About Weight Loss Surgery - Sydney Bariatric Clinic

How do I know if I’m a candidate?

Deciding whether or not to undergo bariatric surgery is a big decision. Chances are if you are looking at this page, you are thinking about it. It is important to know that not everyone is considered suitable for bariatric surgery. The best way to determine if you are suitable is to have a consultation with Dr Ryan or Dr Jameson. Here is a general guide to help you determine if you might be a candidate for bariatric surgery at SBC:

For Adults

  • You have a BMI of 40 or above   
  • You have a BMI of 35 (less for Indigenous and Asians)  or more and one or more obesity related condition(s) eg diabetes, high blood pressure, joint pain, depression etc.
  • (BMI = weight in kg / height in metres x height in metres) e.g. 120kg / 1.7 x 1.7  Therefore BMI = 41.5
  • You are willing to engage with appointments involving doctors, physiotherapists, dietitians, nurses and psychologists (if deemed necessary)
  • You are motivated to commence significant lifestyle changes required to lose weight and improve your health
  • If you have a psychological, psychiatric, or eating disorder or substance and/or alcohol excess/abuse, you must be in active treatment and have been assessed as clinically stable by your treating health professionals
  • You are not a planning pregnancy in the next 12-18 months

For adolescents

Generally, bariatric surgery is not performed on those under 18 years. Only in exceptional circumstances where a thorough assessment has been performed by the minor’s paediatrician, psychologist and other members of the multidisciplinary team will bariatric surgery be considered. The general guidelines for suitability are the same as adults.

What are the options?

There are many different types of operations, procedures and devices available for weight loss in Australia. You will be able to make an informed decision through a general understanding of the options and a discussion with your doctor and/or specialist. Bariatric surgery helps you lose weight and reduces your risk of medical problems associated with obesity. Depending on the type of bariatric surgery you have, one or both of the following mechanisms occur as a result of your surgery:

● Restriction: surgery is used to physically limit the amount of food the stomach can hold. This limits the number of calories you are able to eat

● Malabsorption: surgery is used to shorten or bypass part of the small intestine. This reduces the amount of calories and nutrients your body can absorb

The two main surgery types performed at SBC are:

The most common operation for weight loss in Australia is the laparoscopic (keyhole) sleeve gastrectomy. You might also hear it called a laparoscopic gastric sleeve or vertical sleeve gastrectomy. With this surgery, patients have a very high satisfaction of weight loss within a short period of time.

Although gastric bypass surgery has been the most frequent operation for obesity worldwide, this has not been the case in Australia. This is due to the technical difficulties and challenges presented to surgeons. More recently with surgical improvements it is gaining popularity and is now readily available in Australia. There are now two forms of gastric bypass – the Roux en Y (considered the standard) and the Omega Loop (also known as the ‘mini’ bypass or single anastomosis bypass) There is healthy debate as to which form of bypass is the better option for patients. Gastric bypass has the highest weight loss statistically for patients with excellent outcomes, particularly for type 2 diabetics.

Other surgeries SBC performs include:

● Single-stage revisional bariatric surgery
● Gastroscopy
● Colonoscopy
● Hiatus hernia repairs
● Nissen fundoplication
● Gallstones and gallbladder removal

When having your consultation with Dr Ryan or Dr Jameson, they will discuss the pros and cons for each surgery with you. Together, you will decide which surgery is most appropriate for you.

How do I know what is best for me?

The multidisciplinary team at SBC
brings collective expertise of bariatric surgery. Your initial consultation with Dr Ryan or Dr
Jameson will help you decide what surgery is best for you. They will work with you so you feel
informed and empowered to make the best choice for yourself.

Surgery preparation

The team at SBC will help you prepare for your surgery. They will make sure you are physically and mentally prepared and that all of your paperwork is in order.

It is normal (and completely understandable) that you might feel nervous about your surgery. Rest assured that you are receiving care from highly experienced medical professionals who are genuinely invested in your weight loss success.

You will receive a comprehensive information pack from your surgeon to help you prepare for your surgery.

