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Surgical Opions
Types of Procedures • Conditions & Reactions • Education • Insurance Options
Types of Procedures
The surgery procedures that are offered at the Bariatric Center at Mather
Hospital – Roux-en-Y gastric bypass and laparoscopic adjustable
gastric banding – have outstanding success rates with a proven
track record of excellent weight loss, dramatic improvements in quality
of life and resolution of weight-related medical problems.
Laparoscopic surgery, the medical term for minimally invasive surgery,
is when surgery is performed using a narrow magnification camera, called
a laparoscope, and narrow surgical instruments. Many studies have documented
the benefits of laparoscopic surgery where the small incisions cut very
little skin, muscle and nerve thereby minimizing patient discomfort.
Because laparoscopic cameras magnify the images on a large TV screen,
surgeons can see the internal organs much better than through a traditional
incision which allows for an exactness and visual sensitivity that cannot
be achieved with the unaided eye. If your surgery is done laparoscopically,
expect a faster recovery and a shorter hospital stay.
Laparoscopic Adjustable Gastric Band (LAGB or Lap Band)
This
surgical option is a restrictive procedure because it controls the amount
of food that you can eat at one time. A hollow silicone band, placed around
the top of your stomach, creates a small pouch and narrow passageway into
the rest of the stomach, thereby limiting the amount of food you can consume.
The band is then inflated with a saline solution. After food enters the
pouch, it slowly empties into the rest of the stomach. Liquids pass through
the narrow opening created by the band while denser foods are delayed from
passing through.
Band adjustments occur six to eight weeks after surgery
and as needed thereafter. Patients considering this procedure are carefully
screened for dietary habits and preferences, as well as pre-existing gastroesophageal
reflux disease.
Laparoscopic/Open Roux-en-Y Gastric Bypass
Your
surgeon uses staples to separate a small pouch at the top of the stomach
from the rest of the organ. A hole is then cut in the pouch and the lower
part of the small intestines is rerouted to it. The small pouch serves
as your functioning stomach, limiting the amount of food you can consume.
Food bypasses the lower stomach and upper part of the small intestines
and is digested in the lower part of your small intestines. Gastric bypass
surgery is a restrictive-malabsorptive procedure because it not only limits
the volume of food you can eat, but also leads to decreased absorptions
of fat and calories, thereby limiting your daily caloric intake.
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Conditions and Reactions
| |
Gastric ByPass |
Lap Band |
| Weight Loss |
Most common and successful
surgery; rapid weight loss;
some weight regained over time.
Most effective in reversing obesity- related health
problems. |
Less successful in achieving
substantial weight loss. Upfront weight loss continued
as band is adjusted. |
Permanent/
Reversible |
Permanent alterations to stomach
and digestive process. |
No permanent alterations to
stomach or digestive process.
Band can be adjusted or removed. |
Vitamin and
Mineral Loss |
Decreased vitamin and mineral
absorption.
Must take daily vitamin and mineral supplements.
Requires lifelong medical follow-up and monitoring
of blood levels. |
No vitamin or mineral loss.
Vitamin and protein supplements are recommended. |
Diet
Restrictions |
No fatty foods or sweets. |
Avoid candy, ice cream, caloric
liquids and other high-calorie liquid-like foods that
can slip past band. |
Procedure/
Recovery |
Surgery takes 2-4 hours.
Requires 2-3 day hospital stay.
Returns to work in 2-4 weeks. |
Surgery takes less than 2
hours.
Most patients go home the next day or two.
Usually returns to work within a week. |
Risks/
Side Effects |
Complications:
- Staple line leaks:
Nationwide = 3-5%
- Internal bleeding
- Infection
- Blood clots in lungs or legs
- Bowel obstruction
- Pneumonia
- Ulcers
- Narrowing of the stomach outlet
- Death 1 in 200 cases
Late complication:
- Nutritional deficiencies resulting from malabsorption.
Iron and calcium malabsorption can lead to anemia, osteoporosis
and metabolic bone disease. Consequences of not taking
vitamin supplements are dire.
