I have a sick sense of humor,

My questions were:
have you had anyone die? (the answer was no!)
do you like your job?
do you ever get disgrunteled?
as his wife is his assistant I asked:
Do you guys fight?
If your having an argument on whoever forgot to take out the chicken, dont worry either book me in on a new date, or Ill send my hubby out to buy some for you.
Do you faint at the site of blood?
Do you enjoy slicing and dicing?

he passed all of my questions :)

I would ask the surgeon about golf, I know people can be rather addicted, the walking bit wouldnt be a problem after a couple of weeks, I doubt the putting would either. So if you are a true addict I would run the golf past him and if he says no run past him having a gentle putt he might pass you on that one weeks before the full round :)

applesauce

As a general rule no heavy lifting, shoving or twisting for a minimum of 6 weeks.
I would check with your surgeon.

When can I return to golf. Walking 18 holes twice a week??

Hi, Tam

Thanks, good luck to you, too.

Hi Missty,

I spoke briefly to my surgeon (Michael France in Adelaide) about the lap band and he said he won't even do them anymore because there are so many maintenance issues and he sees so many people for reversals and they can do so much damage to the stomach. That's where I originally started looking too and the main reason was the reversibility.

You said that both have similar Post op as far as eating, but that is not my understanding at all...my research has shown a lot more restrictions in the post-op diet for the band, and some people (not all of course) can never have bread or steak after the band.

I haven't had it done yet but i have chosen the sleeve due to the post op simplicity and lower risks. Also you can't cheat on the sleeve so easily as you can on the band, and I know I would!

Good luck!

To everyone, thank you for all of your comments. I have a surgery date of June 1st for the Lap Band, but have since started to research the Sleeve. It seems that both have a similar Post Op as far as eating, but there seems to be a lot more maintainence and possible problems with the Lap Band. After reading as many letters as I could these last few days, I'm seriously considering changing to the Sleeve. The things that worried me the most about the surgery and quality of life have been addressed here and I feel that the Sleeve would be the better choice for me.

So, thank you, again.

Having now had my appointment I thought that I would add my answers here for others who may be looking for a one-stop shop. My surgeon (9 June 2010) will be Michael France in Adelaide. These questions were answered by him and his surgical assistant, Fiona Nancarrow.

Hope its helpful!

Doctor Qualifications and Experience
1. How many tubes have been done?
didn't ask
2. How many have you done?
about 500

Partnerships, Waiting Times and Cost Questions
1. What is it going to cost me?
2000 pacakge includes everything from surgeon, anaesthetist if extra.
2. What are your waiting times?
it was 6 months for the initial appt and then the surgery wait could be as short as 3 weeks (my husband)
3. Who is anaesthetist?
several, depending on the day of surgery.
4. Pre and Post op referrals etc? Do you have partnerships, if so, with who? Are these things included in the cost or extra?
Pre-op - 1. barium swallow to check for hiatus hernia 2. blood test. He also does an endoscopy but that is immediately b4 the surgery, while you are under anaesthetic.
Post-op - they have a dietician starting on the team March 2010 and 1 or 2 visits with her will be included in the package...you can continue with her at a cost after that.
Partnerships - not as such, but there is a team of psychologists that specialise in weight management they recommend...use a mental health care plan from GP to minimise cost.
5. Do you charge for cancellations if I change my mind?
didn't ask

Pre-Op Questions
1. Can I have a last supper at some point before op and when?
didn't ask
2. I have heard of using Optifast pre-op in order to shrink the liver – how does this work? What is it necessary to shrink the liver? Will this damage the liver? How long do I have to do this?
The liver sits over the stomach and they have to move it aside to get to the stomach for surgery. The liver holds fat, and is often surrounded by fat too. When you lose weight (through any means) the first place the fat comes off is the liver and around the organs. Removing fat from in and around the liver is returning it to its normal state and will not damage it, but help it. A smaller, helathier liver (and surrounds) will make access to the stomach easier and safer in surgery. Generally recommend 2 weeks of optifast but can be longer or shorter depending on where you hold your weight, and how much you have to lose.
3. What are the Pre op referrals, tests, diet etc?
barium swallow. blood test. optifast. appt with anaesthetist.

