Physical changes

Between 2/3  – 3/4 of the stomach is removed. This leaves a long, narrow, vertical “sleeve” (shaped like a banana) which can hold 2-4 oz (60-120 ml). The part of the stomach that creates a hunger-causing hormone (ghrelin) is removed. No intestinal bypass performed.

Eligibility
Calculate your BMI now.

• BMI≥40
• BMI≥35 with other conditions: Type 2 Diabetes, hypertension, sleep apnea, heart disease or other health issues
• BMI 30-34.9 with Type 2 Diabetes that is not well controlled with medication and diet, may be considered
• Multiple, serious, supervised attempts at weight loss were unsuccessful
• Willing to make significant lifestyle changes

Mechanism

• Significantly restricts the volume of food that you can eat
• No malabsorption
• Feel full with smaller amount of food

Expected weight loss

55% excess weight lost after 2 years

Laparoscopic or minimally invasive surgery

4-5 small incisions on abdomen, instruments and camera are inserted through incisions, less chance of wound complications, less pain and quicker recovery

Length of operation

1.5 hours

Hospital stay

1-2 nights

Time off work

1-2 weeks. Varies, depending on how strenuous the job is.

Safety

Risks similar to gallbladder surgery or hip replacement

Advantages

• Most foods are well tolerated
• Decreased appetite
• No malabsorption
• No foreign object in body
• Lower risk of protein and vitamin deficiencies
• Resolution of many health problems: Type 2 diabetes (about 60%), hypertension, sleep apnea, high cholesterol

Disadvantages 

• Not reversible
• Risk of leaks at staple line, which might require further surgery
• Potential for blockages in sleeve
• Reflux is sometimes worse

Physical changes

An adjustable silicone band is placed around the top part of the stomach separating it into a small section and a larger section. The upper portion is a small 1-2 ounce (30-60 ml) pouch. A port is inserted just below the skin to allow for saline to be inserted into the band.

Eligibility
Calculate your BMI now.

• BMI≥40
• BMI≥35 with other conditions: Type 2 Diabetes, hypertension, sleep apnea, heart disease or other health issues
• BMI 30-34.9 with Type 2 diabetes that is not well controlled with medication and diet, may be considered
• Multiple, serious, supervised attempts at weight loss were unsuccessful
• Willing to make significant lifestyle changes

Mechanism

• Moderately restricts the volume and type of foods you can eat
• No malabsorption
• Limits food intake, reduces appetite and slows digestion
• Feel full with smaller amount of food

Expected weight loss

47% excess weight lost after 2 years

Laparoscopic or minimally invasive surgery

4-5 small incisions on abdomen, instruments and camera are inserted through incisions, less chance of wound complications, less pain and quicker recovery

Length of operation

1 hour

Hospital stay

Go home same day

Time off work

1 week. Varies, depending on how strenuous the job is.

Safety

Risks similar to gallbladder surgery or hip replacement

Advantages

• Reversible
• No cutting, removal or rerouting of any part of stomach or intestines
• Lowest risk protein/ vitamin deficiencies
• Resolution of many health problems- Type 2 Diabetes (about 50% patients), hypertension, sleep apnea, high cholesterol
• Restriction is adjustable

Disadvantages

• Weight loss is slower
• Frequent trips to surgeon for adjustments
• Slipping or infection of band can require further surgery
• Band may erode into stomach, requiring surgery to remove band
• Port problems
• Many foods not tolerated well (rice, nuts, popcorn, dense meats)
• Foreign object in body

Physical changes

Small 1-2 ounce pouch (30-60 ml) from the stomach is connected to the small intestine. The stomach remains in the body and is connected to the lower part of small intestine.

Eligibility
Calculate your BMI now.

• BMI≥40
• BMI≥35 with other conditions: Type 2 Diabetes, hypertension, sleep apnea, heart disease or other health issues
• BMI 30-34.9 with Type 2 diabetes that is not well controlled with medication and diet, may be considered
• Multiple, serious, supervised attempts at weight loss were unsuccessful
• Willing to make significant lifestyle changes

Mechanism

• Significantly restricts the volume of food that you can eat
• Intestines are rerouted which causes malabsorption
• Only small amounts of calories and nutrients can be absorbed
• Feel full with smaller amount of food

Expected weight loss

67% excess weight lost after 2 years

Laparoscopic or minimally invasive surgery

4-5 small incisions on abdomen, instruments and camera are inserted through incisions, less chance of wound complications, less pain and quicker recovery

Length of operation

2 hours

Hospital stay

2-3 nights

Time off work

2-3 weeks. Varies, depending on how strenuous the job is.

