Warning!

Please be advised that information on this page is not intended and MUST NOT be taken or used in any way as personal medical advice. Referral to LapSurgery Australia MUST come from your Family Doctor who is the only person qualified to advise you on the need for referral to a surgeon.

Contents

• Introduction

• Definition of Morbid Obesity

• Treatment of Morbid Obesity

• Rationale of Surgery

• Types of Surgery

• Surgery Preferred by LapSurgery Australia

• What The Gastric Band Does

• How the Gastric Band Causes Weight Loss

• So It’s 100% Successful......?

• How do I Know if I Am Suitable For Lap-Band®?

• How do I Calculate my BMI?

• LapSurgery Australia - Valley Private Hospital Obesity Surgical Program

• The Preoperative Process

• The Surgery

• Recovery

• Ongoing Care

• When do You Remove the Band?

• Possible Complications

• The Next Step

• Costs and Payments

• Further Research

• Links

/\  Introduction

The information following is an outline of the surgical management of morbid obesity as seen and practised by LapSurgery Australia. It is by no means exhaustive and further web links are provided at the end of this article. We hope this article will help you decide whether laparoscopic gastric banding is something applicable to you and to start you on your quest for more information and perhaps even a preliminary assessment by our Obesity Surgery Service.

/\  Definition of Morbid Obesity

Morbid obesity is an increasingly common condition seen throughout the Western world. Morbid obesity is defined by a Body Mass Index (BMI) of greater than 40 or between 35 and 40 where there are other major medical conditions such as high blood pressure and diabetes are present. We’ll explain more about BMI a bit later. In Australia about 8% of the health budget is spent on treatment of morbid obesity and its effects.
Morbid obesity, as the term morbid implies, means that the degree of obesity leads to an increased incidence of major medical complications such as high blood pressure, diabetes, heart attack, stroke, gallstones and other conditions such as osteoarthritis of the knees and hips. Some of these conditions can and do lead to early death. In nearly all cases, obese people with these conditions will improve either completely or substantially if the excess weight can be removed. The chance of premature death will also be reduced. The chart on the right shows the increased mortality rate with increasing weight. Note that the chance of early death rises sharply with BMI greater than 40.

/\  Treatment of Morbid Obesity

The cause of morbid obesity is not known, however it is likely that there is no one single cause and that multiple factors are involved including genetic, psychological, sociological, and hormonal factors.
The commonest form of treatment for morbid obesity is dieting, often associated with various commercial weight loss organisations.

Dieting asks you to interpose willpower, and willpower alone, in the path of the factors which are causing your obesity. If this were possible you would not be overweight!
Recognising this, there have been many other forms of treatment including various medications (mostly addictive stimulants) psychological treatment, psychiatric treatment, natural therapies, hypnotherapy and acupuncture. THESE DON'T WORK EITHER! In fact, long term, your weight will probably INCREASE.

/\  Rationale of Surgery

Surgical treatment of morbid obesity is based around fundamental principles of physics. These principles apply all across Australia, the rest of the world and almost certainly the entire universe. There are no exceptions. These principles can be expressed in the following four statements:

1. You absorb energy only from what you eat, and expend it only through your basic body processes plus the activities you perform (exercise).

2. If you absorb more energy than you expend......your weight WILL INCREASE!

3. If you absorb the same energy as you expend......your weight WILL STAY THE SAME!

4. If you absorb less energy than you expend......your weight WILL DECREASE!

/\  Types of Surgery

There are two basic types of surgery. The first type involves bypassing the stomach or bowel in such a way that you can eat what you want, but the food is not absorbed.
The second type of surgery restricts what you can eat and includes laparoscopic gastric banding and stomach stapling.

/\  Surgery Preferred by LapSurgery Australia

Currently we perform the laparoscopic gastric banding operation exclusively. The reasons are that the results of laparoscopic gastric banding are excellent, the surgical risks are very low, the recovery from surgery is rapid and the adjustability of the band gives us great control over subsequent management of your weight loss.

