Dr Rachel Kirby is a laparoscopic upper gastrointestinaI and bariatric surgeon based in Campbelltown, NSW.

Dr Kirby graduated with honours from University College Dublin in Ireland in 2005. She completed her MRCSI (Ireland) surgical exams in 2008 and emigrated to Australia. She completed her general surgical training in 2015 obtaining her General Surgical Fellowship having rotated through Liverpool and St.George hospital network. Dr Kirby subsequently completed a two year fellowship program in mixed hepatobiliary and upper Gi units in Melbourne and RPA Hospital in Sydney.

She is a member of ANZHPBA ,ANZMOSS and is GESA accredited. She has presented her research projects at both national and international meetings and is active in teaching.

Dr Kirby is dedicated to providing the best in patient care.

Alison is a Registered Nurse, graduating in 2007 from University of Technology Sydney with a Bachelor of Nursing.

She has over 10 years experience in both medical and surgical nursing and has worked in both public
and private hospitals.
Since 2015, Alison has been working in Campbelltown Private Hospital looking after a variety of post
operative patients but has developed a keen interest in obesity surgeries and the pre + post operative
management of baraitric surgery patients.

You will see Alison from your first appointment onwards. 

What is Grazing?

Grazing or snacking is a habitual behaviour of eating small meals and snacks all day in-between or instead of full meals, in other terms, it is eating little and often. Grazing is an important cause of obesity and it also can develop insidiously after weight loss surgery.

How Does Grazing Affect My Weight Loss After Surgery?

Sleeve gastrectomy is an effective weight loss operation. Many patients often report increased burping or beltching after the gastric sleeve. In this article I describe burping, its association with sleeve gastrectomy and ways to manage it.

There is no question that weight loss surgery is the most effective treatment for severe obesity. The goals of surgery are:

1. Significant and durable weight loss
2. Resolution or improvement of obesity related health conditions
3. Improvement in quality of life

Successful Weight Loss

Weight loss surgery is considered successful when a patient loses 50% or more of the excess weight. 

Here is how the calculations are done.

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid or content flow back into the oesophgus. This acid irritates the lining of the oesophagus and causes heartburn and regurgitation.

GORD and Obesity

GORD occurs in about 20% of the general population.  Obesity is a known risk factor for GORD, hiatus hernia, ulceration in oesophagus and cancer of the oesophagus. Approximately 60-80% of patients undergoing weight-loss surgery have symptoms of acid reflux and about 15% will have a hiatus hernia. This is because obesity causes a chronic increase in the intra-abdominal pressure and this induces reflux (back-flow) of stomach content through the weakened lower oesophageal valve. The increased abdominal pressure also leads to delayed emptying of the stomach into the intestine and pushes the stomach through the oesophageal opening in the diaphragm resutling in a hiatus hernia. Thus increasing the chance for acid reflux into the oesophagus. 

GORD after Sleeve Gastrectomy

Sleeve gastrectomy (sometimes referred to as gastric sleeve or vertical sleeve gastrectomy) works in many ways to achieve sustained weight loss and resolution or improvement of the obesity related health conditions.

1. Restriction

The small volume of the stomach tube (average around 150 mL) limits the amount of food that can be consumed at any given time. Unlike a gastric band where there is one area of fixed narrowing, in sleeve gastrectomy the whole stomach tube is narrow but pliable allowing patients to eat normal meals but in small portions and feeling full afterwards. The sleeve allows patients to control food portions and improve long term eating habits. It is particularly effective in patients who tend to eat large meals.

2. Effect on Ghrelin (hunger hormone)

What is Dumping Syndrome?

Dumping Syndrome is a collection of symptoms that occur after eating resulting from rapid delivery of stomach content into the small intestine. Symptoms can range from mild to severe. Normally there is a muscle sphincter (the pylorus) at the lower end of stomach that regulates the slow delivery of broken down food into the intestine. Therefore, dumping syndrome is very common in operations that bypass or remove the pylorus such as stomach cancer surgery and gastric bypass (85% of patients). Dumping syndrome is also seen in some patients having other stomach operations such as sleeve gastrectomy.

Dumping Syndrome and Sleeve Gastrectomy

The resection of around 85% of stomach in sleeve gastrectomy results in major changes in the anatomy and function of the stomach. Even though the pylorus valve is maintained, the new stomach tube has a very limited capacity (around 150 mL) resulting in rapid emptying of the stomach content into the intestine.
After sleeve gastrectomy very few patients experience true dumping syndrome, however, studies that used a glucose provocation test showed that around 25% of patients develop symptoms of dumping syndrome with glucose provocation. In general these symptoms are milder than those experienced by patients with gastric bypass. The symptoms tend to improve after the first year. 

What Brings About Dumping Syndrome After Sleeve Gastrectomy?

Wound Care

• Your wounds should heal nicely without special care. The skin has been stiched from the inside with a clear disolving suture. You also have steristrips (paper tapes) then a wound dressing. The wounds will feel lumpy for the first few months then they will soften and become smooth.
• The wounds do not need dressings for healing purposes. However, it is more comforatble to leave the dressings on for 5 days after going home. After that remove he dressings but leave the paper tapes if they remain attached until they start to come off by themselves.
• It is ok for the incisions to get wet in the shower. Simply dap the wound dry with a towel. Do not soak the wounds in a bath or a swimming pool until two weeks after your surgery.
• You may feel a pricking sensation at the corners of the wound. This is a end of the disolving suture sticking through the wound. It will disolve with time.
• Some patients notice a clear orange odourless drainage from one of the wounds within the first coupe of weeks. In the majority of patients this is normal and represent liquified fat if you are concerned then come and see Dr Zarrouk
• Some patients like to apply vitmain E ointment or apply silicon tapes on the wounds to reduce the scaring. There is no evidence that these make any differnece on scarring but they cause no harm either so you can use them if you like.

Medications

Discharge medications