Here are some general tips to help you prepare:
  • Get used to liquid protein because you will be on a liquid-only diet for two weeks after your surgery. Try different protein powders so you can figure out what you like
  • Stock up on clear soups, broths, sugar-free jelly and ice blocks because you will be eating these after your surgery
  • Stop smoking – as this increases the risks associated with surgery and anaesthesia such as lung infection post-operatively 
  • Stock up on your prescription medications, over-the-counter medications such as liquid panadol and stool softeners before your surgery
  • Pack loose, comfortable clothing in your hospital bag
  • Make sure you have organised a lift home from the hospital because you will not be able to drive for one week post-op
  • Holding a pillow over your stomach will help alleviate pain from road bumps when driving home
  • Figure out who is going to be your ‘support group/person’ after your surgery. Many people have a few family members of friends on-call in the first couple of weeks post-surgery

How do I choose a surgeon?

The first thing you need to do when deciding on a bariatric surgeon is talk to your GP. Your GP knows you and will likely be able to recommend a surgeon that fits your needs. You need to have a referral from your GP (or another specialist) before having an initial consultation with a bariatric surgeon.

Some things you might consider when choosing a surgeon:
  • Gender – SBC has a male and female surgeon
  • Availability of the surgeon – SBC aims to have a new appointment available every 2-4 weeks
  • Surgery type – this depends on many factors and is best to discuss with your GP and potential surgeon

Try and talk to other people who have had bariatric surgery as they can give you insight into surgery from the patient perspective. Another thing you can do is have a look at online comments, reviews and forums.

It is important that you feel comfortable with your surgeon so you can achieve the best results possible. We are happy to put you in contact with individuals who have had bariatric surgery at SBC so you can talk directly to them.

What does recovery look like?

Recovery looks different for every person and depends on a number of factors including your state of health pre-surgery and overall fitness.

However, in general pain after surgery is minimal as the key-hole incisions heal up very quickly.  You will be able to walk immediately after surgery and the day after surgery patients are able to shower and walk up and down the hospital corridor. Nausea can be common after the surgery but once this settles and oral fluid intake is adequate, patients are discharged home after an average of 2-3 days in hospital. 

Patients are advised to simply take it easy at home for a few days concentrating on the liquid diet. Driving short distances can resume after one week if you are feeling well. 

In general patients are advised to take 2 weeks off work. Occasionally this may be for longer if work is very physical or intensive.

Always follow the advice from your team at SBC. This is very important because it will be tailored to your specific needs. After bariatric surgery, you must totally change how you eat and approach food. It is also important to incorporate exercise into your daily routine.

Diet

Fluid Phase: initially, you are permitted to take only fluids in your diet for 2 weeks after surgery. There will be a marked reduction in hunger (which will help you during this period)  and you will be sipping a variety of drinks slowly.

Changing Texture: During weeks 2-6, you will have changed the texture of your foods by blending, pureeing, and mashing food to make it easier for you to digest these foods and to help recovery. Softer foods will be incorporated towards the end of this period. 

You will have support from our dietitians during this time to provide you with the right bariatric diet,eating techniques and vitamin replacements that will maximise your recovery as well as your weight loss.

Patient Stories

Our thinking

As cliche as it sounds, at SBC we genuinely care about every patient that walks through our door. We strive to create a supportive environment so that you can achieve long-term success.

We believe that:
1. Bariatric surgery is the most effective treatment for obesity and related medical conditions

Losing significant weight (more than 50% of one’s excess weight) is extremely difficult due to the body’s defense mechanisms. Bariatric surgery has been shown to be more than 90% successful in getting significant weight off (50 – 100% of excess body weight) after two years.

2. Surgery can reverse serious medical effects of obesity such as type 2 diabetes, hypertension, sleep apnoea and many other conditions

Type 2 diabetes – The Australian Diabetic Council recommends surgery as the only effective treatment of type 2 diabetes when associated with obesity.

Sleep Apnoea – one of the most significant health complications of obesity is sleep apnoea which results in poor quality sleep, daytime tiredness and fatigue and even more seriously the long term implications of oxygen deprivation whilst asleep such as heart disease and dementia.

Hypertension – high blood pressure leads to heart disease, kidney failure and strokes amongst other conditions. Hypertension is most commonly associated with being overweight and obese. After bariatric surgery, most patients achieve a reduction in hypertension. Many patients discontinue their blood pressure medications.

Depression – issues relating to poor self-esteem and social withdrawal may be substantially improved once one loses a significant amount of weight. Often an unwanted side effect of antidepressant medications is weight gain. Bariatric surgery can help overcome this problem.

