A Gastric bypass could be the start of your new life

How does a Gastric bypass work?

Your stomach is amazing. It can expand it’s size to about 1 litre when you eat and reduce in size when you are not eating. Over time, the stomach stretches and can accommodate more and more food. If we don’t keep up with using more calories than we have taken in, the result is that we store fat, the result is that we become fat and the quality of life begins to reduce.

A Gastric Bypass is a procedure where the stomach is divided into a small upper pouch and large lower pouch and attached to the small intestine.

Bypass in detail

The malabsorptive element in gastric bypass is achieved by surgically dividing the small intestine in a certain area.

Once divided, the lower part of the intestine (jejunum) is pulled up to directly connect to the small pouch or “new” stomach. The other end of this divided intestine is surgically sewn back at a specific point further down the small intestine. The shape of the intestine now somewhat resembles a “Y.” As a result, when food is eaten, it enters the “new” stomach, then travels into the jejunum, first “bypassing” the upper part of the intestine. The effect of bypassing the upper portion of the intestine decreases the amount of calories and nutrients that are absorbed into the body.

The procedure

  • The stomach is divided into two compartments – the upper part is the new stomach called a pouch and is about the size of a golf ball. No part of the stomach is removed.
  • An outlet is created in the pouch called a Stoma, the opening is about the size of an M&M. (1.2 cm in diametre)
  • The upper intenstine is then divided and joined to the stoma. Food bypasses the lower part of the stomach and a very small part of the small intestine

 

Your questions answered

  • What sort of results can I expect?

    Typically a person should expect to lose up to 70% on average of their excess body weight after 18 months.

    • Within 1 month you should lose on average 2-7kg per week
    • At 3 months you should expect to lose 29% of your excess body weight
    • At 6 months you should expect to lose 50% of your excess body weight
    • At 12 months you should expect to lose 65% of your excess body weight
    • At the 18 month mark, weight loss peaks if you do nothing else to assist (only relying on the surgery) at around 70% of your excess body weight.
  • Will gastric surgery work for me?

    There are prospective patients who know others who have had the surgery and have a fear that it won’t work for them, that “I will be the one it won’t work for”.   This is simply not the case.  Having a gastric bypass will inevitably lead to weight loss.  Why? There are 4 main reasons.

    1. Hunger Monster has gone:  The surgeon will divide the stomach into two sections. A small pouch and a larger section of the stomach. The section that the hunger hormone Ghrelin is produced is bypassed.  See the Gastric Sleeve page for more information on Leptin and Ghrelin.

    2. The stomach is reduced in size: The new stomach pouch is the size of a golf ball as it has been reduced by 90-95%.  Think of it as going from a Super Size soft drink to a Piccolo.  As the mind and body battle over this new status quo, you will find that you simply cannot eat the volumes you once did.

    3. You feel fuller, longer:  Because of the size of the stomach pouch, it fills quickly and the response is you feel full. This is hard to imagine, but imagine eating 3 tablespoons of food and feeling like you’ve just been stuffed full of your favourite buffet?  This is how it is once you’ve had a bypass.

    4. Food does not follow the same path: Food normally travels from the stomach to the small intestine where most of the calories and nutrients are absorbed.  The remainder is then passed to the large intestine and eventually to the colon and excreted.  Because a majority of the small intestine and the rest of the stomach is bypassed fewer calories can be absorbed.

    Dieting is fighting a losing battle as your body sabotages your efforts

    Over time scientists have discovered that an individual who goes on a diet has increased levels of the hunger hormone Ghrelin.  This makes the dieter hungry, even after eating.  The levels of Ghrelin only subside once the diet is ceased.

    How is a gastric bypass different to a diet?

    A diet means you have to make a decision to restrict food for a temporary period of time.  Then, the fight begins.  Even though weight loss will be good for your body, it’s protective systems see the fat disappearing and fights back aggressively to get you to kick the diet.  The fatter you are, the longer this battle goes for.  The moment you ‘stop’ your diet, your body has won.   How many readers have been in a situation where they have lost a good amount of weight and taken a break?  The weight seems to pile back on 10 times faster than you took it off!

    As we have mentioned, removing the hunger hormone means the signal from the Apidose tissue still makes it to the brain, but the signal from the stomach doesn’t get produced.  This means if you feel hungry at all after a gastric sleeve it is because of the small amounts of Ghrelin produced by the brain and other organs. Bottom line, the body is tricked.  The whole hormonal response is still not completely understood, but what is known after 15-20 years of bypasses, is it works.

