“Weight Loss surgery has changed my life in so many positive ways I cannot even begin to contemplate my life before contacting LAPSurgery Australia”

LSA

Weight Management Service Providers

Full Time Dietitian (Non surgical program) Orbera® Intragastric Balloon Endobarrier Laparoscopic Gastric Banding Laparoscopic Sleeve Gastrectomy Laparoscopic Gastric Bypass Revisional Surgery “Supporting your journey “

Phone 9760 2777 www.lapsurgeryaustralia.com.au

LSA Weight Management Services

The contents of this booklet are copyright as follows: © 2014 LAPSurgery Australia Pty. Ltd. and may not be reproduced or distributed in whole or in part without the express permission of the copyright holders. This booklet is not a substitute for a consultation with a LAPSurgery Australia surgeon or Dietitian but should be seen as a resource to complement. Every care has been taken in the preparation of this booklet, however the advice and information contained therein may not meet the needs of, or be entirely suitable for all patients. Information in this book is for educational purposes only

Understanding Obesity, Metabolic disease and your ability to overcome it. The first step in overcoming this disease is to “STOP BLAMING YOURSELF” Evidence from research shows “IT’S NOT YOUR FAULT”. Predominantly the cause of the obesity epidemic is a combination of the environment we live in, lifestyle, genetics and epigenetics.

By the time you receive this booklet you will have experienced all the emotions and prejudices that accompany the disease. This will have been a difficult and painful journey. We are here to help you turn your life around and move on to a more positive rewarding phase in your life.

ARE YOU READY? LET’S GET STARTED !

At LAPSurgery Australia we recognize that there are many elements to consider along the way with YOUR Weight Loss Surgery. Each patient is assessed as an individual, taking into consideration the severity of their weight problems, their lifestyle and geographic location. We offer dietary advice and all forms of Bariatric surgery so that you can come to one centre and know that you will be looked after by a team of highly qualified and diverse Specialists. The severity of Obesity is determined by a measurement called the Body Mass Index (BMI). Our Surgeons have over 15years of experience in performing Laparoscopic Weight Loss Surgery. They are up to date with the research and scientific evidence that supports the need for surgical intervention

The process involves an assessment with a Nurse, Surgeon, Physician, Psychologist and Dietitian guidance and follow up after surgery. The follow up is the most important factor in achieving success and this is where our Clinical Nurse Specialists and Bariatric Specialists play a major role.

BMI kg/M2 Treatment options

Healthy Weight 18—25 Not Usually Required

Overweight 25-30 Diet Exercise, Obera®, Endobarrier

Obese 30—35 Orbera®, Endobarrier, Band, Sleeve

Severely Obese >35 Band, Sleeve or Bypass

Morbidly Obese 40 and Over Band, Sleeve or Bypass

Meet the Team

Weight Loss Co-ordinators Jacqui and Lainie take all our initial enquiries. They will explain the process and the costs, offer health fund advice and make all your appointments for you.

Clinical Nurse Specialists You may meet Cheryl or Fiona at your first appointment. They

will weigh and measure you and talk to you about what to expect. Cheryl and Fiona are available to offer you support all

the way through your journey.

The Surgeons: Mr. Ray McHenry, Mr. Richard Gilhome and Mr. Chris Hensman Your will require a referral to one of our Surgeons. They will assess you for the correct treatment and

provide the information you need to make an informed decision about your weight loss options. Our surgeons have extensive bariatric and general surgical experience and are very passionate about

helping you achieve a healthier and longer fulfilled life.

Specialist Physician Dr. Ivan Stratov will do a full health assessment following blood tests along with any other tests that may be required. This to ensure you have optimal

preparation and recovery for your surgery.

Psychologist Jan Schleiger will assess your wellbeing and guide you through what to expect emotionally on your journey and offer advice on how to manage

changes and attitudes.

Dietitian Alex Hoare is an Accredited Practicing Dietitian, specializing in the

management of obesity along with general dietary advice. Alex provides ongoing nutritional support to each individual on their weight loss journey. Her role is to work with patients both before and after surgery to help them

achieve their weight management goals.

