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Gastrointestinal Metabolic Surgery

Bariatric Surgery: Surgical Treatment of Severe Obesity

For appointments and information, please call (646) 962-8462

WHAT IS BARIATRIC SURGERY?

Bariatric surgery indicates a set of surgical procedures on the gastrointestinal tract originally designed to reduce intake and/or absorption of nutrients by reducing the stomach's size or bypassing a part of the small intestine, or by a combination of the above.

Over several decades of clinical use and research studies, it has become clear that the reduction of food intake after bariatric surgery is not just the result of mechanical reduction of the capacity of the stomach but the consequence of modulation of hormones and neural signals that regulate the feelings of hunger and satiety.

WHY IT IS IMPORTANT TO TREAT OBESITY AND WHAT ARE THE BARRIERS TO EFFECTIVE SURGERY?

Negative societal attitudes about obesity are unfortunately a barrier to bariatric surgery and more in general to the provision of effective health care for obese individuals. In spite of the many benefits to bariatric surgery, in the U.S., less than 2% of patients that eligible by medical and insurance criteria have access to surgery. The figure is even lower in other countries.

Lack of awareness, concerns about risks of surgery may play a role for this low utilization of bariatric surgery. The most important barrier, however, may be a cultural one.

In fact, there are widely held views that the majority of obese people are responsible for their current weight, and severe obesity is too often believed to be a 'cosmetic' problem resulting from lack of self-control or motivation. In reality, severe obesity is not a cosmetic problem, but a condition that can reduce life expectancy in certain cases as well as expose to the risk of severe metabolic cardiovascular disease.

There is also a common perception among public at large (and even part of the medical community) that obesity is merely a behavioral issue and that weight reduction can be achieved by just the decision to eat less and exercise more.

Such assumptions ignore the very strong evidence that body- weight is controlled by powerful physiological mechanisms that make it difficult for people to maintain weight loss in the long term. In fact, weight loss is usually followed by compensatory mechanisms that increase hunger and decrease energy expenditure, ultimately promoting weight regain.

Bariatric surgery can effectively contrast such physiologic, compensatory changes and therefore results in greater and more durable weight loss than any other weight reduction therapy.

BARIATRIC SURGERY: BENEFITS BEYOND WEIGHT LOSS

Although originally developed merely for weight reduction, bariatric surgery results in benefits beyond just weight loss. In fact, surgery can prevent or dramatically improve a number of conditions and diseases including diabetes, elevated blood pressure, high cholesterol and triglycerides, sleep apnea, cardiovascular disease and others.

A recent scientific paper looking at over 2000 morbidly obese patients who underwent bariatric surgery compared to matched individuals treated by usual care as participants of the ongoing Swedish Obese Subject (SOS) study, found that surgery reduces the incidence of heart attacks and stroke. Surprisingly, however, these benefits were not related to the initial BMI, nor to the degree of weight loss after surgery, which brings into question the current use of strict BMI cut-offs for surgical indications. There is increasing agreement now that other parameters in addition to BMI should be considered to determine appropriate candidates who would benefit from the surgery. However, currently, most insurers still use the following criteria to define eligibility:

  1. BMI above 40 kg/m2
  2. BMI > 35 kg/m2 if associated with co-morbidities such as diabetes, hypertension, dyslipidemia, sleep apnea and significant arthritis

COMBINATION THERAPY

As with any other form of surgery, efficacy of bariatric/metabolic surgery varies, depending on the individual characteristics of a patient's disease. In cases where surgery cannot achieve the desired weight loss effect or when weight regain becomes an issue, pharmacotherapy may be a valuable complement to further weight loss. At the NYP/Weill Cornell Metabolic and Diabetes Surgery Center, surgeons, physicians, nutritionists and other specialists work as a multidisciplinary team to ensure each patient is provided with the most appropriate plan of care for his/her condition.

REVISIONAL BARIATRIC SURGERY

In some cases, such as substantial weight regain or side effects of an initial bariatric procedure, revisional bariatric surgery may become necessary to convert one procedure into another as appropriate to improve efficacy or resolve side effects. To further weight loss or metabolic control, sometimes restrictive procedures (i.e. gastric banding, or vertical banded gastroplasty, an older and now uncommon operation) are converted in gastric bypass or sleeve gastrectomy. On the other one hand, rare but possible side effects of gastric bypass or biliopancreatic-diversion duodenal switch may require surgical revision. Our team is able to perform such revisional surgery by laparoscopic approach (minimally invasive surgery).

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Gastrointestinal Metabolic Surgery
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(646) 962-8462
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