It is the gastric band that fails the patient rather than the patient fails the band

Written by Ali Zarrouk on .

gastric band fails patients

The Gastric Band has emerged as a popular weight loss operation during the late nineties and early 2000s, however, over the last 10 years or so its popularity has decreased due to high failure rates, food intolerance and late complications associated with the procedure.
Quite often, the patient is blamed for failing to lose weight or maintain the weight loss. The patient's friends, family and even doctors believe that the patient has stopped following the recommended diet resulting in inadequate weight loss or even weight gain. Even many patients start to drown themselves in self-blame. In my view, this is incorrect.
The gastric band works by creating an area of fixed narrowing in the upper part of the stomach that limits food intake. Because of this area of obstruction, healthy food items such as red meat, chicken, and fruit and vegetables tend to get stuck resulting in frequent vomiting and regurgitation of food. Vomiting or bring up of food becomes part of the patients' daily routine that patients do not even report to their doctors. On top of this, the band does not address the hunger most patients experience with eating less and for losing weight. After few trials patients quickly change their diet from the healthy food that get stuck to diet consisting mostly of smooth, sloppy, calorie-dense food such as smoothies, ice cream and chocolate. These food items go through the band without restriction and without discomfort. In effect the band punishes patient for eating healthy food and rewards patients for cheating.
We cannot blame the patient for failing the band. It is the gastric band itself that fails the patient.

New Weight Loss Surgery Seminar Dates for 2015

Written by Ali Zarrouk on .

Our last seminar for 2014 is going to be on December 10th. The seminars have been very popular with patients considering obesity surgery as well as their friends and families. There will be a break over the the Christmas and the new year period. Our first seminar for 2015 will be on Wednesday 21 January. 

Merry Christmas and Happy a New Year to everyone. 

Hibernation Syndrome

Written by Ali Zarrouk on .

Hibernation Sydrome

One of the challenges some patients face after weight loss surgery is a condition described as the hibernation syndrome. This is a group of symptoms that include feeling fatigued, depressed and lack of motivation to do any physical activity. Patients often feel upset and become plagued by thoughts that the surgery was as mistake.. This can be quite alarming to patients recovering from the surgery and recognizing the signs assist in getting over this stage in recovery.

Hibernation syndrome is common in the first few weeks after the surgery. It is caused by the low number of calories being consumed and the reduced activity associated with this time of healing. The body perceives that it is starving and triggers an evolutionary response that has helped humans survive famines. The main aim of the response is to slow us down to conserve energy and thus resulting in; tiredness, need for sleep, lack of motivation and depression. It is important to understand that these symptoms are normal and will pass with time.

Most patients notice improvement in their symptoms around 4-6 weeks after the operation and the improvement is brought by increasing protein in the diet, taking the multivitamin tablets, increasing the metabolic rate with exercise and return to work and the encouragement patients get as they shed the extra weight. A supportive family member or friend is a great help during this time.

Strangulated Femoral Hernia

Written by Ali Zarrouk on .

An elderly lady presented acutely with a 24 hour history of abdominal pain and vomiting together with a painful lump in the right groin. Last year I repaired a recurrent incisional hernia in the upper abdomen with mesh. She did not have any other hernias elsewhere at that time but she is on steroid long term. 

This time her CT scan confirmed the presence of a large femoral hernia containing small bowel loops and causing small  bowel obstruction. I took her to theatre for urgent repair. At surgery she had a loop of small bowel strangulated inside the femoral hernia. A segment of the small intestine stuck in the hernia had died and she had to have that segment resected and bowel joined back again.  Strangulated Femoral Hernia

The hernia defect itself was of moderate size and I closed it with sutures only. 

After surgery she did well and was discharged home after 6 days. 


Although femoral hernias are less common than inguinal hernias, they are more prone to cause serious complications like bowel obstruction and strangulation. Once the bowel gets stuck in the hernia strangulation of the bowel can occur within about 6 hours. Urgent repair is needed before the loop of bowel dies inside the hernia (as in this patient). 

Most often the patient would be aware of the hernia before the bowel get stuck in it however, this is not the case here. This may be related to the long term use of steroids which are known to weaken tissue and cause hernias. Elective repair is better to prevent bowel strangulation, the repair can be done laparoscopically and mesh would be used. Laparoscopic repair is not an option if there is a chance of bowel strangulation.  I do not use mesh to repair hernias if I had to do bowel resection as the chance of mesh infection would be otherwise too high. So for femoral hernias operation is always needed even if not causing symptoms and the sooner the better. 

Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations

Written by Ali Zarrouk on .

Pancreatic exocrine insufficiency occur due to a variety of pancreatic conditions including chronic pancreatitis, cystic fibrosis, pancreatic cancer and pancreatic surgery. Pancreatic enzymes play a vital role in the digestion of fat and when there is a deficiency fat maldigestion and malabsorption occur resulting in steatorrhoea. This a the passage of frothy, foul-smelling buoyant stools that tend to stick in the toilet bowl. Other symptoms may occur like abdominal pain, flatulence and weight loss. If untreated fat malabsorption may result in micronutrients defeciency.

Food Tolerance and GI Quality of Life is Best After Sleeve Gastrectomy

Written by Ali Zarrouk on .

When deciding on which weight-loss operation to choose, many patients focus mainly on the expected amount of weight loss for each operation. Food tolerance and gastrointestinal quality of life after surgery are often not discussed. In a recent article published in the journal Obesity Surgery, my colleagues at St George Hospital compared food tolerance and gastrointestinal quality of life after gastric banding, gastric bypass and sleeve gastrectomy. They showed that food tolerance and gastrointestinal quality of life following surgery were best after sleeve gastrectomy followed closely by gastric bypass. Patients with gastric banding had the worst food tolerance and gastrointestinal quality of life as well as lost less of their excess weight. Click here to go to the article.

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