Non-surgical weight loss
Bariatric surgery has the best evidence for substantial and sustained weight loss. However, surgery is not right for everyone and given health improvement occurs with modest (5-10%) weight loss all options should be considered.
#1: Lifestyle
Dietary modification and increased activity have been proven to result on average 3-5% weight loss. The assistance of a Registered Dietitian can be very useful, even to those with a ‘healthy diet.’ Exercise has many additional non-weight-related health benefits and plays a crucial role in long-term weight maintenance. Even if you ultimately go on to have surgery, it’s important to put in place healthy eating habits. Support from a psychologist can also be helpful to increase motivation, address other mindset concerns and improve overall wellbeing.
#2: Meal Plan
A meal replacement plan can be a useful strategy for some. This is best done with the oversight of a Registered Dietitian and usually involves replacing a single meal a day with a low-calorie, high protein replacement product.
#3: Medication
Weight loss medication is a rapidly expanding medical field. Historically, options were very limited and of little value. Today, there are a number of effective medications in regular use worldwide, with the two best options currently available in New Zealand being Saxenda and Contrave. On average, when combined with healthy lifestyle change, these medications result in 5-10% weight loss. Whilst available, these are currently not funded and come with a significant monthly cost.
Find out more about weight loss pharmacotherapy:
Endoscopy
As a specialist upper gastrointestinal and bariatric service, Gastroscopy or Upper Endoscopy is also an important part of what we do at Northland Health and Weight. Having awareness of your personal gastroscopy results will give you peace of mind.
Gastroscopies are Day Procedures at Kensington Hospital. You will be given sedation and so you must organise a driver and have a responsible adult with you for 24 hours.
The procedure itself only takes 20 minutes. The surgeon puts a thin tube with a camera down your throat until it reaches the stomach. This enables us to diagnose ulcers, tumours, inflammation, infections or areas of bleeding. Different structures that contribute to acid reflux (Gastroesophageal reflux disease or GORD) can also be identified.
Hernia surgery
At Northland Health and Weight, we provide both open and laparoscopic repair for groin hernia’s, abdominal wall hernias and incisional hernias. After a consultation we can work together and see what approach is best for you.
These are mainly done as a Day Procedure at Kensington Hospital and mostly performed under general anaesthetic. You will require a responsible adult to drive you home and stay with you for 24hrs.
Hernias most often fit into 4 categories; umbilical, groin (inguinal and femoral), incisional (resulting from a previous surgery) and hiatal hernias (see Upper Gastrointestinal section). Hernias result when there is a weakening in the musculature of the abdominal cavity and an organ or tissue bulges through.
The approach to repair depends on the hernia location and size, but the principles are the same; close the defect and strengthen the repair. Surgical mesh is often used.
Gallbladder surgery
The gallbladder acts a storage unit for bile that is made by the liver and contracts to empty this bile into your intestines when you eat. Given regular meals is a part of modern life, the gallbladder is a redundant organ as the constant flow of bile from the liver is enough for digestion. If the gallbladder does not function properly, gallstones can form. Gallstones are common, often asymptomatic and can be left alone, but in some instances they can cause gallbladder pain (biliary colic), gallbladder infection (cholecystitis), bile duct obstruction and pancreatitis. Once gallstones start to cause one of the aforementioned conditions, surgery is wise.
The treatment is to remove the gallbladder and the stones and this is almost always done laparoscopically (keyhole), is generally well tolerated, and is typically a one night stay at Kensington Hospital. Your abdomen will feel fairly normal within a week.
Upper gastrointestinal surgery
Upper gastrointestinal or Upper GI surgery is surgery on the oesophagus, stomach, duodenum and proximal small bowel.
This is a specialist area and something we are well versed in at Northland Health and Weight. Often performed laparoscopically (keyhole), it is generally well tolerated and usually requires 2-3 nights in Hospital.
There are many disorders that can affect the upper GI system, but acid reflux is the most common. Gastroesophageal reflux is when stomach content (stomach acid, fluid and food) comes back into the oesophagus and sometimes your throat and mouth. This may cause heartburn (burning pain behind the chest that may move up towards the neck) and/or regurgitation (the sensation that stomach contents are coming back up into your mouth).
Hiatus hernia
© Dr Levent Efe, courtesy of IFSO
Sometimes gastroesophageal reflux is asymptomatic. The first line management for gastroesophageal reflux is acid lowering medication (proton-pump inhibitors) and is highly effective. Surgery is reserved for those situations where medication is insufficient.
Occasionally gastroesophageal reflux is caused by a hiatus hernia. The diaphragmatic hiatus (hole) is designed to wrap tightly around the bottom of the oesophagus and helps prevent excessive acid reflux. If this structure loosens, the stomach can slip back up through the hiatus to a varying degree (a form of hernia). This can make acid reflux and regurgitation difficult to control and can be an indication for surgery.
Upper GI surgery performed by our team includes:
- Laparoscopic anti-reflux surgery (fundoplication)
- Laparoscopic hiatus hernia repair
- Laparoscopic Heller’s myotomy for achalasia
- Laparoscopic splenectomy
- Laparoscopic and open stomach resection for benign disease
- Laparoscopic and open small intestine resection