Procedures

Below you will find further information on some of the procedures our doctors perform. Although some of our doctors will not perform all of these procedures please see Services on which doctor performs and specialises in the treatments offered.

Due to our colorectal surgeons and the different type of procedures that they perform and due to the complexity of your own diagnosis our surgeons will discuss the procedure in detail and suggest which procedure will be more appropriate for you, therefore we have not included information on the different surgery options.

Capsule Endoscopy (Pillcam)

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What is a capsule endoscopy?

It is a small capsule that contains a very small camera which can take up to 4 images per second for 8 to 9hours. It is used to investigate the small bowel. The capsule endoscopy is used to help view if there is any suspicious bleeding occurring in the small bowel. It can also be used to track small bowel tumours and unknown causes of abdominal pain.

The capsule endoscopy is a very simple procedure which involves swallowing the small pill and travels through the digestive system whilst taking many pictures of the small bowel.

You will have 8 or 9 sensors placed on your abdomen, and during the day you will wear a small belt around your waist to hold it all in place. The pictures that are taken will then be transmitted from the pill to the sensors and recorded. There is no anaesthetic required, and you can drive a car and perform light duties at work.

What preparation is needed?

You can find the preparation instructions in http://segsydney.com.au/preparations/

What happens on the day of the procedure?

You arrive at the consulting rooms and the doctor will inform you in detail of the procedure and the associated risks. You will sign a consent form and the equipment will be placed on you and you will swallow the pill.

After you have swallowed the pill you cannot drink for 2 hours. Most foods will be ok to eat except for heavy and fatty foods after 4 hours.

You will have the harness on for approximately 8-9 hours and will need to return it back to the rooms.

What happens to the capsule?

The capsule will exit the body in a bowel movement and is small enough that you will not experience any discomfort when this happens.

 

Colonoscopy

colonoscopy

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What is a colonoscopy?

Colonoscopy is a procedure that enables your Doctor to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube (flexible fiberoptic colonoscope) that is about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

What preparation is required?

The colon must be completely clean for the procedure to be accurate and complete. Your Doctor and his/her staff will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing routine to be used. Preparation consists of one day of a special diet and one day of a clear liquids only diet and the consumption of 3 or 6 glasses of a special cleansing solution on the evening prior to the examination. Follow the instructions carefully. If you do not, the procedure may have to be cancelled and repeated later.

What can be expected during colonoscopy?

Colonoscopy is usually well tolerated and rarely causes much pain. The anaesthetist will give you a combination of sedating anaesthetic medications through a vein to help you relax and sleep during the test, and better tolerate any discomfort from the procedure. You will be lying on your left hand side during the procedure. Once asleep, the colonoscope is introduced into the anus and advanced slowly through the entire large intestine. As the colonoscope is slowly withdrawn the lining is again carefully examined. The procedure usually takes 15 to 30 minutes. In some cases, passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. your Doctor will decide if the limited examination is sufficient or if other examinations are necessary.

What if the colonoscopy shows something abnormal?

If your Doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

What are polyps and why are they removed?

Polyps are abnormal growths from the lining of the colon, which vary in size from 2-3mm to several cm. The majority of polyps are benign (non-cancerous); your Doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer, as more often than not colon cancer arises from large polyps.

How are polyps removed?

Small polyps (<5mm diameter) may be totally destroyed by biopsy and burning (“hot biopsy”), but larger polyps are removed by a technique called snare polypectomy. A wire loop (snare) is passed through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.

What happens after a colonoscopy?

After colonoscopy, your physician will explain the results to you. If you have been given medications during the procedure, someone must accompany you home from the procedure because of the sedation used during the examination. Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery.

You may have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly with passage of flatus (gas). Generally, you should be able to eat after leaving the endoscopy, but your Doctor may restrict your diet and activities, especially after polypectomy.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.

One possible complication is a perforation or tear through the bowel wall that could require surgery. Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may rarely cause a tender lump lasting for several weeks, but this will go away eventually. Applying hot packs or hot moist towels may help relieve discomfort.

Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever, chills, or rectal bleeding of more than one-half cup. Bleeding can occur several days after polypectomy.

Double Balloon Enteroscopy

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What is DBE?

DBE allows your doctor to examine the small bowel where other endoscopes cannot reach. Depending on the position of the abnormality your doctor will then decide which direction the procedure should enter the small bowel. If the abnormality is higher up the small bowel then an oral approach (antergrade) is preferred. If the problem is lower down the small bowel then progressing up from the colon is preferred.

