We understand that it is a big decision to consider weight loss surgery, but you are not alone! Thousands of Australians have undergone weight loss surgery and have turned their health around.
Losing substantial weight in the long term greatly improves your health and quality of life, and we are here to support you every step of the way.
The first step: Please call (07) 5667 9766 to speak with our friendly team, who will make an appointment for you to have a consultation with Dr Harald Puhalla. You will need a GP referral to claim your Medicare rebate.
Your initial consultation with Dr Harald Puhalla will involve a thorough assessment of your medical history and lifestyle, along with your health goals. He will explain all aspects of weight loss surgery to you, what to expect and answer all your questions. During the consultation, he will discuss the different procedures suitable for you, how they help you to lose weight. This will take about 45 to 60 minutes. Dr Puhalla will organise some investigations and tests, to help determine the optimal procedure for you and your weight loss journey.
For these investigations, you will get a blood test request form, which should be done within the next few days after your consultation. This is a fasting blood test and is done in a pathology lab, such as QML or S&N.
Most patients will also need to have a gastroscopy (also called an upper endoscopy), which will be performed by a gastroenterologist. This procedure involves a flexible endoscopic camera being passed through your oesophagus, stomach and upper small bowel. The procedure is done as a day procedure in a hospital, and typically takes around 30 minutes where you are under sedation or general anaesthetic.
Some patients may need to see another specialist, such as a cardiologist, however, this will be discussed with you if applicable.
After you have had all of your investigations done, you will see Dr Puhalla for your pre-operative consultation. He will discuss the results of the investigations with you, and together, you will discuss and decide on the best weight loss procedure for you, and plan your surgery.
Once your surgery has been planned, you will need to see a dietitian to discuss the pre and post operative dietary requirement. This will include the pre-operative very low calorie diet, which usually must be done for 2 weeks before surgery. You can also discuss the dietary upgrades after surgery, suitable food choices and vitamin supplementation.
For your surgery date, you must go to the hospital as per your admission instructions. You will be advised of your admission times and fasting details via email or phone 1 to 2 business days beforehand. Please reply to the email to confirm you have received it. For your hospital stay, we recommend bringing some personal items with you to make your stay more comfortable. After surgery, Dr Puhalla will visit you daily until you are discharged.
About 2 weeks after your operation, you will have a follow-up appointment with Dr Harald Puhalla to check on your recovery process. You will be given another blood test request form for your next appointment with Dr Puhalla in 3 months.
You should also see your dietitian 10 to 14 days after surgery to assess your fluid intake and upgrade from liquids to a pureed diet. At this stage, we recommend starting on daily multivitamins under the guidance of the dietitian. Within the next few weeks, you will be able to further upgrade your diet.
Your next consult with Dr Harald Puhalla will be 3 months after surgery. Please get the fasting blood test done 1 to 2 weeks before your appointment. Dr Puhalla will check that all of your vitamin levels are normal, and keep track of your weight loss. Around this time, it may also be suitable to see your dietitian again, as they will be able to help you keep on track with your weight loss.
Dr Harald Puhalla will see you again 6 months after your operation. Your health and wellbeing is important, therefore we will check your vitamin levels again with another blood test.
We want to ensure that your weight loss journey is successful and long-lasting. We suggest regular follow up appointments with Dr Harald Puhalla which will be every 3 months in the first year after surgery, then every 6 months in the second year, and then once a year. If you live regionally, you can follow up with your GP.
Recommendations Before Surgery
Please fast (NO FOOD or DRINK) 6 hours prior to your surgery. You can have a 200 ml glass of either water, Gatorade or Powerade two hours before surgery and from then onwards, nothing to eat or drink for the following two hours prior to your surgery. If you are diabetic, the drinks should be sugar-free. If you are undergoing weight loss surgery, please ensure your last meal before fasting is “light”, preferably a shake, such as Optifast or similar.
On the day of surgery, please remove all make-up, false lashes and false nails. This is so they will not injure you during surgery, and your anaesthetic can be carried out safely. If you do not have these removed, you risk having your surgery postponed.
You should take your regular medications including the morning of your surgery, however, there are some exceptions:
- Blood thinners (e.g., Plavix, Xarelto, Brilinta, Warfarin, Aspirin, Fish oil): reduce your ability to form blood clots, which increases your risk of bleeding during and after your surgery. These medications usually need to be stopped several days before your surgery, so please advise us if you take any.
- Diabetic medications & Insulin: If you take medication to control your blood sugar, you should not do that on the day of surgery, since you fast on that day. Otherwise, your blood sugar levels may become very low during the operation. For Insulin, on the day of surgery you might be asked to reduce your usual dose or not to take it at all. All diabetic patients will have their blood sugar checked just before and after surgery.
- Some oral diabetic medication (called Sodium-glucose co-transporter-2 (SGLT2) inhibitors) can interfere with your anaesthetics and need to be stopped 3 days before your surgery (e.g. Forxiga, Jardiance, Xigduo, Jardiamet). During these 3 days, they may have to be replaced by a different medication, or your other glucose-lowering agents have to be increased. Metformin should be paused 2 days before surgery. Please talk to your GP.
