Newer types of weight-loss surgical procedures are helping severely overweight people lose pounds and get healthier, without complications seen with some older types of surgery. Jonathan Arad, a bariatric surgeon at Montefiore Nyack Hospital, says patients who undergo gastric sleeve surgery on average lose 65% of their excess body weight, and often no longer need to take medication for diabetes, heart disease, and high blood pressure. “This is not just a weight-loss procedure, but a way to get healthier overall,” says Dr. Arad.
Who is a Candidate for Weight-Loss Surgery?
Weight-loss, or bariatric surgery, is considered for a person with a body mass index (BMI) of 40 or higher without related illnesses (the equivalent of being about 100 pounds overweight for men and 80 pounds overweight for women), or a BMI of 35 to 39 with a related illness such as diabetes, heart disease, uncontrolled high blood pressure or sleep apnea. BMI takes height and weight into account to measure body fatness.
Gastric Sleeve Surgery
Gastric sleeve surgery, also known as vertical sleeve gastrectomy, consists of removing about 65% of the stomach, resulting in a stomach that looks like a long tube or sleeve. It is performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision. The surgeon inserts a viewing tube with a small camera (laparoscope) and other tiny instruments into these small incisions to remove part of the stomach. The tube-shaped stomach that is left is sealed closed with staples.
The gastric sleeve surgery, which takes about one hour, permanently removes up to 85% of the stomach. This makes the stomach much smaller, so a person can’t eat as much. The “new” stomach restricts food intake by allowing only a small amount of food to be eaten at one time. A person who has undergone the procedure quickly feels full and has a decreased appetite. “By removing the top part of the stomach, you’re removing a hunger hormone called ghrelin, so you’re not as hungry—after a couple of bites, you don’t want anymore,” says Dr. Arad.
Recovery from the surgery is the same as most abdominal surgeries, such as gallbladder or appendix surgery. “Patients are up and walking the first day, and generally go home after a night in the hospital. They can be on the treadmill after two weeks,” Dr. Arad says. “People can go to work after a week or two, but they can’t lift anything over 10 pounds for six weeks.”
Patients start with a liquid diet, and progress to mushy foods and then solid foods over the course of five to six weeks, until they are consuming a high-protein, low-carbohydrate diet.
“Patients experience a big drop in weight at the beginning, when they’re on a liquid diet. Then they lose about a pound a week, until they’ve lost 65% of their excess weight,” Dr. Arad says. He notes this means 65% of the pounds above their ideal weight—not 65% of their total body weight. “I tell patients not to obsess about the scale. If their pants size keeps dropping, and their energy levels are rising, then they’re on the right track.”
Improvement Over Older Procedures
The gastric sleeve procedure is an improvement over older weight-loss procedures, such as gastric bypass, which makes the stomach smaller and reroutes the intestines. Dr. Arad says up to 35% of patients who have gastric bypass surgery gain back more than half of their excess weight within five to seven years of their initial surgery. “This weight regain can happen for many reasons, but one is the technical failure of the procedure over time in which the stomach pouch stretches, allowing for more calories to be readily consumed,” he says.
Another weight-loss procedure, known as lap band surgery, also can cause problems after four or five years, Dr. Arad notes. During the procedure, an adjustable band, designed to restrict food intake, is placed around the top part of the stomach. “Over time the band can shift, causing nausea, vomiting and reflux,” he says. “People may also start to regain weight. The problem is that removing the band isn’t always simple because a lot of scar tissue can develop.”
Overstitch Gastric Bypass Revision Surgery
A newer procedure called overstitch gastric bypass revision surgery can help patients who have had gastric bypass surgery and have regained weight. “Redoing the entire gastric bypass is a big surgery, and is very risky,” Dr. Arad says. “Putting a lap band over a gastric bypass can be difficult because of scar tissue.” The overstitch procedure avoids problems with scar tissue because it is done through an endoscopy, a nonsurgical procedure in which a flexible tube with a light and a camera attached to it is passed through the mouth into the digestive tract.
The doctor first performs an endoscopy to check the stomach pouch size and the opening between the stomach pouch and the small intestines. Then on another day, the surgeon uses the endoscopy to suture and retighten the entire stomach connection. “It’s very safe and effective for getting people back on track to losing weight, with no incisions needed,” Dr. Arad says. Montefiore Nyack Hospital is one of the few hospitals in the area that has the equipment for this procedure, he notes.
As with the gastric sleeve procedure, the overstitch procedure takes about an hour, and most people go home the next day. Because there are no incisions, recovery is fairly quick, and generally involves some nausea for the first several days as the body adjusts.
Making Weight Loss Happen
“When a patient and their doctor decide weight-loss surgery is right for them, the Bariatric Center at Montefiore Nyack Hospital makes it simple. We often can set up a one-day workup so patients don’t have to come back multiple times. Unlike many hospitals, where the wait can be six months to a year, we can usually get patients into surgery in two months.” Dr. Arad emphasizes to patients that surgery alone isn’t enough to achieve permanent weight loss. “We offer nutrition and behavior coaching to help patients stick to their new lifestyle and healthy diet,” he says. “If they do their part, they’re going to keep the weight off.”