Meet the Team

Dr Virginia Boyden & Dr Judy Day have a passion for preventative medicine and weight management which is reflected in their extensive experience as weight loss management consultants. At LAPSurgery Australia, Virginia & Judy perform annual reviews for patients who have undergone weight loss surgery as well as performing lap band consultations and adjustments along with providing valuable education to patients to help them achieve and maintain their long term goals.

Bariatric Specialists

Dr Virginia Boydon Dr Judy Day

Physicians

Assoc. Prof Joseph Torresi and Dr Ruth Chin are Specialist General Physicians. Your surgeon, whilst an expert at operating, is not necessarily the best person to assess and correct any possible vitamin or other deficiencies. For that reason LapSurgery Australia added Assoc.Prof Joe Torresi & Dr Ruth Chin to the LAPSurgery team. As specialist physicians they are best placed to advise you on your nutritional status along with any alterations to your medications or vitamin supplements which may be required in conjunction with your local GP. Your annual reviews will be held with Joe and Ruth and recall letters will be sent to you as a reminder to make these appointments.

Ben's Story ( I Feel Great )

Lap-banding surgery has changed my life

in so many positive ways I cannot even

begin to contemplate my life now without

that tiny little band and all the things it

unlocked for me.

I had been thinking of lap banding for some time but had dismissed it as way too invasive and thinking back on it now, almost like a cop out or a resignation that I could not get thinner/fitter/healthier. I avoided mirrors, I avoided cameras and photos more. I just didn't want to see myself and that should have been a big warning sign. If it is in your power to change

your situation, you owe it to yourself to do it.

Then I had a child (not me personally, but my wife and I) and I KNEW that the time had come to get of my expanding ass and do something, any-thing, to ensure that the time I spent with my child would be healthy,

happy and energetic.

Now that I had made a decision, a psychological weight fell from my shoulders (and soon my waist) and I further investigated the process and outcomes of lap band surgery and sought some personal anecdotes both good and bad to weigh up the pro's and con's in doing this. My decision was really cemented after the first couple of interviews and consultations with everyone at LapsurgeryAuatralia. They were utterly professional,

understanding of my situation, made sure that I was aware of everything that this process would involve

and the risks and benefits of what I had chosen to do.

Have I mentioned I love my band? I do. It took away the sensations (consciously and unconsciously) of wanting to eat. I felt full for the first time in years without having to undo my top button. I didn't feel like eating all the time (non hungry eating) and I really hadn't changed my diet all that much. I was more aware of the need for really good things to go in as I wasn't eating so much, but that was another great

by product – my diet got better because I didn't have enough room for bad stuff anymore.

I have one regret though – not doing it earlier. I want those years back. I want that time with my friends back. I want my enjoyment of life back. If you asked me at any point in this process if you should do it, at any point including just post-surgery, I would say yes. I would shout yes. The things you go through to get this band are absolutely inconsequential compared to the outcome. It is not a cop out, it is certainly not the easy way out, you should not feel bad about this decision – you are making a really tough decision to turn your life around. Tell people or don't – they don't have to know how you are doing it, but

they WILL know you are losing weight. Do it for your own reasons, but do it. Start living.

Janys' Story ( I Feel Great )

"I got rid of the type 2 diabetes within 2 months of the operation"

My life and health prior to discovering Lapband® surgery was a mish mash of yoyo dieting coping with type 2 diabetes, high blood pressure and sleep apnea.

I would diet and lose a few kilos only to put it back on plus a bit more. This I saw as going on forever and my health getting worse. One thing I didn't want was going in to older age with this burden, I wanted to be fit and healthy so that I was able to

keep up with grandchildren.

I then heard about an information evening for Lapsurgery Australia and thought I would attend, this was in my mind the last hope. This information session for me was like a light

being switched on, it was definitely the answer.

Six weeks later I had my operation and have not looked back, sure there have been a couple of times when I have had difficulty with some food but re-educating myself (as to eating

slower) has alleviated that problem.

