Obesity and Weight Loss
Professor Lord performs weight loss (bariatric or metabolic) surgery at St Vincent’s Private Hospital and Macquarie University Hospital for individuals who meet standard eligibility criteria and are highly motivated to improve their health.
There are many factors involved in deciding who is suitable for weight loss surgery, but the main ones are:
- Previous serious efforts with diet and exercise which has not provided adequate long term weight loss
- Morbid obesity (BMI > 40 kg/m2), alone, or severe obesity (BMI > 35 kg/m2) with a weight related health problem such as:
- Type 2 diabetes mellitus
- Dyslipidaemia, for example high cholesterol
- Obstructive sleep apnoea
- Osteoarthritis affecting the weight bearing joints of hips, knees or ankles
- Gastro-oesophageal reflux disease
- Weight related low mood or depression
- Polycystic ovarian syndrome
- Weight related difficulty in achieving pregnancy
In some individuals, especially if they have with Type 2 diabetes mellitus, weight loss surgery may be considered for BMI between 30 and 35.
The main operations performed by Professor Lord are laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Through working as the surgery Fellow with the originator of the sleeve gastrectomy operation (Dr Gary Anthone at the University of Southern California), Dr Lord was one of the first few surgeons worldwide to perform laparoscopic sleeve gastrectomy, more than ten years ago. Dr Lord also devised and first performed the sleeve gastrectomy with fundoplication operation, a new operation which treats reflux as well as providing weight loss.
Dr Lord will discuss with you the advantages and disadvantages of each operation. The decision regarding the choice of operation type is best made in consultation with detailed discussion, but a brief outline of some factors to consider is provided below.
LAPAROSCOPIC SLEEVE GASTRECTOMY
The laparoscopic sleeve gastrectomy operation is a keyhole operation with typically a one to three night hospital stay. It has the advantage of reliably excellent weight loss and reliable resolution of weight related health problems such as type 2 diabetes in most patients. It provides reduced appetite which makes weight loss easier, through mechanisms for which we have theories but no definite understanding. It has the advantage that people are able to eat all types of food, although only in small quantities. It has the advantage that, unlike the gastric band, there are no adjustments to be made after the operation. This makes the operation appealing to patients who live outside Sydney as well as patients who wish to go straight to a maximum weight loss phase post-operatively.
The disadvantage of the sleeve is that most of the stomach is removed permanently and the operation is therefore not reversible. Individuals must therefore feel sure that they accept that they will only be able to eat small meals after the sleeve gastrectomy operation. Eating small meals is generally tolerated better than expected because there is a feeling of satiety or fullness with small meals due to the greatly reduced stomach volume. There is also the reduced appetite noted above.
LAPAROSCOPIC ADJUSTABLE GASTRIC BAND
The advantage of the laparoscopic adjustable gastric band operation (LAGB) is that it is a simple straightforward keyhole operation with on average only a one night hospital stay. A silicone ring is placed around the upper stomach and connected to a port which sits under the skin on the abdominal wall.
The operation is fully reversible and no part of the stomach is being removed. The laparoscopic gastric band operation therefore appeals to individuals who wish to lose weight and improve their health in general but who may not wish to have permanent restriction on the amount of food they can eat. It is important to note however that most patients will regain considerable weight if the band is removed and one should therefore consider the gastric band as a non-permanent solution.
The band is adjustable, which is both an advantage and a disadvantage. Adjusting the band involves adding or removing fluid through the access port, which is connected by plastic tubing to the band around the stomach. This fluid is added or removed using a special needle introduced into the port after numbing the area with local anaesthetic.
In Professor Lord’s experience the amount of weight loss with the gastric band is more difficult to predict than with the laparoscopic sleeve gastrectomy. Some individuals do extremely well with the band but some others have disappointing results and fail to achieve the weight loss they desire or require. In this circumstance the band is sometimes removed and laparoscopic sleeve gastrectomy is performed as a second operation to achieve further weight loss and health benefits (this is performed as two separate operations).
Other disadvantages of the laparoscopic gastric band operation are the long-term complications of band slippage (the band moves lower down the stomach) and band erosion (in which the band erodes into the stomach) necessitating band removal.
Laparoscopic roux-en-y gastric bypass (commonly called the gastric bypass operation) and other operations such as duodenal switch (see publication below on duodenal switch) are popular in the United States where patients tend to be on average far larger than Australian patients. These operations generally involve some malabsorption. Since some well designed studies have demonstrated very similar weight loss with laparoscopic sleeve gastrectomy compared to laparoscopic gastric bypass, Dr Lord generally recommends the sleeve operation rather than the bypass operation. There are also serious complications which can occur with the bypass at the time of operation and afterwards which do not occur with the sleeve operation.
COST OF THE PROCEDURE:
Please telephone or email our Practice directly for a surgical price guide (ph. 02 8382 6671 or e. email@example.com). Professor Lord performs bariatric surgery at St Vincent’s Private Hospital and Macquarie University Hospital. His fees are standardised across these facilities. The anaesthetic and hospital fees are separate and additional to the surgical fees. Patients with health insurance will be able to claim a partial rebate on the fees from their health fund and from Medicare.
Patients who do not have health insurance aregenerally encouraged to join a health fund, after which they have to wait twelve months before the health fund will cover the costs of the operation and hospitalisation.
Patients who do not wish to wait twelve months can opt to pay all surgical, anaesthetic and hospital costs themselves. An option which has interested more people since the performance of superannuation funds has declined in recent years is to pay for the operation using funds from your superannuation account.