Norwest

P RI VATE H OSP I TAL

APRIL 2012

TOTAL HIP REPLACEMENT USING THE ANTERIOR APPROACH

DR MUNJED AL MUDERIS
Orthopaedic Surgeon

What is the Anterior Approach?

In the anterior approach to hip
replacement, the patient lies in the supine
position and hip replacement surgery is
performed through a small incision at the
front of the hip. Alternate techniques require
the patient to lie laterally, with the surgeon
gaining access to the hip posterioraly or
laterally, cutting through important muscles
used in hip function.
Anterior
Approach

What are the advantages of the

Anterior Approach?
1.Reduced Dislocation Rate
As the posterior structures are
maintained when performing the
Anterior Approach, the chance of post
operative dislocation are reduced.
2.Reduced Trauma
The Anterior Approach to hip
replacement is a true minimal invasive
technique since no muscles are being
detached or resected. This reduces the
amount of trauma to the muscles which
are essential for daily hip activities.
3.Reduced Pain
Minimal trauma to the muscles means
minimising tissue injury and less
bleeding resulting in reduced post
operative pain.

Posterior
Apprioach

The Anterior Approach is unique and unlike

all other approaches to hip replacement it
does not require any muscles to be resected
or detached from the bone. Surgery is
performed
through
the
natural
intramuscular plane of the Tensor Fascia
Lata and the Gluteus Medius muscles.
Special retractors are used to hold the
muscles apart to gain sufficient access.

4.Quicker Recovery with less restrictions

The important muscles used in hip
function are not damaged when using
the Anterior Approach. The result of
this reduced trauma means that
patients can return to normal daily
activities quickly. A major advantage of
the Anterior Approach is that there is
little restriction post operatively. Unlike
the Posterior Approach, post operative
restrictions such as not sitting down in a
low chair or not bending down to tie
shoelaces do not apply with the
Anterior Approach since the posterior
structures are not damaged using the
Anterior Approach.
Conclusion
The
Anterior
Approach
minimises
discomfort for patients, accelerates post
operative rehabilitation and reduces
hospital time, making it my preferred
technique for Total Hip Replacement.

Anterior
Approach

Tensor
fascia lata

Gluteus
medius

DR MUNJED AL MUDERIS
Orthopaedic Surgeon
Dr Munjed Al Muderis is an
Orthopaedic Surgeon and a clinical
lecturer at Macquarie University and
The Australian School of Advanced
Medicine. He practices with the
Specialty Orthopaedics Group and is
the Chairman of the Osteointegration
Association of Australia. He obtained
his surgical fellowship, FRACS (Orth),
in 2008.
Dr Al Muderis completed three post
specialisation fellowships:- a fellowship
in Sydney with Dr Ali Gursel in lower
limb arthroplasty at the Sydney
Adventist and Baulkham Hills
Hospitals, fellowship in Berlin,
Germany in Hip and Knee arthroplasty
at the Emil von Behring Hospital a
Teaching Hospital of the Charite
Medical School, Berlin with Prof. Dr.
med. Jorg Scholz and a Trauma
Fellowship at the Unfallkrankenhaus
Berlin (UKB) a Teaching Hospital of the
Charite Medical School, Berlin,
Germany with Prof. Dr. med. Axel
Ekkernkamp.
Dr Al Muderis commenced his practice
in 2010 and has appointments at The
Sydney Adventist Hospital and Norwest
Private Hospital. Dr Al Muderis sees
patients at Macquarie University,
Parramatta,
Bella
Vista
and
Wahroonga clinics.
Dr Al Muderis specialises in hip, knee
and trauma surgery with particular
interest in hip arthroscopy, resurfacing,
arthroplasty, knee arthroplasty and
reconstruction of recurrent patellar
dislocations.

