5 Things to Know About Bariatric Surgery

Bariatric surgery is the most effective way to lose excess weight and keep it off in the long term that we have available at this stage. Because of this, some people view it as the “easy way out.” This certainly is not the case since the whole process requires a lot of effort and can often come with a range of difficult to manage side-effects. If everything goes as planned however, it can result in some life-changing health benefits.

Types:

The most common types of bariatric surgery in Australia are the Laparoscopic Adjustable Gastric Banding, Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

 

Lap Band:

Lap Band Surgery involves placing an inflatable band around the top of the stomach through keyhole surgery. The tightness of this band can be adjusted to change the size of the opening, which can adjust the level of restriction. By tightening the band further, the amount of food that can be eaten in an individual sitting is reduced, while also reducing hunger between meals.

Benefits:

  • The surgery is completely reversable and it is also possible to adjust the level of restriction after the surgery.
  • Lower risk of mortality than other common forms of surgery.
  • No malabsorption of nutrients due to the stomach still being fully intact.

Drawbacks:

  • Statistically it results in less weight loss than the other common forms of surgery (50% of excess weight loss – while the others average 70% of excess weight loss).
  • Revision rate for surgery 5-10% due to pouch dilatation, food obstruction, band slippage, leaking and wound infections.

Roux-en-Y Bypass:

Benefits:

  • Usually leads to the most dramatic results. In 6 months, as much as 50% of total weight loss takes place, and often it continues for up to 2 years.
  • Due to the larger weight-loss there are even more improvements in weight-related conditions, such as high blood pressure, sleep apnoea, osteoarthritis and diabetes.

Drawbacks:

  • Malabsorption of nutrients (such as calcium, iron and B12) due to the decreased stomach size and increased speed of food progressing through the digestive tract. This often means lifelong vitamin and mineral supplementation.
  • Higher risk for gallstones due to the faster weight-loss.
  • Since it is a more invasive surgery, there is a higher risk such as blood clots and infections.
  • Not reversible.
  • Can be dangerous for people who are extremely obese.

 

Sleeve Gastrectomy:

A sleeve gastrectomy involves the removal of roughly ¾ of the stomach and the area that is leftover is stapled shut. The remaining stomach looks like a “sleeve” connecting the oesophagus to the small intestine, which is why it is often referred to as a gastric sleeve.

Benefits:

  • The most common type of bariatric surgery in Australia.
  • Faster weight loss than the gastric band (although not quite as fast as the bypass). People average 30-50% weight loss within the first 6 months to a year.
  • This surgery leaves the option open to be followed up with gastric bypass. Since it can be dangerous for individuals who are extremely obese to get a bypass, a sleeve gastrectomy can be used as a stepping stone prior to that surgery.

Drawbacks:

  • Not reversible.
  • The staples can leak, which could cause infection.
  • It is still possible for the stomach to stretch post-surgery. Consistently overeating can lead to it stretching back to its normal size.

Side Effects:

  • Reflux
  • Nausea and vomiting
  • Inability to eat certain foods – certain foods may no longer be tolerated well.
  • Infection – issues with the surgery related to leakage or band slippage can lead to infections.
  • Nutrition deficiencies can occur due to the combination of decreased food intake and malabsorption of nutrients (not relevant for the gastric band).
  • Constipation
  • Gallstones can be found in as many as 35% of weight loss surgery patients, due to the rapid weight loss.
  • Dumping syndrome – which can lead to low blood sugar, malnutrition, vomiting, ulcers, bowel obstruction and hernias

 

Cost:

The cost can vary depending on a variety of factors. Without insurance, the total process will likely cost between $12,000 to $18000 after factoring in the Medicare rebates.

The surgery itself will cost slightly less than that, but the costs of add-ons including initial surgeon’s consultation fee, medications, dietitian and psychologists should be factored in as they are essential for the surgery’s overall success. A lot of people only factor in the upfront cost of the surgery, which leaves them frustrated at other costs associated with it, or without the results they desired because they did not access the services that would have benefitted them.

It is also worth factoring in that if the surgery needs to be revised, that will be an additional cost as well.

In terms of the cost of the surgeries themselves in Australia:

Gastric Band

  • $2,000 – $5,000 with private health Insurance.
  • $9,500 – $15,500 without private health insurance.

Gastric Sleeve

  • $3,500 – $5,500 with private health Insurance.
  • $15,500 – $17,500 with private health Insurance.

Gastric Bypass

  • $4,000 to $6,000 with private health insurance.
  • $16,000 to $18,000 without private health insurance.

Where you get the surgery done has an impact on the price as well. The average gastric sleeve cost in Brisbane and The Sunshine Coast is $4,454 while the average price for the same surgery in Adelaide is $3,070.

Requirements:

To undergo bariatric surgery, you first need be eligible based on a specific criterion, and then you need to follow certain procedures to prepare for the surgery.

Eligibility

To be eligible you need to meet criteria based on body mass index (BMI) and the presence of comorbidities.

Those who are eligible are:

  • individuals with BMI >40 kg/m2
  • individuals with BMI >35 kg/m2with one or more obesity‑related complications.

Preparation

Weight loss prior to surgery reduces the size of the liver and decreases the amount of fat around the abdominal organs, which will make for a quicker and easier surgery. A very low-calorie diet (VLCD) such as Optifast, is recommended. This process should be undertaken for 2-4 weeks prior to surgery and can look like:

 

 BREAKFAST 1 shake sachet of Optifast OR 1 Optifast Bar
LUNCH 1 shake sachet of Optifast Plus 1 cup of non-starchy vegetables

OR

1 Optifast Bar Plus 1 cup of non-starchy vegetables

OR

1 Optifast Soup Plus 1 cup of non-starchy vegetables

DINNER 1 shake sachet of Optifast Plus 1 cup of non-starchy vegetables

OR

1 Optifast Bar Plus 1 cup of non-starchy vegetables

If hungry may include

65-100g (raw weight) steamed chicken or white fish + 1 cup of non-starchy vegetables

How to get the process started:

The first step is to do as much research as you can to decide whether bariatric surgery is the right choice for you. If you do decide that it is, the next step is to book in for a consult with a surgeon.

Often it will take 3-6 weeks of screening, which will include looking at whether you are deficient in any nutrients pre-surgery, as well as looking for any other potential health complications that might effect the outcomes. During this time, it is great to start seeing a dietitian so that you can transition towards healthy eating patterns prior to starting the VLCD to prepare for surgery. They will also be able to tell you what to expect post-surgery, which will prepare you for the process required afterwards.

Following this, you will need to get authorisation from your insurance company (which can take anywhere from 5-30 days). You will likely also need to go through pre-surgery education sessions and workshops, depending on which surgeon you go through.

Two to four weeks prior to surgery you will need to start the VLCD to make the surgery easier, due to reduced liver volume and fat around the organs.

The final step is the surgery, which generally takes 1-3 hours, followed by a 1-2 day stay in the hospital (if there are no major complications).

Overview

Bariatric surgery is a long process that does not end after the surgery. A commitment to long-term follow up with the multi-disciplinary team is vital to the success of the surgery. For some people, the surgery is an absolute life changer and turns out to be everything they hoped for. Others find that it creates more problems than it solved. The best thing you can do is be as informed as you can be and make sure that you access the services required to get the best outcome possible.