Questions about the Surgery
1. Obviously the surgery is best used in conjunction with a good diet etc. once past all the surgery recovery, but how do specific weaknesses impact which surgery is best? For example my issue is chocolate, but my husband’s is Coke.
Didn't ask specifically. We talked mainly about the band vs the sleeve. They prefer not to do bands and will only do them very very occassionally. Problem with the band is that while the operative risks are lower, the post-operative risks are much higher, and they see too many people for revision and removal. The sleev is the least invasive, physiologically...you don't actually change the way anything works, just the size of an organ. The band creates a pouch with a small hole into an otherwise unchanged stomach...so if you have something like coke of ice-cream that can get through that small opening, it will not work for you at all because you are not actually reducing the overall size of the stomach. With the sleeve you are reducing the size of the whole stomach so even if all you have is water, you can't have much of it at a time...but the key words are 'at a time' if you snack all day in small amounts then the sleev won't help as much. The sleeve removes part of the stomach though, and the part that it removes is the part that produces the hunger hormone ghrelin...after the surgery you produce much less ghrelin and therefore your hunger levels are much much lower. New 5 year data just out shows that the lowered ghrelin levels are sustained.
2. How do eating types affect which surgery is most suitable? For example I tend to binge eat related to depression and stress, where my husband tends not to binge but rather to simply eat too much for the amount of activity he does.
See above
3. How is the sleeve different to the ‘stomach stapling’ that happened years ago?
This was a very big question for me. the old stomach stapling was actually very similar to the current band. So look at a picture of a banded stomach but think of the band being replaced by staples. All the issues of the band where there, but also it was quite common for the stomach to stretch to open the small opening left by the staples and render the surgery useless.
4. How many incisions will you make? How big will they be? How much scarring can I expect?
five incisions, each about an inch long. scraring takes a long time to establish...will be worse at first then settle into a small red line and then clear up a bit and then over several years develop into a scar. Different people scar differently - look to your own scars to see how your are likely to look in several years time.
5. Will I need blood, if I do should I start donating some before the operation?
Only if they nick something they shouldn't - thats why they take blood from you a few days prior to the surgery.
6. Are the staples used permanent or are they dissolved, and can they fail down the track? If they remain in place, why is this so? Is the stomach not able to reheal after the surgery?
Yes they are permanent, they are titanium. Staples are apparently better than sutures, and they use a little stapler that actually does six rows of staples and then cuts with three on each side. this minimises bleeding and is the best way to ensure no leakage of stomach contents into the abdominal cavity. The stomach does heal around them, and they become unnecessary but to remove the staples would require another surgery, so they are left there.

Questions about Surgical Complications
1. What is the complication rate and what are the main complications? I have heard a statistic of 1 in 50 sleeves leaking. What exactly is a leak, what damage can it do and do you agree with the statistic?
Several different complications that we discussed and I can't remember the details of them all. They were quite up front about having made mistakes and continually trying to improve their practices. Their highest compliactions rates were about 5%, but they now have most things down to about 1%.
A leak is when the contents of the stomach escape through the staple line into the abdominal cavity. Obviously this is not supposed to happen and your body fights it by creating a cyst around the escaped bacteria, which then needs to be surgically removed. Their incidence is about 1% (1 in 100). They tell you to call with even the slightest feeling of unwellness and they will put you in for a CT scan to make sure everything is OK..they would prefer to do unecessary CT scans than to have you in pain and miss something taht might be wrong. Call if you get any flu-like symptoms, as these can be signs of something amiss.
2. I’ve also heard reflux can be an issue – how big an issue is this?
didn't ask.
3. What percentage of sleeves kink or fold and why?
she didn't really answer this one...didn't seem to have heard of this issue.
4. What's your personal complication rate and what were the complications??
As above...about 1%. Various.
5. Have you personally had any deaths or serious disabilities?
didn't ask
6. When were the first sleeves done? What is known about the long-term effects?
five year data commonly available now and all is positive. one surgeon in Aust is up to nine years and still has positive data. It is common to lose weight rapidy at first then less rapidly and then stabilise. It's also common a few years down the track to put a little back on and you need to make sure you watch for this and address your lifestyle.