Chronic knee and back pain – chronic pain in the back and knees is common when carrying excess weight. Often this manifests in the later years of life and can be one of the most debilitating aspects of health when you reach 50+ years (sometimes earlier). Often after having bariatric surgery, knee and hip replacements can be avoided later in life.

3. Surgery is not a quick fix

Anyone that thinks bariatric surgery is the easy way out has probably not done their research! If you undergo this type of surgery, you will need to continue to work at it. It is a lifelong commitment to a healthy lifestyle.

Patients who have better long-term results see surgery as a way to break the cycle of obesity. They are committed to thinking and working long-term. Surgery combined with a healthy diet, regular exercise and a positive mental approach is the key to success.

Many patients who have undergone bariatric surgery will attest to the fact that surgery is not the easy option:

  • It involves a preparation diet to shrink the liver e.g. Optifast or similar VLCD diet
  • Some patients experience nausea and tiredness for a few weeks after surgery
  • Drinking water at the same time as eating is often difficult and may result in regurgitation
  • Eating is not the same after bariatric surgery. The first six weeks immediately afterward require a very specific diet of soups, blended and pureed foods. Portion sizes are dramatically reduced which can impact social situations. Certain foods are more difficult to eat e.g. bread and red meat for the first few months
  • Some patients find that success may be resented by others, including family members. Disparaging comments like “she/he took the easy way out” show a lack of understanding. Some family members won’t want you to have surgery as they fear the complications of surgery. The reality is simply that surgery risks are very low 1% or less versus the adverse effects of ongoing obesity such as a reduction in life expectancy, developing diabetes, heart disease, cancer, sleep apnoea, joint damage, etc. Not to mention the massive psychological impact of constantly being obese and being treated differently by family, friends and work colleagues

BMI

Your BMI is used to determine if you are a candidate for bariatric surgery.

Body mass index, or BMI, is used to determine whether you are in a healthy weight range for your height. It is useful to consider BMI alongside waist circumference, as waist measurement helps to assess risk by measuring the amount of excess weight carried around your stomach.

Excess weight around the stomach is a risk factor for health complications such as cardiovascular disease and type 2 diabetes. Typically, excess weight around the hips and buttocks does not pose the same risk.

BMI is a useful measurement for most people over 18 years old. However, it is only an estimate and it doesn’t take into account age, ethnicity, gender and body composition.

It is important to note that BMI does not differentiate between fat and muscle. This means that people who have a lot of muscle will have a high BMI but this does not make them overweight or obese.

BMI = Weight (kg) / Height (m)2  

e.g. For a person weighing 100kg and being 1.6 m tall, the BMI is

100kg / 1.62  = BMI = 39

Why choose Us?

Choosing to have bariatric surgery is a big decision. Firstly, it takes a lot of courage to decide to get bariatric surgery in the first place. It can also be overwhelming because there are so many variations of surgeries offered and it is difficult to know where to start.

Calling around to different clinics will help you get a feel for the place and their approach to bariatric surgery. Some reasons why you would pick to have your surgery at SBC:

  • We care about every single person that walks through our doors and go above and beyond to satisfy our patients
  • We are non-judgemental. We know everyone has a story and that there are so many factors that contribute to weight gain
  • Our multidisciplinary team has been working together for many years with thousands of success stories
  • We have many patients who have had surgery at our clinic and are so happy with their results and are happy to talk to you if you are considering Bariatric surgery (we do not give them anything for doing this. They do it because of how satisfied they are)
  • Both Dr Ryan and Dr Jameson have achieved Surgeon of Excellence status in Bariatric and Metabolic Surgery 
  • SBC are committed to providing safe and best practices in surgery
  • SBC has been recognised as an International Centre of Excellence in Bariatric Surgery

Contact us to find out more about our practice and if bariatric surgery is for you. We look forward to meeting you and working with you to start your new life.

Multi-disciplinary approach

At SBC, we take a multidisciplinary approach when it comes to bariatric surgery. Like in many other areas in medicine, the best outcomes rely on expertise from various disciplines. Treatment is not just surgery alone. Diet and nutrition, exercise physiology and psychology also have a big influence on your weight loss success. SBC’s comprehensive approach to the management of our patients is unique with the integral involvement of the anesthetist, surgeon, physician, dietitian, physiotherapist and allied staff. Working together, your health care team provides a safe and high-quality service that ensures you achieve the best results possible.

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