    The gastric bypass helps you limit the number of calories you can eat whilst stop the absorption of most of the minerals and calories from food.   The smaller stomach pouch means you are fuller quicker (satisfied feeling) on the food you do eat with very little hunger effect.

  • What will I be eating before and after gastric surgery?

    What will I be eating before?

    Most Australian based bariatric surgeons prescribe one month prior you will start on a liquid VLCD (very-low-calorie diet) using a product called Optifast. These are liquid meal replacements, and let’s face it, aren’t fun at all!  This is due to the fact the surgery requires access around the liver and if it is large (fatty liver) it makes the surgery more difficult. Being on the diet one-month prior will in most cases reduce the size of the liver making it easier to operate.  Generally in Australia, if you don’t have a fatty liver, you will still have to go on this diet as standard.

    For your Malaysian procedure, unless you have been diagnosed with a fatty liver, VLCD is not required. In fact, you are encouraged to enjoy your food right up to 8 hours prior to surgery.  If you have been diagnosed with a fatty liver, you will let us know in the Eligibility Assessment and the surgeon will make a recommendation.

    What will I be eating after?

    Again, if you were being operated on in Australia you would more than likely be on a VLCD shake regime for a month after surgery.  However with A New Life organised procedure in Malaysia, from the first day after surgery you will be eating real food.  You may not feel like eating straight away, but eating is the best way to get your body back on track and fast track recovery.  Our surgeon has used this method successfully for hundreds of patients and because of it, patients are back to work quicker and returned to their normal lives.

    • Day 1-2:  Soup broth and protein drink, clear liquids, black coffee or tea. (no solid pieces of food)
    • Day 3-5: Thick liquid: Milk, soy, cream soups, yoghurt (curd). Soft foods including tofu, scrambled/poached/steamed eggs, soft cheese such as Brei and soft jelly.  Our local ground agent knows where to buy the best Australian food!
    • Day 6-10: Semi-solids: fish, prawns, crab, eggs, rice porridge, overcooked pasta (al forno), overcooked noodles,
      ripe papaya (pawpaw) and watermelon.
    • Day 11-14: Regular Solids: minced chicken, beef, chicken, rice, lentils, dhal, apple, guava and honeydew
    • Day 15 onwards: Regular diet can be tried in stages. Fibrous foods such as green leafy vegetables, mushrooms and oats should be avoided until a month after the surgery.

    You will be provided with a schedule post hospital stay and part of our service is taking you shopping in Malaysia after surgery to pick up your food for up to day 10 of your stay in KL and your trip home if you wished.  Dietary support is ongoing with access to the dietitian.

  • How much pain should I expect after a gastric bypass?

    Most of the pain associated with the procedure is in the first few days after surgery.  Although this is minimally invasive surgery (keyhole) you should still expect some pain and discomfort.

    Of course, each individuals pain threshold is different, but most of our clients’ report (using the scale below)

    • Day 1 scale: 3-6 –  No pain to very intense (controlled by drip pain relief medications)
    • Day 2 scale: 3-5  – (pain relief is still administered by drip or orally)
    • Day 3 scale: 4-6  – Peak of pain/discomfort.
    • Day 4 scale 1-3 – Better every day
    • Day 5 scale: 1 – Nearly back to normal
    • Day 6 scale: 0-1 – Very little pain if any

    Pain relief:

    The hospital staff under the direction of the surgeon will provide pain relief when required.  Normal practice is there are standard intervals for pain relief to ensure you don’t risk adverse reactions.  Nurses will generally be the staff who administer the pain relief plan provided by the surgeon.  During his regular post-surgery check-ins, he will always ask your pain level. Dosages and pain relief types will be adjusted accordingly and the surgeon is only a page away for the nursing staff for any changes to the pain relief regime.  In this modern age, there is no need to have excessive pain with such great relief available.  You just need to ask.

    After hospital discharge, you will be provided with strong oral pain relief, but after 4-5 days the worst is over and the discomfort is manageable with Panadol.

    Alternative pain relief

    Clients report that a hot water bottle is extremely helpful in the first 3-4 days and means less pain medication was required.   We would recommend that you purchase or take with you a hot/cold pack as others report that the cold pack is also helpful after a few more days.