Recovery Questions
1. Recovery diet? How long on liquids, mush, lumps etc until I get back to a normal diet?
the average is 6 weeks in 3 x 2 weeks, liquids, mushies, lumps. It varies.
2. Time in Hospital?
two to three nights.
3. Recovery time? When can I pick up the children? Resume normal housework? Driving? Personal Care?
about 10-14 days. personal care - from day one

Post-Op Questions
1. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food (in efficiency, type or rate)?
No, the digestion happens with the most muscular part of the stomach, which is right at the base, near the beginning of the intestine...this part of the stomach remains. Only volume is affected
2. Does the surgery affect nutrient absorption? Are any nutritional or Vitamin supplements are needed after.
It doesn't affect nutrient absorbtion at all (this happens in the intestines not the stomach) however they do recommend you stay on a multivitamin due to the reduced volumes of food and therefore reduced volume of nutrients.
3. Is Constipation or Diarrhoea an issue?
Can be in some people
4. Post op diet is normal foods?
yes, but it will take timeto get there. steak and fresh bread can take up to 9-12 months
5. What is the effect of the stomach surgery on the surrounding organs?
the least of all surgeries as nothing is actually moved. the stomach that is being removed is attached to other organs (can't remember which) and this attachment is severed. Other organs are only moved to allow access to the stomach. The stomach attachment naturally fixes itself and attaches back to the smaller stomach. If you went into a sleeved abdomen not knowing that the person had had surgery you would just assume that they had a very small stomch, there is no evidence of surgery internally.
6. Exactly how ‘unnatural’ is the post-op stomach?
not very. basically the pouch part of the stomach was intended for gorging, which we traditionally did as a hunter-gatherer race. When a large animal was killed the tribe needed to get as much of it inside as they could before it went off and so they gorged, and the large stretchy stomach allowed them to do this. Then they would go back to eating small amounts of foods that were gathered until the next kill. We no longer have a need to gorge. We have food available in plenty and refrigeration available to keep food fresh for longer - the pouch is therefore not necessary in our modern society, and the sleeve removes it. In the long term, no other part of the body is affected by this.
7. Will the stomach stretch after the operation? How far can it stretch now and post-operatively?
Yes it will stretch somewhat, and the more you push into it the mor eit will stretch. It could even potentially burst (as could your pre-op stomach)...but you would have to try *really* hard to achieve this.
8. What tube size French Bougie is usually used? Why do you use this size? Can we discuss the size of the post-op stomach or is it ‘one size fits all’? (Not that I want to eat a huge amount, but in terms of eating a sufficient amount I would like to eat at least as much as my kids do…hard to tell them to eat their food if you’re only eating half what they are!)
Generally they use a standard size (didn't ask what size specifically) but in some special cases they will use something larger - usually for people with lots of comorbidities which are a worry, or for older people. Basically the smaller the stomach the higher pressure system they make. For otherwise healthy(ish) people they go standard, but if they want to put less pressure on the person's body as a whole then ethy will go bigger...obviously bigger means a bigger stomach and less weight loss overall.
Regarding eating less than the kids...probably better to move away from a 'finish everything on your plate' mentality with the kids anyway...present their food but tell them they only need to eat as much as they want to, same as you. Eliminate desserts and there is no need for an 'eat this before you eat that' argument.
9. My expected weight loss after 1 & 2 years? Is it reasonable to expect to achieve and maintain a weight of around 65-70kg?
I actually didn't ask that!

Breastfeeding Questions
1. Can the surgery be done while breastfeeding?
The issue is your fluids. You need lots of fluids to create breastmilk, and on a small stomach you may not get enough in and so your milk may dry up. Also issues of anaesthetic going through to milk. My son is 15 months old and doesn't *need* breastmilk so we have decided that we will try to wean before my surgery (which is in 3.5 months)
2. Will the detoxing of my body release toxins into my milk? If so how long will this last? (Can I express enough milk to get through this detox period and continue feeding again afterwards?)
didn't ask.