- Gallstones needing surgery
- Dumping syndrome in 30% of cases (caused by consuming
too much sugar or eating too fast, includes nausea,
stomach cramps and diarrhea)
- Possible lactose intolerance
- Temporary thinning of hair
- Possible need for plastic surgery following weight
loss to remove excess skin
- Prolong vomiting/food intolerance
- Weight regain or inadequate weight loss
- Hernias needing surgery
|
Complications:
- Tear in the esophagus or stomach
- Band slips, leaks or erodes into the stomach
- Narrowing of the esophagus
- Abnormal esophageal contractions, such as spasms,
which can result in the inability to eat
- Gastroesophageal reflux disease
- Disconnection of band from port ? requires re-operation
- Failure of band to inflate
- Failure to lose weight
- Gallstones needing surgery
- Breakage of band
- Death 1 in 500-1000 cases
- Hernias needing surgery
- Bleeding and infection
- Band slippage needing further surgery
- Vomiting
- Clots in legs or lungs
- Possible need for plastic surgery following weight
loss to remove excess skin
|
| Pregnancy |
It is imperative to ensure
that you do not become pregnant for 18 months after the
surgery. There is concern that fetal well being may be
jeopardized during the period of weight loss. Please
see your doctor or obstetrician for effective means of
contraception during this period. This is a chance that
you take should you decide to undergo surgery. You are
solely responsible for your decision. |
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Bariatric Education Sessions
Hosted By:
Arif Ahmad, MD
We are pleased to announce Arif Ahmad, M.D as Medical Director
of Bariatric Surgery at John T. Mather Memorial Hospital.
Dr. Ahmad is a Board Certified Laparoscopic Bariatric and
General surgeon; a member of the American Society of Bariatric
Surgeons', American College of Surgeons', Society of American
Gastrointestinal Endoscopic Surgeons'.
Dr. Ahmad presents educational and support groups to patients
on the following days:
| Patient Education
Sessions |
| Day(s): |
On a Tuesday
evening once a month. |
| Time: |
5:30
pm |
| Place: |
Conference Rooms 1 & 2
(Next to Coffee Shop) |
| |
|
| Support Groups |
| Day(s): |
On a Tuesday evening once
every other month. |
| Time: |
6:30 pm - directly following
the patient education sessions |
| Place: |
Conference Rooms 1 & 2
(Next to Coffee Shop) |
*Please contact Dr. Ahmad's office to register and for further
information at (631) 689-0220.
Please note: The Support Groups are conducted by Dr. Ahmad
and his office for his patients only.
We look forward to seeing you there!
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Insurance Information
Insurance coverage for this surgery is variable. It is your
responsibility to inquire about your insurance company's
requirements and to be certain you have covered benefits
for morbid obesity surgery. (If you prefer to pay for bariatric
surgery out of your own pocket, contact your surgeon's office
for financial advice). Your procedure may be covered by out-of-network
coverage if you have that in your policy. Mather Hospital
participates in many plans. When you come in for your consultation,
please bring in the name and phone number of the insurance
representative with whom you spoke.
Physician Letter
Most insurance carriers that cover bariatric surgery require
documentation of medically supervised weight loss attempts
within the last two years. Ask your primary care physician
to write a letter that documents:
- How long you've been obese.
- Attempted weight loss methods and the outcome of those
efforts.
- Advice given to you by your primary care physician such
as diet types and exercise recommendations.
- Visits or instruction from a dietitian.
- Weight loss prescription medications.
- Psychotherapy for eating disorders or stress reduction.
A sample physician letter might read as follows:
Dear Dr. ____,
Jane Doe has been under my care for the past two years.
She suffers from severe obesity as well as diabetes, hypertension
and severe joint pain. During the past two year period, I
advised Jane to participate in Weight Watchers, prescribed
sessions with a nutritionist and supervised her through these
efforts. While Jane did lose some weight and demonstrated
minimal improvement in her health issues, she regained the
lost weight and more. At this point, the only reasonable
treatment alternative is bariatric surgery.
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