  • Scarring

    There are five incisions in the abdomen the surgeon works through with the surgical tools.  The wounds are so small and fine that they are glued and do not even require stitches.  Some bruising may occur around some of the wounds depending on how thin your blood is.  Below is a patient immediate post-op showing the dressings and where the incisions are made, and 8 days post op. As you can see, if at all, there will be finest of scars. Looking after your surgical wounds post op is important.  Follow the surgeons and medical staff advice.

     

     

  • Recovery time

    Generally, full recovery from this surgery is 6 weeks.  If you were fit and active prior to surgery, we encourage you to slowly resume your normal activity, but listen to your body and allow it the fullest time to heal as you can allow. (work/personal circumstances). Each person is different and there is no one size fits all when it comes to recovery.

    As a guide only:

    • Most people report they are up and walking around 6 hours after surgery. (The hardest part is using your core to get yourself out of bed!)
    • Most clients report they are walking (as walking is awesome) exercise from day 3
    • Most clients report they are able to bend and lift carefully within 2 weeks
    • Normal activity (like you were before) absolute longest time is 6 weeks from surgery.

    REMEMBER:  This is a marathon, not a sprint.  Recovering and allowing your body to heal is important.   Racing off to the gym when you are trying to get used to a new food regimen may do more harm than good.  Speak to the surgeon about your normal activity prior and during your post-surgery consultation and follow the directions!

  • How much time will I need off work after gastric surgery?

    If you work a physically demanding job, the normal time to a full recovery is 4-6 weeks.  If your job is not so demanding, that is; you may sit in an office chair or behind a counter, you may be ready to go back after 2-3 weeks.  Let us know if you require a medical certificate, as this can be provided by the surgeon. You can also get your GP to provide you a medical certificate for the time you require off work.

    Please note:  A New Life cannot provide you with a medical certificate, nor can we speak your employer on your behalf, however, the surgeon in Malaysia can provide you a certificate.

  • Will this affect me falling pregant or breastfeeding?

    Obesity can be a roadblock to having children.  Most doctors will tell you that losing weight will increase your chances of falling pregnant. There is no link between Gastric bypass surgery and failures to fall pregnant.  If you are trying for children, we encourage you to discuss with your local GP before signing up for gastric surgery as they will provide medical advice around the ideal time before you should start trying to fall pregnant.

    Will this surgery affect breastfeeding?

    Women that are still breastfeeding can have surgery.  There are certain medicines that may be given to you that cross into the breast milk and others do not.  You need to advise us when completing the Eligibility Assessment and then consult with the surgeon and the anesthesiologist prior to surgery.  Another option is to pump and freeze some of the milk before your surgery and use that stored milk instead until it is safe to breastfeed again.  Consult with your local GP or lactation consultant (or both) for qualified advice.

  • Cost

    Gastric Sleeve surgery in Australia can cost up to $32,000.  We have found that depending on where you are in Australia, the price varies greatly.  This can be due to the surgeon’s fees, the hospital fees or a combination of both.  In Malaysia, the cost to have the surgery is greatly reduced due to the Australian Dollar buying power in Asia, and the fact the hospital system is cheaper in Malaysia.

    With private health: If you are considering Australia to do the surgery and you have private health cover, you are probably looking at $12,000 out of pocket. (estimate).  The average cost of top private health cover per year is between $2,000 – $3,000.

    Without private health: If you do not have private health (top cover) you have to find a surgeon who is willing to take on your case (as most don’t operate on noninsured patients), then you are looking at between $25,000-$38,000 all in, including pretesting.

    In Malaysia: Including economy flights, accommodation, testing, surgery, hospital, ground customer service care, post operation food shopping, medications, dietician consult and access, and a contingency, the approximate cost is a maximum of $14,000 AUD*.

    Hidden or other costs not part of the actual surgery

    In Australia, you have a lot of pre-testing to be completed that can add to the cost.

    • Blood tests
    • Endoscopy
    • Ultra-sound
    • Psychologist
    • Sleep tests
    • Dietitian
    • VLCD (Optifast) meal replacement for 2 months

    Some of these can be claimed on Medicare, others cannot.  In Malaysia, the only two tests required as a minimum for an uncomplicated surgery are the blood test and the ultrasound. These can be done in Australia before you leave and claimed on Medicare.

    *based on current conversion rates from AUD to MYR

The only regrets I have after having the gastric sleeve is that I procrastinated for over 2 years before making the decision. I spent hundreds of dollars a pay on junk food and I was balking at a holiday and surgery that would change my life. I realy appreciated the team at A New Life for continuing to be patient with me. 13 months and 65kg down and I can’t be happier.

Lisa - Townsville

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