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Weight loss surgery

Weight loss surgery (often known as Bariatric surgery) is usually recommended when efforts with diet, exercise and medication have not been successful. This surgery is also recommended if thereare worsening health conditions associated with obesity (excess weight). These health conditions may include heart and artery disease, asthma, high blood pressure, type 2 diabetes, obstructive sleep apnoea and psycho-social problems, or other conditions. Many of these obesity related conditions can be either completely resolved or very much improved.

Weight loss surgery reduces the risk of death from obesity. Surgery is not a quick-fix cure, and weight loss still depends on healthy eating and exercise.

In Tauranga Hospital the surgery that is offered is called a Laparoscopic (keyhole) gastric sleeve procedure.

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What is a 'Laparoscopic gastric sleeve' procedure?

Laparoscopic gastric sleeve proceedure is a relatively new restrictive weight loss procedure. It involves reducing the size of the stomach from a sac to a narrow tube. Weight is lost because there is an earlier feeling of fullness after eating due to the smaller size of the stomach. Also, some appetite stimulating hormones normally produced by the stomach, are reduced by the procedure. Apart from this change the stomach digests calories and nutrients in an almost normal way.

The surgery greatly reduces the size of the stomach by changing it into a long tube. The stomach is stapled along its length, and the excess stomach is permanently removed.

Laparoscopic or keyhole surgery involves several very small incisions rather than open surgery, which uses one large incision. Harmless carbon dioxide gas is introduced into the abdomen, inflating it, and creating a space for the surgeon to work. The surgeon introduces a long narrow camera and surgical instruments, and uses these to perform the procedure.

Keyhole surgery has many advantages, including less pain, a shorter hospital stay, and a quicker recovery. There is also a reduced risk of wound infection or hernias. If for some reason your surgeon can not complete the procedure laparoscopically, he can convert to the open procedure safely. The chance of this occurring is low, and would only be done in your best interests.

Most patients achieve good to excellent weight loss results following this surgery; typically this can be 50-60% of excess weight. Patients lose most of their excess weight in the first year and can lose more weight over the next 6 to 12 months. Weight will usually stabilise after this. There can be some weight regain, but this is usually minor and is very dependent on you following the post-operative diet and exercise instructions.

The surgery generally takes about 2 hours and then you will spend some more time in the recovery room as you gently wake up from the anaesthetic.

There is no amount of weight loss that is guaranteed

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What complications (risks) can occur?

This section is not meant to frighten you, but help you to make an informed decision on whether to have a Laparoscopic Gastric Sleeve procedure. When planning to have surgery, your biggest concern should be the final outcome. Will your life be improved by the procedure or do the risks outweigh the rewards? No surgery is risk free, but understanding the possible complications can help you make a better decision.

Most problems that can occur after this surgery are relatively minor and do not have a long-term effect on your recovery. Some complications may be more significant and require a longer hospital stay and recovery period.

Antibiotics at the time of surgery, deep breathing exercises and early mobilisation after surgery, are some of the measures taken to reduce the risks of these complications. Precautions are taken during surgery and your hospital stay to minimise risks, but there remains a chance that you could develop a complication, which in rare cases can cause death.

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During Surgery

Your surgeon may need to make a larger incision because of technical difficulties with the keyhole surgery approach. This should not significantly alter your recovery from surgery. There are risks with any abdominal surgery using keyhole surgery instruments. These risks could be an accidental injury to the bowel or any closely related organs, such as the pancreas, spleen or liver.

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After Surgery

Infection:
  • Possible infection sites include chest infection (pneumonia);
    Urinary tract infection; Infection of the keyhole incisions,
    or deep within the abdomen, and can include pancreatitis.
  • Antibiotics used during surgery can cause inflammation of the colon (colitis).
  • Severe infection can lead to prolonged hospital stay and further surgery.
Bleeding:
  • This may either require a transfusion or return to the operating theatre (there is more information on blood transfusion on page 25).
Allergic reactions:
  • To medication, anaesthetic agents, or prosthetic devices.
Constipation:
  • Due to anaesthetic, reduced mobility and changed diet.
Nerve or muscle injury:
  • Due to positioning during surgery, or related to intravenous and arterial lines.
Blood clots:
  • Can occur in the lower leg (deep vein thrombosis, or DVT) or in the lungs (pulmonary embolus).
  • There is a small risk of developing DVT following surgery.
  • When detected, the treatment may involve blood thinning injections, followed by a course of tablets.
Leak:
  • From the staple line.
Stroke:
  • Heart attack or abnormal heart rhythm.
Respiratory failure:
  • The inability to breathe adequately after surgery.
  • This may require support for breathing in an intensive care unit.

All surgeries whether planned or urgent, carry a risk of death.

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In the longer term

Troublesome symptoms may include abdominal pain, a change in bowel pattern, tiredness, bloating, nausea or vomiting.

Narrowing at the middle of the stomach (Hour Glass Stomach) may require stretching with a balloon, or rarely, further surgery may be required.

Excessive or inadequate weight loss is likely a consequence of not following the advice after surgery and seldom requires further surgery.

Dehydration or imbalance of body salts is usually from inadequate

fluid intake, and does not usually require admission to hospital. Inflammation of the remaining stomach or oesophagus may occur.

Gallstones can form during rapid weight loss, and may require surgical removal of the gallbladder.

Hernias (muscle weakness) may occur at the site of the incisions.

Psychological problems can include depression, adjustment disorder, relationship difficulties and rarely suicide.

Liver disease or failure can occur if there is underlying liver damage that is worsened by weight loss or surgery.

Hair loss from protein malnutrition may occur.

Vitamin deficiencies - Commonly, symptoms will not appear until sometime after surgery, even several years. After a Gastric Sleeve procedure, you will need to take vitamin supplements for the rest of your life. Some people need to take iron or calcium supplements as well. Failure to take these can have significant health consequences. If you become anaemic, you may require a vitamin B12 injection.

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Last updated: October 3, 2017