FAQ's

You may be wondering who is the Best Bariatric Surgeon to look after you or a family member considering weight loss surgery. This is your most important decision. Your GP may be able to assist you with a referral, or you may be guided by recommendations from family and friends.

These are some things to consider:

• Does the surgeon have specific training and expertise in bariatric surgery?
• What is surgeons experience and how many cases have they performed?
• Do they audit their results and contribute the Bariatric Surgical Registry?
• What are their results? How many complications including leaks, bleeds have they had?
• Have they published their data in peer reviewed journals?
• Is the surgeon invited to speak at bariatric conferences or involved in mentoring programs?
• Do they work in a clinic with in-house dietitians, psychologist, exercise physiotherapist to provide on-going care and support?
• See Dr Roy Brancatisano’s biography and research and results

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. Some patients with lower BMI 32 to 35 may be considered candidates if they have diabetes or heart disease.

The health fund waiting period for weight loss surgery is 12 months as obesity is considered a pre-existing condition. However, there may be other options available to you including Early release of Superannuation for medical reasons. For further information please contact us.

Laparoscopic Sleeve Gastrectomy or Bypass is performed 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

Usually there is minimal pain after keyhole surgery, however, some patients experience “gas pain” in the left shoulder or chest. We make every attempt to control pain so that you move about quickly and become active. This helps avoid problems such as blood clots and speeds recovery. Several drug options are used to help manage your post-surgery pain as required.

Although the weight loss surgery procedures are minimally invasive, there are risks and complications, especially if the patient suffers from a pre-existing illness, such as heart disease or 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: General 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 may require the patient to remain in hospital longer and have ongoing antibiotic treatment.
• Surgical complications may include perforation of the stomach, bleeding from the staple line or joins, 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 including Fe, B12, Calcium are uncommon but do occur if ones diet is poor and supplements are not taken .
• Leakage and Bleeding: The sleeve or bypass has a 1-2% rate of bleeding and leakage. These are serious complications and may require further surgery and prolonged stay in hospital
• 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 from bariatric surgery is about 1 in 1000, (according to the Bariatric Surgery Registry up to June30 2018.) 

Circle of Care results can be found at “our 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 and bypass procedures  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 few 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.

Circle of Care results can be found at “our results”

Yes, our Nutritionist will go through your supplement requirements in your first or second visit. Because of changes to gastric and bowel function caused by The Sleeve or bypass, you will need to take a multivitamin and mineral supplement daily for the rest of your life. Vitamins and minerals may become depleted and require supplementation such as iron and vitamin B12. Regular blood tests will help determine this.

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.

No. 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.

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 wise 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.

Of course, we have many delightful patients who are happy to speak to you about their experience

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

Meal sizes should be kept to entrée size due to your limited capacity now. Remember, you will not be inclined to eat large portions as your appetite will be reduced dramatically. Eat slowly and enjoy the taste and flavours of food! Social eating may be harder initially after the sleeve or bypass. If your dining with friends at a friend's, you may wish to advise them that you can only eat a small amount of food to save any embarrassment.

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.

A quarter of our patients seek advice regarding excess skin following weight loss surgery. This depends on the age of the patient which determines the amount of elastin in the skin and thus the ability of the skin to shrink. Removal of the abdominal apron is the most common, followed by arms and breast lifts or augmentation. Plastic surgery is not usually considered for some months after reaching your goal weight. We can assess and discuss the need considering cosmetic surgery to remove excess skin at an appropriate time.

We have access specialist plastic surgeons at Circle of Care with the expertise in body contouring required after weight loss.

We believe that life-long on-going care and support following weight loss surgery is important to achieve sustainable weight loss and improvement in health and day-to-day quality of life. That is why we offer an extended care program and recommend twice annual visits after 2 years.