Pregnancy Questions
1. Will the changes to the stomach and the addition of staples affect future pregnancies?
No. They don't recommend falling pregnant within a year of the surgery due to your diet and getting used to your new stomach, and your body recovering. Also, being pregnant squashes everything and puts everything under pressure, and thats not good on your new stomach. Having said that, it has been done and there were no issues.
2. Will this surgery affect birthing? Will normal birthing place excessive strain on the stomach?
No. The muscles for birthing are not near the stomach.
3. I have had liver issues (choleostasis) in my previous pregnancies – is this surgery likely to affect my liver in future pregnancies?
Didn't ask.

It is very true tho the size bougie they use is not that relevant as it is how tight they pull the stomach when stapling that will determine the size you end up with. Your best guide to finding out the size of your new stomach is to talk to patients of your surgeon, but even then it is hard to get the perfect idea because just how tight they pull will not only change with each patient but over time.

But you seriously want to pick a surgeon who has NOT had to do any revision sleeves on his own patients, that would be asking for trouble.

applesauce

Tam,

I've sent you a PM. If your surgeon is Michael France...you're in safe hands and he will answer any question you have but you will need to see his GP Dr Fiona Nancarrow first so she will probably cover most of them off.

Jo

I am due to be sleeved in October and read with interest Peters questions and answers and the one relating to death did not scare me.At my last appointment with my surgeon i had to sign a consent form stating that complications COULD result in death but i am sure this is very rare,i would rather be told the facts than be kept in the dark.It would not put me off having the op and i think thats the chance you have to take.

Well the doctor definitely will know youv'e spent time thinking about this.

Good luck with your decision making.

xxx

Thanks bushgirl, I will certainly look around and I know that some answers are around, but I would still like to ask them of my surgeon...it's part of how i select a surgeon a sit means a great deal to me to have someone who is willing to talk and explain just as much as how good their technical surgical skills are. I have rejected several surgeons in the past (for different surgeries) based on their attitude.

Having said that, that is one of the reasons I have put them into sections, so that I can make sure I cover the most important ones first.

Tam, A lot of your questions are answered here in various threads if you'd like to read about them before your appointment. The Dr. may not have enough time in your appointment to answer all these in enough detaikl for you, given they are usually booked pretty solidly. Have a read through on the pre and post op sections, and diaries and see :)

Hi there. I am a newbie and I am getting my list of questions together, having stolen a heap from this list and added some of my own. I know it is really *long* but I would still like to see if you guys think I have missed anything? Thanks!

Tam

Doctor Qualifications and Experience
1. How many tubes have been done?
2. How many have you done?

Partnerships, Waiting Times and Cost Questions
1. What is it going to cost me?
2. What are your waiting times?
3. Who is anaesthetist?
4. Pre and Post op referrals etc? Do you have partnerships, if so, with who? Are these things included in the cost or extra?
5. Do you charge for cancellations if I change my mind?

Pre-Op Questions
1. Can I have a last supper at some point before op and when?
2. I have heard of using Optifast pre-op in order to shrink the liver – how does this work? What is it necessary to shrink the liver? Will this damage the liver? How long do I have to do this?
3. What are the Pre op referrals, tests, diet etc?

Questions about the Surgery
1. Obviously the surgery is best used in conjunction with a good diet etc. once past all the surgery recovery, but how do specific weaknesses impact which surgery is best? For example my issue is chocolate, but my husband’s is Coke.
2. How do eating types affect which surgery is most suitable? For example I tend to binge eat related to depression and stress, where my husband tends not to binge but rather to simply eat too much for the amount of activity he does.
3. How is the sleeve different to the ‘stomach stapling’ that happened years ago?
4. How many incisions will you make? How big will they be? How much scarring can I expect?
5. Will I need blood, if I do should I start donating some before the operation?
6. Are the staples used permanent or are they dissolved, and can they fail down the track? If they remain in place, why is this so? Is the stomach not able to reheal after the surgery?

Questions about Surgical Complications
1. What is the complication rate and what are the main complications? I have heard a statistic of 1 in 50 sleeves leaking. What exactly is a leak, what damage can it do and do you agree with the statistic?
2. I’ve also heard reflux can be an issue – how big an issue is this?
3. What percentage of sleeves kink or fold and why?
4. What's your personal complication rate and what were the complications??
5. Have you personally had any deaths or serious disabilities?
6. When were the first sleeves done? What is known about the long-term effects?

