On mesh and hernia repairs

Posted by on 10 Jul 2014 in Evidence Based Medicine, Hernia, Uncategorized | Comments Off on On mesh and hernia repairs

There have been a number of articles published in the popular press recently discussing the use of mesh in surgery, and associated complications.  Unfortunately this is a complex topic, and the published articles have in many cases made it more confusing.

The use of artificial materials in surgery is something that has been going on for some time, with many benefits.  Millions of people have benefited from joint replacements, mechanical heart valves, and artificial lenses to restore sight following cataract removal.  The role of surgical mesh is to reinforce or reconstruct areas of soft tissue loss or weakness.  Surgical mesh may be a tight weave where the mesh itself provides strength or an open weave to encourage natural scar formation to provide strength.  Mesh may also be artificial, usually polypropylene, or made from natural animal tissues.

The highly publicised problems from mesh use have almost always occurred when artificial meshes have been placed in direct contact with abdominal organs such as to repair weaknesses in the pelvic floor or around the diaphragm.  In some cases, artificial mesh has eroded in to the nearby organs, causing serious infection.  However, in many cases, the same operations are now able to be performed using natural tissue meshes without risk of complications.

The other very common area for mesh to be used is to strengthen the abdominal wall to repair hernias.  Artificial mesh has been used since 1989 to repair groin hernias, and is now used for most open hernia repairs and all laparoscopic hernia repairs.  In hernia repair, artificial mesh is placed in the muscular layers of the abdominal wall, not adjacent to abdominal organs.

The use of mesh in hernia repairs has been extensively studied, with outcomes published for tens of thousands of patients.  Some of the best quality evidence comes from a study combining the results of multiple different trials on using mesh for open groin hernia repairs.  When examining the outcomes of over 4000 patients, randomly assigned to open groin hernia repair with or without mesh they found that the use of mesh was associated with a lower risk of the hernia coming back, lower risk of ongoing pain in the groin after hernia repair, and no change in the risk of infection or other complications after surgery.

Despite the recent articles in the popular press discussing the risks of artificial mesh inside the abdomen, there is little doubt that modern surgical techniques using an open weave artificial mesh is the ‘gold standard’ best way of repairing a groin hernia.  On a follow-up post I will also discuss the option of laparoscopic hernia repair with mesh, and its potential advantages over open hernia repair.


Agreed prices for bariatric surgery in Dunedin and Invercargill

Posted by on 27 May 2014 in Announcements, Bariatric Surgery, Dunedin, Gastric Bypass, Sleeve Gastrectomy | Comments Off on Agreed prices for bariatric surgery in Dunedin and Invercargill

I am pleased to announce that ABLE Ltd now has agreed pricing contracts in place for Mercy Hospital in Dunedin and Southern Cross Hospital in Invercargill.  These contracts mean that people are able to know in advance how much their surgery is going to cost and what is included.  In general we have structured our costs to include follow-up for two years following surgery, with the surgeon and dietitian.

Prices and inclusions vary slightly according to which operation you choose and where you choose to have the surgery.  To find out more please contact us.


Unimed insurance now partially covering weight loss surgery

Posted by on 21 May 2014 in Bariatric Surgery, Gastric Bypass, Sleeve Gastrectomy, Weight Loss | Comments Off on Unimed insurance now partially covering weight loss surgery

I was very pleased to hear that Unimed health insurance has recently introduced partial coverage for bariatric surgery. Details vary according to individual policies and there are specific requirements that need to be met, but if you have Unimed insurance and are interested in bariatric surgery, then give them a call to see if you qualify.


While insurance coverage for bariatric surgery in New Zealand still lags behind other countries such as Australia and the USA, this is an important step forward.  Offering insurance coverage acknowledges that obesity is a medical condition, and that significant health benefits can come from weight loss surgery.  Also, now that at least two major medical insurers in New Zealand partially cover bariatric surgery, hopefully it will encourage the others to follow.


