BARIATRIC SURGERY GUIDE

“Australians keep dieting

to lose weight, but
bariatric surgery is the
most effective treatment
out there for obesity.”

Ta k e b a c k y o u r l i f e
“This man saved
my life. My surgery
was a complete
success. Thank you
Dr. Gounder. ” D.R.
THANK YOU
Please find attached the following documentation to help you make an informed decision
regarding your bariatric surgery:

Financial Guideline to Bariatric Surgery

Patient information regarding surgery

Please also note the following important information:

• We restrict bariatric surgery to patients with a BMI of more than 35. If your BMI is lower
than 35, it’s unlikely we will perform surgery, unless you have obesity related illness such
as diabetes, severe sleep apnoea or hypertension.
• P
lease ensure you check with your health fund to identify whether you have cover for
either of the procedures. The item numbers are provided on the attached Financial
Guideline to Bariatric Surgery sheet.
• A
current referral from a General Practitioner (GP) or Specialist is required for your
appointment with Mr Siva Gounder.
• I f you would like to access your Superannuation to pay for your procedure, please follow
the link below for further information. The form is called Early Release of Superannuation
on Compassionate Grounds by a registered medical practitioner. If you elect to utilise your
Superannuation for payment of the procedure please also let the Administration staff know
at Mr Siva Gounder’s rooms.

https://www.ato.gov.au/Forms/Compassionate-release-of-superannuation---Report-by-
registered-medical-practitioner/

Can I use my husband’s super? Yes

What if I do not have enough super? Can I split the surgery costs
between my husband’ superannuation and mine? Yes

How long does the superannuation process take? 4 - 6 weeks

If I have money left over, do I have to put it back into my super? No*

Can my son or daughter use my super for their surgery? Yes, absolutely

*If the quote comes in lower, then you do not need to reimburse your fund

If you require any further information, please don’t hesitate

to contact Mr Siva Gounder in his private rooms at 42 Great
Northern Highway, Midland on either (08) 6155 8822 or via
email info@perthweightlosssurgery.com.au.

Visit Mr Siva Gounder’s website:

www.perthweightlosssurgery.com.au
for more information.

Kind regards
Mr Siva Gounder
 FINANCIAL GUIDELINE TO
BARIATRIC SURGERY COSTS
The following is a guideline to bariatric surgery costs and associated procedures. We strongly advise you to ring
your private health insurer to ascertain any rebates to which you might be entitled.

If you reach your safety net threshold with Medicare, you may be entitled to a higher Medicare rebate for some
of your appointments. Mr Gounder does not participate in any private health insurer’s “gap scheme” with the
exception of endoscopy and colonoscopy procedures.

A current referral from a GP or Medical Specialist is required for your appointment with Mr Gounder so that you
can claim a rebate.

Outpatient appointment fee schedule. Consultation payments are required on the day of your appointment.

Mr Siva Gounder Consultation Private Fee Rebate

Initial Consultation $180.00 $76.15

Subsequent Consultation $100.00 $38.25

1-2 weeks post-surgery follow up No charge -

3 months post-surgery (item 105) $100.00 $38.25

12 months post-surgery (item 105) $100.00 $38.25

Dietitian
Further information will be provided at your initial consultation with the dietitian

Consultation Private Fee Rebate

Initial Dietic Appointment $180.00

Post - Op Appointment $90.00
6 weeks post-surgery follow up $90.00

3 months post-surgery follow up $90.00 Dependent on health

fund cover
6 months post-surgery follow up $90.00
12 months post-surgery follow up $90.00

Perth Weight Loss & Surgery | Page 4

 Gastric Band Estimated total cost to
Surgeon & Assistant Anaethetist Hospital
Surgery Patient after rebate
Insured $4,400 Fully Covered - $3,350
Uninsured $4,400 $1,850 $12,080 (approx.) $18,330

Gastric Bypass Estimated total cost to

Surgeon & Assistant Anaethetist Hospital
Surgery Patient after rebate
Insured $5,900 Fully Covered - $4,610
Uninsured $5,900 $1,850 $14,455 (approx.) $22,205