Recovery Questions
1. Recovery diet? How long on liquids, mush, lumps etc until I get back to a normal diet?
2. Time in Hospital?
3. Recovery time? When can I pick up the children? Resume normal housework? Driving? Personal Care?
Post-Op Questions
1. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food (in efficiency, type or rate)?
2. Does the surgery affect nutrient absorption? Are any nutritional or Vitamin supplements are needed after
3. Is Constipation or Diarrhoea an issue?
4. Post op diet is normal foods?
5. What is the effect of the stomach surgery on the surrounding organs?
6. Exactly how ‘unnatural’ is the post-op stomach?
7. Will the stomach stretch after the operation? How far can it stretch now and post-operatively?
8. What tube size French Bougie is usually used? Why do you use this size? Can we discuss the size of the post-op stomach or is it ‘one size fits all’? (Not that I want to eat a huge amount, but in terms of eating a sufficient amount I would like to eat at least as much as my kids do…hard to tell them to eat their food if you’re only eating half what they are!)
9. My expected weight loss after 1 & 2 years? Is it reasonable to expect to achieve and maintain a weight of around 65-70kg?

Breastfeeding Questions
1. Can the surgery be done while breastfeeding?
2. Will the detoxing of my body release toxins into my milk? If so how long will this last? (Can I express enough milk to get through this detox period and continue feeding again afterwards?)

Pregnancy Questions
1. Will the changes to the stomach and the addition of staples affect future pregnancies?
2. Will this surgery affect birthing? Will normal birthing place excessive strain on the stomach?
3. I have had liver issues (choleostasis) in my previous pregnancies – is this surgery likely to affect my liver in future pregnancies?

Hi MissKax, The requirement for a pre-op diet varies considerably with each surgeon. Even people with similar BMI's are told different things by different surgeons. Some do not require a diet at all, where others are 1,2,3,4 weeks or more. The pre-op diet is beneficial for a number of reasons:

1. It shrinks the Liver which makes the surgery easier for the surgeon and also minimises the risk of a tear or other damage to the liver it self.
2. Any reduction of weight before surgery makes the operation and anaesthetic safer for you
3. It helps gets you prepared for the post-op diet when you usually have liquids for 2 weeks followed by soft foods.

Personally after doing it for 2 weeks, I think it made the next two weeks much easier.

Hi Molly, The term XX French Bougie refers to the diameter of the flexible rod (dilator) that the surgeon puts down the throat into the stomach used as a guide to staple against. One French equals 0.3302 millimetres, so a 40 French bougie is 13.208mm, or about the size of a male index finger. So in reality when Dr's here use 34-42 French Bougie here there is only a maximum of around 2.6mm difference smallest to largest diameter. There is a thread on the subject here.

Peter.

Hi All,

Peter what is a "40 French bougie"??

[quote]Regarding his choice of a 40 French Bougie, he says that it is not only the size of the bougie that matters, but also how it is used. He uses a tight method, which means he pulls the stomach while using the insert. Some surgeon do not do this. So his 40 may be similar to another doctors 36-38.

Quote:

sounds like i should know what that is but i've not heard that term before..

Cheers,
Molly

Hi all. Peter, does everyone have to do the optifast before surgery or only your BMI is a certain number? TIA

Yes it is scary to talk about a possible death, but reality is that with any operation there is a least a small percentage chance that it will result in death. And it is best if the information given to people who come here includes both the negatives as well as the positives.

So, I just thought I would update some of the Answers given earlier as I have asked Dr Cohen for some more details.

The single death at the Mercy Bariatric unit occurred about 3-4 years ago following a reversal (band to sleeve) operation. There was a leak which caused a fungal infection. I do not have the full details but the patient died about 6 months later because the fungus was resistant to all three lines of treatment.

Band to Sleeve operations have a much higher chance of a leak. 8 in the 60 Dr Cohen has done so far (13%). I assume this is beacuse often there is damage from the band weakening the stomach, but this is just a person opinion. Of Dr Cohens Sleeve only operations there have been 11 leaks in 490 operations (2%).