Safety

Risks similar to gallbladder surgery or hip replacement

Advantages

• Rapid weight loss
• Most foods, except sweets and fats, are well tolerated
• Resolution of many health problems- Type 2 diabetes (about 80% patients), hypertension, sleep apnea, high cholesterol
• No foreign object in body

Disadvantages

• Difficult to reverse
• Decreased nutrient absorption (vitamin B12, calcium, iron, zinc)
• Dumping syndrome: nausea, vomiting, diarrhea, flushing, dizziness, light-headedness, and sweating
• Potential for leak
• Potential for infection
• Potential for bowel obstruction

The National Institutes of Health sets minimum requirements for recommending bariatric surgery as a treatment option: 100 pounds or more above ideal body weight or a BMI of 40 or greater, or a BMI of 35 or greater with one or more obesity-related health condition. Calculate your BMI now.

Other qualifying factors may include:

• History of documented, failed weight loss attempts
• Lifelong commitment to lifestyle changes in diet, exercise, and medical guidelines
• Psychological evaluation

Together, you and your bariatric surgeon take steps to determine if surgery is the right treatment for you, which type of procedure is right for you, if you are mentally and emotionally prepared to make lifelong lifestyle changes, and that you have, or will have, the necessary support system around you.

The qualification process will include a series of tests. You also will meet with a dietician, psychologist, and other support staff members in sessions leading up to surgery. Each healthcare professional will help you prepare for the changes and challenges that lie ahead.

Those considering weight-loss surgery at Englewood Hospital and Medical Center are invited to attend one of our free, regularly scheduled informational seminars. During the seminar, the medical center’s bariatric surgeons provide extensive information on the types of procedures and the lifestyle modifications that weight-loss surgery entails, including education about diet, exercise, and relationship changes. They will explain the benefits and risks of surgery and answer your questions.

Sessions are held four times a month on various days and times for your convenience. See schedule and register now.

For many people, bariatric surgery is affordable because it is included in their health insurance coverage. For other people, bariatric surgery is a medical treatment they pay for themselves, called self-pay or cash pay. Whether your insurance company will cover the cost of bariatric surgery or you are paying for it yourself, you will need to prepare detailed written documentation to support the medical necessity of your surgery.

Obtaining insurance approval:

• Consult your insurance company regarding your benefits
• Determine if a medically supervised weight-loss diet program is required
• Consult with your primary care medical doctor and ask for a letter of medical necessity
• Obtain your diet history and record of your weights from your doctor or other supervised weight-loss program. Most insurance companies are looking for a 5-year history of morbid obesity.

Our information sessions are presented by one of our bariatric surgeons. You can choose to have a follow-up appointment with the presenting surgeon or are welcome to make an appointment with another one of Englewood Hospital and Medical Center’s bariatric surgeons.

At your initial consultation, the procedures will be reviewed. You and your surgeon will decide which procedure is best for you. Pre-surgery evaluations including blood work, X-rays, and EKG are required. Nutritional and psychological evaluations are required. Other tests or consults may be necessary based on your health. During this preparation process, your surgery date is scheduled.

In some patients, the laparoscopic, or minimally invasive, approach to surgery cannot be used. Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:

• Prior abdominal surgery that has caused dense scar tissue
• Inability to see organs
• Bleeding problems during the operation

The decision to perform the open procedure is made by your surgeon either before or during the actual operation and is based on patient safety.

For people suffering from the lifelong disease of morbid obesity, bariatric surgery can be a powerful tool that helps people  manage their condition. Of course,  bariatric surgery is a tool, not a cure. Each procedure works in a different way to make following the dietary changes easier. Following the dietary and lifestyle changes are the keys to success.

Learn more about Englewood Hospital and Medical Center’s Nutrition Counseling Services.