Gastric Sleeve Estimated total cost to

Surgeon & Assistant Anaethetist Hospital
Surgery Patient after rebate
Insured $4,900 Fully Covered - $3,850
Uninsured $4,900 $1,850 $14,660 (approx.) $21,410

Lap Band Estimated total cost to

Surgeon & Assistant Anaethetist Hospital
Reversal Patient after rebate
Insured Fully Covered Fully Covered - Fully Covered
Uninsured $2,400 $1,850 $7,340 (approx.) $11,590

Estimated total cost to

SIPS / SADI-S Surgeon & Assistant Anaethetist Hospital
Patient after rebate
Insured $6,500 Fully Covered - $5,210
Uninsured $6,500 $1,850 $13,180 (approx.) $21,530

Inpatient admitted to hospital fee schedule.

The payment of your operation is required at least one week prior to the procedure. Failure to make payment may result
in your surgery being delayed.
Anaesthetist Fee:
There will be no out of pocket fee for your anaesthesia, provided you have the appropriate level of cover with your
private health fund

If you have appropriate cover, your anaesthetic invoice will be billed directly to your health fund as a no gap arrange-
ment. If you do not have hospital cover, then you will need to contact the anaesthetist for a detailed quote.

Pathology Fees:
Medicare does not fully cover the costs of all tests and may not cover the cost of some tests at all.

Please note that all pathology costs are billed to the patient directly by the laboratory, and they are not included in
the doctor’s fee.

Hospital and Theatre Costs:

Please contact your private health fund to find out your hospital excess (if applicable) or any other hospital out of
pocket expenses there may be.

If you do not have health insurance hospital and theatre costs will occur. This cost may vary from $12,000- $15,000
depending on the type of bariatric surgery. Please call 6155 8822 or email info@perthweightlosssurgery.com.au to
get a more accurate quote.
 BARIATRIC
SURGERY
PATIENT
INFORMATION
This document aims to provide you with an initial source of
information on obesity surgery. There’s lots of information out
there regarding weight loss surgery, and our goal is to help you
understand the critical points before considering surgery.

If you are reading this brochure it’s likely you have struggled
against weight gain for years and have tried numerous diet and
exercise regimes (and perhaps weight loss medications such as
Reductil, Xenicalor Duromine) with little result.

For many people, once you have reached a certain weight, it

becomes even more difficult to achieve sustained weight loss
through diet and exercise alone. The vast majority of people will
“yo-yo” diet and end up heavier than when they started.

Progressive weight gain is associated with medical

complications such as Type 2 diabetes, high blood pressure,
high cholesterol and sleep apnoea. There are also fertility
issues for young women of child-bearing age. As you put
on weight, it becomes more challenging to exercise which
compounds the problem.

Obesity surgery has developed rapidly due to recent medical

and technological advances.

Often performed laparoscopically (through keyhole surgery)

obesity surgery is a procedure from which most patients
quickly recover.

Weight loss through obesity surgery is reasonably predictable.

Most people do well and are satisfied with the decision to
undertake surgery.

Research from many global medical trials shows people who

have undergone weight loss surgery are expected to resolve
many of their health problems and go on to live longer lives.

Perth Weight Loss & Surgery | Page 6

SHOULD YOU CONSIDER
WEIGHT LOSS SURGERY
Surgery is an excellent option for significant weight loss, however, as
with any surgical procedure, there are risks, and complications occur
from time to time.

We restrict surgery to patients who meet specific criteria. To undergo

surgery patients should:

• Be aged 18-70
• Have a body mass index (BMI) of over 35.
• Have a body mass index of 30 to 35 with obesity related illness

You generate your BMI by dividing your weight in kilograms by your

height in metres squared.

Work out your BMI by going to our website

(www.perthweightlosssurgery.com.au) where we feature a BMI
calculator on the home page.

BMI gives a reasonably accurate idea of possible future weight-related

risks, such as type-2 diabetes.
 WHAT ARE THE
SURGICAL
OPTIONS
The operations Mr Gounder performs are straightforward
keyhole surgeries with fast recovery time and good weight
loss.

