Candidate for Weight Loss Surgery
The decision to undergo weight loss surgery is one of the biggest decisions you will ever make in your life, it should not be taken lightly. Weight loss surgery is generally considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight. If you have not tried a formal, doctor-supervised dietary regimen, you should join an out-patient weight loss program, or consult with a registered dietitian, or discuss using medications to help you lose weight with your doctor. If these approaches have failed, then weight loss surgery may be an option for you. Before making an appointment to see Mr Steven Karametos who is an experienced weight loss surgeons in Melbourne, you should discuss your weight loss options with your GP.
Gastric Band and Gastric Band Removal
In this operation, an adjustable silicone tube is placed around the "neck" of the stomach. When inflated, this tube constricts around the stomach and restricts the amount of food ingested. It is the simplest bariatric operation. The band is adjusted by accessing a device implanted underneath the skin of the abdomen to "inflate" or "deflate" the stomach.
How Does Sleeve Gastrectomy Surgery Work?
Laparoscopic Sleeve Gastrectomy also known as laparoscopic gastric sleeve surgery or simply a 'sleeve' is a procedure in which a portion of the stomach is surgically removed. The procedure is typically performed laparoscopically and is an irreversible procedure. The stomach size can be reduced to as little as 15% of the original size. As a result of this surgery, a person feels fuller upon eating a relatively small amount, body metabolism is altered and the craving for food is reduced.
In this operation, the stomach is cut into a long, thin tube, or a "sleeve." This operation acts mainly by restricting the amount of calories ingested. In addition, since a large portion of the stomach is removed, it alters the expression of hormones in the gastrointestinal tract, leading to an earlier feeling of fullness. Hunger is therefore more easily satisfied, making it more manageable to eat small portions of healthy food long term post surgery. Your new sleeve shaped stomach empties more quickly than your previous stomach did, meaning food and fluid passes more quickly into your intestine. This triggers more hormonal changes that again, help you feel more satisfied.
However, weight loss surgery is not a miracle; rather, it is a powerful tool to help you lose weight. In order to achieve the best results, one must also participate in regular exercise. Surgery will help to restrict the amount of calories that one takes in, but it has no effect on the number of calories burned. Successful weight loss surgery requires a lifelong commitment to exercise and fitness to keep the weight off. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team.
Overall, the gastric sleeve surgery has proven to be a highly effective and sustainable weight loss surgery. Mr Steven Karametos regularly performs Gastric Sleeve Surgery with excellent long term results. Please call our Melbourne office to book an appointment at one of our consulting locations.
In this operation, the stomach is cut into a long, thin tube, or a "sleeve." This operation acts mainly by restricting the amount of calories ingested. In addition, since a large portion of the stomach is removed, it alters the expression of hormones in the gastrointestinal tract, leading to an earlier feeling of fullness. Hunger is therefore more easily satisfied, making it more manageable to eat small portions of healthy food long term post surgery. Your new sleeve shaped stomach empties more quickly than your previous stomach did, meaning food and fluid passes more quickly into your intestine. This triggers more hormonal changes that again, help you feel more satisfied.
However, weight loss surgery is not a miracle; rather, it is a powerful tool to help you lose weight. In order to achieve the best results, one must also participate in regular exercise. Surgery will help to restrict the amount of calories that one takes in, but it has no effect on the number of calories burned. Successful weight loss surgery requires a lifelong commitment to exercise and fitness to keep the weight off. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team.
Overall, the gastric sleeve surgery has proven to be a highly effective and sustainable weight loss surgery. Mr Steven Karametos regularly performs Gastric Sleeve Surgery with excellent long term results. Please call our Melbourne office to book an appointment at one of our consulting locations.
Pros and Cons Of The Sleeve Gastrectomy Surgery
Advantages: Gastric sleeve surgery has a lower complication rate and faster recovery than gastric bypass. Patients can lose weight similar to gastric bypass surgery, over a significantly shorter time. A section of your stomach is removed which produces the hunger hormone - Ghrelin.