Why is DBE done?

DBE has two main roles. Firstly, it can detect and treat lesions in the small bowel. In comparison to capsule endoscopy which can only “see” lesions, DBE can treat them. Some patients have a low suspicion for a small bowel lesion seen by capsule endoscopy or xray. To clarify if there really is a lesion we use DBE and this is a common reason to perform DBE.

In some cases, DBE cannot treat the lesion successfully and a tattoo is made to assist in finding the correct area if surgery is required.

Bleeding or anaemia is the most common reason to perform DBE. We call this type of situation OGIB (obscure GI bleeding). This can be a difficult area as many patients don’t have definite bleeding sites and even when treatment is performed by DBE, not all will stop bleeding. Overall, we estimate that up to 80% of patients will benefit from DBE but this may not last forever.

How should I prepare for DBE?

For antegrade or oral DBE fasting for a minimum of 8 hours is required. For the anal or retrograde approach a full bowel preparation like is used for colonoscopy is required.

Tell your doctor in advance of the procedure about all medications that you’re taking and about any allergies you have to medication. He or she will tell you whether or not you can continue to take your medication as usual before the DBE examination. In general, you can safely take aspirin and similar blood thinning medications before an DBE examination, but it’s always best to discuss their use with your doctor. Usually, essential medications can be taken on the procedure morning with only a small cup of water.

If you have an allergy to latex you should inform your doctor prior to your test. Patients with latex allergies often require special equipment and may not be able to have a DBE examination.

What can I expect during DBE?

For an DBE examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. You will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the DBE scope through your mouth, esophagus and stomach into the duodenum and small bowel. The instrument does not interfere with your ability to breathe. The actual examination generally takes up to 60 minutes. Most patients consider it only slightly uncomfortable. The retrograde approach is similar to colonoscopy where the colon is examined and then the scope is inserted into the small bowel where progress is then made up the small bowel. This can be difficult and overall success may be only 80-90% as difficult loops and angles make upstream progress too difficult.

What are the possible complications of DBE?

Although complications can occur, they are not common. The chances for any complication are less than 1%. The chances of a major complication are less than 0.5% or 1 in 200. For the oral approach you will have a sore throat for a day or more. Pain is unlikely and serious problems like pancreatitis or perforation will cause pain and should be reported to the doctor ASAP. In rare situations surgery may be required to repair a perforation. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; backwash of stomach contents into your lungs; infection; and complications from heart or lung diseases.

Endoscopic Retrograde Cholangiopancreatogram (ERCP)

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What is ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. If your doctor has recommended an ERCP, this information sheet will give you a basic understanding of the procedure – how it’s performed, how it can help, and what side effects you might experience. Please ask you doctor about anything you don’t understand.

During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays. Most patients require some therapy during ERCP such as stone removal or plastic stents (tube) insertions to unblock narrowings.

What can I expect during ERCP?

You should fast for at least six hours (and preferably overnight) before the procedure to make sure you have an empty stomach, which is necessary for the best examination. Your doctor will give you precise instructions about how to prepare.

You should talk to your doctor about medications you take regularly and any allergies you have to medications, or intravenous contrast material. Although an allergy doesn’t prevent you from having ERCP, it’s important to discuss it with your doctor prior to the procedure. Also, be sure to tell your doctor if you have any major diseases.

Your doctor might apply a local anaesthetic to your throat before giving you a sedative to make you more comfortable. Some patients also receive antibiotics before the procedure. You will lie on your abdomen on an X-ray table. Your doctor will pass the endoscope through your mouth, esophagus, stomach and into the duodenum. The instrument does not interfere with breathing, but you might feel a bloating sensation because of the air introduced through the instrument.

What are possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Complications or side-effects requiring hospitalization occur about 1 in 20 patients. Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. They are usually minor and resolve within 2-3 days. Complications can include pain, infections, pancreatitis (an inflammation or infection of the pancreas) and bleeding. It is rare to have more severe complications such as perforation however if any symptoms develop please inform the doctor to manage the problem immediately. Sometimes the procedure cannot be completed for technical reasons and may need an additional procedure.

What can I expect after ERCP?