The two most popular weight loss surgery options are

laparoscopic sleeve gastrectomy and the gastric bypass
operation.

In our initial consultation we’ll discuss your particular health

problems, your goals and your current situation, and if
appropriate, explain both procedures in detail.

We then tailor the surgery to your particular needs.

Perth Weight Loss & Surgery | Page 8

LAPAROSCOPIC SLEEVE
GASTRECTOMY
This is a restrictive stomach procedure. Initially
performed as the first stage of a more complicated
2 stage duodenal switch procedure, Surgeons found
that many patients lost so much weight having the
sleeve procedure that they did not need to come back
for the second bypass operation. Now it is performed
as a standalone procedure. It is a laparoscopic keyhole
procedure that involves stapling off and completely
removing ¾ of the stomach, leaving a small tube
remaining with a capacity of approximately 150ml.
This procedure is irreversible and more radical than
laparoscopic band surgery but has advantages and
disadvantages.
Sleeve gastrectomy is straightforward to perform,
usually with five, less than 1.5cm keyhole laparoscopic
incisions. We use an array of staples to create the sleeve,
then remove a substantial portion of the stomach, as
shown in the diagram.
The procedure takes 1-2 hours, and patients usually stay
in the hospital for two nights, returning to work in 1-2
weeks.
Unlike lap band surgery, a gastric sleeve doesn’t involve
any adjustments or concerns about long-term issues
such as band slippage or erosion.
Weight loss appears to be better than lap band in short
to medium term with most patients losing roughly 70%
of their excess weight at 12 months.
Gastric Sleeve surgery also appears to be better than the
lap band procedure regarding resolving type-2 diabetes
and sleep apnoea.
Dietary restrictions are also less for sleeve patients.
Unlike lap band patients, most gastric sleeve patients
can still eat meat and bread post-surgery.
The sleeve gastrectomy is, however, an irreversible
procedure and does have slightly higher initial post-
operative risks associated. There is a 1% risk of having
either a leak or a bleed from the staple line.
A leak from the staple line would require re-operative
surgery either via keyhole surgery, endoscopy
or possibly a larger incision and could involve an
extended stay in the hospital and perhaps further
operations.
A bleed from the staple line might require blood
transfusions or re-operation, usually via a keyhole
approach.
As the sleeve procedure has only been performed
for less than 15 years, it is yet to be proven how the
surgery results withstand over extended time periods.
There is the possibility of putting on weight in the
future if the stomach sleeve were to stretch over time.
The stomach plays a vital role in the absorption of
vitamin B12 and iron, and it’s possible we’ll see some
deficiencies in these vitamins and minerals in the
future.
We recommend taking daily multivitamins and very
occasionally it has been necessary to give patients an
iron infusion or B12 injection.
Laparoscopic sleeve gastrectomy may be attractive
for patients in regional settings in Western Australia,
as it doesn’t require the intensive follow up lap band
patients need.
We like to see sleeve patients at six months and then
yearly for five years, for blood tests.
Up to 10 to 15 % patients can expereice reflux
symptoms. This may require lifestyle change,
medications or rarely further surgery such as hiatus
hernia repair or gastric bypass surgery.
 LAP BAND
SURGERY
Laparoscopic Adjustable Band Procedures (lap band
surgery) have been available since 1994. It is an example
of a restrictive procedure where a small silicone band is
passed around the upper stomach and sutured in place.
This band compresses the upper part of the stomach and
restricts solid food from entering the stomach for several
hours.

It converts the capacity of the stomach from its usual

500 ml to a small pouch of about 50-80 ml. The solid
food is held up in the pouch before it eventually drops
through the band into the rest of the stomach and gets
absorbed normally.