I was 103kg and over a three year period have lost 51kg, I got rid of the type 2 diabetes within 2 months of the operation, the high blood pressure within 5 months and the sleep apnoea took

8 months, I am now happy, healthy and enjoying life to its fullest.

Primary Sleeve Gastrectomy patient 53 Kilogram weight loss after 6 months

At my worst I weighed 181 kilos and was still gaining. I had leg ulcers on both legs, bad knees and was contemplating knee surgery, serious lower back pain and then I was told I had diabetes and my liver was starting to show signs of failure, I was struggling to keep my business running. I just couldn’t find a solution and there was no magic pill or physiotherapy to take the pain away. Life was a battle which I was going to lose. I had lost weight in previous years but always put it back on plus more.

This was one battle I could not win on my own. Life became a battle of survival. The cost of carrying this weight was also financially difficult with doctor’s visits, specialists, and medication not to mention the depression it all took its toll. It has taken 5 years to make the decision with my brother having the Lap Band procedure 4 years prior with success but the band wasn’t for me. I was looking for a procedure that didn’t give me an option. So many people and friends were telling me “Steve you have got to do something we don’t want to lose you” With my health getting worse I made a phone call and made a appointment to see Mr Hensman. He discussed the procedures of the lap band and the sleeve in a way I could understand and then I made my decision base of the advice of Mr Hensman. We agreed to go with the sleeve procedure. I don’t take operations lightly. In my head I knew it could be a life or death situation but as I looked at my life and it was a battle I was losing anyway. On the day before the operation I had made a decision that was going to be the turning point in my life. With the support of my wife, friends and the LAPSurgery team I felt confident and committed to a successful outcome which was achieved. After the operation I felt excited about the future and couldn’t wait to start my new life. The support given to me by the team was instrumental in my fast recovery. With the on going support in the weeks after the operation from the dietitian and the team I was able to overcome any obstacles. Now I am 6 months down the track and 53 kilos lighter whilst learning and still learning to eat

again and listen to my body. I am still receiving support from the team with amazing results I am achieving better health. My diabetes is gone, leg ulcers have healed, liver is now functioning properly, back and knee pain have eased dramatically. I no longer require all the medication. The cost of the operation is nothing compared to the spending on medical and food bills of the past. It has basically been paid off in 5 months.

I am feeling like a bottle of champagne that has just been uncorked.

I have so much energy and I have a second shot at life and I’m not wasting a day. No words can express the gratitude and appreciation I have for the team for giving my life back. I feel the sleeve procedure that I have had, is too important not to share with others suffering obesity. It’s nice to know there is help “You don’t have to suffer anymore” Your head should be in the right place and you need to take advantage of the team support and you will achieve the outcome your are looking for.

Stephen’s Story

Weight

Revisional Surgery - Gastric Bypass

Kathy’s Story

Approximately 35 years ago I had gastric stapling surgery to lose weight.

I lost 8 stone with this as I vomited many times daily. I was in constant pain 24/7 and consuming a lot of medication to try and function with some normality throughout my

day. I had extremely high blood pressure and high cholesterol.

The pain was unbearable to the point my stomach would bloat and I could not fit into

the clothes I was wearing each day. My life was painful and unbearable.

Just over two years ago I consulted with Mr. Ray McHenry. We discussed my options. I was past caring and it wouldn’t have bothered me if I had to eat baby food forever

just as long as the pain and bloating ended

Now at 65 years of age and having had a Gastric Bypass I am absolutely pain free, having no bloating and have lost 40 kilos.

I work full time, fit in a plane seat and I even have the energy to go on holidays. My only regret is that I didn’t have the surgery 20 years earlier as it has made such a

difference to my life and my family.

I no longer need any medication except for daily vitamins and a Nexium tablet.