Another benefit of this surgery is that your stomach will continue to function normally. As a result, you can still eat most of your favourite foods with no worries about 'dumping syndrome', which is characterised by abdominal discomfort and other related symptoms. also, you won't have any foreign bodies implanted in you, as is the case with lap band surgery.
Disadvantages: The world's first sleeve gastrectomy was performed in 1988, therefore it is considered a relatively new operation and therefore long-term data is not available. Because a long tube is created with a lot of resistance, it does severely limit the amount of food that a patient can eat. While the sleeve gastrectomy is generally very well tolerated, it does have higher complication rates than the adjustable gastric banding procedure, due to the risk of leaks or bleeding from the staple lines.
The gastric sleeve procedure is also irreversible, the benefits need to outweigh the risks for you to undergo the surgery. We select our patients carefully by a strict set of cretiria. Mr Karametos will go over these with you and you may ask any questions you might have so that you can feel confident about making an informed decision.
Another benefit of this surgery is that your stomach will continue to function normally. As a result, you can still eat most of your favourite foods with no worries about 'dumping syndrome', which is characterised by abdominal discomfort and other related symptoms. also, you won't have any foreign bodies implanted in you, as is the case with lap band surgery.
Disadvantages: The world's first sleeve gastrectomy was performed in 1988, therefore it is considered a relatively new operation and therefore long-term data is not available. Because a long tube is created with a lot of resistance, it does severely limit the amount of food that a patient can eat. While the sleeve gastrectomy is generally very well tolerated, it does have higher complication rates than the adjustable gastric banding procedure, due to the risk of leaks or bleeding from the staple lines.
The gastric sleeve procedure is also irreversible, the benefits need to outweigh the risks for you to undergo the surgery. We select our patients carefully by a strict set of cretiria. Mr Karametos will go over these with you and you may ask any questions you might have so that you can feel confident about making an informed decision.
The Sleeve Gastrectomy Journey For Patients
We understand the frustration and struggles our weight loss patients have gone through in life. Losing weight for the obese population is not as simple as “eating less and exercising more”. As an experienced bariatric surgeon, Mr. Steven Karametos and his team are well aware of the biological, metabolic, psychological, and social barriers to losing weight and maintaining the results.
Preparing for Sleeve Gastrectomy:
The Day of Surgery:
The gastric sleeve surgery is performed in the hospital under general anaesthesia and the surgery usually takes around an hour. Mr. Steven Karametos utilises the laparoscopic approach, which is by making several small incisions and using small instruments and a camera to guide the surgery. There will also be an anaesthetist and assistant surgeon working alongside Mr. Karametos. Generally, they would introduce themselves and speak to you briefly while you are in the waiting bay before being put into the trolley for theatre transport.
Recovery from Sleeve Gastrectomy:
There will be pain and swelling associated with creating the new, smaller stomach. You will need to take pain medication as instructed, and follow a recovery diet for the first 4-6 weeks. Personalised meal plans will be discussed upon your consultation with our experienced bariatric dietitian. Another common type of discomfort is the shoulder tip pain, which can happen after a laparoscopic surgery. Contributing factors include the effect of gas used to create space in the stomach cavity during surgery; irritation to the diaphragm or even movement of the shoulder during surgery.
Preparing for Sleeve Gastrectomy:
- Initial Consultation with Mr. Steven Karametos. We allow for 20 minutes for initial consultation, which is usually ample time for the surgeon to assess your general health, discuss your concerns, and recommend 'next step' treatment plans. Please note not all patients are suitable candidates for weight loss surgery.
- Meet with our experienced bariatric dietitian Margaret who is genuinely passionate about helping people along their weight loss journey. She will discuss the lifestyle changes you will need to make before and after surgery.
- Book the surgery date. Given you have made the informed decision and received the clear go-ahead from your doctors.
- Undergo pre-operative evaluations, blood tests, and diet.
The Day of Surgery:
The gastric sleeve surgery is performed in the hospital under general anaesthesia and the surgery usually takes around an hour. Mr. Steven Karametos utilises the laparoscopic approach, which is by making several small incisions and using small instruments and a camera to guide the surgery. There will also be an anaesthetist and assistant surgeon working alongside Mr. Karametos. Generally, they would introduce themselves and speak to you briefly while you are in the waiting bay before being put into the trolley for theatre transport.