Femoral head

For all appointments for your patients with Dr Al Muderis

Phone: 02 9806 3333
Macquarie Clinic:
Suite 303, Level 3, 2 Technology Place Macquarie University
Parramatta Clinic:
116 Macquarie St, Parramatta
Wahroonga Clinic:
Suite 601B The SAN Clinic 185 Fox Valley Road, Wahroonga
Norwest Clinic:
Ground floor 6 Meridian Place, Bella Vista
www.almuderis.com.au

Norwest

P R IVATE HOS P ITA L

ADVANCES IN BARIATRIC SURGERY PROVIDE MORE CHOICES FOR THE OBESE

DR ROY BRANCATISANO
Upper GI, Obesity and Laparoscopic Surgeon

As the prevalence of obesity continues to

increase in Australia, with 60% of the
population now being classified as
overweight or obese, innovations in the field
of bariatric surgery are being developed.
At the forefront of new surgical techniques
and research, principle obesity surgeon,
Dr Roy Brancatisano and his team at Circle
of Care are offering alternate procedures
for obese patients in Australia. These
comprise the gastric sleeve resection and
revolutionary neuroblocking technology,
VBLOC therapy. Patients now have greater
choices in procedures to meet their weight
loss needs.

Laparoscopic Gastric Sleeve

Resection
The laparoscopic gastric sleeve resection
(GS) is a partial gastrectomy of the fundus
and body, creating a long, tubular gastric
tube or sleeve, constructed along the lesser
curve of the stomach (Fig. 1). A relatively
new bariatric procedure, GS involves
resection of 80% of the stomach, with the
remainder of the gastrointestinal tract left
unaltered. Weight loss following the
procedure results from reduced stomach
volume and distensibility, leading to
decreased food intake and possible
modulation of gastrointestinal hormones
leading to reduced appetite.

bariatric procedures. However, as with all

bariatric surgery, a comprehensive multidisciplinary care program is vital in helping
patients achieve their weight loss goals.
The gastric sleeve resection has a number
of advantages and benefits for patients, as
an alternative to laparoscopic gastric
banding.
Advantages:
The relative simplicity and safeness of
the procedure results in a shorter
duration of surgery and fewer
complications compared to gastric
bypass surgery.
The small bowel and mesentery are not
altered.
Studies report fewer nutritional
deficiencies.
No added risk of internal hernia.
Upper gastrointestinal tract remains
intact.
No permanent foreign body installed,
as in gastric lap banding surgery.
Loss of at least half of excess weight is
achieved in 80% of patients (See
results).
Improvement in co-morbid diseases,
including Type 2 diabetes, high blood
pressure, high cholesterol, obstructive
sleep apnoea (OSA), depression and
anxiety (See results).
Quantity of food consumed is
restricted, with minimal effect on quality
of eating.
Risks involved with the GS procedure
include:
Gastric leak and fistula (1.0%)
Postoperative bleeding (1-2%)
Deep vein thrombophlebitis (0.5%)
Non-fatal pulmonary embolus (0.5%)
Strictures (2%)
Splenectomy (0.5%)
Pneumonia (0.4%)
Death (0.25% or 1 in 300 patients)

Figure 1: Vertical Sleeve Gastrectomy

Previously introduced ten years ago as the

first of a two-stage gastric bypass procedure
for high-risk obese patients, GS is becoming
increasingly popular. Now approved by the
American Society for Metabolic and
Bariatric Surgery (ASMBS) as an acceptable
primary bariatric option, the procedure is
also performed on lower-risk obese
patients. Patients now choose to opt for this
procedure due to individual preferences
and if there are contraindications to other

demonstrated superiority of the GS over

LAGB, with an Excess Weight Loss (EWL) of
66% and 48%, respectively. In relation to
comorbidities, a 66% resolution rate of Type
2 diabetes has been found for patients at a
mean follow-up of 13 months following the
procedure.
With long term data, the SG is a procedure
which has been proven to lead to durable
weight loss, improved comorbidities, longterm patient satisfaction and improved
quality of life.
Dr Roy Brancatisano and Circle of Care
now offer the gastric sleeve resection as an
alternate option for patients.