Westpac Chopper Ride

Posted by on 28 Apr 2014 in Announcements | Comments Off on Westpac Chopper Ride

On Friday the 9th of May I will taking part in a charity bike ride from Queenstown to Invercargill to raise money for the Westpac rescue helicopter service.

This is a great cause for Southlanders.  Here in the South we have the most spread out population compared to the local hospitals of anywhere in New Zealand.  With these distances to deal with the rescue helicopter service is literally lifesaving.

Agreeing to raise money for this worthwhile cause was easy, however two weeks out with not enough training it is looking pretty daunting at the moment.

If you would like to find out more please check out the ride’s Facebook page, or if you want to donate please visit

To show my personal support of this cause (other than the blisters and frostbite) ABLE will match the total donations I receive up to $500.

Bariatric Surgery and Pregnancy

Posted by on 17 Mar 2014 in Bariatric Surgery, Uncategorized | Comments Off on Bariatric Surgery and Pregnancy

To follow on from the previous post on fertility and contraception, this post will cover the effects of bariatric surgery on the outcomes of mothers and babies.

Considering first the effect of bariatric surgery on women and their pregnancies, it is important to realise that many women after bariatric surgery will still have a body mass index of greater than 25 kg/m2.  This is important as comparing pregnancy outcomes of women after bariatric surgery to all pregnant women, or to women with an elevated BMI will lead to different conclusions.

When comparing women who become pregnant after having bariatric surgery to women with an elevated BMI (or pregnancies in the same women before bariatric surgery), we know that bariatric surgery reduces the risks of gestational diabetes, high blood pressure and pre-eclampsia.  However the risks of gestational diabetes and Caesarian birth are still higher than the base line population.

Looking at the outcomes for the babies of women who have had bariatric surgery we know that bariatric surgery does not increase rates of stillbirth or congenital abnormalities, but does increase the risk of pre-term birth and of small for gestational age babies.  Importantly, there is also some evidence that bariatric surgery reduces the risk of these children having weight problems as they grow up.

The American College of Obstetrics and Gynecology offers the following guidance:

  • Conception should be delayed for 12 months after bariatric surgery to allow weight and nutritional status to stabilise.
  • A comprehensive nutritional assessment should occur early in pregnancy to assess nutritional status.
  • Women should take a prenatal multivitamin in addition to a bariatric multivitamin, but the total daily dose of vitamin A should not exceed 5000 IU.
  • Regular review by a bariatric surgeon and dietitian is recommended.
  • Serial ultrasound growth monitoring should be considered especially if time to conception is short.
  • Women may not tolerate the standard screening test for gestational diabetes (oral glucose tolerance test) after a Roux-en-Y gastric bypass and alternative tests should be considered.
  • Any unusual abdominal pain or vomiting during pregnancy should be urgently investigated by a bariatric surgeon.
  • Bariatric surgery is not an indication for Caesarian delivery.


Bariatric Surgery, Fertility and Contraception

Posted by on 11 Mar 2014 in Bariatric Surgery, Gastric Banding, Gastric Bypass, Sleeve Gastrectomy, Uncategorized, Weight Loss | Comments Off on Bariatric Surgery, Fertility and Contraception

I had the privilege last week on being asked to talk at the Royal Australian and New Zealand College of Obstetrics and Gynaecology conference in Queenstown.  The subject was pregnancy and fertility after bariatric surgery; which is very topical given the numbers of women who undergo bariatric surgery, and the questions they have on their ability to have children.  I will summarise the important parts of the talk below, and in the next blog post.

So what effect does weight loss surgery have on women’s fertility?

Firstly, we know that many women suffering from obesity, also suffer from infertility and/or have polycystic ovarian syndrome (PCOS).  The reason behind this is that carrying extra weight around the abdomen causes people to become resistant to the hormone insulin.  Initially, the pancreas responds to this by producing extra insulin, which among other effects drives the ovaries to produce male hormones, leading to further weight gain, hair growth and reduced fertility.

