FAQs About Bariatric Surgery

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 who have a BMI of 40 or higher. Additionally, individuals who have a BMI of 35 and suffer from life-threatening complications from obesity are also considered for surgical intervention.

Bariatric surgery is the only treatment that has been proven to help most individuals with obesity lose weight in the long term. Surgery doesn’t replace the need to make healthy diet and lifestyle changes; however, it does make it easier to achieve weight loss and other health-related goals.

Our medical team believes that bariatric surgery should not be the first choice for treating obesity. However, it is the best choice for those who have attempted non-surgical methods and have failed to achieve lasting weight loss.

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 are unable to lose weight through non-surgical methods and your weight status is affecting your health and quality of life, then surgery should be considered.

Gastric Bypass makes both a smaller gastric pouch and bypasses 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, you feel 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.

Gastric sleeve surgery, also known as a laparoscopic sleeve gastrectomy or vertical sleeve gastrectomy, transforms the existing, pouch-shaped stomach into a long tube or sleeve shape that is roughly the size of a banana. The remaining stomach tissue is fully removed, and the stomach is stitched or stapled back together.

Gastric sleeve surgery preserves the pylorus, the valve that regulates the emptying of the stomach. This provides a feeling of fullness after consuming a relatively small quantity of food, leading to a dramatic reduction in the patient’s total caloric intake. In addition, the procedure prompts hormonal changes that assist with weight loss. These same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

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.

These are bariatric
operations in which the stomach is made smaller and a significant amount
of the intestines are bypassed. Instead of relying solely on feeling full faster, these operations also create malabsorption: food is redirected to bypass a large amount of the intestines, meaning fewer calories and nutrients are absorbed. These operations cause markedly greater weight loss than a
Vertical Sleeve Gastrectomy, but protein and vitamin/mineral supplementation are mandatory to prevent nutrient deficiencies and malnutrition.

The Modified Duodenal Switch or Stomach Intestinal Pylorus-Sparing (SIPS) surgery is a simpler duodenal switch procedure with fewer complications and nutritional deficiencies. The
benefit of SIPS is that it preserves the functioning of the pyloric valve and prevents wide swings in blood glucose. With a smaller intestinal bypass than the traditional duodenal switch, it reduces the complications of short bowel syndrome.

The amount of weight a patient will lose depends on a wide range of variables such as genetics, the operation selected, portion sizes prior to surgery, portion sizes and food choices after surgery, exercise, and metabolic rate.

Patients who rely completely on the surgery and do not change their food choices and lifestyle behaviors will not have as favorable a result.

With minimally invasive surgery, it is not necessary to cut through the muscle — the surgery is performed through small incisions, and the surgeon is able to view the operative field using a television monitor. Advantages include reduced risk of wound complications, reduced risk of hernia, and a quicker return to daily activities. It is important to emphasize that minimally invasive surgery 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)

There is no fixed timeframe for returning to work after bariatric surgery, but on average, most patients recover for two to three weeks before returning. A delay in returning to work is not necessarily due to 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 who work in more physically demanding occupations may require a longer healing period, such as four to six weeks. However, if feasible, arrangements can be made for an earlier return to light-duty tasks.