Recovery from Sleeve Gastrectomy:
There will be pain and swelling associated with creating the new, smaller stomach. You will need to take pain medication as instructed, and follow a recovery diet for the first 4-6 weeks. Personalised meal plans will be discussed upon your consultation with our experienced bariatric dietitian. Another common type of discomfort is the shoulder tip pain, which can happen after a laparoscopic surgery. Contributing factors include the effect of gas used to create space in the stomach cavity during surgery; irritation to the diaphragm or even movement of the shoulder during surgery.
- Timeline: Hospital Stay: 1 to 3 days. Return to Work: 1 to 3 weeks
- Pain: Managed with pain medication, which is typical for any laparoscopic surgery
- Diet: Slow transition from clear liquids to solid foods
- Activity: Slow transition back to regular activity and exercise
- Driving: You may receive a prescription for post-surgery pain medicine. It is important to refrain from driving as long as you are taking pain medication. Typically our patients take pain medication for about a week.
- Moving: It will be beneficial to do some movement regularly after your surgery. Regular gentle walking is a great exercise.
- Vitamins: Our team will talk to you about what vitamins you should be taking. Since you’re now are on a restrictive recovery Stage 1 diet, it is very important to take vitamins.
- Post-Operative Appointments: Our staff will schedule follow up appointments with you. We generally arrange the first review a week after your procedure. We will then continue to see you multiple times throughout your first year and beyond. Follow up throughout your weight loss journey is critical. It is through your follow up visits that we can help you stay on track, address any challenges you’re facing, and celebrate your successes with you.
The Success of Weight Loss Surgery
It is important to consider your expectations around weight loss. Whilst there is a wide variation in weight loss following surgery, the average weight loss with a gastric sleeve is about 25-30% of your total body weight, with the majority of this occurring in the first year following your sleeve gastrectomy. The average Excess Weight Loss (%EWL) at 3 years after sleeve gastrectomy is 60%. This means that half of the patients will lose less than 60% and the other half will lose more than 60% of their excess weight. Losing all the excess weight (that is %EWL of 100%) is achieved by only a small percentage of patients and, therefore, is a not realistic goal.
Patients considering weight loss surgery often have unrealistic expectation of the amount of weight they are going to lose. About two thirds of patients considering surgery report that they would be disappointed if they lose only 50% of excess weight, although this level is considered a successful outcome. It is therefore important to think about your own goals from having surgery and set achievable goals and manage your own expectations.
The success of Weight Loss Surgery are measured by the following:
Patients considering weight loss surgery often have unrealistic expectation of the amount of weight they are going to lose. About two thirds of patients considering surgery report that they would be disappointed if they lose only 50% of excess weight, although this level is considered a successful outcome. It is therefore important to think about your own goals from having surgery and set achievable goals and manage your own expectations.
The success of Weight Loss Surgery are measured by the following:
- Weight loss alone (as measured by kilograms lost) should not be the sole reason to undergo weight loss surgery.
- Resolution, improvement or prevention of obesity related health conditions (such as type II diabetes, hypertension, sleep apnoea, metabolic syndrome, etc.) is as important as weight loss.
- Even a modest weight loss of 5% of total body weight can improve metabolic factors and health risks.
- Ask yourself this question "What is lowest amount of weight you hope to lose to not feel disappointed?"
- It is important to pay attention to quality of life after surgery. Frequent vomiting or inability to eat good quality food is not worth looking skinny.
- Patient weight loss results vary widely due to many factors as will be discussed during your consultation with Mr Karametos.
Living with Sleeve Gastrectomy
The First Year: this is the 'honeymoon' period. The average weight loss with a gastric sleeve is about 25-30% of your total body weight, with the majority of this occurring in the first year following your sleeve gastrectomy. Most of the weight is lost in the first 6 months then weight loss slows down and stabilizes between 9 and 12 months. There will be a normal weight regain of 1-5 kg after the first year due to the expected adaptation.