Regarding his choice of a 40 French Bougie, he says that it is not only the size of the bougie that matters, but also how it is used. He uses a tight method, which means he pulls the stomach while using the insert. Some surgeon do not do this. So his 40 may be similar to another doctors 36-38.

Dr Cohen does not do any leak testing while in hopspital. He believes if there is a leak while in hospital you will become ill straight away. He is not aware of any doctor who has found a leak because they performed a leak test prior to discharge.

Dr Cohen usually performs the surgery between your legs, some doctors do it from the side.

Dr Cohen uses a dissolving strip on the staple line for added safety the first week. Some surgeons use glue or stitches, I have read that stitches can cause stictures so are not recommended.

The access ports are closed with staples and may be removed before discharge.

As for the post-op diet I was given more detailed information during the assesments. The Mercy Plan is for 2 weeks Nourishing fluids, then 4 weeks on soft foods (Mushies), then gradually see what you can eat.

I hope that clears up some things.

Peter.

yes it is possible to eat solids as straight after op.but most dr's say to have liquids then mushie etc to give the stomach time to heal without working on solid foods.sounds ok to me,

I am happy to remove the answers if most people request it, but I thought it would actually be useful if others also provided the answers to the questions they asked. It would be nice to see responses from different Surgeons.

I certainly didn't post this as medical advice and it should not preclude anyone from asking any of the same questions from their Surgeon.

While a few of the answers may have been longer, the answers I have listed are a fair representation of what was said.

For example question 9 about the change in tastes, her answer was just simply no to the question. I then said that wasn't the answer I was expecting (not the only one that surprised me) She did then say, as you cannot eat as much after the operation some people choose to eat different foods. But your actual taste does not change. Right or wrong this is what was said.

As for the death, it should frighten you. Any operation is a risk and any operation could result in a death. I chose not to ask about the details as I didn't think it would make any difference to my choice. I assumed this one death was for a Tube patient, and if it was performed by Dr Cohen that would make better than 1 in over 600, so less than 0.167%. This is only counting the operations performed by Dr Cohen and this is less than the percentage given by ssteph2342 in this post. I do not know who the actual Surgeon was during that resulted in death, how long ago or the total number of surgeries performed by the Mercy unit, so it's quite possible the figure as a percentage is even lower.

Steph, the post op diet also surprised me. She was really talking about immediately post-op! See said that there is nothing medically stopping you from eating solids, but most people just do not feel like anything. Again this seems to go against what others have said.

Regarding the size of the bougie used, I told her that I was expecting her to say somewhere between 34-38. She believed anything smaller makes it difficult for the patient. I didn't ask if 40 was used for everyone or if this was just what she recommended for me. This is probably one of the questions I'll bring up at the Pre-Op meeting with Dr Cohen.

Again, what I posted should not be taken as a definitive answers for all doctors. This is just what I was told by my Doctor regarding my Surgery.

Peter

i agree hayley, if i was a newbie and saw about the death it would frighten me....maybe peter could leave the questions on here but edit it and take out the answers. I do beleive they are great questions but we all have different surgeons and they have different answers.

Nicole

Wow I am surprised Cohen uses a 40 as well.

Why would more leaks occur with high risk patients?

Steph I think he means he can eat any type of food once he is healed and over the post op diet requirements, at least I hope so lol.

Hi Peter,

Your list of questions and answers is very interesting. I'm curious about how you are allowed anything to eat post op. So your surgeon doesn't recommend fluids, then mushies before moving onto real foods?

Also Applesauce, I don't think there is any surgeon in Australia doing a 32 bougie. My surgeon does a 34 and is apparantly the smallest in Australia. But he said that in the States there is a surgeon doing a 32 and it is considered too small but that surgeon claims you have to be cruel to be kind and likes to make his patients struggle in the beginning.

steph

well that is interesting as I thought he was the only one using a 32 for surgery. If I remember correctly he even said that in his video. My brain must be failing hehehehe. Great questions and answers :)

applesauce

Peter:

That's a good list of questions. I know I didn't ask a lot of that stuff!

Did you ask him how many leaks he'd had? (I think it was the first questions I asked mine!)

And I met Dr Kurian several times when I worked at Osborne Park Hospital and she's lovely. :)

Kaili.