If you have ERCP, you will be observed for complications until most of the effects of the medications have worn off. You might experience bloating or pass gas because of the air introduced during the examination. All patients should remain on a liquid diet until the day after the procedure and can resume normal diet if they are well.

Someone must accompany you home from the procedure because of the sedatives used during the examination. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day.

Endoscopic Ultrasound

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Understanding EUS (Endoscopic Ultrasound)

What is EUS?

EUS allows your doctor to examine the lining and the walls of your upper gut including the oesophagus, stomach and duodenum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gall bladder, bile duct and pancreas. Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth to the area to be examined. Your doctor then will turn on the ultrasound component to produce sound waves that create images of the digestive tract.

EUS provides your doctor more detailed pictures of your digestive tract anatomy. Your doctor can use EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. Or, if your doctor has ruled out certain conditions, EUS can confirm your diagnosis and give you a clean bill of health.

EUS is also used to evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS provides a detailed picture of the growth, which can help your doctor determine its nature and decide upon the best treatment. In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.

Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes between 15 to 45 minutes. Most patients are very comfortable with a few who consider it only slightly uncomfortable.

How should I prepare for EUS?

For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink, not even water, usually six hours before the examination. You will be advised when to start this fasting.

Tell your doctor in advance of the procedure about all medications that you’re taking and about any allergies you have to medication. He or she will tell you whether or not you can continue to take your medication as usual before the EUS examination. In general, you can safely take aspirin and similar blood thinning medications before an EUS examination, but it’s always best to discuss their use with your doctor. Usually, essential medications can be taken on the procedure morning with only a small cup of water.

If you have an allergy to latex you should inform your doctor prior to your test. Patients with latex allergies often require special equipment and may not be able to have an EUS examination.

What are the possible complications of EUS?

Although complications can occur, they are rare when doctors with specialized training and experience perform the EUS examination. Bleeding might occur at a biopsy site, but it’s usually minimal and rarely requires follow-up. You might have a sore throat for a day or more. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; backwash of stomach contents into your lungs; infection; and complications from heart or lung diseases. One major, but very rare, complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair.

FNA is generally very safe but in rare circumstances pain, bleeding or infection could occur after the biopsy is taken. Every precaution is taken to prevent these problems but they may still occur.

Gastric Balloon

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What is the Gastric Balloon?

The Gastric Balloon is a soft, expandable, silicone balloon shaped device that is placed inside the stomach via endoscopy and remains there for a six month period. It is filled with a saline solution, which, when full, sits in the upper part of the stomach, balloonreducing the capacity of the stomach. This creates a feeling of fullness and satiety and does not allow for overeating.

The balloon remains in the stomach for a six-month period, where it is the removed the same way is was placed, via endoscopy.

How Is the Gastric Balloon procedure performed?

The balloon is introduced into the stomach through the mouth via endoscopy, without the need for surgery. The physician inserts an endoscopic camera (gastroscope) into the stomach. If no abnormalities are observed, the physician proceeds with the placement of the balloon through the mouth and down the oesophagus into the stomach. Once the balloon is inside the stomach, it is filled with sterile saline through a small filling tube attached to the balloon. Once filled, the doctor removes the tube by gently pulling on the external end, leaving the balloon inside the stomach.

The procedure is performed at several private Day Surgeries and Private Hospitals throughout the Sydney region by a qualified specialist Gastroenterologist, in conjunction with an Anaesthetist and trained nursing staff

Placement of the balloon takes approximately 15-20 minutes, after which time you will be monitored by nursing staff in the recovery bay. As this is a “day-only” procedure, you can generally be escorted home within two hours after the balloon is inserted.

Patients may feel quite nauseous for the first few days after the procedure. You will have been given a prescription for various medications to help control these symptoms. Once home, it is recommended that you rest for the first three days.

How Much Weight can be lost with the Gastric Balloon?

Studies have shown that patients can lose 15-20 kilos or more, however, it is important to understand that the Gastric Balloon is an aid to weight loss and must be used in conjunction with diet, exercise and a behavioural modification program. The amount of weight one can lose depends on how closely individuals adhere to the programme and adopt long-term healthy lifestyle changes.

Our Lifestyle Team

We offer a twelve month programme.  Ongoing support is offered during this time, with individuals meeting regularly with our Lifestyle team, which consists of our Dietitian as well as our Fitness & Lifestyle Coordinator. They work with the patient to help tailor an individual programme, setting obtainable goals and working closely with each person to achieve maximum results.

