Surgical Weight Reduction Program /Bariatric Surgery

Surgery has been shown to be the only therapeutic modality that can provide morbidly obese patients with significant and sustained weight loss.

The Surgical Weight Reduction Center is a hospital-based program providing treatment for severely obese individuals who have not been able to achieve success through non-operative means. The Program is staffed by highly trained surgeons specializing in this type of surgery, by physicians with related specialties, and by support personnel including nutritionists, physiologists, and clinical social workers.

In recognition of its high standards of treatment and patient care, The American Society of Bariatric Surgery has designated the program at New York Methodist Hospital as a "Center of Excellence in Bariatric Surgery."

Surgical Weight Reduction

An individual may be a candidate for surgical weight reduction if he or she:

• Has body mass index (BMI) of at least 35 (about 100 pounds above ideal body weight)
• Has repeatedly attempted to lose weight through dieting but has not been successful
• Is highly motivated to lose weight
• Is willing to change current eating habits
• Is between the ages of 18 and 68

Surgical weight reduction is major surgery that results in progressive, long-term weight loss in the majority of morbidly obese patients. These people can then look forward to an improvement in their overall health and improved quality of life.

Bariatric Operations

The Roux-en Y gastric bypass (RYGB) and the lap band system (Lap-Band) are the two most commonly performed operations for obesity.

The gastric bypass (RYGB) is considered the "gold standard" of modern obesity surgery. This operation achieves its effect by creating a very small stomach pouch (about one ounce), from which the rest of the stomach is permanently divided and separated. The continuity of the GI tract is restored in a form of a "Roux-en Y" loop, also creating some degree of malabsorption, which additionally helps to reduce weight because not all food that is swallowed is absorbed. This operation alters the absorption of some vitamins and minerals; therefore, vitamin and mineral supplements such as multivitamins, calcium, and iron are recommended after the operation. This operation, however, has been shown to give consistent weight loss averaging 60 percent to 80 percent of excess body weight.

The lap band system (Lap-Band) is an operation designed to create a very small stomach pouch with the placement of a silicon band around the very upper portion of the stomach. The Lap Band functions to divide the stomach into a small upper pouch that is more restrictive to the ingestion of food and the remaining lower portion of the stomach. When the patient eats, the pouch will distend and will produce a sensation that the stomach is distended (but only the pouch will be distended). The patient will feel "full" and not hungry. If the patient eats more, he or she will feel nauseated and bloated. Since there is no malabsorption with this operation, no special vitamin supplementation is required. However, this operation has been shown to produce less weight loss than the gastric bypass operation (RYGB).

Laparoscopic Bariatric Surgery

Laparoscopic surgery, also known as minimally invasive surgery, duplicates the anatomy and physiology of the standard, open procedure. Laparoscopic surgery first became available around 1990, when small, lightweight, high-resolution video cameras were developed. The surgeon uses a pencil-thin optical telescope, termed a laparoscope, to "see" into the abdomen and the image is then projected from the laparoscope onto a TV monitor at the head of the operating table. The surgeon must develop special laparoscopic skills in order to operate using this method. The benefits of the laparoscopic approach result from the very small incisions that are created, which induce less pain, and very little scarring. Patients are able to get up and walk within hours after surgery, can breath easier, and move with less discomfort. Bowel activity usually is less affected than it is with the open operation. The recovery to normal activities is quicker than with an open procedure.

When performed by an experienced and skilled laparoscopic surgeon, the risks of surgery performed laparoscopically are less when compared to the standard operation. Both gastric bypass and the Lap Band system can be performed laparoscopically. The surgeon will decide if a patient is a candidate for a laparoscopic operation.