Weight Loss Surgery for New York and Long Island

In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creating a small pouch in a narrow passage into the large remainder of the stomach. The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution. The entire procedure is done laparoscopically. Like a wristwatch, the band is fastened around the upper portion of the stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the stomach and intestines. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. In turn, this results in weight loss. Advantages include: least invasive surgical option, no intestinal rerouting, no cutting or stapling of stomach wall of the bowel, reversible, reduced patient’s pain and recovery time.

Roux-en-Y Gastric Bypass Surgery is the most common and successful combined procedure in the United States. It is considered the ‘gold standard’ of bariatric surgery. First, we create a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 75 to 85 percent of their excess weight for 10 years or more. Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis. Combined procedures are more difficult to perform than the restrictive procedures. They are also more likely to result in long-term nutritional deficiencies. This is because the operation causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed.

Of the procedures that are currently performed for the treatment of obesity, it is ideal for patients who have very high medical risk, high weight or BMI, complex surgical histories or those who are fearful of potential complications from an intestinal bypass. It is also ideal for lower BMI patients who wish to avoid a more complex intestinal bypass or the possibility of vitamin or nutritional deficiencies secondary to procedures which cause malabsorption. Patients interested in Gastric Banding may also want to consider this procedure, since it avoids the foreign body issue of a Band. Patients using anti-inflammatory medications also should consider this procedure because ulcer risk is probably less than after gastric bypass or band procedures. This procedure greatly reduces Ghrelin-hormone production and helps reduce appetite and the hunger sensation. Five-year results from England and three-year results from the United States suggest the Vertical Gastrectomy has weight loss similar to other procedures with lower risk of complication. The stomach is restricted by dividing it vertically and removing more than 85 percent of it. This part of the procedure is not reversible. The stomach that remains is shaped like a thin banana and measures from 2-5 ounces (60 - 150cc) depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. This is the newest and most promising procedure for obesity with lower complications than Gastric Bypass and better weight loss than LapBand. Currently it is approved by some insurance companies, but may be considered investigational by others.

Laparoscopic Adjustable Gastric Band—Restrictive Procedure

Laparoscopic Roux-en-Y Gastric Bypass—Restrictive and Malabsorptive Procedure

Laparoscopic Sleeve Gastrectomy—Restrictive Procedure

Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Severe obesity is the second most common preventable disease in the United States, second only to lung cancer. Only approximately 5% of patients can lose and maintain long-term weight-loss through dieting and exercise. Bariatric surgery is one of the best options for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity related health problems. The surgery promotes weight loss by restricting food intake and, in some operations, interrupting the digestive process. As in other treatments for obesity, the best results are achieved with healthy eating habits and regular physical activity.

To be considered for bariatric surgery, you must be 100 pounds or more over your ideal body weight with a body mass index (BMI)of 40 or greater. Your body mass index is calculated by taking your weight in kilograms and dividing by your height in meters squared (BMI=kg/m²). Surgery may also be considered for patients with a BMI of 35 who have other serious health conditions. The serious health conditions are known as comorbidities. Common comorbidities include diabetes mellitus, hypertension, heart disease, arthritis, sleep apnea, respiratory problems, heartburn and reflux, gallbladder disease, depression, infertility, skin breakdown or ulcers, and circulation problems.

The Roux-en-Y gastric bypass procedure has generally been considered the gold standard based on the availability of long-term results that achieve an approximate 70% excess body weight loss over seven to 10 years. The correction of comorbid conditions has been reported for diabetes mellitus (83%),hypertension (69%), gastric reflux (100%), urinary stress incontinence, and degenerative joint disease. It has also been shown to provide a significant improvement in survival for those treated with surgery compared with conventional weight-loss treatment. When one considers the improvements in life expectancy, resolution of severe chronic disease, improvements in quality of life, and reduction in risk of cancer, there is hardly a procedure or medication in the history of medicine that can equal bariatric surgery.

Weight Loss Surgery for New York and Long Island

The Bypass Effect

It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Surgeons have been performing bariatric, or weight loss operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation.

Correspondent Lesley Stahl met some people who were once morbidly obese.

Please watch the video to the right as broadcasted on 60 Minutes on April, 20th, 2008.

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