FREQUENTLY ASKED QUESTIONS

WHICH WEIGHT LOSS SURGERY IS BEST FOR ME?

There is no ‘one size fits all’ operation when considering metabolic surgery. Each surgery has its advantages and disadvantages, as well as slightly different risk profiles. What is ‘best’ for you, may not be best for your neighbour. At your initial consultation we will discuss your individual circumstances – (e.g. your BMI, goals and medical history) as well as the pro’s and con’s of the different surgeries. I have outlined a few points below addressing some pertinent considerations.

It is important to remember that surgery (irrespective of which one) is an aid to help you achieve your goals. Metabolic surgery offers powerful neuro-hormonal effects to suppress your appetite, alter your food absorption and metabolism as well as significantly reduce your stomach size. Surgery will not, however, force you to make the appropriate food and lifestyle choices. That decision is up to you. Our program incorporates dietitian and psychology support to help you understand and adjust to the changes you should be implementing.

Things to consider:

Do I have gastro-oesophageal reflux disease?

Following a sleeve gastrectomy (LSG) the stomach has a higher internal pressure compared to a bypassed stomach. This can promote gastro-oesophageal reflux disease. It is preferable to avoid a sleeve gastrectomy if you have oesophagitis or Barrett’s oesophagus. On the other hand the Roux-en-Y Gastric Bypass (RYGB) is the ‘gold standard’ anti-reflux operation. The One Anastomosis Gastric Bypass (OAGB) is also an anti-reflux operation.

Will I develop an internal hernia?

Internal hernias can develop following a gastric bypass. This risk is lifelong. The highest risk is associated with the RYGB, although case reports of internal hernias following a OAGB have been reported. Small bowel can become trapped in an internal hernia – a potentially life threatening situation. Warning signs include crampy abdominal pain and if you experience this you should seek medical help immediately.

Am I a smoker?

Smokers are at an increased risk of developing gastritis or gastric/anastomotic ulcers following a RYGB or OAGB. It is strongly advised that you cease smoking after these operations.

Is my smaller stomach at risk of developing an ulcer?

Yes. Ulcers can develop in stomachs for a number of reasons. After metabolic surgery this risk is much higher than a ‘normal’ stomach. Stomach or anastomotic ulcers can perforate – a potentially life threatening condition. After surgery you must avoid medications that can cause ulcers – eg NSAIDs (neurofen/ibruprofen) and Alendronate. Other medications which can damage the stomach include Aspirin and Plavix.

Smoking and alcohol can also damage your stomach.

Does my stomach need endoscopic surveillance?

Following a gastric bypass food is diverted away from the ‘remnant’ stomach. As a result the ‘remnant’ stomach, duodenum and distal bile duct is unable to be accessed by endoscopy. If you require regular endoscopic surveillance (eg for a strong family history of gastric cancer) then a gastric bypass should be avoided.

Can I still have surgery if I have recently had my COVID-19 vaccination?

An elective Surgery procedure is not a contraindication to routine COVID vaccination. Our Practice recommends that the date of Surgery is separated from the date of vaccination by at least ten days. This applies to both the Pfizer or the AstraZeneca vaccines.

Allowing this period of time between doses of the vaccine and surgery will reduce the chance that adverse events following the vaccination, such as fever, are attributed as a complication of surgery, such as a surgical wound infection.

If you are unwell following the COVID vaccination your elective surgery should be delayed until you have recovered fully.

If you are unwell following your elective surgery you may wish to consider postponing yourCOVID vaccination until you have recovered fully.

Do I have to adjust the dose of my normal medications?

Maybe! The changes in the stomach anatomy and physiology after surgery alters how medications are absorbed. Great care must be taken with medication dosing. We strongly recommend you discuss your normal medication dosing with your prescribing doctor. Medications where dose levels are monitored (eg: Warfarin, Lithium and Thyroxine) may need to be checked more frequently.

Am I planning pregnancy in the future?

Our Practice recommends allowing for a minimum of 18 months after your surgery to fall pregnant. The American College of Obstetricians and Gynaecologists advise: ‘…a women should wait 12-24 months before conceiving so that the foetus is not affected by rapid maternal weight loss, and so that the patient can achieve her weight loss goals.’

Please note that following metabolic surgery the absorption and effectiveness of oral medications can change. After surgery the oral contraceptive pill may not be as effective and it is strongly recommended that non-oral contraceptive methods are used.

Are there any situations when I should not undergo a gastric bypass?

In general, if you suffer from Crohn’s disease, faecal incontinence or significant osteoporosis then a gastric bypass would not be recommended. In these circumstances, a sleeve gastrectomy would be the preferable option instead.

Where will my operation be performed?

All operations are performed at the Sunshine Coast University Private Hospital (SCUPH). SCUPH is a Level 6 accredited hospital with a 6 bed Intensive Care Unit.
All ward beds are individual private rooms with ensuites. The SCUPH team – ranging from the surgical scrub nurses to the recovery and ward staff – are experienced with bariatric surgery and patients.

Will I see Dr Askew after surgery?

Dr Askew is a thorough and meticulous surgeon – both during surgery and also in your aftercare. Dr Askew attends the hospital daily and will be personally keeping a close eye on your recovery.