 

Gastroscopy

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What is a gastroscopy?

Gastroscopy (also known as an upper GI endoscopy) is a procedure that enables a gastroenterologist to examine the lining of the upper part of your gastrointestinal tract, i.e. the oesophagus (swallowing tube), stomach and duodenum (first portion of the small intestine) using a thin flexible tube that has a camera lens and light source.

Why is a gastroscopy done?

Gastroscopy is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It is the best test for finding the cause of bleeding from the upper gastrointestinal tract. Gastroscopy is more accurate than x-ray films for detecting inflammation, ulcers, or tumours of the oesophagus, stomach and duodenum. Biopsies (small tissue samples) may be taken at the time of your gastroscopy.

Gastroscopy is also used to treat conditions present in the upper gastrointestinal tract. Many abnormalities can be treated directly with little or no discomfort. For example:

  • stretching narrowed areas
  • removing polyps
  • removing swallowed objects
  • treating upper gastrointestinal bleeding Safe and effective endoscopic control of bleeding has reduced the need for transfusions and surgery in many patients.

What are the possible complications of gastroscopy?

  • Endoscopy is generally safe. Complications can occur, but are rare when the test is performed by physicians with specialised training and experience in the procedure. Bleeding may occur from the biopsy site or where a polyp was removed. This is usually minimal and rarely requires blood transfusions or surgery.
  • Localised irritation of the vein where medication is injected may rarely cause a tender lump lasting for several weeks, that will subside eventually.
  • Reactions to the sedatives used and complications from heart or lung diseases are rare, but potential risks.
  • Aspiration: If a patient’s stomach is not completely empty at the time of the procedure, vomiting can be induced. If any of this vomit goes into the lungs there can be further problems with infection.
  • Major complications, for example perforation (a tear in the wall of the stomach) are very uncommon. It is important for you to recognise early signs of any possible complications. If you develop a fever after the test, have trouble swallowing, have increasing chest or abdominal pain, pass any black bowel motions, or have any other symptoms that concern you, please contact your doctor

What is the preparation required for a gastroscopy?

If you have a morning procedure: You must begin fasting from midnight the night before the test.

If you have an afternoon procedure: Have an early and light breakfast (eg cup of tea and toast) prior to 7am.

You may have your throat sprayed with a local anaesthetic before the test begins and will be given a sedating anaesthetic medication through a vein to make you asleep prior to beginning the test. The endoscope does not interfere with your breathing during the test. Most patients sleep through the whole precedure.

Heliprobe: Urea Breath Test for Helicobacter pylori

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What is Helicobacter pylori?HeliProbe

Helicobacter pylori is a bacterium which affects the lining of the stomach and is responsible for a large percentage of stomach and duodenal ulcers and is associated with stomach cancer and MALT lymphoma.

People are usually infected in childhood and the infection can persist for many years. Helicobacter pylori is thought to be spread through person to person contact and is regularly spread between family members.

If you are diagnosed to be infected with this bacteria, usually it can be eradicated easily.

How Does the HeliProbe Test Work?

The HeliProbe system is a ‘urea breath test’ which is a procedure used to identify Helicobacter pylori infections.

You will swallow a HeliCap capsule containing crystals of urea. The urea has been exposed to extremely low levels of radiation. (The radiation is very low, it is less than the amount a person would be naturally exposed to on a normal day).

If you are infected with Helicobacter pylori, the bacterium will consume some of the urea in a process which leads to minute amounts of radiation being breathed out by the patient as carbon dioxide. The HeliProbe analyser is designed to detect these minute levels of radiation, the presence of which indicates a Helicobacter pylori infection.

Is it Safe?

Yes. The HeliCap has no known or documented side effects.

Laparoscopic Adjustable Gastric Band

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The Laparoscopic Gastric Band is the most common surgical weight procedure performed in Australia through our weight loss Surgeons at Bondi Junction.

What is a Gastric Band?

The device is an inflatable silicongastric_bandinge ring that is placed and secured around the upper part of the stomach by keyhole surgery. This ring creates a smaller ‘pouch’ at the top of the stomach, which limits the amount of food that is consumed. This also slows the foods movement through the stomach, reducing and suppressing the appetite.

The inflatable silicone ring has a small port attached, that is placed in the abdomen. Fluid can then be inserted or removed to control the amount of food that can be consumed. These adjustments, ‘band-fills’ are performed regularly at our clinic, taking approximately 10 minutes.

