My blog posts are often about the running of the hospital and the staff we have providing care and attention to our patients. A crucial part of this team is our doctors. In this new series on the blog – Date with a Doctor – I’ll be chatting with doctors and surgeons from different specialties about what they do, common questions they are asked and what’s new within their specialty.
To start the series off I spoke with Mr Michal Hii, Oesophago-Gastric and Bariatric Surgeon. Mr. Hii has performed gastric bypass, sleeve gastrectomy and gastric banding for many patients. He also covers other special procedures in particular situations when patients are not suitable for the above operations. Mr Hii is able to perform all of these surgeries with the “keyhole” technique, and patients benefit greatly from this compared to the traditional “open” surgeries.
I asked Michael if he would be happy to answer some questions for me:
Type 2 diabetes is the fastest growing chronic condition in Australia, with 280 Australian’s developing diabetes every day. For some patients, surgery can assist in managing diabetes. Can you tell me more about what this surgery is?
Metabolic surgery can be an effective treatment option for some patients with diabetes.
In appropriate circumstances, both the sleeve gastrectomy and the gastric bypass have been shown to be very powerful tools for both weight loss and better sugar control. This means, in appropriate patients, some are able to reduce anti-diabetic medication and some able to cease these altogether. Sugar control can become a relatively easy thing.
This is achieved by the fact that these operations have strong hormonal effects (can ‘reset’ some of the gut hormones) and that they result in dramatic weight loss.
Recently a large and very reputable trial was run in the United States (the STAMPEDE trial) where patients were randomly allocated to standard therapy or surgical therapy. This trial confirmed dramatic improvement in diabetic control in patients in the surgical arm.
Of course, not all patients are suitable for surgery and specific advice must be tailored to the needs of the individual, but there is no doubt that surgery is becoming an increasingly popular option for management of this increasingly common and severe disease.
Bariatric surgery has changed a lot over the last decade, what can a patient expect in terms or days required in hospital or time it will take to recover from the surgery?
Bariatric surgery is now almost exclusively performed via the keyhole surgery or laparoscopic technique. This has resulted in a dramatic reduction in the amount of discomfort patients experience during early recovery and consequently the length of the postoperative hospital stay.
Most patients would expect to be in hospital for three nights and usually take about 2 weeks off work. For the first month after surgery, patients will slowly make the transition towards a normal diet but most patients don’t find this to be particularly troublesome.
Patients will experience really dramatic weight loss, particularly in the first 3 – 6 months. During this period, most patients find that they can’t eat a great deal of food and importantly, there are not a lot of hunger cravings, making this a relatively simple process. Of course, surgery is not a ‘fix-all’ solution and it is really important that patients engage in lifestyle and behavioural changes in order to ensure that this weight loss is long lasting.
Some people believe that surgery should only be considered as a last resort in managing their health? Is this correct, at what stage should a patient consider asking more about surgical help for their overall health?
Surgery has become an important part of the treatment pathway for patients with obesity and diabetes. Of course, surgery is not for everyone and specific advice should first be sought from a patients GP and then, if necessary, their treating surgeon. In general, patients who have a BMI of more than 30 or 35 with diabetes would be considered for surgery on a case by case basis.
It is usually not advisable to wait until things have reached a “last resort” stage. This is like waiting until your wheels fall off before you get your car serviced. There is a window (not too early, not too late) during which treatment will be safe, and have the best chance of dramatic weight loss and improvement of conditions like diabetes. Using surgery as a last resort simply means that many otherwise curable conditions may be too far gone to resolve.
There is a multitude of information readily available on the internet for patients considering bariatric surgery – is this a good place to start when looking for more information?
The Obesity Surgical Society of Australia and New Zealand (OSSANZ) has a great deal of information available on their website. Our practice provides further information on our website www.melbweightloss.com.au
There are also numerous patient generated resources and chat rooms where people share their experiences and a great deal of information. This can be useful if patients are looking for a client centred perspective. With that being said, the ultimate source of information would of course be your local doctor or treating surgeon.
A big thank you to Michael for being the first in my new blog series, I am looking forward to the conversations and discussions I will have with doctors to learn more about how they provide exceptional medical care to patients at St Vincent’s Private.