Obesity and the metabolic consequences are a more common problem in Australian society. 71% of men and 56% of women are obese or overweight. The surgical management of obesity and improvement in weight loss and co-morbidity resolution are well accepted treatment options and are performed generally as laparoscopic procedures.
Indications
Surgery is currently recommended for patients with BMI > 35kg/m2 (IFSO guidelines). The American Diabetes Society currently recommends surgery as first line treatment for patients with BMI > 40 kg/m2 or patients with poorly controlled diabetes and BMI > 35kg/m2.
Studies have demonstrated improvement or reversal of: Diabetes (glycaemic control), Hypertension, Dyslipidaemia (high fat levels in blood), Obstructive Sleep Apnoea, Symptoms of osteoarthritis due to weight loss, Fertility, Polycystic ovarian syndrome, Cardiovascular risk, Asthma, Life expectancy.
Surgery
Weight loss surgery is generally performed laparoscopically and involves 5 small incisions in your abdominal wall. The abdomen will be inflated with gas to create space for your surgery to be performed. Surgical instruments will be introduced to assist in performing your surgery. Your surgeon will then operate on the stomach, the technique of which varies depending on the operation being performed. These techniques include the following:
Sleeve Gastrectomy involves use of a medical stapling device to divide the stomach whilst a calibration tube (bougie) is placed within the stomach. Approximately 80% of the stomach will then be removed via your port sites.
Roux-en-Y Gastric Bypass involves use of a medical stapling device to create a small tube (gastric pouch) and separating it from the remaining stomach (gastric remnant). The pouch will then be attached to small bowel (jejunum). A join between two loops of small bowel will then be performed.
Single Anastomosis Loop Gastric Bypass (Mini-bypass) involves use of a medical stapling device to create a small tube (gastric pouch) and separating it from the remaining stomach (gastric remnant). The pouch will then be attached to a loop small bowel (jejunum).
All operations involve closure of the port sites with dissolvable sutures. Most patients will stay 1-3 days following surgery.
Risks
May include: Pain (typically left shoulder) following surgery, Bleeding, Staple line or anastomotic leak, Heart attack or stroke, Blood clots
All surgical complications are at increased risk in overweight or obese patients.
Post-operative Information