1. Photo One Year before Surgery Weight loss of 40 Kilos (Graph)

2. Photo 18 Months after surgery

Weight Graph Photo 2: Photo 1:

Non surgical Weight Management

“I don’t have Private Health Insurance” “I am not keen to have surgery”

“I am waiting to qualify for Private Health Insurance”

Alexandria Hoare is a Dietitian and Nutritionist and has

Experience in Weight Management

An appointment with our Dietitian Alex Hoare will get you on the path to managing your weight. By drawing on her extensive experience and success with our patients, Alex can guide you to keep focused and provide strategies to help you reach your goals in an encouraging environment. Controlling non hungry eating and a no-dieting attitude is the approach that Alex will take in guiding you to manage your weight. Little setbacks should be treated as just that. Don’t judge or punish yourself.

TURN SETBACKS INTO COMEBACKS.

Slow and steady wins the race. Even 10% weight loss will achieve health benefits. Keep your goals realistic and achievable. Alex will give you tips on how to manage your hunger and choose the correct foods for snacks and meals. Being aware of food choices, and keeping a diary will be helpful when planning your weekly meals. A planned shopping list and recipes that keep you interested will make the journey more rewarding. Try new foods that you may not have thought of trying before. How to choose the menu in a restaurant and think about portion size. Eating out with friends can be challenging. Eat slowly and enjoy your food chewing it well. Allow 20mins to eat an entree size plate. Be careful about functions that have finger food. Eat before you leave home so you won’t be tempted to eat too much. Increase protein and moderate carbohydrates. Avoid large meals. Eat small portions four times a day. Alex can help with strategies to avoid binge eating. Your may be eligible for an Enhanced Primary Care Plan (EPC) to cover some of the cost for your dietitian appointments. You will need to discuss this with your GP.

Exercise

Try to move your body every day; it only takes 30 minutes each day to improve your health.

Every little bit counts - take the stairs, park the car further away, walk to get the newspaper.

Make exercise a part of your routine - put it in your diary just like you would with your work

tasks or social events; and see it as time for you.

Organize to walk with friends instead of having coffee, and make exercise something you will

enjoy for life.

If you work full time and struggle to fit in exercise; make the weekends as active as you can,

go to the beach, swim or bush walk!

Weightloss Surgery Meal Plate

This plate is designed to help you portion a meal to provide a balance of protein, vitamins and minerals as well as ideal kilojoules for weight loss. It is the correct portion size that you should be aiming for at all meal times. Ideally the food should fit inside the rim of the plate.

How to approach your meal

Cut: Chop the food up into small pieces. Tiny Bites: Take very small bites, this makes it easier to chew the food more effectively. The bite size you should be taking is shown in the middle of the plate.

Chew: Chew the food well, this prevents discomfort. Taste: Savour your meal. Part of feeling full is satisfying your taste buds, it’s not all about satisfying the physical hunger. Relax and Enjoy: Stress and tension can create an upward pressure which makes it more difficult to get food down. Eat slowly and enjoy your meal.

Aim to take 15 to 20 minutes to eat your meal.

How does LAPSurgery Australia support you?

One of our surgeons is on call 24/7 365 days a year – for emergency care.

We are very focused on research projects that enable us to fully understand the science of obesity and the best treatment.

A bariatric Specialist is available most weekdays for LapBand® care,

Tips for losing weight and keeping motivated.

The commandments of Weight Loss can guide your weight loss efforts and show you the way to a healthier, happier lifestyle. They’ll help you get started, and they’ll serve as guide posts on your personal path to weight loss.

1. Believe in yourself 2. Set the right goals 3. Eat More Interesting Meals 4. Eat Smart 5. Get Moving 6. Build Muscle Keep a Diary Buy a small notebook and carry it with you. Immediately after meals and snacks, write down what you have eaten. Studies have found that people are more true to their weight loss when they write everything down. At first you’ll probably be amazed at how much and how often you eat. Later you’ll be proud of the positive choices you make. Avoid Non Hungry Eating. Stop and think, do I really want or need this? Remember why you made the decision to lose weight—keep reviewing.

Program Costs with LAPSurgery Australia

LAPSurgery Australia ’s complete program has an out of pocket cost which is above the amount claimable from Medicare and your Private Health Insurance. Our Bariatric Coordinators can provide you with a detailed outline of the costs for each different procedure. The below is a guide but more accurate costing will be given once your procedure has been chosen.