Vagal BLockade for Obesity

Control (VBLOC):
Technological advances in weight loss and
its management have led to the
development of new treatments. The Vagus
nerve has an important role in gut-brain
communications and obesity.
Established by EnteroMedics Inc., developer
of medical devices using neuroblocking
technology to treat obesity, VBLOC Therapy
is delivered through laparoscopically
implanted leads to intermittently block vagal
nerve trunks (Fig. 2). High frequency, low
energy electrical impulses are transmitted by
the system via an implantable device - to
block the messages conveyed through the
vagal nerves, thus manipulating feelings of
hunger and fullness and helping patients to
lose weight.

Results of GS
The results of GS and its use as a bariatric
procedure remains an active area of
research. In a 2011,
ASMBS report
statement, which culminates data from
various worldwide studies, the weight loss
outcomes, clinical conclusions and
improvements
in
obesity-related
comorbidities are shown to be equivalent to
or exceeding those of laparoscopic gastric
banding.
Randomised studies have

Figure 2: Vagal BLockade for Obesity Control

The device forms part of a comprehensive

weight loss management programme
comprising a virtual coaching system and
support from a team of allied health
professionals to maximise weight loss.

Norwest

P R IVATE HOS P ITA L

Advantages:
The system is minimally invasive and
designed to meet individual needs.
Normal digestive system anatomy is
preserved unlike the majority of existing
bariatric procedures, namely the gastric
band and the gastric sleeve resection,
which alter anatomy to reduce the
stomach size. In this way, it is perceived
as a less radical surgery.
Minimal complications and risk.
Well tolerated by the patient.
The delivery of energy is intermittent,
and the effects of VBLOC Therapy on
nerves and end organs are intended to
be reversible.
The effect of VBLOC Therapy on controlling
obesity has been studied at several select
centres within and outside the US. In
Australia, Circle of Care has been involved
in early clinical trials such as the Empower
Study, which showed a 37% excess weight
loss at 12 months for patients receiving
greater than 12 hours of VBLOC therapy
per day. These findings report that VBLOC
Therapy is a safe and effective alternative to
the known complications associated with
existing approaches to obesity surgery.
Following
the
Therapeutic
Goods
Administration (TGA) approval of the device
in December, the clinic will begin to offer
this VBLOC procedure to patients, as part of
the Circle of Care program.

DR ROY BRANCATISANO
Upper GI, Obesity and Laparoscopic Surgeon
Dr Roy Brancatisano is an upper gastrointestinal, obesity and
laparoscopic surgeon and Director of the Institute of Weight Control.
He trained in Sydney where he achieved his surgical qualifications
and fellowship of the Royal Australasian College of Surgeons in 1993.
He undertook further specialist training in upper gastrointestinal
surgery as well as advanced laparoscopic surgery.
He has been a Fellow of the Australasian College of Surgeons (ACS) since 1993. He is
also a member of the International Federation for the Surgery of Obesity (IFSO), the
Obesity Surgery Society of Australia & New Zealand (OSSANZ) and a founding member
of the Asia Pacific Bariatric Surgery Society (APBSS).
In 2003, he became interested in obesity surgery, and developed the Institute of Weight
Control and the 'Circle of Care' Program, which comprises a multi-disciplinary team of
health professionals to help patients achieve their goals of weight control and a healthier
lifestyle.
He has successfully performed over 3500 laparoscopic gastric banding operations, and
100 gastric sleeve resections which have been followed in the Circle Of Care program.
He also performs laparoscopic cholecystectomy, anti
reflux surgery, hernia surgery as well as endoscopy.
To book patients in for a bulk billed
The Institute of Weight control is dedicated to obesity
research, and has been involved in a number of
weight loss device clinical trials, including VBLOC
therapy. Dr Brancatisano is a world leader in VBLOC
therapy and is pleased to offer this new treatment to
his patients.