Right: Inamed Adjustable Gastric Band  

/\  What the Gastric Band Does

The band is applied around the outside of your stomach so as to divide the stomach into two unequal parts. The upper part (or pouch) has a capacity of only three teaspoons! Once you have eaten just three teaspoons of food you cannot eat anything else until this food has gone through into the lower (large capacity) part of your stomach. The rate at which the food passes into the lower part of the stomach controls how fast you eat. The tighter we make the band, the smaller the opening into the lower stomach and the slower the food passes through.

/\  How the Gastric Band Causes Weight Loss

The band works (when properly adjusted) to cause weight loss in three ways:

1. Eating is slowed very greatly. In the time everyone else has finished a three course meal, you might just be finishing a small first course. Unless you can sit and do nothing but eat all day, you should lose weight.

2. You have been very good with your diet then comes that weekend party, a delicious smorgasbord, a couple of drinks and wham! You just undid three weeks of dieting with one big binge. Well not with a band you won’t! You just can’t binge - food won’t go down fast enough!

3. This is a bit more subtle, but it is the way the band works in the long run. The longer you have the band and cannot use a big, calorie laden meal for reward, comfort, disappointment, happiness etc, the more your attention will divert away from food and the less effort there will be in losing and then maintaining a healthy weight.

/\  So It’s 100% Successful - Just Put the Band in and Bingo! - The Weight Goes?

No, of course it’s not 100% successful. However there are only three rules which, if followed, just about guarantee success:

1. You eat a balanced diet at meal times- nothing special, just what the rest of the family is (or should be) eating, but no Mars Bars vitamised with double cream. (Yes, we have seen this combo used!)

2. You don’t eat between meals. Fluids, to be taken between meals, should be non-calorie or very low calorie.

3. You don’t drink fluids with meals. Fluids with meals mush up the food allowing it to pass from the upper pouch much more quickly and defeat the purpose of the band.

/\  How Do I Know If I Am Suitable For Lap-Band®?

There are four common reasons why you will not be suitable.

1. Addiction to alcohol and drugs, both legal (Valium etc) and illegal (heroin, cocaine etc). There is strong scientific evidence that Lap-Band® WILL NOT WORK if you are addicted.

2. You are not big enough. You need a BMI of more than 40, or more than 35 with other diseases (diabetes, high blood pressure etc). Unless you fit into these categories WE WILL NOT OPERATE. Why? Because unless you fit these criteria the risk to your life from the operation is greater than the risk of your obesity.

3. You don’t have Private Health Insurance. Although you might be prepared to pay the full cost of the operation yourself, if there are complications you may run out of money. For instance, just one night in the intensive care ward would cost you an extra $1,500. This would be fully covered if you had private health insurance. If you need a further operation later, this would be covered by private health insurance, but if you do not have cover you may not be able to afford it and it may be VERY DIFFICULT or even IMPOSSIBLE to get you into a public hospital for this sort of operation.

4. You live too far away for regular follow-up. Follow up is for life. We cannot treat you if, for example, you live interstate or overseas.

Some other conditions may make lap-banding an unattractive option including major illnesses such as heart failure and previous upper abdominal surgery. A previous operation such as gastric stapling can make lap-banding very complicated indeed and would require careful assessment before we agreed to lap. (or open) banding.

/\  How do I Calculate My BMI?

Easy! Find out your weight in kilograms and your height in metres.
Click on the button below and enter your details into the calculator.

/\  LapSurgery Australia - Valley Private Hospital Obesity Surgery Program

LapSurgery Australia is a group of surgeons specialising in advanced general surgery including advanced laparoscopic surgery such as the Lap-Band®. See the contacts page on this web site for information on our location and contact details.

The Valley Private Hospital is an Acute Medical and Surgical facility fully equipped to deal with all the requirements of this advanced surgery. It is situated in Mulgrave, a suburb of Melbourne, 25 minutes from the CBD. It is owned and operated by the Benchmark Group, the third largest private hospital operator in Australia.

