New Developments in Weight Loss Surgery

By John Mecenas, MD

There are some interesting research findings and new surgical developments in the field of bariatric surgery, commonly referred to as weight-loss surgery.

A study reported in the January 2008 issue of the Journal of the American Medical Association concluded that patients with extreme obesity who are treated with surgical therapy are more likely to achieve remission of type 2 diabetes than those people who are treated with conventional therapy. Their successful remission was attributed to their ability to lose more weight than those people in the study who were treated with medical therapy, lifestyle modification, and encouraged to exercise. Surgical patients in this particular study all had laparoscopic adjustable gastric banding surgery performed by an experienced bariatric surgeon.

Is laparoscopic adjustable banding surgery available locally?

Yes, for the past six years we have been performing both laparoscopic adjustable gastric banding (lap-band) surgery and laparoscopic gastric bypass surgery, (also known as roux-en-y surgery) at Cayuga Medical Center. The lap-band surgery has gained in popularity in recent years because it is less invasive, it can be reversed if necessary, and it has the additional benefit of being adjustable. There is also greater acceptance by health insurance companies for the lap-band surgery due to supporting data that shows its efficacy in weight loss as well as combating obesity-related illness.

How do the two types of surgery work?

Basically lap-band surgery restricts intake of food with the placement of a foreign body that partitions the stomach. Gastric bypass surgery restricts intake and bypasses part of the small intestine, altering the amount of nutrition the body can absorb.

Who should consider bariatric surgery?

Bariatric surgery is considered a treatment option for people with a body mass index (BMI) of greater than 40, who are between 18 and 65 years old. If your BMI is equal to or greater than 35 and you have associated obesity-related illnesses such as diabetes, high blood pressure, respiratory problems, or debilitating joint disease, you may also be a candidate for this surgery.

Are there other bariatric surgery procedures available?

Yes, there is a newer weight-loss surgery we are prepared to offer locally; however, the health insurance field has not caught up with this new development so many policies do not yet cover it. The procedure, which is called “sleeve gastrectomy,” is performed laparoscopically, similar to the lap-band and gastric bypass surgeries. During a sleeve gastrectomy the surgeon removes the bulky section of the stomach (to create a stomach shaped like a sleeve), which reduces stomach volume and induces weight loss.

What are the advantages to sleeve gastrectomy?

A March 2008 European study showed that excess weight loss was greater with a sleeve gastrectomy at six and eight months than with gastric bypass surgery. Sleeve gastrectomy may also be a better operation for high-risk patients who are extremely obese and are better served with a staged approach to surgery. These patients might begin with “sleeve” surgery to achieve significant initial weight loss. However, to lose their remaining weight they return for a second stage surgery, gastric bypass, which can be performed at this point with lower risk.

What related services are available locally for patients undergoing weight-loss surgery?

There are two active local weight-loss surgery support groups that meet at 6 p.m. at Cayuga Medical Center in the Bonnie H. Howell Education Center. The roux-en-y group meets on the first and third Monday night of every month and the lap-band group meets on the second and forth Monday nights. We are also in the process of combining our established weight-loss surgery program with the full services offered at the Cayuga Center for Healthy Living, including nutritional counseling, lifestyle modification, and supervised exercise.

Over the years, we have helped a number of patients achieve and maintain their weight loss. The strength of our program lies in our commitment to provide services before and after surgery that help our patients with long-term success. Some bariatric surgery programs limit their services to surgery, and their patients do not always succeed in losing or maintaining their weight loss. However, in the long run, no operation is a cure for extreme obesity; treatment is long term and requires active patient participation for behavioral changes, exercise, and proper diet. That support is readily available in Tompkins County, where we take a multidisciplinary approach to weight-loss surgery.

Dr. Mecenas is a board certified general surgeon with advanced training in bariatric surgery. He completed his surgical fellowship in minimally invasive surgery at New York University Medical Center. He is on staff at Cayuga Medical Center and is in practice with Surgical Associates of Ithaca. For more information on bariatric surgery, you can reach him at (607) 273-3161.

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