Is it permanent?

It is designed to be placed permanently, however can be removed if needed.

Advantages and Disadvantages

Advantages:

  • Keyhole approach. Less scarring or wound problems Earlier return to work (1-2 weeks)
  • Adjustable : by filling port the outlet size can be reduced
  • Reversible: By removing fluid or the band.
  • No malabsorption
  • Lower risk

Disadvantages

  • Easy to cheat (if chocolates or sweets taken).
  •  Mechanical problems:
    • prolapse
    • pouch dilatation
    • food bolus obstruction
    • slippage of the stomach through the band erosion
    • infection of the band or port leak
    • Revision rate 5 -10%
  • An entree portion forever.

Optimal pouch capacity 30 mls

Weight loss expected?

Usual weight loss with the Lap Band is approximately  50-60% of excess weight lost in 2 yrs

Laparoscopic Gastric Bypass

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Laparoscopic Gastric Bypass is a weight loss procedure and offered by our weight loss surgeon at Bondi Junction.

What is a Gastric Bypass?

Gastric Bypass is the current “gold standard” weight control operation, and is the most frequently performed bariatric (obesity) procedure world wide (65% of operations). It is the operation to which all other procedures are compared, and it has the best, and best known long term results.

The operation is popular because:

  1. It produces massive and appropriate weight loss in most patients. Median weight loss at 12 months is 60-70% excess weight, with consequent loss (or cure) of complications of obesity such as diabetes, lipid abnormalities, sleep apnoea etc.
  2. The operation can be done at an acceptable mortality (0.5 – 0.01 %). Morbidity (significant post operative illness) is low and post operative side effects and nutritional deficiencies are only rarely severe. B 12 and Iron are a predictable problem as the stomach is by-passed. Calcium may also be required because of the duodenal bypass and reduced amounts of post operative food eaten.
  3. World wide there is >15 years of experience with the operation with weight loss maintenance of approximately 50% of excess weight. There is little variation in results from hospital to hospital and country to country.

How is it done?

The operation is truly a by-pass of the stomach. The stomach is by-passed so that food eaten goes into a small gastric  pouch and then into a loop of small bowel (the jejunum).

How does it work?

Weight is lost by the following 4 mechanisms:

  1. Satiety is induced by the small gastric pouch, and through the “switching off’ of the hormones that cause hunger. Most patients go many months before they have any recognisable hunger sensations.
  2. Over-eating is prevented by the small pouch. Too much food causes discomfort and vomiting. In some patients a ring can be put around the pouch to further prevent overeating (the Banded Bypass).
  3. The operation causes intolerance to sweets and high density carbohydrates (fatty, oily food) as the rapid presence of sugar or large volumes of carbohydrate in the small bowel leads to unpleasant symptoms called “dumping”.
  4. There is trivial malabsorption of fat as the food eaten is initially not mixed with bile and pancreatic juice. There is no protein or carbohydrate malabsorption.
  5. 85-90% of diabetics have their diabetes completely resolve, often before they leave hospital. The mechanism for this is not known but it may be due to bypass of the duodenum and pancreas.

What is Achieved by the Operation?

First and foremost the operation achieves weight loss. Significant weight loss will then  have an effect on the physical and psychological consequences of obesity. These effects however, are not as predictable as the weight loss.

The operation allows the average patient to lose 60 – 80% of their excess weight in 12-18 months. After this most patients re-gain some weight. This weight gain occurs for a variety of reasons such as poor compliance with diet and exercise and physiological       adaptation of the body to the operation. At 5, 10 and 15 years the weight loss stabilises at approximately 50-70% of excess weight. Weight regain may be preventable through dietary compliance.

Approximately 5-15% of patients will not lose adequate weight with the operation 9ie>50% excess weight). These patients cannot be reliably identified pre-operation but weight loss failure very uncommon apart from in the super obese (BMI >50) who may still lose significant weight. More “aggressive” surgery is possibly but leads to severe nutritional problems in some patients. Re-operations for “failure” can sometimes be difficult and may have variable success.

For most patients the operation will result in the average patient losing 60-80% of excess weight which means they will still be a little overweight but will have lost enough weight to reduce their obesity related risk profile to that approximating the normal population.

What is Life Like With a Gastric Bypass?