Our approach to Obesity Surgery is multidisciplinary, or team based. We recognise that there are various causes of obesity and that everyone is unique. Lap-banding is MUCH MORE than just having an operation, and it requires more expertise than what your surgeon alone can provide.

The team consists of:

Nurse Counsellor: Surgeons: Anaesthetist: Psychologist: Dietician: Hospital: Support Group:

Your FIRST CONTACT for assessment and education. Two at each operation, but one will supervise your ongoing care. To assess your risks and provide a safe anaesthetic for the operation. Vital for initial assessment and help during the weight loss phase. To assist with dietary changes and to ensure proper nutrition. Provides inpatient care, the Nurse Counsellor and Support Group. Called BandWorks. Nobody knows more about Lap-Band® than those who have one!

/\  The Preoperative Process

The FIRST contact is the Nurse Counsellor. She will perform a basic assessment (including BMI) and provide you with a lot of information about the procedure including approximate costs. If you do not qualify she will advise you and you need waste no more time or money.
If you are still interested, the next step is a consultation with one of the three surgeons. A referral from a General Practitioner, preferably one who knows you, is ESSENTIAL. Under no circumstances will we see you without an appropriate referral.
If you still want to proceed you will see the dietician, psychologist and anaesthetist and then have a second consultation with the surgeon before a final decision on surgery is made. You will have the OPTION of attending a support group meeting to speak to those who have already had the operation.
Only then will we make a booking for the operation.

/\  The Surgery

You will be admitted to hospital and have your operation performed on the same day. In almost every case, the band will be inserted laparoscopically (i.e. keyhole surgery). On returning to the ward you will have an intravenous drip and only be able to have sips of fluids for the first night. On the next day, all being well, you will start taking fluids and the intravenous will be removed.
You will go home on either Day 2, or Day 3 post operation.

/\  Recovery

The stitches/staples will be removed two weeks after the operation. For the first 4 weeks you will only be allowed a fluid diet. You will then see the dietician again and commence a "mushy" diet and by the end of the 8th week you will be eating normal food. You will probably lose several kilograms in this first 8 weeks, but this has nothing to do with the band, just the dietary restrictions.
At 8 weeks the band will be tightened for the first time. Usually this is an office procedure, but occasionally we may need to do the first one or two adjustments in the X-ray department.

/\  Ongoing Care

We will continue to monitor your weight and wellbeing during the weight loss phase. You may need further visits to the dietician and psychologist. Support from your family doctor can be invaluable. We always keep your family doctor up to date with your progress.

/\  When do you Remove the Band?

Never! It is there for life. Experience shows that removing the band results in rapid reversal of the weight loss.

/\  Possible Complications

These will be discussed with in detail with you PRIOR to the operation. Possible complications include but are not limited to:

• Band Slippage - Occurs in about 5% of cases. Usually means another operation, sometimes keyhole, sometimes a large incision.

• Band erosion - Rare, less than 0.5%. Requires another operation, usually a large incision.

• DVT (blood clots in the leg or pelvic veins). Rarely, but occasionally fatal if clots spread to lungs.

• Respiratory complications, usually pneumonia.

• Damage to other organs during procedure - risk common to all laparoscopic surgery.

• Open surgery - on rare occasions it may be impossible to insert the band with keyhole surgery and a large incision may be needed.

/\  The Next Step

If you would like to take the next step, ring EndoSurgery on 9210 7277 to book an appointment with one of our surgeons. You will need a referral from your local doctor for the consultation.

/\  Costs and Payments

Operations are performed only in Private Hospitals. For an estimate of costs please telephone us on (03) 9210 7277.

/\  Further Research

The better informed you are when you come for a consultation, the more you will get out of it. The following is a list of web sites of interest. The MOST IMPORTANT of these is the Bioenterics Site. They are the manufacturers of the band. There is an online booklet in Adobe Acrobat© format which we strongly recommend you download and read. It is situated at this web address: www.inamed.com/products/obesity/us/patient/lapband/information.html

/\  Links