Bariatric and
General Surgeon

Dr Harald Puhalla

Associate Professor of Surgery

If you’ve been struggling with your weight for some time, you’re not alone. More than 14 million Australians are obese or overweight, and obesity is now a global health concern.

While a healthy body requires a small amount of fat for normal functioning, being overweight or obese means you have considerably more fat than your body actually needs.

For most people, living with obesity has a significant impact on their daily quality of life.

Thankfully, there is a safe and effective solution that can improve life expectancy and overall quality of life. Weight loss surgery, also known as bariatric surgery, is a safe, effective and powerful option for attaining long-term weight loss if you have developed a significant weight problem. It is the only treatment that has been shown to result in major and long-lasting weight loss. Unfortunately, diets and other attempts to lose weight fail for most people.

Weight loss surgery can help you to achieve a higher standard of health and longevity – and it can also reduce the risk of many obesity-related diseases.

The extent of weight loss achieved depends not only on the type of surgical procedure but also on the individual’s commitment to maintaining a healthy lifestyle in the months and years after the procedure.

Changing to a healthier diet and exercise routine will provide you with substantial weight loss and a better quality of life.

The following information has been put together to help you learn more about weight loss surgery and the various surgical procedures offered by experienced Gold Coast surgeon, Dr Puhalla, and his team of health professionals.

The Benefits Of Weight Loss

  • Better Quality of life
  • Prolonged life expectance (calculated from the age of 40years)
  • Increases physical activity
  • Improved fertility female (polycystic ovarian syndrome) and male 
  • Decreased risk for diabetes or hypertension
  • Decreased risk of heart attacks, strokes or blood clots
  • Decreased risk of developing thirteen different types of cancer (e.g. large bowel, ovarian)

If you have been treated for obesity related health conditions, after weight loss surgery the substantial and sustained weight loss leads to

No or reduced medication for:

  • Type 2 diabetes
  • Hypertension 
  • High cholesterol
  • Depression
  • Osteoarthritis / Joint pain

The Benefits Of Weight Loss

  • Better Quality of life
  • Prolonged life expectance (calculated from the age of 40years)
  • Increases physical activity
  • Improved fertility female (polycystic ovarian syndrome) and male 
  • Decreased risk for diabetes or hypertension
  • Decreased risk of heart attacks, strokes or blood clots
  • Decreased risk of developing thirteen different types of cancer (e.g. large bowel, ovarian)

If you have been treated for obesity related health conditions, after weight loss surgery the substantial and sustained weight loss leads to

No or reduced medication for:

  • Type 2 diabetes
  • Hypertension 
  • High cholesterol
  • Depression
  • Osteoarthritis / Joint pain

The Surgical Procedures

Sleeve Gastrectomy

During a sleeve gastrectomy (SG) a narrow gastric tube is fashioned in-between the food pipe (oesophagus)  and the small bowel, while the majority of the stomach (80%) is removed. The continuity of the stomach is not interrupted compared to a bypass procedure. The SG is a solely restrictive operation but since the removed part of the stomach is the major production area of the hunger hormone (Ghrelin), the Ghrelin level drops significantly after the SG, which decreases the food craving.

Hospital stay: usually 2-5 days

Weight loss: about 60 % of excess weight in 5 years. (Please be aware that the extent of weight loss is very individual and cannot be guaranteed.)

Following SG there is a rapid weight loss, but somewhat slower than after any gastric bypass surgery. The SG is considered to have slightly less complications compared to a bypass procedure. In few patients the long term weight loss after a SG might not be sufficient. In which case the sleeve can be converted to a bypass and adding a malabsorbtive component to the initially just restrictive procedure.

A SG seems to be less efficient in binge eating (uncontrolled over eating) or sweet eating (preferably high-calorie sweets or beverages such as fruit juices, soft drinks) compared to a gastric bypass. After a SG preexisting heartburn can increase, which can require a live long anti acid medication. If despite medication the patients still experiences significant heartburn symptoms the SG might be converted to a bypass to separate the acid gastric content from the gastro-oesophageal junction, so reflux into the food pipe cannot occur.

The differences of a SG to the Roux-en-y gastric bypass and Single anastomosis gastric bypass are :

  • According to current knowledge no regular three monthly vitamin B12 injections are required but periodic monitoring of the vitamin B12 level is strongly recommended.
  • The residual stomach is still accessible by gastroscopy; therefore ERCP (endoscopy technique) can be used in case of gallstones blocking the bile duct.

Single anastomosis gastric bypass

By completely dividing the upper part of the stomach a small gastric pouch is formed, which results in a drastic reduction of the gastric volume. Further a bypass of the first section of the small bowel is created.

The small gastric pouch restricts the oral intake and additionally the small bowel bypass reduces the absorption of nutrients (malabsorption). The Single Anastomosis Gastric Bypass (SAGB) requires just one joint in between bowels compared to the Roux-En-Y gastric bypass, which requires two joints.

Hospital stay: about 2-5 days

Weight loss: about 70 % of excess weight in 5 years. (Please be aware that extent of weight loss is very individual and cannot be guaranteed.)

The SAGB usually leads to a rapid weight loss. This operation can be applied in eating disorders such as binge eating (uncontrolled over eating) or sweet eating (preferably high-calorie sweets or beverages such as fruit juices, soft drinks). The SAGB induces hormonal changes, which improve the blood sugar regulation and it therefore often cures diabetes or at least significantly reduces the required medication. The SAGB occasually causes biliary reflux from the small bowel into the stomach. If it is symptomatic the reflux can be treated by converting the SAGB into a Roux-en y gastric bypass. Independently of any preexisting diabetes the intake of carbohydrate-rich food after an SAGB can cause temporary discomfort, dizziness and sweating (dumping)

Roux-en-y gastric bypass

By completely dividing the upper part of the stomach a small gastric pouch is formed, which results in a drastic reduction of the gastric volume. Further a bypass of the first section of the small bowel is created during which the bilio-digestive enzymes joining the digestion of the nutrients about 1.5m downstream after the stomach.

