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Bariatric Surgery

Bariatric Surgery

Obesity is a serious problem resulting from a mix of genetic problems, environmental effects, abnormal physiology and overeating. It has serious medical, physical, social, psychological and economic effects for patients. Obesity brings with it a host of related conditions including heart disease, stroke, type 2 diabetes, and certain types of cancer—some of the leading causes of preventable death.

More than two-thirds of U.S. adults are overweight, meaning they have a Body Mass Index, or BMI, of 25 or higher. (A person with an ideal body weight typically has a BMI of 20-24.9.) Five percent of U.S. adults are considered morbidly obese, meaning they are more than 100 pounds over their ideal body weight and have a BMI of 40 or higher.

Bariatric surgery has proven to be a long-term aid for those who struggle with their weight and suffer from morbid obesity. It’s a common, safe and effective procedure that allows restriction of food intake by means of a plastic band placed on the upper section of the stomach. This produces a small pouch—adjustable to each patient’s needs—which prevents patients from overeating.

Patients who have had bariatric surgery have significantly reduced rates of developing cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, psychiatric disorders, and pulmonary disorders.

The University of Miami Hospital Advantage

As the only university-based bariatric center in the region, University of Miami Hospital Center of Excellence for Bariatric Surgery provides leading-edge patient care by the nation’s top physicians and offers the latest options for the morbidly obese.

The Center carries the American Society for Metabolic and Bariatric Surgery (ASMBS) designation as a Bariatric Surgery Center of Excellence because of the individual and collective experience of the Center’s physicians, and its demonstrated track record of favorable outcomes.

The Center of Excellence for Bariatric Surgery at University of Miami Hospital offers three types of minimally invasive bariatric procedures: Gastric Banding, Gastric Sleeve, and Gastric Bypass. All of these are performed laparoscopically, which means smaller incisions, less pain, reduced risk of infection, and shorter recovery times.

Three Types Of Bariatric Surgery

University of Miami Hospital Center of Excellence for Bariatric Surgery specializes in three types of bariatric surgery: Gastric Bypass, Gastric Banding, and Gastric Sleeve.

Gastric Bypass
Laparoscopic Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States, using a combination of restriction and malabsorption.

In this procedure, the surgeon creates a small stomach pouch and then attaches a Y-shaped section of the small intestine directly to the pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach pouch makes you feel fuller sooner and eat less food; bypassing a portion of the small intestine means your body absorbs fewer calories. Most patients spend only one night in the hospital following a gastric bypass procedure.

Adjustable Gastric Banding
Gastric banding is a restrictive surgical procedure in which two medical devices are implanted in the patient—a silicone band and an injection port. The silicone band is placed around the upper part of your stomach, molding it into two connected chambers. The injection port is attached to the abdominal wall, underneath the skin, and the port is connected to the band with soft, thin tubing.

Adjustments are made using a needle to inject saline solution into your band through the port. Adding saline increases the amount of restriction provided by the band, helping patients feel fuller sooner and with less food. Keep in mind that even after reaching and maintaining your success weight, you will need follow-up for further evaluations and adjustments.

Gastric banding can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines to achieve success. Gastric banding requires more intensive follow-up care than most other bariatric surgeries, mostly because the band is adjustable.

Since there is no cutting, stapling or stomach re-routing involved in the banding procedure, it is considered the least traumatic of all weight loss surgeries. The laparoscopic approach to the surgery also offers the advantages of reduced post-operative pain, shortened hospital stay and quicker recovery. If for any reason the band needs to be removed, the stomach generally returns to its original form.

Gastric Sleeve
Gastric Sleeve surgery, or Sleeve Gastrectomy, is a restrictive bariatric surgery. During this procedure, the surgeon creates a small, sleeve-shaped stomach. It is roughly the size of a banana, and larger than the stomach pouch created during Roux-en-Y bypass.

Sleeve gastrectomy is typically considered as a treatment option for bariatric surgery patients with a BMI of 60 or higher. It is often performed as the first procedure in a two-part treatment that also can include gastric bypass.

Sleeve gastrectomy patients experienced resolution rates for type 2 diabetes, high blood pressure, high cholesterol, and obstructive sleep apnea that were similar to resolution rates for other restrictive procedures such as gastric banding.

There are no published long term outcome studies on the sleeve gastrestomy. Short term results have been very good, but patients need to realize that the data is lacking about the possibility of significant weight regain.

Although there is no “malabsorbtion” that occurs with a sleeve gastrectomy, most surgeons recommend daily multivitamin supplementation.

Considering Bariatric Surgery?

Bariatric surgery should not be considered until you and your doctor have explored all other options. The best approach to bariatric surgery calls for a discussion of the following:

  • Bariatric surgery is not cosmetic surgery.
  • Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
  • Together, you and your doctor should discuss the benefits and risks.
  • You must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
  • Complications after surgery may require further operations.

Nestor F. De La Cruz-Munoz, M.D.

University of Miami Miller School of Medicine Faculty

Specialty: Bariatric Surgery

Appointments: 305-243-4400

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