People with a band in place can only eat small portions.
There is often a mild effect on reducing appetite due to
the band pressing on the upper stomach and sending
messages to the brain to switch off the hunger centre.
The combination of not feeling hungry and only
tolerating small meals starts the weight loss process.
Lap band surgery is straightforward, taking around an
hour to perform under general anaesthetic.
We use 4-5 small incisions of 1-2 cm, passing our
instruments through these to reach the stomach. There
is a small piece of tubing attached to the band which
connects to a small reservoir implanted under the skin,
below the ribs, on the left side.
This tubing allows us to adjust the tightness of the band
on the stomach. Immediately following surgery, there
is no fluid in the band system. Five weeks after surgery
patients can attend the rooms for their first “fill”.
This involves feeling the port under the skin and injecting
a small amount of saline into the chamber and band to
cause it to squeeze on the stomach. This creates dietary
restriction and a feeling of fullness, prompting the start
of weight loss.
KEY FACTS
• Patients are usually in the hospital for
one night
• Most people take a week off work
• T
he band will need to be adjusted (filled)
5-8 times in the first year and then less
after that, to work well
• M
ost people will lose 40-50% of their
excess weight after 12 months at a rate
of 500gm to 1kg a week
• T
here are dietary restrictions associated
with the band, which the Dietitian will
discuss with you in detail.
• After surgery, most people have
difficulties with steaks, chicken and
some bread. Lap band patients should,
however, be able to eat rice, fruit and
vegetables, fish and soft meat.

Perth Weight Loss & Surgery | Page 10

PROBLEMS WITH
LAP BAND SURGERY
The band is safe and effective but by no means perfect. Some problems can occur during
the operation and in the years that follow surgery.

In roughly 1 in 300 operations the stomach or oesophagus can suffer damage and leak.
If this occurs, it would be a severe complication requiring re-operation(s) either via
laparoscopy (keyhole) or open surgery (a larger abdominal incision).

This may involve a prolonged hospital stay for some weeks and possibly a transfer to
another hospital in an intensive care environment.

Very occasionally the band access port can become infected with skin bacteria. This
usually settles with antibiotics, but if not, removal of the band may occur.

Anyone having an operation is at risk of anaesthesia complications, but obese patients

have a higher chance of having chest problems (lung collapse or pneumonia) and clots in
the legs and lungs (Deep Vein Thrombosis /DW or Pulmonary Embolism).

We aim to mobilise patients quickly to avoid this and give patients heparin to thin the
blood and prevent clots. You will also wear TED stockings in the hospital to prevent clots
forming in the legs.

We now know bands do run into mechanical problems over the passage of time. Recent
research has shown that 50-60% of bands will need to be repositioned or removed for
mechanical problems by the 10-year mark.

Often this is due to slippage, where the stomach above the band stretches up and can
block off the passage.

In roughly 1% of patients, the band can erode/ulcerate the stomach and work its way into
the inside of the stomach. If this occurred, the band would need to be removed.
If the band does need to come out, many patients will battle weight regain.

Deciding to have a laparoscopic band requires a lifetime of follow up to make sure no

problems occur.

We like to see patients several times a year in the first year and then at least once
annually for subsequent years.
 WHAT IS
GASTRIC BYPASS?
A Gastric Bypass involves stapling your stomach to create a
smaller stomach ‘pouch,’ bypassing the rest of your stomach
and part of your bowel. It works by making you feel full sooner,
so you eat less and also reduces the calories and nutrients in
your food from being absorbed.

IS A GASTRIC BYPASS
SUITABLE FOR ME?
The decision to undergo a gastric bypass depends on many
factors such as history of smoking, NSAID intake, presence of
diabetes, reflux and your long term goals.

WHAT ARE THE BENEFITS

OF A GASTRIC BYPASS? SINGLE ANASTOMOSIS GASTRIC
BYPASS
Gastric Bypass is one of the oldest weight loss surgeries,
having been successfully performed for the last 40 years and
has a proven track record.

With Gastric Bypass it is likely you will achieve long-term

weight loss, but this depends on your ability to adhere to your
new lifestyle.

Long-term weight loss is almost secondary to the way this

surgery improves most obesity-related health problems,
diabetes, hypertension, obstructive sleep apnoea etc.

ARE THERE ALTERNATIVES

TO A GASTRIC BYPASS
Put simply, losing weight involves eating less, improving your
diet and doing more exercise. Sometimes medication given by
your GP can help. However, we know from various studies only
a small group of people (<1%) suffering from obesity can lose
and maintain their weight to healthy limits.