The Critical First 3 Years with a Sleeve: The early years of the sleeve journey are critical. Most people will loss the majority of their excess weight in the first year post surgery. By three years after surgery, a sleeve is likely to stretch, therefore it is important not to push the limits and only eat to the point of being comfortably satisfied. In a nut shell, your ongoing success will depend on your effort and commitment to change your lifestyle and maintain positive habits in the first three years.
Please remember, it is a life style change and it is not easy. There will be bumps in the road. However, we will be there to guide you and support you along the journey.
The Critical First 3 Years with a Sleeve: The early years of the sleeve journey are critical. Most people will loss the majority of their excess weight in the first year post surgery. By three years after surgery, a sleeve is likely to stretch, therefore it is important not to push the limits and only eat to the point of being comfortably satisfied. In a nut shell, your ongoing success will depend on your effort and commitment to change your lifestyle and maintain positive habits in the first three years.
Please remember, it is a life style change and it is not easy. There will be bumps in the road. However, we will be there to guide you and support you along the journey.
Insurance & Cost
Please note Mr Karametos accepts both privately insured patients and selected uninsured patients for weight loss surgery at present. For Insured Patients, The out of pocket fee for Weight Loss Surgery such as Gastric Sleeve is dependant on many factors however patients do find our fees very fair, often much less than they would have thought. At your initial consultation with Mr Karametos, full financial consent will be provided to you for consideration.
Please note that there is no public availability for weight loss surgery at present. Patients with health insurance may be able to claim a partial rebate on the fees from their health fund and from Medicare. Patients should check with their health fund to see if weight loss surgery is covered. Patients who do not have health insurance are generally encouraged to join a health fund, after which they have to wait twelve months before the health fund will cover the costs of the operation and hospitalisation. Patients who do not wish to wait twelve months can opt to pay all surgical, anaesthetic and hospital costs themselves. Please contact us should you require additional information.
For Uninsured Patients, we can offer self- funded weight loss surgery packages upon your initial consultation.
Please note that there is no public availability for weight loss surgery at present. Patients with health insurance may be able to claim a partial rebate on the fees from their health fund and from Medicare. Patients should check with their health fund to see if weight loss surgery is covered. Patients who do not have health insurance are generally encouraged to join a health fund, after which they have to wait twelve months before the health fund will cover the costs of the operation and hospitalisation. Patients who do not wish to wait twelve months can opt to pay all surgical, anaesthetic and hospital costs themselves. Please contact us should you require additional information.
For Uninsured Patients, we can offer self- funded weight loss surgery packages upon your initial consultation.
Early Super Release for Weight Loss Surgery
Because it is recognised that morbid obesity and the medical problems associated with it will reduce a person’s life expectancy, and that weight loss surgery is not yet readily available in the public hospital system, the Australian Government allows early access to your or another family member’s superannuation to cover the costs involved in weight loss surgery.
The application for early super release is processed by Centrelink- you will need to fill out an application form, and obtain a written letter of support from both your GP and Specialist. (Mr Karametos will provide his letter of support to you upon request after your initial consultation). The processing time by Centrelink generally takes around 3 weeks, and allow a further 4-6 weeks for your superannuation fund to release the funds to your personal bank account. For more details on the early release of Super to pay for medical expenses click HERE. To download the application form HERE.
The application for early super release is processed by Centrelink- you will need to fill out an application form, and obtain a written letter of support from both your GP and Specialist. (Mr Karametos will provide his letter of support to you upon request after your initial consultation). The processing time by Centrelink generally takes around 3 weeks, and allow a further 4-6 weeks for your superannuation fund to release the funds to your personal bank account. For more details on the early release of Super to pay for medical expenses click HERE. To download the application form HERE.
Diastasis Recti/ Tummy Tuck with Hernia Repair (Abdominal Separation)
Mr Karametos is one of the few Australian surgeons who offer Diatasis Recti along with umbilical hernia repair. This is often achieved with the Robotic approach, please contact us for an initial consultation to discuss.
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