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Enhanced Recovery After Bariatric Surgery

Posted by on 27 Nov 2019 in Announcements, Bariatric Surgery, Evidence Based Medicine | Comments Off on Enhanced Recovery After Bariatric Surgery

I have recently return from the Annual Scientific Meeting of the American Society of Metabolic and Bariatric Surgeons. This is one of the world’s largest scientific meetings of bariatric surgeons and is always a good opportunity to see what is new, what is coming up, and to meet up with colleagues from when I was working in the US. Although there were few surprise developments, it is interesting to see where things are going and where we in Aoteoroa/NZ sit compared to some of the busiest practices in the world.

In this regard, one not particularly headline grabbing, but very important development in the last few years is the so called ERAS or enhanced recovery after surgery pathways. These pathways developed over a decade ago with people undergoing surgery to remove portions of their large bowel. The include a large number of small interventions before surgery (such as limiting the period people have to fast), during surgery (such as laparoscopic surgery and anaesthetic techniques to reduce pain without using strong narcotics), and after surgery (such as letting people eat and walk much sooner). The cumulative effect for these interventions is that people recover from surgery quicker, with fewer complications.

The growth of ERAS across different surgical specialties paralleled the growth of laparoscopic bariatric surgery so many of the now accepted interventions, just became part of the standard care packages for bariatric surgery. This is all well and good, but about a year ago, bariatric surgeons in the US asked if we can do better. They looked at all the studies and evidence since ERAS pathways first developed and came up with a set of new interventions to further smooth people’s recovery after bariatric surgery. These include newer anaesthetic techniques and drugs, nerve blocks of the abdomen at the time of surgery, and moving physiotherapy from after surgery to before surgery where people are more able to take it in.

Second generation ERAS pathways for bariatric surgery have now been in use for long enough for the first results to come through and things look good. Most people are now only staying one night in hospital after surgery and complication rates and readmission rates are dropping. The best news however it that here at Aspiring Bariatrics we have already been adopting these techniques in our patient care pathways over the last few years, with the same results as high volume bariatric surgery centres in the US are reporting. While we are continuing the search to further improve things, I am constantly amazed that my patients mostly go home the day after major digestive surgery looking little different from someone who has had their gallbladder removed or a hernia repaired.

There was a lot of other interesting material covered at the conference including the toxic effects of sugar, how bariatric surgery can prevent cancer, weight loss medications, the one anastomosis (or loop) gastric bypass, and gastric balloons. I will plan to cover these topics with separate blog posts in the coming weeks.

ABLE Moving to Dunedin

Posted by on 27 Nov 2017 in Announcements, Dunedin | Comments Off on ABLE Moving to Dunedin

With the holidays approaching, there are some changes in store for ABLE Ltd and myself.  In January 2018, I will be relocating to Dunedin with my family to take up a position at Dunedin hospital.  Although the reasons for any move like this are numerous, one of the primary goals for me was to protect the future of bariatric surgery in the south.  This will entail working with my upper gastrointestinal surgeon colleagues in Dunedin to support the delivery of surgery for benign and malignant upper gastrointestinal disease throughout the south; with the intention in the future of recruiting another well trained bariatric and upper GI surgeon who can grow the present program with me.

In a practical sense this means that from January 2018:

  • I will still offer clinic appointments for new and follow-up patients in Invercargill, Queenstown and Dunedin.
  • I will see patients with a broad range of general surgical and upper gastrointestinal conditions in Queenstown and Dunedin, but limit my Invercargill practice to bariatric surgery and specialist upper gastrointestinal surgery.
  • I will do all my private operating at Mercy Hospital in Dunedin.
  • I will no longer operate in the private sector in Invercargill
  • I will continue to operate on public bariatric patients in Invercargill every month
  • I will continue to conduct public bariatric surgery clinics in Dunedin and Invercargill
  • I will continue to work with Renovate Nutrition Ltd in Invercargill, and Nutrition and Life Ltd in Dunedin

I am very grateful for all the support I have received over the last 6 years in Invercargill and rest assured that although I will be based in Dunedin I will continue with my goal of excellence in Bariatric and Upper GI surgery throughout Southern New Zealand.  If you have any questions, please contact me.