There are other surgical options such as gastric banding,

duodenal switch/SIPS and sleeve gastrectomy.
ROUX EN Y GASTRIC BYPASS

Perth Weight Loss & Surgery | Page 12

HOW IS A GASTRIC
BYPASS PERFORMED?
Performed under a general anaesthetic the operation
usually takes two to four hours. Your surgeon will make
several small cuts on your abdomen. They will insert
surgical instruments, along with a telescope, so they can
see inside your belly and perform the operation.
Your surgeon will divide your small bowel below your
stomach. They will bring up the lower end and attach it
to your new stomach pouch. The contents of your new
stomach pouch will now bypass the rest of your stomach
and the first part of your small bowel.

Your surgeon will create a tunnel behind your stomach. We offer two types of gastric bypass, the Roux en Y gastric
They will pass a stapling device through the tunnel and bypass and the single anastomosis or mini gastric bypass.
then staple your stomach to create a smaller stomach Mr Gounder will discuss the best option for you based on
pouch. your medical history.

WHAT COMPLICATIONS
COULD OCCUR?
GENERAL COMPLICATIONS OF LONG-TERM PROBLEMS
THIS OPERATION CAN INCLUDE:
• Pain • Nutritional deficiencies
• Bleeding • Anastomotic Ulcer
• Infection of the surgical site (wound) • Developing Gallstones
• Developing a hernia in the scar • Dumping syndrome
• Blood clots (www.perthweightlosssurgery.com.au/dumping-syndrome/)

SPECIFIC COMPLICATIONS OF
THIS OPERATION:

• Anastamonis stricture
• Staple-line bleeding
• Anastomotic or staple line leak
• Developing a hernia inside your abdomen
 EFFECTIVENESS OF
GASTRIC BYPASS
• Studies show patients typically lose the most weight within one year after surgery,
and maintain substantial weight loss with improvements in obesity-related conditions

• P
atients may lose as much as 60% of excess weight six months after surgery, and 70
to 80% of excess weight as early as 12 months after surgery

• B
y improving your diet and exercising regularly, you can maintain this weight loss in
the long run

• H
elps to improve or resolve many obesity-related diseases and conditions, including
type-2 diabetes, heart disease, certain cancers, sleep apnoea, GERD, high blood
pressure, high cholesterol, sleep apnoea and joint problems

• 6
0% reduction in mortality from obesity-related cancer, with the most significant
reductions seen in breast and colon cancers

• 56% reduction in mortality from coronary artery disease

• Up to 70% induction of remission of Type 2 Diabetes within the first two years

Perth Weight Loss & Surgery | Page 14

HOW SOON
WILL I RECOVER?
You should be able to go home in 2 days. You’ll take only liquids for
2 weeks, progressing to soft food for another two weeks and then
progress on to solid food.

You should be able to return to work after two to four weeks,

depending on the extent of surgery and your type of work.

Regular exercise will help you return to normal activities as soon as

possible. Before you start exercising, ask the health care team or
your GP for advice.
 WHAT IS
SADI-S/SIPS
Single anastomosis duodeno ileal switch (SADI-S) also known as Stomach Intestine
Sparing Surgery (SIPS) involves a sleeve gastrectomy being performed along with surgery
to reroute the small intestine.

SADI-S is a weight loss surgery that produces malabsorption along with restriction to
effect weight loss. It also produces good control for diabetes – greater than 95% – and
other obesity-related illnesses.

Single anastomosis duodenal ileal switch is an effective technique to facilitate weight

loss in obese patients. This procedure is effective because it reduces the body’s ability
to absorb the calories in the food that has been consumed due to the shortening of the
digestive tract. However there is always a compromise with effecting greater weight loss
mainly with needing increased protein and vitamin intake and potential for developing
deficiencies in these.

Perth Weight Loss & Surgery | Page 16

FREQUENTLY ASKED
QUESTIONS
Does the superannuation cover surgery?