What our fees may cover:

Surgical and assistant Fee

Anaesthetist Fee

A set number of appointments allocated for our dietitian to be used over an 18 month period.

Appointment with our Physician

An appointment with our Weight loss Counsellor (Psychologist) depending on the procedure

Post operative consultation visit

(please note that other fees maybe required eg: theatre and prosthetic costs, radiology, pathology etc)

Other Costs to be aware of:

Health fund excess fees. (this is dependant on your level of Private Health Insurance)

Pathology, Radiology or other investigations that may be required.

Specialist fees where the specialist is not directly related to LAPSurgery Australia for example: sleep studies, echocardiogram, Endocrinologist, 24 hour Blood Pressure monitoring etc.

Have you have had surgery elsewhere but need to access our services for post operative care or revisional surgery? In this event we are very happy to take over your care and offer our services following a consultation. To enter our program we will require documentation from your previous surgeon eg: operation notes, results and (details regarding you band size and amount of fluid—if this applies to you) . Please phone 9760 2777 and speak to our Bariatric coordinators for further information.

Health Insurance. You will need to check that your Private Health insurance covers you for Bariatric Surgery. They may ask you for the item number of the procedure you are going to have.

Gastric Banding—Item No 31569

Sleeve Gastrectomy—Item No 31575

Gastric Bypass- Item No 31572

Orbera Intra Gastric Balloon—no item number

Endobarrier—no item number

Uninsured Patient At LAPSurgery Australia we can offer the Orbera© Intra Gastric Balloon for self pay (uninsured) patients. We also include appointments with our dietitian in this package. We do not offer EndoBarrier, Gastric Band, Sleeve Gastrectomy, Gastric Bypass or Revisional surgery to uninsured patients. We will offer advice on which Private Health fund to join and whilst waiting for the qualifying period you can start your weight loss journey in consultation with our Dietitian and Weight Loss Counsellor (Psychologist). It is important to understand that in the event of a possible complication, or the need for readmission to hospital the costs will keep adding up placing you and your medical specialist under stress if you do not have private health insurance. Therefore for this surgery we strongly recommend you take out private health insurance and wait the qualifying period., this way we can ensure that we give you the best possible care available.

Financing Options www.medicredit.com.au/customer-form.html Medicredit and similar organizations will source payment plans for medical services.

Early Release of Superannuation You may be able to access your superannuation fund early to cover the out of pocket costs of Weight Loss Surgery however you are still required to have the appropriate level of Private Health Insurance. Obesity and related diseases are life threatening and therefore may be considered a valid reason for early release of superannuation funds. Please call our Weight Loss Co-ordinators for advice on this option on (03) 9760 2777

Medical Expenses Tax offset You may be able to claim a significant rebate from your procedure through your tax return. You can claim a tax offset of 20% of your net medical expenses over $2120.00 (Figure as at 1st July 2012). This claim is not means or assets tested. Check with your accountant if this is appropriate for you. Visit the Australian Taxation Office Website for further details.

Orbera® Intragastric Balloon a non-surgical procedure The surgeons at LAPSurgery Australia perform this procedure at The Valley Private Hospital only. This is a very simple non surgical procedure done as a day case in hospital. We offer this procedure to self paying patients who are uninsured and insured with private health funds.

The Procedure The balloon is inserted into the stomach via an endoscopic approach (via the mouth under sedation). Insertion takes between 20 and 30 minutes. 1. The Surgeon will first look at the stomach with an endoscopic camera and once it is

determined there are no abnormalities, will proceed with the procedure. 2. The balloon is inserted in a deflated state whilst you are sedated. 3. Once inside the stomach, the balloon is immediately filled with saline

water through a small filling tube. The balloon has a self sealing valve and once it is filled, the tube is removed. At this point, the balloon will be too large to leave the stomach via the digestive tract.

4. After insertion the patient will be observed in hospital for 1 to 2 hours after which they will be discharged home with an accompanying person. We offer ongoing telephone support over the initial 3 days to assist you in your recovery.

