life

It is important to realise that these are general expectation bases on published studies. No guarantee can be given for to any individual patient.

The ultimate goal of weight control surgery should be an improvement in health achieved by a sustainable weight loss that reduces life-threatening risk factors, and improves the patient's day-to-day quality of life.

 

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