MESSAGE FROM THE GENERAL MANAGER

Norwest Private Hospital had a very
successful year in 2011 with over 27,000
patient admissions and 16,000 procedures
performed.
In the final quarter of 2011, Norwest
conducted a patient satisfaction survey and
we are extremely proud of the feedback.
Excellent results were achieved with an
overall satisfaction rating of 96%. Patients
were surveyed in the Emergency Dept,
Medical Ward/ Coronary Care and Surgical
Admission Centre/DSU. All patients (100%)
who responded to the survey indicated that
they would recommend Norwest Private
Hospital. The high satisfaction ratings are a
testimony of the contribution and effort from
our dedicated team of specialists and
nursing staff and we aim to maintain these
high standards in 2012.
Norwest is pleased to welcome PRP
Diagnostic Imaging who took ownership of
the imaging services at Norwest in late
2011. PRP owns and operates 23 practices
across NSW and brings to Norwest their
expertise and excellence in imaging services
for inpatients as well as outpatients.
Hospital catering is a vital component of the
service that we offer our patients. The

assessment Phone: 9639 1033 or visit

www.circleofcare.com.au
Circle of Care,
495 Windsor Road,
Baulkham Hills NSW 2153
Phone: 9639 1033

Deborah Fogarty. General Manager, NORWEST PRIVATE HOSPITAL

Healthscope MasterCook Extravaganza,

held in Sydney on 2 March 2012, was an
opportunity to showcase the talent from
Healthscope Hospital kitchens.
Healthscope hospitals from around Australia
sent a representative from their kitchen to
participate in the cooking competition which
was judged by Australias first MasterChef
winner, Julie Goodwin. Phuong Toms was
chosen to represent Norwest Private Hospital
and take part in the one day event event and
although Phuong was not the winner, Robert
Cooke, Managing Director and Executive
Chairman of Healthscope commented that
Phuong's dish was his favourite on the day.
All participants demonstrated the skill

displayed in the kitchen every day and

created some fine culinary master pieces.
To join in the Chinese New Year Celebration,
an enthusiastic team of 25 staff members
from Norwest Private Hospital took part in
the Sydney International Dragon Boat
Festival at Darling Harbour on 5 February.
With little experience or training, the team
competed well against many corporate
teams that had been training all year for the
event. Despite a few sore arms and backs
the next day, the perfect weather and great
camaraderie made the event a fantastic day
for the Norwest team. Well done team!
We look forward to another successful
and busy year ahead.

Norwest Private Hospital Chinese New Year Dragon Boat Racing Team

Norwest

P R IVATE HOS P ITA L

DOCTOR PROFILES

DR BRIAN HSU

DR IMAD MAHMOUD

Orthopaedic
Surgeon

Obstetrician and
Gynaecologist

Dr Brian Hsu is an
Orthopaedic Surgeon
specialising exclusively in
spinal surgery. Dr Hsu
completed his medical degree at the
University of Sydney in 1996 before
obtaining his qualifications as an
Orthopaedic Surgeon in the NSW AOA
Advanced Training Programme. Pursuing
his interest in Spinal surgery, he spent a
further 18 months in the United States
completing additional specialised training
in all facets of Spine surgery. During his
fellowship he worked and trained at two
world-renowned institutions, University of
California San Francisco and Twin Cities
Spine Center, Minneapolis, Minnesota.
UCSF is a tertiary referral Spinal unit
specialising in complex revision Spinal
surgeries. Spinal fusion for Scoliosis was
first pioneered at the Twin Cities Spine
Center in the 1960s.
Dr Hsu is an Adult and Paediatric Spine
Surgeon with interests in all aspects of
Spinal surgery and spinal disorders, in
particular, Adult and Paediatric spine
deformity, complex cervical reconstructions,
spinal osteotomies and degenerative
cervical and lumbar conditions.
Dr Hsu has immense interest in education
and research and is an active participant in
global Spinal organisations, such as the
Scoliosis Research Society in which he is a
candidate member and a member of the
Education Committee, which sets the
education programme for the Annual
Meeting.
He has a particular interest in intraoperative neurophysiological monitoring
(IONM). IONM is the standard of care for
all Spinal surgery in North America and
reduces the risk to neural structures during
Spinal surgery. Dr Hsu uses IONM for all
Spinal fusion surgeries and includes a
Neurophysiologist as part of his surgical
team.
He has written several book chapters on
topics such as Managing severe Scoliosis in
Adults and Minimally-invasive Spinal
Surgery. Dr Hsu is fluent in English and
Chinese (Cantonese). His practice is
located at Bella Vista.
Dr Brian Hsu
Suite 209 Norwest Central
10 Century Circuit
Bella Vista NSW 2153
Phone: 1300 975 800 Fax: 8572 8269

