Bariatric Weight Loss Surgery
Your life shouldn't be defined by what your body will and won't let you do. For those suffering from obesity this is a day-to-day struggle. At Orange Regional Medical Center, we believe you deserve a better quality of life.
Led by Dr. Seth Judd, Medical Director of Bariatric Surgery, and Janet Kovler, M.S., R.D., C.D.N., C.D.E., Bariatric Surgery Program Manager, Orange Regional Medical Center offers three minimally-invasive weight-loss procedures called:
- Gastric Bypass
- Gastric Banding
- Sleeve Gastrectomy
These bariatric services can help you get back on track to living a fuller, healthier, more active life.
Orange Regional Medical Center is designated by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program as an Active MBSAQIP Center.
This designation recognizes Orange Regional as demonstrating an unparalleled commitment and ability to consistently deliver the highest level of bariatric surgical care possible. Earning the MBSAQIP Active Center designation also distinguishes Orange Regional from other providers in both professional and patient situations.
Your Bariatric Surgery Treatment Options
Overall, bariatric surgery can help patients improve the quality of their life and increase the amount of years to live. The benefits of bariatric surgery may also include the improvement or resolution of:
- Type 2 diabetes
- Reduction in high blood pressure
- Resolution of sleep apnea conditions and other sleep disturbances
- Diminished swelling and pain of legs and joints
- Many infertile women become pregnant and have a safer pregnancy and delivery
- Changes in cholesterol and other blood lipids reduce the risk of heart attack and strokes
There are a few different types of bariatric surgery. The kind of surgery determined best for you will be based on your overall health, lifestyle, and a number of other factors that you and your doctor will access and go over together. At Orange Regional we offer three bariatric surgery options:
This procedure involves the reorganization of the digestive system. The surgeon creates a small pouch in the upper part of the stomach by stapling it together. The surgeon then attaches part of the small intestine to the new pouch, effectively "bypassing" the part of the stomach that has been sealed off. This causes your body to absorb fewer calories, leading to weight loss.
Benefits for gastric bypass include rapid weight loss at @ ½ lb. to 1 lb. per day, significant improvement or resolution of Type 2 diabetes even before weight loss occurs, resolution of other co-morbid conditions, avoidance of sweets which is necessary or dumping syndrome will occur (intolerance to sweets). The benefit of avoiding sweets is to prevent the side effects of dumping syndrome; i.e., rapid heart rate, sweating, feeling faint and severe diarrhea.
Volume eaters benefit greatly from gastric banding surgery. This option provides volume restriction, gradual weight loss at @ 1-2 lbs per week and resolves co-morbid conditions.
During this procedure, the surgeon places an inflatable and adjustable band around the upper part of the stomach, partitioning it into two parts. The band creates a small opening that allows limited food to pass through each section, resulting in controlled food intake. This means you will feel full while eating less.
This procedure removes approximately seventy-five percent of the stomach and results in less food consumption, causing you to eat less and lose weight. Following the surgery, what remains of the stomach is a narrow tube or sleeve which connects to the intestines. There are no nutritional deficiencies as a result of a Sleeve Gastrectomy because it does not affect the absorption of food and the intestines are not affected by the surgery.
The Benefits for sleeve gastrectomy are significant weight loss without bypassing the intestines or introducing a foreign object (like a gastric band) and no need for post-surgery adjustments of a foreign object periodically and resolution of co-morbidities.
Da Vinci Robotics for Bariatric
Additionally, certain bariatric procedures are performed at Orange Regional Medical Center using the robotic-assisted da Vinci Surgical System, however it may not be appropriate for every individual. Always ask your physician about all treatment options, as well as their risks and benefits.
What To Expect: Bariatric Surgery
Deciding on bariatric surgery is a life-changing decision for all of our patients. This is not a procedure that begins and ends in the operating room. This is a journey that the patient has choosen to take on that influences many significant aspect of how they live their lives - from what and how you eat and interact with food, to health changes including daily activity and exercise. Many patients may also notice their way of thinking change or their relationships with others. We like to think that these changes, though may be challenging at times, are overall positive and healthy changes.
Once you have choosen bariatric surgery at Orange Regional Medical Center, there are many mandatory steps and resources available to you to ensure the best possible outcome from this life-style change, including:
If you and your doctor decide that surgery is the best option, a pre-surgical risk assessment will be done by your doctor, and if necessary, a pre-surgical testing appointment will be scheduled.
Pre-operative consultations are provided by members of the bariatric surgery team including your
- Bariatric surgeon
- Bariatric dietitian educator
- Bariatric behavioral health therapist consultant
Additional consultations will be needed for surgery clearance, and your bariatric surgeon will refer you for cardiology, pulmonary, gastroenterology, and laboratory screening.
Our program provides you with an all inclusive step-by-step process to fulfill all insurance requirements to pre-authorize you for bariatric surgery.
Pre- and Post- Operative Education
Education is key to making important decisions about whether bariatric surgery is right for you.
Are you a viable candidate for bariatric surgery? What surgical options are available? What are the post-operative complications/side effects/signs and symptoms? How does the diet change just before and after surgery?
These and many other questions are answered for you at a mandatory 2.5 hour pre-op education class. We also offer an optional 1.5 hour bariatric seminar (orientation) program which explains the entire process with presentations by our bariatric surgery program manager and one of our board-certified bariatric surgeons. The education continues with your attendance at two mandatory 1.0 hour pre-operative support groups at which time various topics are discussed and presentations are made by post-op patients who share their overall hospital and program experiences with you. You are encouraged to continue to attend support groups regularly after surgery as well.