Weight loss surgery is very effective in helping reverse this cycle.  Loss of weight from the middle of the body results in increased insulin sensitivity and improvement of the other hormonal changes.  Two studies measuring the outcomes of women with PCOS and infertility show that 70-100% of women with irregular menstrual cycles resume normal menstruation following bariatric surgery.  At least 20% of women were able to conceive without the help of additional therapies, and three-quarters of the women with abnormal hair growth had moderate or complete resolution of this.

It is important to realise that bariatric surgery is not recommended as a first line treatment for infertility, but that weight loss after surgery does lead to significant improvements in fertility and may be useful as part of an overall treatment package.

Does weight loss surgery affect birth control?

Given weight loss surgery improves fertility, it is also important to consider the effect on contraception, for women who are not wanting to become pregnant.  Oral contraceptives (the pill) are not considered to be reliable after weight loss surgery due to differences in absorption with gastric bypass or vomiting after adjustable gastric banding.  The large amount of weight that women lose after surgery may also increase failure rates of contraceptive caps and diaphragms.  Contraceptive recommendations for women after bariatric surgery include hormonal methods not taken by mouth (the injection, contraceptive implants, and IUCD’s such as Mirena) and male barrier methods (condoms).  For further advice, please talk to your general practitioner or family planning specialist.


Waimumu Southern Field Days

Posted by on 9 Feb 2014 in Announcements, Bariatric Surgery, Gastric Bypass, Sleeve Gastrectomy, Weight Loss | Comments Off on Waimumu Southern Field Days

Wanting to know more about weight loss surgery?

If there are questions you have always wanted to ask, or you are interested in finding out more about weight loss surgery visit the Southern Cross stand at the Waimumu Southern Field Days.  The staff at Southern Cross Hospital, Invercargill, will be giving out information on their services, including gastric bypass and sleeve gastrectomy surgery.


New operating theatre at Southern Cross Hospital, Invercargill

Posted by on 3 Feb 2014 in Announcements, Bariatric Surgery, Laparoscopy | Comments Off on New operating theatre at Southern Cross Hospital, Invercargill

On Friday I had the pleasure of attending the formal opening of the new operating theatre (theatre 3) at Southern Cross Hospital, Invercargill.  This is a state of the art facility and includes a military grade, high definition, Black Diamond video system, the first of its kind in New Zealand.

This new operating theatre underscores Southern Cross Hospital’s commitment to advanced laparoscopic surgery including weight loss surgery.  Advanced laparoscopic surgery is very dependant on having technology which is of very high quality as well as very reliable.  This new operating theatre will help us to do more, and to do it more safely at the same time.


Queenstown clinic March 2014

Posted by on 23 Jan 2014 in Announcements | Comments Off on Queenstown clinic March 2014

Dr Smith has scheduled the first Queenstown clinic for 2014.  It will be on Friday the 7th of March at the Queenstown Medical Centre.  If you live in Central Otago and are interested in a consultation to discuss anti-reflux surgery, weight loss surgery, laparoscopic surgery or for other general surgical conditions please ask you GP for a referral or contact us.


Free public information seminars

Posted by on 12 Aug 2013 in Announcements, Bariatric Surgery, Weight Loss | Comments Off on Free public information seminars

We are please to announce that we will shortly be offering free public information seminars about bariatric surgery.  These will discuss eligibilty for surgery, the most common surgical options, and the process involved.  It will also be an opportunity for people to meet Dr Smith and to ask questions.  Seminars will initially be held in the evenings at Southern Cross Hospital, Invercargill; with dates in Dunedin and Queenstown to follow soon.

If you are interested in pursuing bariatric surgery in the future, or simply want to find out more about it please register for our next seminar by phoning 0800-377-6484 or contact us.