Smoking & Vaping
Smoking and vaping increases your saliva production during the anaesthetic, which increases adverise side-effects and risks of anaesthetia. It also increases your risk of post-operative coughing, and subsequent pain after surgery. It also slows down your recovery process and overall healing. It is recommended that you cease smoking at least one week before and one week after your surgery. If you need help to overcome smoking, this may be a good opportunity for you to speak to your GP about quitting.
Recommendations After Surgery
The following information should help you during your recovery after surgery. You may organise someone to pick you up and try to have a friend or family member help you for the first few days so that you can avoid bending over or lifting. Having some groceries ready at home after surgery can also avoid unnecessary trips to the supermarket.
Pain medication will be ordered for you as needed on discharge. You are encouraged to take the prescribed pain medication in order for you to be comfortable during your recovery. Pain may prevent you from doing the activities that help with your recovery. If you have concerns about your pain management, please contact us or talk to your GP. Please report any new, increasing, or unrelieved pain. If you require anti-nausea medication, this will also be arranged on discharge.
It is important to stay hydrated after surgery. Please ensure you are drinking water throughout the day. This can help you avoid constipation and make your recovery smoother.
Constipation after surgery is not unusual, since anaesthesia, pain medications or abdominal surgery can slow down the movement of the intestine. On discharge, we will order some laxatives for you that can be taken to relieve constipation for the first few days after surgery. If you develop very loose bowel motions, please reduce the laxatives. If very loose motions continue, you may stop this medication.
Caring for your incisions:
Dr Puhalla often uses a purple glue covering over surgical incisions (especially for laparoscopic surgery). Please do not remove the purple glue. It will come off by itself over several weeks following your surgery. There are no stitches to be removed.
If an incision at your umbilicus is necessary, a dressing may be used to cover the wound. Please remove the dressings on the 7th day after surgery. If the dressing starts to come off before day 7 after surgery, please replace it. If you are uncomfortable doing this, you may see your GP to do it for you.
For larger incisions (usually made during open surgery), dressings are used to cover it. They can be removed on day 7 after surgery. If the dressing starts to come off before day 7 after surgery, please replace it. The skin may has been closed with staples. They need to be removed after day 10 – you will be advised in this regard.
Watch for any separation, bleeding, or signs of infection, which include:
- Drainage of fluid or puss
- Heat at the incision site
- Fever (which is usually a temperature of 38 ºC or higher)
If you notice any of these problems, please call us or your GP.
You can shower using soap and water with the glue or dressings on, and after you have removed the dressing on day 7 after surgery. Only use water and no soap around the wound site and be gentle in this area. If water collects behind the dressing, please remove the dressing to let the incision dry up and replace the dressing.
Generally, you should not lift objects heavier than 5 kg for 2 to 3 weeks after your surgery. Lifting heavy objects too soon may weaken your incision. Plan your daily activities so that you can rest often. Do not expect your energy level to be the same as it was before surgery. Your body needs more energy to heal, and this may cause you to feel weaker and sometimes tired. Different surgeries require different limitations on activity. However, at your follow up appointment 2 weeks after surgery, increases in activity will be discussed.
You should continue taking your regular medication as before your operation unless advised otherwise. If you had to stop a blood-thinning medication before surgery, you need to restart it after your procedure when it is considered safe to do so. You will be advised on discharge. Diabetes medication should be restarted once you are back on a normal or soft diet.
After weight loss surgery, your blood sugar levels are usually lower than before the operation due to the very low-calorie diet before and after surgery. Some types of operations may also reduce your blood sugar without recent weight loss. To avoid hypoglycaemic episodes, you should monitor your blood sugar regularly after surgery, and follow up with your GP if you have concerns. It is recommended that you meet with your GP a week after surgery to discuss if any diabetes medication needs to be restarted or adjusted.
Blood clots, also known as deep vein thrombosis (DVT) can form after surgery and prolonged rest. These blood clots can travel to the lung, causing a pulmonary embolism (PE). The best way to prevent DVTs is to mobilize early after surgery and wear TEDs (anti-embolism stockings). While in the hospital, you will be given a medication that helps prevent these clots. In some instances, it might be necessary to continue this medication for several weeks after your surgery. This medication is injected just under the skin.
The diet recommendations after surgery vary and depend on the type of surgery you had.
- After hernia surgery, patients can continue their usual diet without any changes.
- After removal of the gallbladder, you should have a low fat diet for the first 2 weeks after surgery and then, if desired, you may introduce more fat into your diet.
- After weight loss surgery, you should follow the instructions of your dietitian, which usually involves a fluid diet (e.g., shakes or soups) and good hydration (about 1 – 2 L of fluid, depending on individual build). Aim for about 80 – 100ml per hour. You should have a follow-up appointment with your dietitian 10 – 14 days after surgery, which gives you the opportunity to discuss any diet-specific questions and to be upgraded to a pureed diet.
Most patients, especially after laparoscopic surgery, are clear to do short drives about one week after the operation in a private vehicle. Never drive while taking narcotic pain medications (e.g., Targin, Oxycodone) and make sure you are able to do the emergency breaking, fasten seatbelts and can visualise traffic as you did before the surgery. If this does not apply to you, you will be advised when you are able to drive again.
Your routine follow up will be about 2 weeks after surgery. This can be booked before surgery, or the ward staff can organise this for you on discharge from hospital.
If you have any concerns in between the time of your discharge and follow-up appointment, please call your GP or us. After hours, you can contact the hospital/ward where you have been a patient.