Post procedure. Once the balloon is in place, it will take some time for the stomach to adjust to it’s presence. For the first week patients will be on a fluid only diet. Our dietitian will provide sample menus of what use should eat. After about one week to make the transition from PUREE to SOFT foods and finally back to SOLID foods. Again our dietitian will provide you with meal options. This dietary transition is important because it will not only allow you to adjust to the balloon, but it will help you gain a new perspective on food and retraining you for a healthier lifestyle.

How much weight will you lose? The question on everyone’s mind! The amount you will lose depends on how well you adapt to the Intragastric Balloon, altering your eating pattern and the exercise regimen you adopt.

A good aim is to achieve an average weight loss of 1kg per week.

Studies have shown that with the Intragastric balloon you can expect to lose 10—15 kg over six months.

Who is a candidate? To qualify for the Intragastric balloon you must be:

Overweight with a BMI of 27+

Motivated and ready to comply with a medically supervised program of diet and exercise.

In general not suitable for BMI > 35

Endobarrier (BMI 27—35 with or without Type 2 Diabetes)

The Surgeons at LAPSurgery Australia are performing

Endobarrier® at The Valley Private Hospital. EndoBarrier® is a thin

tube-shaped liner designed to be inserted endoscopically into a

portion of the intestinal wall. Once in place it acts as a barrier

between food and the portion of the intestine, achieving an effect

similar to a gastric bypass without the risks of the invasive

procedure.

How Endobarrier works The Endobarrier is a Teflon coated sleeve of 60cms which is placed using a telescope method (no incisions are required for this) as a day procedure. The sleeve lines the first 60cms of the small intestine separating the food from digestive juices as a result the ingested food does not digest and reaches the intestine resulting in release of special hormones similar to the process after gastric bypass. Clinical studies have shown that 85% of patients are able to reach their target blood sugar levels and lose up to 20% of their total body weight by 12 months, which may lead to a reduction in diabetes related complications. EndoBarrier® Therapy can result in patients having a reduced reliance on diabetes medications. Most patients treated with EndoBarrier ® therapy report having a rapid improvement in their blood sugar levels, reduced appetite, and immediate and continued reduction of weight. EndoBarrier® therapy works in conjunction with, but is not a substitute for, physical activity and a balanced diet. In clinical studies, the most common complications were nausea, vomiting and upper abdominal pain. Other unlikely risks include infection, trauma and bleeding. The procedure is performed as a day case and you will be off work for approx,.3 days How long can it stay in? The Endobarrier sleeve can only be left in for 12 months and then has to be removed at that point. Its main role in Type 2 Diabetic patients with a BMI 27-35 is that it can lead to remission of diabetes

Adjustable Gastric Banding The surgeons at LAPSurgery Australia have been performing Gastric Banding surgery for 16 years and have done over 3,000 procedures. The procedure is performed at The Valley Private , Knox Private, St John of God Berwick and The Bays Hospital.

About Laparoscopic Gastric Banding Through tiny incisions, our surgeons place the band around the top of the stomach to restrict the amount of food that can be eaten. The band has a connecting tube that is placed under the skin of the abdomen. The band is inflated or deflated by injecting fluid into the tube. This is done gradually to achieve the optimum level of hunger control for each individual. The procedure takes around an hour and your stay in hospital is usually 1-2 nights, returning to normal activities in 7 to 10 days in most cases.

How the Band works The adjustable band is placed around the top of the stomach creating a small pouch and works in the following ways. 1. Slows down the eating process 2. Reduces the amount of food you can eat. 3. Sends messages to the brain that you are satisfied after a small portion of food. 4. Allows you to eat most normal foods as part of a healthy lifestyle.

Success For people with serious weight problems, scientific studies have proven the adjustable band to be safe, effective method of achieving long term weight loss for many people. After surgery most people can expect to lose between 50-60% of their excess weight and dramatically reduce the risk of developing further health problems and premature death.

Is Gastric Banding right for me? The decision to undergo gastric banding surgery is very important. The procedure may not be suitable for everyone, and your LSA Surgeon will take many things into consideration when helping you decide if it’s right for you. You may be eligible for gastric banding if you

Are 18 years or older

BMI of 35 or above (or 30 and above with obesity related diseases such as Type 2 diabetes.)

