Surgical Weight Loss Procedures

Obesity results from the body’s energy regulation system being broken. It is incorrect that eating more causes obesity. Instead, obesity is a condition that causes people to eat more. Since physicians, the general public, and even those with obesity do not recognize these concepts, obesity treatments have been ineffective and caused frustration.

Placing a person with obesity on a low calorie restrictive eating program, causes short term weight loss and activates the body’s system that defends body mass, with ultimate weight regain and a body weight that is higher than when the restrictive diet began. Exercise, which is essential for wellness and fitness, increases appetite. As a result, treatments must focus on entities that restore the body’s energy regulation system to normal. Surgical stapling procedures are the most effective means we have to accomplish this. They do far more than just make it difficult to eat. They allow the body to reach a lower set point, or weight at which the body feels comfortable.

As an analogy, consider your set point as the body’s thermostat. With obesity, the thermostat is broken, raising your internal energy and requiring you to eat more. Surgery fixes the thermostat. It must be remembered that what broke the thermostat is a diet full of ultra-processed foods and high-calorie beverages. These foods have created an inflammatory condition. Therefore, along with surgery, food choices must change to prevent breaking the new thermostat.

Our Bariatric Surgery Program at Lenox Hill Hospital offers many weight loss surgery options, but our goal is not to offer every procedure. Instead, we emphasize what will work for an individual patient. Certain practices feel obliged to offer all weight loss options. We believe that we have a responsibility to explain what works and why. To treat obesity effectively, you must understand the disease. We hope to make healthy weight loss practical and the process less frustrating.

Each surgical weight loss solution offers slightly different benefits, risks, and post-surgical effects, so it’s important to match each patient’s expectations and objectives with the right bariatric operation. At Lenox Hill Bariatric Surgery Program, we perform minimally invasive laparoscopic or robotic procedures. Our world-renowned bariatric surgery team performs the following types of weight loss surgeries:

Gastric Bypass Surgery

Roux-en-Y gastric bypass (RYGB) is a well-known bariatric procedure that was the most common stapling procedure until 2015. In this procedure, the stomach is divided into a small upper pouch leaving a gastric remnant that does not receive food. The small intestine which is where chewed and liquified food products are absorbed, is divided. The far end is then attached to the small pouch and then this limb of bowel is reattached to the intestine near the other staple line. The net result is that food fills a small pouch, which holds less food than the normal stomach and is then transported into the small intestine further down than with a normal gastrointestinal tract. RYGB is an effective weight loss operation and is the preferential procedure for severe reflux and those with a condition caused by reflux called Barrett’s esophagus.

Many surgeons consider RYGB to be the gold standard. Our research has questioned this. RYGB causes considerable glucose variability(your bodies blood sugar going up and down with little consistency) and we believe that these fluctuations can be harmful. As a result, we use RYGB for revisions and patients that have anatomical reasons such as severe heartburn that make this procedure preferable.

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LAP-BAND® Adjustable Gastric Banding System

Also known as adjustable gastric banding, LAP-BAND surgery entails placing a small silicone band around the stomach to restrict the size. This band is then inflated with saline that is placed through a port on the abdominal wall.

Bands were very popular until 2010. Since that time, their insertion rate has declined and is now less than 5% of current bariatric procedures. This has happened since the pressure on the band with inflation has caused many symptoms. These symptoms, combined with weight loss failure and other complications have mandated many patients to have their bands removed. As a result, bands are less frequently placed as a primary procedure for obesity.

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Sleeve Gastrectomy

Sleeve gastrectomy, or gastric sleeve, converts the stomach surgery from a large sphere, into a narrow tube, reducing the volume and capacity of the stomach. To accomplish a large portion of the stomach is removed. The remaining stomach has a the shape of a banana.

The advantage of the sleeve is that it offers weight loss that rivals RYGB without use of the intestine. A disadvantage is that is a high pressure system, and rates of reflux like symptoms can be higher. For patients with very high BMI, a VSG may not offer the degree of weight loss that is desired. It can be used as a first stage procedure for patients that are super morbidly obese or have a BMI > 50.

