Frequently Asked Questions

While the general perception of obesity often pertains to excessive weight, the precise definition revolves around the accumulation of surplus adipose or fatty tissue.

Healthcare professionals rely on a more precise measurement known as body mass index (BMI) to gauge an individual’s weight status. Clinicians employ BMI to gauge an individual’s weight status. Here is a table outlining the relationship between BMI and health risks:

When evaluating potential candidates for bariatric surgery, our specialized team focuses on individuals with a BMI of 40 or higher. Additionally, individuals with a BMI of 35 who suffer from life-threatening complications from obesity are also considered for surgical intervention.

Bariatric surgery is an option for very overweight people who have tried other methods to lose weight without success. To qualify, they need to have been obese for a long time, not have problems with drugs or alcohol, and not have major psychiatric disorders. Also, the risks and emotional impact of their obesity should be higher than the risks of having surgery.

Bariatric surgery is the only treatment that has proven to help most very overweight people lose weight in the long term. It doesn’t mean that nobody can lose weight without surgery because some people can. However, most people who try to lose weight without surgery end up gaining it back after a while. Surgery doesn’t replace the need to exercise and make healthy food choices, but it makes it easier to reach those goals and helps with long-term weight control.

At our clinic in Manhattan, the doctors believe that gastric bypass or LAP-BAND® Adjustable Gastric Band surgery should not be the first choice for treating weight problems. If you can lose weight without surgery, that’s better.

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 fixed timeframe for a bariatric patient who has undergone surgery to return to work—it typically takes around two to three weeks, and sometimes longer. The potential factor causing a delay is not necessarily pain but rather a lack of strength and the challenge of adapting to a new eating routine. Moreover, any medical complications that arise can also contribute to a delay in returning to work. To ensure sufficient recovery, we recommend planning to take three to four weeks off from your job. Individuals engaged in physically demanding occupations may require a longer healing period of 4-6 weeks. However, if feasible, arrangements can be made for a return to light-duty tasks earlier.