Have made serious attempts to lose weight before and failed

Are not pregnant at the time of the procedure.

Do not drink excessive alcohol or are prepared to reduce to moderate amounts.

Are prepared to commit to a long-term, significant change in eating habits and lifestyle, including regular follow up with our clinic.

A Team approach to weight loss Gastric banding surgery doesn’t work by itself. Success comes when you partner with your LapBand® and our team of health professionals working together to achieve the best possible results. Your weight loss journey will be supported by our Surgeons, Nurses, Dietitian, Bariatric Physicians, Specialist physicians and our Psychologist. Constant communication and review is the key to your success.

Sleeve Gastrectomy

Introduction to Sleeve Gastrectomy The sleeve gastrectomy is surgery on the stomach alone. It is a restrictive procedure and does not involve any surgery on the intestine (which would make it malabsorptive). Sleeve gastrectomy has also been called partial gastrectomy, tube gastrectomy and vertical sleeve gastrectomy. It basically consists of changing the shape of the stomach from a pouch to a long tube: therefore the name “sleeve”. The sleeve gastrectomy removes more than 3/4 of the stomach, which provides for quicker satiety (sense of fullness) and decreased appetite. The smaller stomach capacity restricts the intake of food by allowing only a small amount of food to be eaten at one time. After the

separation of the stomach into a smaller tube, the remainder of the stomach is removed—it is not re-

versible. Meals Typically, sleeve gastrectomy patients will have between 4-6 small meals per day, which is actually the ideal way to eat. Dietitians recommend small frequent meals as a way of avoiding big swings in insulin levels and achieving a more even intake of calories as part of a healthier eating pattern. Despite being smaller, the stomach functions normally. Food and nutrients continue to enter and leave in the same way, acid continues to be made to assist digestion and essential vitamins and minerals such as B12, calcium, folate and iron can be absorbed normally.

Hospital stay The usual stay in hospital is 3-5 days days and 2-3 weeks off work. Regular follow up is required, 3 monthly initially and then annually to track weight loss. The predicted weight loss is around 60-70% of excess body weight over two years.

How does a sleeve gastrectomy work? The sleeve gastrectomy works in three distinct ways. 1. The major reduction in stomach capacity allows patients to become full and satisfied

with a much smaller meal, providing portion control. 2. Levels of the hunger hormone Ghrelin are reduced by 50-65%, as the removed part of

stomach is rich in cells that make that hormone. Patients consistently report feeling less hungry between their meals possibly as a result of this.

3. There appears to be a change in the way fatty foods are handled by the digestive track. Patients frequently report losing their taste for foods high in sugar and fat such as chocolate, fried food and soft drink, which seem to make them feel more bloated, unsettled or queezy.

Am I Eligible for this surgery? A consultation with our surgeons will determine whether this is the procedure for you. Your BMI, health status and age are some of the factors considered in making the decision. The surgery benefits and the risks will be outlined for you at consultation.

The Surgeons at LAPSurgery Australia have performed over 700 Laparoscopic Sleeve Gastrectomy operations over the past six years. This surgery is always performed by two surgeons to ensure the best possible results. Hospital Locations: The Valley Private Hospital Cnr Police & Gladstone Rds Mulgrave Knox Private Hospital 262 Mountain Highway Wantirna

Gastric Bypass The surgeons at LAPSurgery Australia have been performing Gastric Bypass surgery for 8 Years. This surgery is always performed by two surgeons to ensure the best possible results. Hospital Locations: The Valley Private Hospital Cnr Police & Gladstone Rds Mulgrave Knox Private Hospital 262 Mountain Highway Wantirna

Introduction To Gastric Bypass The Roux-en-Y gastric bypass is the “Gold” standard operation against which all obesity operations are judged. Globally it is the most common procedure with over 200,000 gastric bypasses performed in the United States alone each year.