Patients get used to eating three small meals a day. Usually 25% of previous serves. When going to a restaurant they can eat an entree sized meal and feel satisfied (while they watch their friends over-eat with an entree, main and dessert).

Sweets and fatty foods are poorly tolerated and best avoided. These foods will cause “dumping” due to the rapid presence of high osmolarity fluid in the small bowel. Symptoms are nausea, dizziness, palpitations, sweating and abdominal discomfort. To  avoid dumping, high sugar and fat content foods should be avoided and food should be eaten dry and not mixed with fluids. Otherwise apart from a commitment to “healthy eating” no other foods are specifically banned. Snacking especially with junk foods is to be avoided as it will greatly negate the effects of the surgery.

Multivitamins and B 12 peed to be taken by all. Menstruating females need iron supplements, post-menopausal women will need calcium (as well as some premenopausal women and some men). These requirements are life long.

Laparoscopic Gastric Plication

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Gastric Plication is a weight loss procedure performed by our weight loss surgeons at Bondi Junction.

What is Gastric Plication?

Gastric Plication is performed as a laparoscopic procedure. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscopic) and long instruments that are placed through these small incisions.

Laparoscopic Gastric Plication involves sewing one or more large folds in your stomach. During the Laparoscopic Gastric Plication the stomach volume is reduced to about 70% which makes the stomach able to hold less and may help you eat less. There is no cutting, stapling or removal of the stomach or intestines during the Gastric Plication. The Gastric Plication may potentially be reversed or converted to another procedure if needed.

The Gastric Plication procedure is minimally invasive and takes approximately one to two hours to complete. Most patients stay in hospital for at least two days after the procedure.

How Does Gastric Plication Cause Weight Loss?

Gastric Plication is a restrictive procedure. It greatly reduces the size of your stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass your intestines. After eating a small amount of food, you will feel very full very quickly and continue to feel full for several hours. Gastric Plication may also cause a decrease in appetite.

What Are The Risks of Laparoscopic Gastric Plication?

There are risks that are common to any laparoscopic procedure, such as bleeding, infection or injury to other organs or the need to convert to an open procedure. There is also a small risk of a leak from the suture line used to imbricate/plicate (fold) the stomach. These problems are rare and major complications occur less than 1% of the time.

What are the Benefits of Laparoscopic Gastric Plication?

Depending on your pre-operative weight, patients can expect to lose between 40% to 70% of your excess body weight in the first year after surgery. Many obesity related comorbidities improve or resolve after bariatric surgery. Diabetes, hypertension, obstructive sleep apnoea and abnormal cholesterol levels are improved in more than 75% of patients undergoing a bariatric procedure. Though long term studies are not yet available, the weight loss that occurs after Gastric Plication results in significant improvement in these medical conditions in the first year after surgery.

Is Laparoscopic Gastric Plication a Good Choice for Me?

Our surgeons will talk to you about Gastric Plication as an option if you have a BMI over 27 with one or more significant co-morbidities which are generally expected to be improved, reversed or resolved by weight loss.

We perform the Gastric Plication as a laparoscopic procedure. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (Iaparoscopic) and long instruments that are placed through these small incisions.

Laparoscopic Gastric Plication involves sewing one or more large folds in your stomach. During the Laparoscopic Gastric Plication the stomach volume is reduced to about 70% which makes the stomach able to hold less and may help you eat less. There is no cutting, stapling or removal of the stomach or intestines during the Gastric Plication. The Gastric Plication may potentially be reversed or converted to another procedure if needed.

The Gastric Plication procedure is minimally invasive and takes approximately one to two hours to complete. Most patients stay in hospital for at least two days after the procedure.

Sleeve Gastrectomy

sleeve_gastrectomy

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This is another weight loss procedure performed by our weight loss surgeons at Bondi Junction.

What is a Sleeve Gastrectomy?

This is a relatively new approach, where the outer part of the stomach is removed, turning the upper part into a tube like section. As only a small portion is left at the base of the stomach, eating capacity and food absorption is limited.

The residual stomach capacity is about 200mls so a generous entrée should be possible.

Who it is recommended for?

Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60)  because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.

It  might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don’t want a full bypass.

Is it permanent?

This procedure is not reversible and is sometimes used as the first stage prior to a Laparoscopic Gastric Bypass.

Weight loss outcome?

The weight loss seems to be a little better and more rapid than the lap band (60-70% EWL) over two years but it is not adjustable.