Wilbur: The King in the Ring

Posted by on 28 May 2017 in Announcements, Bariatric Surgery, Dunedin, Sleeve Gastrectomy, Weight Loss | Comments Off on Wilbur: The King in the Ring

Notable Pictures have just released a brilliant New Zealand made documentary of one man’s struggle with obesity and journey back to health. It stars Wilbur McDougall, a former pro wrestler, who agrees to let his best friend J. Ollie Lucks make a documentary about his laparoscopic sleeve gastrectomy surgery and subsequent transformation. It is a very human story, and is told with respect and compassion. I would highly recommend it for anyone contemplating weight loss surgery, or who knows others who have had it.

Wilbur: The King in the Ring is currently touring New Zealand.

For more information, check out the Facebook page.

ORBERA® Intra-gastric Balloon

Posted by on 4 May 2017 in Announcements, Dunedin, Endoscopy, Weight Loss | Comments Off on ORBERA® Intra-gastric Balloon

 

Here at Aspiring Bariatrics we are pleased to announce that we are now offering the ORBERA® Intra-Gastric balloon.  The ORBERA® balloon is a temporary endoscopic treatment that helps people to feel full, and therefore lose more weight while undertaking a diet and exercise program than with diet and exercise alone.  The ORBERA® balloon is placed under conscious sedation during an outpatient endoscopic procedure, and is removed six months later by a similar procedure.  It is accompanied by a supervised diet and exercise program lasting 12 months in total.ORBERA® Balloon in Stomach

On average people lose 10-15 kilograms of weight while the balloon is in place, approximately three times the amount of weight lost through diet and exercise alone.  The ORBERA® balloon is indicated for people with a body mass index of 27 – 40 kg/m².

For further information please click here.

Southern Cross Affiliated Provider for Consultations

Posted by on 30 Oct 2016 in Announcements, Fundoplication, Gallbladder, Hernia, Laparoscopy | Comments Off on Southern Cross Affiliated Provider for Consultations

Southern Cross AP Horizontal Logo for Web

We are pleased to announce that we have added Consultations to the list of Affiliated Provider services we contract with Southern Cross Health Insurance.  This means that for people with Southern Cross Health Insurance, we are able to directly invoice your insurer and all you will need to pay for on the day is your co-pay (if applicable). In addition, we are also Southern Cross Affiliated Providers for laparoscopic gallbladder surgery, hernia surgery, anti-reflux surgery, skin surgery, gastroscopy and colonoscopy.

For people with other health insurers, we are able to provide assistance, cost estimates, and documentation in a timely manner to facilitate your insurance claim.

 

Caution with activity trackers

Posted by on 15 May 2016 in Weight Loss | Comments Off on Caution with activity trackers

I want to share a good link that explains the potential pitfalls with activity trackers.  These devices, like the Fitbit and others, are a common way for people to track their exercise and other physical activity.  Regular physical activity is important for good health, including cardiovascular health and maintaining healthy bones and joints.  Activity is also important for weight loss and long term weight maintenance following bariatric surgery.  We recommend at least 30 minutes of moderate intensity physical activity on most days of the week.

Fitness trackers are a great way to measure physical activity and to ensure you are meeting your physical activity goals.  They can cause problems for people trying to lose weight however, when the calories burned as measured by the activity tracker are added to the daily calorie budget.  This link explains the issue in more detail.

At Aspiring Bariatrics we encourage regular physical activity and support anything that helps people to incorporate this in to their lives.  Just beware of the calories burned measurement provided by physical activity trackers and use it as a measure of day to day activity, not a reason to eat more.

