Surgical Management of Obesity

Weight Criteria  
BMI > 40 (or)  BMI > 35, with co-morbid medical conditions

Other Criteria

• History of genuine effort to lose weight by non-surgical therapy, without sustained weight loss
• History of good compliance with medical recommendations
• Absence of prohibitive surgical risk

There are three common bariatric surgical procedures, each of which is typically performed laparoscopically. This minimally invasive technique results in decreased pain as well as a dramatically reduced rate of wound complications.

It is reasonable to think of these three procedures as a spectrum of options, ranging from the gastric bypass (most complex and also most effective) to the adjustable gastric band (least complex and least effective), with the gastric sleeve in between. When a patient suffers from diabetes or severe GERD, the gastric bypass is the most effective option.

For most patients who meet the surgical criteria, any of the three procedures is likely to lead to reduced weight and improved health that is sustainable for decades. The bariatric surgical community has not been able to identify any questionnaire or other study that effectively determines which procedure is best suited to a given patient, so our approach is to educate patients thoroughly about all three options and involve them closely in the decision process. 

Please note that the simplicity of the Band procedure does not necessarily mean it has the lowest risk for the patient in the long run. Although the Band has the lowest risk of the three procedures on the day of surgery, we should remember that the plan is for the patient to carry this medical device on the proximal GI tract for life. This creates a small but real chance of long-term problems that is somewhat greater than for the gastric bypass or the gastric sleeve. It is our impression that in the long run, the risk of the three procedures is essentially equivalent.

We generally recommend that a revision surgery be completed by the patient’s original surgeon. But, in some cases, that’s not possible. At New Dimensions, we have performed revisional surgery to convert patients’ gastric band procedures to a gastric bypass. This includes not only the surgery itself, but also teaching the patient a different set of diet procedures. It is also common to do a re-division of the staple line for gastric bypass patients. This surgery is necessary when an unwanted connection is found between the stomach pouch and the lower stomach.

In a revision surgery, weight loss is often much less than the amount lost with the first surgery, and patients often have prolonged recovery due to increased scar tissue. While revision surgery inherently poses a higher risk of complications, our surgeons’ extensive experience in bariatrics and laparoscopic techniques allow us to achieve successful outcomes for most patients.