Bariatric Surgery Questions & Answers

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 above	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 life threatening complications from their obesity.

We invite you to learn more by attending one of our free Educational Bariatric Seminars.

Bariatric surgery should be considered for morbidly obese people who have failed non-operative weight loss options. They should qualify as obese for several years prior and not have any active drug or alcohol 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 has documented 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 lose weight only to relapse and regain their weight. Surgery does not replace the need to exercise and wise food choices, but it 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 should not be a first option for treating your weight problem. In fact, if you can lose weight without an operation, it is preferable.

Bariatric surgery should be considered when you feel you have exhausted all other options, or your condition is so severe that it requires rapid, urgent treatment. Nutritional counseling, exercise and group programs should all be considered prior to surgery. If you can lose weight without an operation you are better off. If you cannot, and obesity is affecting your health or quality of life, then surgery should be considered.

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 stomach stapling.

For years this was the most popular operation. Over the last decade most experts in bariatric surgery have moved away from this operation. This is a trend which we anticipate will continue with the development with the adjustable laparoscopic band.

Gastric Bypass makes both a smaller gastric pouch and bypasses 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, foods high in sugar and fat are not efficiently digested and fewer calories are absorbed.

All patients after a bypass must take a daily multi-vitamin and calcium and many, especially menstruating women, require an iron supplement.

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. 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 the skin. The port can be used to adjust the tightness of the band. If the patient requires more control the band can be tightened. If he/she is having difficulties or needs 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 have good results, band placement does not preclude future bypass. Weight loss is not as fast as with bypass.

Lenox Hill Hospital 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.

Duodenal Switch Surgery/SIPS procedure (Stomach Intestinal Pylorus-Sparing Surgery) is a simpler duodenal switch procedure with fewer complications and nutritional deficiencies. The benefit of SIPS is that it does not cause wide swings in blood glucose which helps to preserve the pyloric valve. And by not bypassing as much intestine, it reduces the complications of short bowel syndrome.

These are bariatric 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 genetic makeup, what operation selected, how much he/she typically ate before surgery, how much he/she will be able to eat after, how much exercise the patient gets and his/her metabolic rate.

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—the surgery is done through small incisions. The surgeon is able to see the operative field using a television monitor. Advantages include reduced wound complication potential, less 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.

In medicine, there are no absolutes and each operation has advantages and disadvantages. It is important during your consultation that you and your doctor discuss your major health problems, concerns and expectations. Your surgeon will outline a strategy that works best for you.

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
• Weight Gain
• Anesthesia
• Slippage/Prolapse
• Injury to Other Organs
• Vomiting
• Cardiac Arrest
• Frothing
• Bleeding
• Tube Leakage
• Respiratory
• Erosion
• Abcess
• 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
• 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)

While most of these issues are rare, we wish to emphasize that these bariatric revision procedures should only be done by a highly-experienced surgeon when all other options have been exhausted.

There is no specific time limit when a post-operative bariatric patient can return to work—generally, it takes two to three weeks, and occasionally more. The potential 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 also 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.