Dr Imad Mahmoud is a
Consultant Obstetrician
and Gynaecologist. His
main practice is at
Norwest Medical Centre and he also consults
in Windsor and Auburn.
Dr Mahmoud completed his Obstetrics and
Gynaecology
fellowship
in
Sydney,
undertaking the first four years of his
specialist training at Liverpool Hospital, and
then subsequently started at Nepean
Hospital as a Senior Registrar, where he
completed his advanced training and was
appointed as a Consultant.
Dr Mahmoud is committed to teaching and
supervising junior colleagues.
He is
appointed as a Training Supervisor for
Registrars and Residents at the RANZCOG.
He oversees the Antenatal and Gynaecology
clinics at Auburn Hospital and a Senior
Clinical Lecturer for the University of Sydney
and the University of Notre Dame medical
students.
Dr Mahmoud has extensive knowledge and
experience in laparoscopic surgery,
advanced pelvic floor repairs, urinary
incontinence surgery and high risk obstetrics.
He specialises in the following:- laparoscopic
hysterectomy, endometriosis, menorrhagia,
pelvic organ prolapse, urinary incontinence,
uterine fibroids, abnormal pap smears,
management of menopause, obstetrics
high and low risk pregnancies,Infertility both
primary and secondary.
At the Norwest Private Practice the following
services are provided:
Obstetrics Care:
Private Obstetric
patients to be delivered in Norwest
Private Hospital
Office
Gynaecology
procedures:
Colposcopy, Vulvoscopy, Insertion of IUD
and Implanon
Neocontrol chair for pelvic floor therapy
(A conservative treatment for urinary
incontinence and pelvic organ prolapse)
Dr Mahmouds experience and open
communication enables him to offer
patients, empathy and commitment to
achieving exceptional results with the least
invasive procedures for womens health
related issues and obstetric care.
Dr Imad Mahmoud
Norwest Private Hospital Medical Centre
Suite 107 / 9 Norbrik Drive
BELLA VISTA NSW 2153
All appointments: 8883 4333
Mobile: 0401679940 Fax: 8883 4952

DR ELISABETH ELDER
Specialist
Sydney
HillsBreast
Imaging
Surgeon
@ NORWEST
PRIVATE HOSPITAL

Dr Elisabeth Elder is a
Breast Surgeon and a
Senior
Lecturer
at
University of Sydney.
She graduated from the Karolinska Institute
in Stockholm, Sweden in 1992, where she
also completed her general surgical
training together with a PhD in tumour
biology in 2002. After migrating to
Australia for family reasons, she specialised
in breast cancer surgery at Concord
Hospital, the Royal Hospital for Women
and Royal North Shore Hospital and was
awarded a Clinical and Research
fellowship by the NSW Cancer Institute in
2008. In 2009 she returned to the
Karolinska Hospital to develop skills in
oncoplastic breast surgery techniques.
Dr Elder is an active member of Breast
Surgeons in Australia and New Zealand
and a member of the oncoplastic
subcommittee as well as other national and
international breast societies. She is a
member of the Editorial Board of World
Journal of Surgery and a peer reviewer for
several international journals.
Dr Elder has a special interest in
oncoplastic and reconstructive breast
surgery with the goal to optimise
oncological, cosmetic and psychological
aspects of each patients care. She is part of
the Multidisciplinary Breast Team within
Specialist Services at Norwest Private
Hospital providing a comprehensive service
for diagnosis, treatment and follow-up of
breast cancer in a warm and compassionate setting.

Dr Elisabeth Elder
Specialist Services, Suite G12
Norwest Private Hospital
Phone: 9687 0900
Fax: 8883 5237
Email Elisabeth.elder@specialistservices.com.au
Westmead Breast Cancer Institute
Westmead Hospital
Phone 9845 8464
Fax
9845 8334
Email Elisabeth.Elder@bci.org.au