Additionally, we also offer support groups to our patients pre- and post- operative, bariatric grocery shopping tours, and post-operative nutrition conference calls. The dial-in number and monthly schedule for our conference calls will be given to your prior to your discharge and, similarly to our support groups and other offerings, offers our patients an opportunity to obtain valuable insight as you evolve between the many stages of this life-changing decision.
Frequently Asked Questions
Who should consider bariatric surgery?
Bariatric surgery should be considered after conservative treatment of morbid obesity including diet, exercise, drugs and behavioral modification has failed. Surgery for morbid obesity is the only successful method of long-term weight reduction, as well as, significant improvement or complete resolution of co-morbidities (associated diseases – like Type 2 diabetes, sleep apnea, cardiovascular disease).
Patients seek out Orange Regional’s Bariatric Surgery Center of Excellence Program after failing to lose weight through traditional means or when attempts at non-surgical treatment for morbid obesity has failed. Some have already begun researching the idea of bariatric surgery via the internet or other means, and others have heard from existing patients to attend one of our free informational seminars.
Am I a candidate for bariatric surgery?
At Orange Regional, we follow the National Institutes of Health (NIH) guidelines and criteria for determining whether an individual is a candidate for Bariatric Surgery. Those guidelines indicate the following:
- Body Mass Index (BMI = weight divided by height in meters squared) of ≥40 (@ 100 pounds overweight), or ≥ 35 to 39.9 with at least one other obesity-related disease; i.e., Type 2 diabetes, sleep apnea, severe osteoarthritis, cardiac disease including high blood pressure and high cholesterol, polycystic ovary disease, etc. Those with BMI ≥ 30-34.9 can be considered for a gastric Lap-Band ® only and must also have at least one other obesity-related disease to qualify for bariatric surgery.
- Must have tried and failed conservative treatment and be overweight for a minimum of 5 years.
- Must be 18 years of age or older.
- Must be mentally prepared for the procedure without having an eating disorder such as bulimia.
How successful is the surgery?
Results at Orange Regional correspond to the national average. In the majority of cases, bariatric surgery patients lose anywhere from 45% to 83% of their excess body weight and improve or resolve 90% of their obesity-related health conditions within one year post-operatively.
Are there risks with weight loss surgery?
There is always a certain degree of risk involved with any surgery. At Orange Regional, all bariatric surgeries are performed as minimally invasive, laparoscopic procedures which decrease risks and complication rates. Risk of mortality has been reduced from 2% with open gastric bypass to 0.5%, the same rate if the patient were having a laparoscopic gall bladder removal. Laparoscopic gastric banding is ten times safer than gastric bypass with a mortality rate of 0.05%. The laparoscopic sleeve gastrectomy mortality rate is also low at 0.39%.
What are the most common side effects?
Some of the more common side-effects after bariatric surgery are:
- Surgical pain (mild to moderate)
- Loss of appetite
- Gas pain
- Constipation or lose stools
- Emotional ups and downs
- Dumping syndrome (sugar intolerance after gastric bypass)
What diet regimen is required before surgery?
Pre-operative diet is also important. It is strongly recommended and sometimes required by insurance companies that bariatric surgery candidates attempt to lose five percent body weight prior to surgery. This is recommended so the liver shrinks in size, making the surgery safer and because research has shown better outcomes for patients who have already started to lose weight prior to surgery. Orange Regional’s bariatric dietitian educators work closely with each bariatric surgery candidate to help to achieve this goal.
What diet regimen is required after surgery?
At Orange Regional, all bariatric surgery patients are required to remain on bariatric clear liquids for a few days and then advance to a bariatric full-liquid diet including protein shakes for 2 weeks post-surgery. During week three, the diet varies depending upon the procedure. Gastric Bypass and sleeve gastrectomy patients advance to a puree diet, and gastric band patients advance to soft solids. All patients eventually consume well-balanced and portion -controlled solid foods. The “slow, small, moist, and easy” eating techniques are critical for patients to follow:
- Set aside 30 minutes to consume each meal
- Chew food 28 to 30 times before swallowing
- Take small bites and use a saucer in place of a plate to aid in portion control
- Stop eating as soon as you feel full
- Eat all of your protein first to ensure adequate amounts before feeling full
- Stop drinking 30 minutes before eating; do not drink during your meal; wait 30 minutes after eating to resume drinking
Can a person still overeat?
Attempts to overeat immediately after surgery will cause the patient to regurgitate. Over time, with the gastric bypass and sleeve gastrectomy, the pouch will expand slightly and allow more food to be ingested at one time. As a result, patients must be educated pre-operatively to the difference in rules of their stomach pouch to prevent weight regain. Moreover, it is very important that patients continue to attend support groups after surgery to learn behavior modification techniques necessary to prevent weight regain.
What kind of follow-up is there after surgery?
A follow-up is conducted at the surgeon’s office during the following intervals:
1 wk/1 mo/3 mo/6 mo/9 mo/1 yr and once per year for life. For gastric banding patients, add additional follow-ups for adjustments of the band – once every 6 weeks to 3 months within the first year.
Follow-up is also provided by the bariatric dietitian educator from Orange Regional; as well as, physical and behavioral health therapists and other physicians/ancillary staff representing the multidisciplinary approach to care at our bariatric support groups provided throughout the month.