Our team encourages individuals who are considering having surgery to speak to a physician.
While most people think obesity means to be excessively overweight, the definition of obesity is excess adipose or fat tissue.
A more accurate number utilized by clinicians, is body mass index or BMI. Your BMI is calculated by dividing your weight in kilograms by your height in meters squared. A BMI of 22-25 is considered normal, 25-30 overweight, 30-35 obese, 35-40 class II obesity and more than 40 morbidly obese or class III obesity.
| BMI | Classification | Health Risk |
|---|---|---|
| Under 18.5 | Underweight | Minimal |
| 18.5 - 24.9 | Normal Weight | Minimal |
| 25 - 29.9 | Overweight | Increased |
| 30 - 34.9 | Obese | High |
| 35 - 39.9 | Severely Obese | Very High |
| 40 and over | Morbidly Obese | Extremely High |
Our bariatric surgery specialists consider individuals with a BMI of 40 as candidates for surgery, as well as those with BMI of 35 with a life threatening complications from their obesity.
We invite you to learn more by attending one of our free Educational Seminars.
Surgery should be considered for morbidly obese people who have failed non-operative weight loss options. They should be obese for several years and not have any active drug or alchohol addictions or major psychiatric disorders. In addition, the risk and emotional cost of their obesity should exceed the risk of having an invasive operation.
Bariatric surgery is the only remedy that can document long term weight loss in the majority of morbidly obese individuals. This does not mean that no one is successful without surgery, because some certainly are. However, most of the patients lose weight only to relapse and regain their weight. Surgery does not replace the need to exercise and make better food choices, but makes these goals realistic and provides a long-term control mechanism to assist in managing this chronic problem.
The physicians at our practice in Manhattan stress that gastric bypass or LAP-BAND® Adjustable Gastric Band surgery for obesity is not the first option that should be used to treat your weight problem. In fact, if you can lose weight without an operation, it is preferable.
This is an operation where a smaller gastric reservoir is made with a stapler and the outlet of the smaller pouch of stomach is kept tight by a band. This is the operation that most refer to as a stomach stapling.
For years this was the most popular operation. Over the last decade most experts in obestiy surgery have moved away from this operation. This is a trend which we anticipate will continue with the development with the adujustable laparoscopic band.
Gastric Bypass combines making a smaller gastric pouch with a bypass of the first portion of the small intestine. As a result, eating behavior is altered. Since the storage capacity of the stomach is reduced, and the outlet is restricted, a person gets full faster. In addition, food enters the small bowel without mixing with the digestive juices from the liver and pancreas. As a result food high in sugar and fat is not efficiently digested and fewer calories are absorbed. Therefore, weight loss with a bypass is approximately 70% of excess weight.
All patients after a bypass must take a daily multi-vitamin and calcium. Many, especially menstruating women, require iron supplementation.
Following surgery, you will meet with our nutritionist to discuss short-term and long-term nutritional needs.
The LAP-BAND® Adjustable Gastric Band is a device that is FDA approved for the treatment of morbid obesity. It is a silicone band that is placed around the top portion of the stomach and when the band is tightened, the gastric reservoir is made smaller and the patient gets full after eating less food. The band is attached to a port which is implanted beneath your skin. The port can be used to adjust the tightness of the band. If you require more control the band can be tightened. If you are having difficulties or need to eat more, the band can be loosened.
The adjustable nature of the band offers numerous advantages. Your anatomy stays in its normal position. Malabsorption and vitamin deficiency is not a concern. The chance of intestinal leakage and infection is reduced. Also, if you do not do well, band placement does not preclude future bypass. Weight loss is not as fast as with bypass.
Lenox Hill was part of an FDA trial evaluating the LAP-BAND® Adjustable Gastric Band prior to its approval in the United States. Over 300,000 bands have been placed worldwide with documented results. There are several unique complications associated with the band including erosion into the stomach and slippage of the band.
These are operations in which a very significant amount of the intestines are bypassed. Instead of relying on getting full faster, these operations rely on creating malabsorption. Part of the stomach is removed in these operations, and food is redirected to bypass a large amount of the intestines. These operations cause marked weight loss but protein supplementation is mandatory because malnutrition is a concern.
The amount of weight a patient will lose depends on a wide range of variables like your genetic makeup, what operation you select, how much you eat before surgery, how much you will be able to eat after, how much exercise you will do and your metabolic rate.
On average, people lose approximately 70% of their excess weight one year following a gastric bypass. Our practice patient results show that after 10 years, most will maintain 60% of the initial weight loss. With a LAP-BAND® Adjustable Gastric Band, weight loss is about 55%to 60% of excess weight.
Those that only rely on surgery and do not change their behavior and become more active will not have the as favorable a result.
With minimally invasive surgery, it is not necessary to cut through the muscle and the surgery is done through small incisions. The surgeon is able to see the operative field using a television monitor. Advantages include a reduction in potential wound complications, hernias and a faster return to full activity. It is important to emphasize that even when surgery is done through small incisions, it is still a major operation.
We wish to emphasize to our patients that all bariatric surgery operations are major procedures and have serious risk. The national average death rate for bariatic surgery is 0.5%. The following list outlines some risks, but is far from exhaustive.
Risks and Possible Complications of LapBand
|
Operative |
Short-Term |
Long Term |
|
Death |
Death |
Weight Gain |
|
Anesthesia |
Slippage/Prolapse |
Slippage/Prolapse |
|
Injury to Other Organs |
Vomiting |
Vomiting |
|
Cardiac Arrest |
Frothing |
Frothing |
|
Bleeding |
Tube Leakage |
Tube Leakage |
|
Respiratory |
Erosion |
Erosion |
|
Abcess |
Port-Dislodgement |
Port-Dislodgement |
|
Pneumonia |
|
Mechanical Failture |
|
Infection |
|
Esophogeal Dysfunction |
|
Blood Clots (DVT/PE) |
|
Infection |
|
|
Re-operation |
Risks and Possible Complications of Gastric Bypass
|
Operative |
Short-Term |
Long Term |
|
Death |
Death |
Weight Gain |
|
Anesthesia |
Stricture |
Malnutrition |
|
Injury to Other Organs |
Vomiting |
Calcium Deficiency |
|
Cardiac Arrest |
Frothing |
Anemia |
|
Bleeding |
Ulcer |
Hernia |
|
Respiratory |
Dumping |
Bowel Obstruction |
|
Leak |
Obstruction |
Chronic Abdominal Pain |
|
Abcess |
Re-operation |
Fistula |
|
Pneumonia |
|
Ulcer |
|
Infection |
|
Leak |
|
Blood Clots (DVT/PE) |
|
Re-operation |
While most of these issues rarely arise, the major point is that these procedures should only be done when necessary and by doctors that have experience in this area.
There is no specific time limit when a post-operative patient can return to work. In general, it takes at least two to three weeks, and occasionally more. The reason for delay is not pain, but lack of strength and difficulty making the adjustment to a different way of eating. Any medical complication can cause delay. We suggest that you plan to be away from your job for three to four weeks. For patients with strenuous physical jobs, 4-6 weeks is necessary to allow for adequate healing. If arrangements can be made, you can return to light duty earlier.