I had my first appointment at Mercy Bariatrics with Dr Deborah Jenner and Dr Leon Cohen today.

Thought I'd post the questions I asked and the answers I got while there.

Some of the answers are different to what people have reported on some of the forums.

Peter.

1.Is there any difference between Vertical Sleeve & Tube Gastrectomy operations
No

2. My expected weight loss after 1 & 2 years in KG.
30kg, ??kg (can't remember)

3.Is Mercy Hospital the only hospital Dr Cohen operates at
No, and we do not use Mercy for Tube operations as there is no Emergency Dept. We use The Mount or St John of God

4.How many tubes have been done by Leon
600+

5.What is the complication rate and what are the main complications
1 in 50, leaks

6.Have you had any deaths or serious disabilities
The mercy team has had 1 death, no serious disability

7.Is it possible to talk to a couple of Previous tube only Patients 2-3 years out
Yes we usually have a couple of past patients at our seminars

8.Have you heard of Lactose intolerance from Op
No

9.Have you heard about peoples taste changing
No

10. Does Ghrelin production increase to pre op levels over time
Not really

11. Does the removal of most of the stomach interfere with the rate of digestion
No, as most digestion is actualy done in the intestine

12. Is it likely to stop my Diabetes
Yes, but may take 20-30kg of weight loss Edit 18/11/8: My diabetes has resolved immediately after the operation

13. What tube size French Bougie is usually used
Current operations are done with a 40. Used to be 50.

14. Is stomach stretching still an issue
Not since moving to a size 40, yes with 50

15. Are the staples used permanent or are they dissolved, and can they fail down the track
Staples are titanium and remain in the body. Little chance of failure after the 1st week

16. Is it possible to reduce the tube size further after a few years
Yes, and has been done with size 50 patients

17. How is Leak testing done, and how will I know if I have a leak
Leak testing is not done, but if there is a leak you feel very sick quickly, usually while still in hospital.

18. Time in Hospital
3 days

19. Recovery time, when can I shower, drive, work
Can shower right away, drive 1 week, work 2 weeks

20. Usually how long until healing of the stomach tube can be considered complete
1 week

21. Currently using CPAP how long till I can use after surgery
Right away, may even be used in recovery

22. What are the Pre op referrals etc
Blood & Urine tests, GP, Dietician, Exercise Physiologist, Hospital Admin Nurse, Pre-Op Surgeon Appointment, Maybe also Anaesthetist (not for mine)

23. Pre op diet. Optifast is disgusting, any other method of shrinking liver
Optifast recommended for 2 weeks.

24. Can I have a last supper at some point before op and when
Yes, but please have it before you start on Optifast. “At least your honest :), most people do it during Optifast which effects the Liver and reduces the effectiveness of the whole Optifast period"

25. Post op diet
You will not feel like much, but can eat anything. Edit 18/11/8: This is untrue as you are on nurishing fluids for 2 weeks, then soft foods for another 4 weeks

26. Is Constipation or Diarrhoea an issue
Not with a good diet

27. What foods cannot be eaten
None

28. What nutritional or Vitamin supplements are needed after
Multivitamin

29. Post op referrals etc
Depend on your needs, but maybe GP, Dietition, & Exercise Pyhsiologist Edit 18/11/8: there is a post op appointment at 2 weeks out with both Leon and the Dietitian, then another with at least Leon 6 weeks, 3 months, & 6 months out

30. Will HIF GoldStar cover all costs
No

31. Can I be treated as a HIF Access Gap patient
No

32. What is it going to cost me.
$200 1st appointment (some medicare refund)
$1000 for facility fee. Incl fees for pre-op assessments (small refund)
$??? Pre-op appointment with surgeon
Up to $4800 for Surgeon & Assistant ($3900 out of pocket)
Up to $1300 for Anaesthetists fee ($180 out of pocket)

33. Who is Anaesthetist
Dr. Sarah Kurian

34. Operation date
31/10/2008 7AM at the Mount Hospital

35. Can I have a video of the operation
Yes if you like. Edit 18/11/8: Turns out they would not give me a copy of the video. They have said that it is only used by the surgical team when there is a problem