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Duodenal Switch

A duodenal switch procedure is a complex weight loss surgery alternative that offers the greatest weight loss, the lowest chance of weight regain and the highest resolution of metabolic diseases like type 2 diabetes. To accomplish a sleeve gastrectomy that is designed to be slightly larger than a primary sleeve gastrectomy is combined with an intestinal bypass that is placed beneath the pyloric valve. The pyloric valve is at the end or bottom of the stomach and controls the release of food substances into the intestine. It can be considered a gateway. In a classic duodenal switch a Roux en Y construction is done and the majority of the bowel is not in contact with food. As a result, although weight loss is higher, the risk of vitamin and nutrient deficiencies is also higher. An active area of research at Lenox Hill Bariatric Surgery Program has been to try to utilize the effectiveness of this procedure and attempt to reduce side effects by bypassing a reduced portion of the small bowel.

As opposed to RYGB, we find that DS surgery allows for the body’s blood sugar to remain at a normal level with reduced fluctuations. We believe this will be an increasingly important topic in the future.

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SIPS or Modified Duodenal Switch Surgery

SIPS or MDS surgery, an operation that was pioneered at Lenox Hill, combines a calibrated sleeve and an intestinal bypass with a single attachment to the mid portion of the intestine. As a result, the operation appears to have lower complications than the classic DS and reduced risk of nutritional deficiencies. Interestingly, complications such as ulcer and stricture also seem reduced with SIPS as compared to gastric bypass. Finally, the single anastomosis lowers the risk of delayed small bowel obstruction. We believe this procedure will become the standard for those with extremely severe obesity and in individuals who have had inadequate weight loss or weight regain following sleeve gastrectomy.

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Complex Bariatric Revisional Surgery

For patients who experience complications or who regain weight after surgery, a revision procedure can help restore the effects of initial bariatric surgery to promote continued weight loss.

At Lenox Hill, the surgical team performs minimally invasive bariatric surgery, often patients referred from other institutions where these advanced procedures are not possible. This eases recovery and enhances our patients results. Patients are often referred to our program from other institutions where these advanced procedures are not possible.

A method for performing minimally invasive surgery that is becoming popular is Robotic Surgery. Similar to laparoscopic bariatric surgery, there are no large incisions and the procedures are done through small key holes. However, instead of the surgeon directly placing instruments through these keyholes, robotic arms are inserted.

Today, the robot primarily used is called the DaVinci, but there are several additional robots currently entering the market. When the robot is used for bariatric surgery, the surgeon sits at a console and directs the robotic arms. These arms have an identical range of motion as the human wrist. Additionally, the robotic camera provides a three dimensional image, offering complete visibility into the body. This combination of improved instrumentation and imaging are very exciting, offering significant advantages for the most complex procedures. Lenox Hill Hospital is robotic leader in the field, employing minimally-invasive robotic procedures wherever possible.

Advantages of robotic bariatric surgery include:

• Improved instrumentation and visualization
• More precise movement.
• Potential to improve outcomes and reduce complications in complex cases like revisions

Disadvantages of robotic bariatric surgery:

• Longer operative times, particularly for standard bariatric procedures in low risk patients

At Lenox Hill Bariatric Surgery, we understand that the vast majority of our patients have spent many years struggling with both the physical and psychological effects of obesity, and the decision to undergo a life-changing procedure like bariatric surgery is one that requires careful consideration. We encourage you to thoroughly research the least invasive weight loss surgery options, connect with other bariatric patients, and consult with our team of obesity experts prior to deciding whether to pursue weight loss surgery.

To learn more about the benefits and limitations of each type of weight loss surgery offered here at the Lenox Hill Bariatric Surgery Program in New York City, register for our free weight loss seminar. During the seminar, you will be provided with detailed information about the causes of obesity, surgical treatment options, realistic outcomes, and potential risk factors.

If you have any questions about your weight loss surgery options through Lenox Hill Bariatric, give us a call at 1-888-949-9344. We look forward to working with you!

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