Bariatric Surgery (Weight Loss Surgery)

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Obesity, an emerging health epidemic around the world, affects approximately 10% of the Australian adult population. It is a risk factor leading to serious medical conditions such as the heart disease, stroke, high blood pressure, diabetes, gallbladder disease, osteoarthritis, sleep apnoea, asthma, some cancers, and gout.

Obesity is caused by several factors such as genetics, overeating, lack of physical exercises, misbalances in metabolism (conversion of the food into body’s energy), and psychological factors such as stress and anxiety.

Body Mass Index (BMI) calculated by dividing your weight in kilograms by your height in metres squared serves as an indicator of healthy weight. For adults, over 20 years a BMI between 18.5 and 25 is considered healthy. If a BMI is between 25 and 30, the person is considered overweight, while people with BMIs over 30 are considered obese. Persons with a body mass index (BMI) of more than 40 are defined as morbidly obese who have a reduced life expectancy of 5–20 years.

While the lifestyle measures such as healthy eating and exercises are the best way to address the obesity problem and restore a healthy weight, for those with the BMI index over 35, it may not be enough. Providing all other treatments have failed, bariatric surgery is the most effective treatment of morbid obesity. Outcomes of the surgical procedure include a sustainable loss of body weight, reduction and sometimes resolution of medical comorbidities, and improved quality of life.

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To assist patients with weight loss our practice offers Laparoscopic Sleeve Gastrectomy surgery (Gastric Sleeve) at Sunnybank Private Hospital (Brisbane) and at St Stephen’s Private Hospital (Hervey Bay, QLD). We are pleased to provide this life changing opportunity to patients who are covered for Bariatric Surgery with their Private Health Insurance and who is Uninsured.

Dr Mastakov also performs Roux-en-Y Gastric Bypass (RYGB) at Sunnybank Private Hospital (Brisbane) for Privately Insured Patients.

  • Please note, that Dr Mastakov does NOT perform a lap band surgery or follow up lap band adjustments/managements. However, if medically required, he can perform a lap band removal procedure for privately insured patients.

We believe that your follow up appointments after your Bariatric Surgery are one of the most important factors that will help you to achieve long term success. With this in mind, we offer Bulk Billed appointments for the first 12 months following your surgery.

All uninsured patients are encouraged to consider investing in private health cover and wait the 12 month qualifying period. Where applicable, we will provide documentation to support your claim to the Australian Taxation Office (ATO) for accessing your superannuation early on “compassionate grounds” to finance treatment expenses.

Sleeve Gastrectomy

Sleeve Gastrectomy (SG) is a laparoscopic or keyhole surgical procedure, which actually doesn’t include any surgery on the intestines. It is one of the most effective bariatric procedures. By changing the stomach shape from sac to a long narrow gastric tube, SG dramatically reduces the capacity of the stomach from approximately 2L to 100-150 ml.

In addition, the recent studies have shown, the part of the stomach that is removed during sleeve gastrectomy plays a major part in producing the hunger hormone (Grehlin). This further aids in the reduction of appetite and food craving.

The smaller stomach capacity restricts food intake by allowing only a small amount of food to be eaten at any meal. As a result, the patients feel early fullness and satiety while eating just 3 small meals per day. This facilitates weight loss. In addition, regular exercise and healthy food choices are also necessary to optimize the outcome.

Sleeve gastrectomy is becoming increasingly popular and has progressively been performed as a standalone procedure. With satisfactory results in the mid-term the extent of excess weight loss is about 60% (final results may vary on the individual). Risks of the surgical complications such as bleeding and leakage from the cut edge of the remaining stomach are low within 1-3%.

Sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) are most effective bariatric surgical procedures.

sleeve gastrectomy

Further Reading

Better Health Channel
Laparoscopic Sleeve Gastrectomy

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
Sleeve Gastrectomy

The Science of Obesity
thescienceofobesity.com.au

sleeve gastrectomy

Roux-en-Y Gastric Bypass

A gastric bypass (Roux-end-Y gastric bypass) is a common and popular bariatric procedure in Australia as well as overseas and has been considered the gold standard of bariatric surgery. The procedure has been extensively studied over the last 50 years and can be performed using a laparoscopic (keyhole) approach. A standard gastric bypass is performed under general anaesthesia in less than 2 – 3 hours and typically involves a hospital stay of one to two days.

The operation involves the creation of a small stomach pouch and diversion of food away from most of the stomach and a small portion of the small intestine. The surgery allows for digestive fluids to still meet with ingested food and enable nutrient digestion and absorption. A significant advantage of the procedure is that no portion of the stomach is removed and essentially the procedure can be reversed if necessary.

The gastric bypass procedure helps obese people to lose weight by:

  • Restricting the amount of food that can be eaten due to the small stomach pouch

  • Metabolic and hormonal changes due to bypass of the food directly into the small bowel resulting in a reduced appetite and an increased feeling of fullness

The gastric bypass procedure produces excellent outcomes in long term studies and results in an increased longevity and quality of life. On average a patient is expected to lose around one third of their total body weight after undergoing the gastric bypass procedure in the first two years. Most patients will maintain a weight loss of around 25% beyond 10 years. Additionally, there is significant reduction/improvement in obesity related diseases including:

  • Diabetes (More than half of patients with type 2 diabetes will have normalization of blood glucose and may be able to discontinue or reduce the amount of medication required)

  • Sleep apnoea

  • Hypertension

  • Elevated cholesterol

  • Fatty liver

  • Infertility

  • Risk of cancer

The risk of postoperative complications associated with the gastric bypass procedure is low with a less than 0.2% risk of dying from the surgery. The risk of severe complications such as bleeding, infection and thromboembolism is less than 5%.

Gastric bypass surgery is currently as safe as gallbladder surgery.

However, the procedure results in permanent alteration in the absorption of vitamins and minerals and as a result can cause such important clinical conditions as anaemia, osteoporosis, and malnutrition. The following are the most common micronutrient deficiencies:

  • Iron

  • Vitamin B12

  • Vitamin B1

  • Calcium

  • Vitamin D

  • Zinc

  • Folate

Therefore, all patients undergoing a gastric bypass require ongoing life-long surveillance and supplementation of vitamins and minerals.

According to The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) the following lists summarise the pros and cons of the gastric bypass procedure.

Pros

  • Mortality < 0.2%, major complication <5%

  • It is particularly effective for patients with a larger BMI

  • Average weight loss is usually greater than with other procedures, such as Laparoscopic Adjustable Band and Sleeve Gastrectomy.

  • Long-term weight loss maintenance

  • Excellent for treatment of diabetes and GORD (Gastro-oesophageal reflux disease)
  • Reversible Digestive issues such as diarrhea, nausea or vomiting are very infrequent

Cons

  • Higher risk of some vitamin and mineral deficiencies compared to normal patients: B12, D, iron and calcium in particular.

  • Higher risk of gallstones

  • Higher risk of ulcers if taking NSAID’s or smoking

  • Complications include the possibility of leaks, bleeding, blood clots, infection, and bowel obstruction

  • Dumping syndrome (low blood sugar)

  • Risk of alcohol dependence because of more rapid absorption

  • Increased suicide risk

Further Reading

The American Society for Metabolic and Bariatric Surgery (ASMBS)
Roux-en-Y Gastric Bypass (RYGB)

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
Roux-en-Y Gastric Bypass

The Science of Obesity
thescienceofobesity.com.au