28. What percentage of sleeve kink or fold and why?

Denise I am so not putting you off asking all those questions I think they are awsome, I will tho be surprised if you get answers to all of them hehehehe

You also need to know how to interpret the answers. My surgeon Mr Epari had not done a lot of sleeves yet, BUT had extensive surgical experence dealing with bariatric cancer. Which when you way them up actually made him as good a bet as somebody with more sleeves under their belt. Another good way to tell about a surgeon is what the threatre staff think of surgeon, and everybody who had worked with my surgeon had nothing but praise for him. Another funny thing to judge a surgeon on is also how rough they are. I had 1 tiny tiny tiny bruise on my for the main incision site and not a single other one on me. Comapre that to any other surgery I have ever had and I have been a mass of bruises. Just shows a hell of a lot of care was taken. Somthing I like.

I also think you will have a tough time working out who say has the most leaks. I can pretty much tell you that from what I hear the guy who actually does the most sleeves here in Perth has the most leaks. So it is more the odds are stacked against him if that makes sense. Tho there is one Perth surgeon, the one old fart is seeing who has done over 800 sleeves withe NO leaks at all. Now that is damn amazing, and should be something to be considered highely. So what I am trying to say is great questions but be prepared to have to interpret them at more than face value to get the facts you will want :)

applesauce

No the previous questions were 25 and 26

This is 27

27. I got a video of my knee reconstruction operation, do I get a video of this one?? As a safety precaution if there needs to be any repairs, adjustments, complications.

Another one or two :?:

23 (i think) Why a sleeve as opposed to a sac or a pouch what is the difference and how is it going to affect me?

24 What's your success rate? Meaning how many people have to go one and have a full gastric bypass or some other method of surgery?

Oh yeah I'm going to this appointment with my Dad ( :cheers: good old Dad) so he will probably have questions for the doctor as well

Hi Hayley,
No worries.

This is the sort of info I want to get from the Doctor because it's a life changing MAJOR operation. I want to be sure the the Doc knows what he is doing and so I can make an informed decision about what I should do - if he is the doctor for me.

Wow that is a thorough list, I might have to nab it for my first appointment. :) I'll have to take out the pregnancy questions though although I hope you come back and let us know what he says as I'm sure this is of great interest to many on this thread.

good luck for the 23rd.

Cinni :)

Hi everyone,
I have my initial appointment with Dr Thomas on wednesday 23rd july.

I was hoping you could help me out with the questions I should ask him.

The ones I have so far are;

1. How many surgeries have you done?

2. What's your complication rate and what were the complications??

3. How many deaths from this surgery or the related complications have you had?

4. How long does the operation take and how long will I have to stay in hospital?

5. Will I need blood, if I do should I start donating some before the operation?

6. Will I have to take vitamins supplements?

7. Since the majority of my stomach has been removed along with the areas of the stomach that produce the various digestive enzymes, is this going to affect the digestion of food? If it does what do you have to do to fix the problem or do you just have to live with?

8. What will I be able to and not be able to eat?? Will I be able to eat normally but smaller amounts?

9. How long does it take for the stomach to recover, repair and completely heal?

10. How long will I need to be off work? I'm a school teacher and have to go up a couple of flights of stairs to get to some of my classroom and the toilets.

11. Will I have any problems with constipation and diahorrea??

12. How will I know if I have a leak or an infection on the staple line?

13 Is there any chance of the staple line bursting - say in a month, year, 10 years??

14 How will the staple affect the neighbouring organs when and if I get pregnant?

15 Will this surgery affect the method of delivery I choose - natural or C setion?

16 Will I be able to carry to the full 40 weeks with a sleeve?

17 What affect will this have on my diabetes?

18 How much weight can I expect to lose? Give me kilo number not percentages.

19 How much is this going to cost me?

20 What hospital will I have to go to?

21 What is the pre-op procedure and when does it start?

22 What is the post-op regime??

23 Give me the details of someone who has had this surgery about 2-3 years ago and what is thier quality of life like??

24 Why a sleeve as opposed to a sac or a pouch what is the difference and how is it going to affect me?

25 What's your success rate? Meaning how many people have to go one and have a full gastric bypass or some other method of surgery?

These are my questions if there is anything I've missed that I should ask the doctor could you please let me know