You can apply to your super fund with support from your GP and us to cover the out of pocket fees.
Weight loss surgery is usually considered and approved by the super fund as it is an important
treatment for obesity.

Do I need private health insurance?

• For private bariatric surgery it is important to have private health insurance that covers obesity
surgery.
• There will be out of pocket costs or gap charges depending on health fund and type of surgery.

What are the risks of weight loss surgery?

• All major surgery comes with risks, and the risks are different for each patient. During your first
appointment, your surgeon will explain your individual risk level.
• Overall the major morbidity risks are under 5%
• Mortality is under 0.5%

What and how much can I eat after surgery?

• Depending on the type of surgery the quality of eating varies. With the gastric band there is much
more restriction on type of food. With the sleeve gastrectomy and gastric bypass you will be able
to eat most types of food albeit in smaller quantity.
• As you will only be able to eat a small quantity of food. Usually an entrée size meal will be your
main. It is advised that you concentrate mainly on protein intake and daily vitamin supplements.

How long will I be off work?

If all goes well most people will return to work in 10 to 14 days. You should be able to drive after 5
days.

What about pregnancy and weight loss surgery?

• Fertility increases after surgery. Birth control pills are not very reliable during the time your weight
is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse
is recommended.
• Most groups recommend waiting 12-18 months after surgery before getting pregnant.
• Babies born to mothers who have had weight loss surgery have been shown to be slightly
smaller in size for gestational age. The good news is that, after surgery, there is much less risk
of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and
during childbirth. There are also fewer miscarriages and stillbirths than in overweight women who
have not had surgery and undergone weight loss.
• Children born after mother’s surgery are less at risk of being affected by obesity later, due to
activation of certain genes during fetal growth There is also less risk of needing a C section during
pregnancy.
 FREQUENTLY ASKED
QUESTIONS
When and why should I consider weight loss surgery?

• Surgery is the best long-term treatment for obesity. Its recommended for patients
with BMI of more than 40 or more than 35 with comorbidities such as diabetes, high
cholesterol and sleep apnoea. It can be also considered for lower BMI with severe
diabetes. Patients can expect long term excess weight loss of between 50 to 90%
based on type of surgery and compliance.
• Obesity is a disease and large population based studies have shown that it leads to a
myriad of problems like diabetes, increased cancer risk, heart disease, sleep apnoea,
arthritis and many others. The chances of losing and maintaining a health weight by
diet and exercise is 1 in 1,290 for men and 1 in 677 for women with severe obesity.

Which is the best surgery?

There is no one best surgery. The best operation is determined based on multiple factors
and is individualized. After the initial consult and assessing your health and risk factors an
appropriate surgery will be determined.

Is the surgery painful?

Surgery is done with laparoscopic or key hole technique. The largest cut is usually
only 15mm in size. Most patients have very tolerable pain that is well managed with
analgesics.

WHERE TO
FROM HERE
If you are interested in a free consultation, please contact Mr Siva Gounder on either
(08) 6155 8822 or via email at info@perthweightlossandsurgery.com.au.

Visit our website: www.perthweightlosssurgery.com.au for further information.

Perth Weight Loss & Surgery | Page 18

TAKE BACK
YOUR LIFE
 Sleeve Gastrectomy
Gastric Bypass
Gastric Band
SADI-S/SIPS Procedure
Revision Surgery
General Surgery
Colonoscopy & Gastroscopy

Perth Weight Loss & Surgery

42 Great Northern Highway,
Midland WA 6065
P: 08 6155 8822 F: 08 6155 8823
E: info@perthweightlosssurgery.com.au
Consultation & Surgery
Surgeries performed at St John of God
Midland Public and Private Hospitals

Hollywood Private Hospital

Monash Avenue,
Nedlands WA 6009
P: 08 6155 8822 F: 08 6155 8823
E: info@perthweightlosssurgery.com.au
Surgery

Perth Specialist Centre

Tenancy 13, Level 1, 11 Wentworth
Parade, Success WA 6164
P: 08 9498 6277 F: 08 9414 3032
E: info@perthweightlosssurgery.com.au
Consultation only

perthweightlosssurgery.com.au