The small gastric pouch restricts the oral intake and additionally the small bowel bypass reduces the absorption of nutrients (malabsorption).

Hospital stay: about 4-6 days

Weight loss: about 66 % of excess weight in 5 years. (Please be aware that extent of weight loss is very individual and cannot be guaranteed.)

The Roux-en-y Gastric Bypass (RYGB) usually leads to a quick weight loss. This operation can be applied in eating disorders such as binge eating (uncontrolled over eating) or sweet eating (preferably high-calorie sweets or beverages such as fruit juices, soft drinks). The Roux-en-y Gastric Bypass induces hormonal changes, which affect the regulation of the blood sugar. This significantly improves an already existing Diabetes in most of the patients. Independently of any preexisting diabetes the intake of carbohydrate-rich food after a Roux-en-y Gastric Bypass can cause temporary discomfort, dizziness and sweating (dumping).

Loop-Duodenal Switch (SADI-S / SIPS)


The Loop Duodenal Switch (SADI-S or SIPS) combines a moderate restriction (reduced portion sizes) of a sleeve gastrectomy with a moderate reduced absorption (bypassed small bowel). The surgeon first performs a sleeve gastrectomy. Secondly, just after the junction of the stomach and the small bowel (pylorus), the food passage is redirected and enters further downstream, bypassing the upper small bowel and leaving three metres of small bowel for absorption of nutrients before entering the large bowel.

Hospital stay: 2-5 days

Weight loss: about 85-95% of excess weight in five years. (Importantly, the extent of weight loss varies for each individual and cannot be guaranteed). Weight loss occurs over an 18-month period following surgery.

Like gastric bypass surgery, the Loop DS induces hormonal changes which can have significant positive effects on type-2 diabetes. Weight loss surgery often improves the symptoms of type-2 diabetes, even before patients start to lose weight. After surgery, many patients find that they need less medication or none at all. As well as being a powerful procedure to improve or achieve long-term remission of type-2 diabetes, the Loop DS can also improve high blood pressure and high cholesterol. The Loop DS is best suited to patients who have a high body mass index (BMI), type-2 diabetes or have previously undergone unsuccessful gastric sleeve or lap band surgery.

The loop DS has a lower risk of gastric ulcers and dumping, which occurs after having a carbohydrate-rich (sugary) drink, compared to a gastric bypass. However, on the other side, heartburn is seen more often after Loop DS than gastric bypass surgery.

Intra-gastric Balloon (Orbera)


The Intra-gastric balloon, is a non-surgical weight-loss procedure which involves the insertion of a specialised balloon inside the stomach to occupy space and limit the food carrying capacity of the stomach.

It is designed to assist patients with a BMI over 27 who want to lose 10-15kg. It may also be suitable for patients in the super obese category (BMI>50) who would benefit from non-surgical weight loss before being admitted for a necessary surgical procedure.

How does it work: The procedure itself lasts 20-30 minutes and is performed under light sedation. The gastric balloon is introduced into the stomach via the mouth and food pipe (oesophagus) in a deflated state. Once in position, sterile water is used to inflate the balloon. The balloon remains in the stomach for 6 months and will then need to be removed.

The system works by reducing feelings of hunger by giving you a sense of fullness more quickly when eating.  The balloon helps control portion size as it takes up space in the stomach. With the support from the dietician, the intra-gastric balloon can help you change poor eating habits and behaviours to achieve your weight loss goals long term.

Expected Weight Loss: Weight loss average is 10-15kg in 6 months. Studies have shown that patients with the balloon lose 3.1 times more weight compared to patients who undergo diet and exercise programs alone.

What are the side effects: The intra-gastric balloon may cause some nausea and abdominal discomfort during the first few days, for which you will receive medication.

What else is involved?

Consultation and preparation with Dr Puhalla and the dietitian
Day procedure for insertion of the balloon
Gradual dietary transition after placement of the Intra-gastric balloon with the guidance of the dietitian
Regular follow up consultations with your team while the balloon is in place
Removal of the balloon after 6 months as a day procedure

Contact Us for more information on Bariatric Surgery

Take the first step by making an initial appointment with Dr Puhalla, who has decades of surgical experience. Understanding your full medical history will assist Dr Puhalla in providing you with a holistic treatment plan to help you reach your goals. Our friendly and caring team are more than happy to answer your questions and guide you through your weight loss journey. Your health is worth your focus!

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Bariatric Surgery

Dr Harald Puhalla is a General Surgeon with a private practice in Gold Coast Private Hospital and Pindara Private Hospital. For more information about the surgical procedures offered by Dr Puhalla, please contact us to arrange a consultation or phone (07) 5563 1360.

Consulting At

Gold Coast Private Hospital
Ground Floor, Suite 7
14 Hill Street
Southport, QLD 4215

Contact Info

Dr Harald Puhalla, PO Box 927,
Southport, QLD 4215

Phone: (07) 5563 1360
Fax: (07) 5563 1950
E-Mail: admin@generalsurgerygoldcoast.com.au

Disclaimer: This website contains general information only about medical conditions and treatments and does not replace a detailed medical or surgical consultation. The information provided is done so without any representation or warranty of any kind, either expressed or implied.

All medical and surgical procedures carry a risk and visitors to this website are advised to consult a registered medical practitioner for advice applicable to their individual requirements. Treatment outcomes and results may differ from person to person.