 

Resources added to web site

Posted by on 16 Jun 2015 in Announcements, Bariatric Surgery, Endoscopy, Fundoplication, Laparoscopy, Weight Loss | Comments Off on Resources added to web site

I have been busy updating the web site over the past couple of weeks, in particular adding many resources for patients and doctors.  In particular I have added a page about gallbladder surgery, and updated the previous links page, now called resources.  This page contains downloadable patient information resources about gastro-oesophageal reflux and weight loss surgery, as well as our new patient and GP information guidelines for follow-up after bariatric surgery.

The web site has also been updated to confirm our status as affiliated providers for gallbladder surgery, hernia surgery, anti-reflux surgery, minor skin surgery, gastroscopy and colonoscopy with Southern Cross Health Society.

Southern Cross AP Horizontal Logo for Web

For more information on this or other services please contact us.

 

Change in vitamin recommendations

Posted by on 24 Sep 2014 in Announcements, Bariatric Surgery | Comments Off on Change in vitamin recommendations

I would like to announce a change in our recommended multivitamin for patients who have had gastric bypass or sleeve gastrectomy.

We have been starting to notice a number of patients developing low levels of vitamin B12 at between 18 months to 2 years after gastric bypass surgery.  In response to this, Renee Ladbrook has reviewed the detailed descriptions of all the multivitamins currently available in New Zealand and compared them against the vitamin supplementation recommendations by the American Society of Metabolic and Bariatric Surgery.  She found that most of the available multivitamins do not contain enough B12, and consequently body stores may become slowly depleted over many months.

The new recommended multivitamins are Celebrate Multi-complete capsule or Celebrate Multivitamin Chewable.  Both are available on-line from AMS nutrition here.  These should be taken at the doses recommended on the bottles, and should be taken in addition to calcium and any other individual vitamin recommendations.  Unless you have been noted to have a low vitamin B12 level then it is ok to finish you current multivitamin stocks before switching over.

If you have any questions please contact me or Renee.

 

Weight Loss Surgery Conference

Posted by on 23 Sep 2014 in Announcements, Bariatric Surgery, Gastric Banding, Gastric Bypass, Sleeve Gastrectomy, Uncategorized, Weight Loss | Comments Off on Weight Loss Surgery Conference

This October, Invercargill will be hosting the 5th Weight Loss Surgery NZ Trust National Conference.  The conference runs from October 31st to November 2nd and will be held at the Kelvin Hotel.  Highlights will include patient testimonies, a clothing swap, discussions on weight maintenance and re-gain, and looking at postoperative effects on relationships.

To find out more visit www.weightlosssurgery.org.nz or download a flyer.

 

Laparoscopic groin hernia repairs

Posted by on 12 Aug 2014 in Hernia, Laparoscopy | Comments Off on Laparoscopic groin hernia repairs

Hernias are where a weakness in the abdominal wall allow some of the abdominal contents to squeeze out so they sit directly beneath the skin.  One of the most common sites of hernias is the groin also known as an inguinal hernia.

As a primarily mechanical problem, groin hernias have long been fixed by surgery.  In fact, surgery is the recommended treatment for almost all groin hernias.  The choice of operation has evolved over time with using surgical mesh to reinforce the abdominal wall becoming the gold standard since 1989.  The most recent evolution in hernia repair surgery is using laparoscopy, also known a keyhole surgery, to repair the hernia and place the mesh.

In traditional open groin hernia surgery a cut is made over the groin where the hernia occurs, cutting open the outer of the three layers of abdominal wall muscles and placing a mesh between the outer two muscle layers.  With laparoscopic groin hernia surgery a camera and fine instruments are used to repair the hernia and place the mesh on the inside of the abdominal wall muscles without having to cut the muscles.

Laparoscopic groin hernia surgery has been studied extensively over the last decade and have been demonstrated to reduce the risk of ongoing pain and numbness in the groin after surgery by about half compared to open surgery.  Laparoscopic groin hernia surgery is also associated with people being comfortable to return to their normal activities about 7 days sooner than with open hernia surgery.  There is no difference in the rates of the hernia coming back when comparing open and laparoscopic groin hernia surgery.

Dr Smith is very experienced at laparoscopic groin hernia repairs and stands behind this operation as the new gold standard technique when repairing groin hernias.