How does a gastric bypass work? A gastric bypass has both a physical and hormonal effect. Physically it restricts food intake which results in early feeling of fullness, if a patient with a bypass tries to over-eat they can experience abdominal symptoms of dumping syndrome. While the majority of the reduction in a patient’s calorie intake is attributed to the restriction, initially there is also an element of malabsorption of fat. Long-term malabsorption is probably not a significant factor as your body adapts to the bypass. Bypass surgery also affects the hormones that control blood sugar and consequently many diabetic patients become non-diabetic post surgery.

Hospital Stay The usual hospital stay is around 5—7 days depending on how well you recover. You should allow at least three weeks off work, more if keyhole surgery is not possible.

Preparation and Recovery You will have planned appointments with our dietitian prior to surgery and at least one 2—3 weeks after surgery. You will need to go on an Optifast meal replacement program 2 weeks prior to surgery unless otherwise specified by your surgeon. There is a 4 week phased eating plan toward eating solid food to allow the suture line to heal. There is of course a need to follow a healthy eating plan and long term monitoring of vitamin deficiencies is required. Our dietitian will guide you through this. Regular follow-ups are required, three monthly initially and then annually to track weight loss. The predicted weight loss is around 60-70% of excess body weight over 2 years. Weight maintenance is achieved by the quantity of food consumed and healthy food choices incorporated with a personalized exercise program.

The decision to have this Surgery. Your surgeon will discuss the operation in detail with you and explain why this might be the most appropriate option for you. This surgery can usually be performed as a laparoscopic procedure but this is dependent upon whether there has been any previous surgery performed in the same region in which case it may need to be done as an open procedure. Your surgeon will discuss all the risks and benefits of the surgery with you at your consultation so that you are well informed before you make the decision to proceed

Revisional Surgery

“I’ve had a gastric band procedure which hasn’t worked as I had hoped” “I had a gastric stapling procedure and I am having problems”

We have performed over 3,000 gastric banding operations and we know that 15-20 % of these don’t achieve a satisfactory result. We have significant experience in helping patients in this situation. All our patients deserve every chance at success and we started doing revisional procedures six years ago for patients’ who were not successful with the Gastric Band and also for patients’ who have previously had Gastric Stapling surgery and now require revisional surgery. As a first step we would always check to see if the LapBand® can be revised. This involves a consultation with one of our surgeons and an assessment by our dietitian and weight loss counsellor. Tests including X-Ray and gastroscopy will be required. In some cases it may be possible to put in a new Band but our experience in general is that second Gastric Bands are not as effective. If we do not think that the Band procedure can be resurrected, then we have two alternatives, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass. For a Laparoscopic Gastric Bypass the band can be removed at the same time as the Bypass. For the Laparoscopic Sleeve Gastrectomy the Gastric Band will be removed first then a further procedure at a later date, usually 3 months after removal of the Gastric Band. The decision as to whether the sleeve gastrectomy or the gastric bypass is the better procedure is very complex and will require careful discussion with you. It is beyond the scope of this article to explain the issues. In either case the majority of patients will experience significant further weight loss and improvement in quality of life after the revision procedure. You must be aware that complication rates of revisional procedures are greater than those where the previous surgery has not been performed and we will discuss this with you in full and openly at consultation before going ahead with any further procedure.

This is a graph of a patients’ journey. Struggling with a gastric band, having the band removed and weight loss within four months after having a sleeve gastrectomy

Gastric Band

Sleeve Gastrectomy

Weight Graph

LAPSurgery Australia Head Office 2 Langwith Avenue Boronia 3155 Phone: (03)9760 2777 Fax 9761 0207

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Head Office

Boronia

2 Langwith Avenue

Also Consulting at:

Cranbourne

Cnr Thompson & Woodbine Roads

Mulgrave

Cnr Police and Gladstone Roads

Berwick

Gibb Street

Mornington

Vale Street

Rosebud

1537 Point Nepean Road

Operating at: Knox Private The Valley Private

262 Mountain Highway Cnr Police and Gladstone Roads

Wantirna 3152 Mulgrave 3170

St John of God The Bays

Gibb Street Vale Street

Berwick 3806 Mornington 3931

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