Upstate is high-volume, high-quality center for weight loss surgery
Its bariatric surgery program has been in place the longest, since the 1970s, and its surgeons handle about 450 cases per year. They are also involved in weight loss surgery research, and in training doctors to become bariatric surgeons. The program is comprehensive, meaning it includes in-house dietitians and pre- and post-operative services, and it serves as the tertiary center for bariatrics, meaning it welcomes referrals of patients with complications. Also, in 2011 the program was rated 5-stars by HealthGrades, one of the country's largest health care rating organizations; it's the only bariatric program in Syracuse to earn this rating, and the only one accredited by the American College of Surgeons Bariatric Surgery Center Network.
But scheduling surgery isn‘t as simple as circling a date on the calendar.
Would-be patients must be morbidly obese – at least 100 pounds overweight, or a body mass index of 40 or more, or a BMI of 35 or more along with weight-related health conditions such as high blood pressure or diabetes. They must also have made weight loss attempts and be willing to attend an informational session about the bariatrics program at Upstate.
Then they can obtain an appointment and begin what may be a three- to six-month process before surgery. During that time, they will undergo medical and psychological evaluation, attend support groups, learn the lifestyle and dietary modifications that will be necessary for surgery to be successful, and lose 5 percent of their weight as a demonstration of their seriousness.
“We fully realize that most patients would prefer to be operated on right away, but that‘s actually counter-productive,” says Howard Simon MD, director of the Bariatric Surgery Center.
Already an experienced surgeon, Simon began offering laparoscopic gastric bypass surgery at Upstate in 2002. Dr. Taewan Kim MD was a fellow then. Today, Simon has completed about 2,000 cases, and Kim has completed about 1,000, making them the most experienced laparoscopic weight loss surgeons in Central New York.
They tell their patients that surgery, alone, will not take the weight off. “The operation is necessary, but it‘s not sufficient,” Simon emphasizes. Patients will regain the weight if they become grazers, constantly nibbling on small amounts of food. “The other thing is, you‘ve got to exercise,” Simon says.
Patients range in age from the late teens to the late 60s. Many have diabetes, which usually resolves after surgery. Many also see improvement in high blood pressure and sleep apnea, and women are likely to experience improved fertility.
The gastric bypass used to take six to eight hours. Today, Simon and Kim usually complete the surgery in an hour. They hand sew the jejunum to the stomach, which keeps their leak rate low. Nationally 2 to 3 percent of gastric bypass patients experience leakage; at Upstate, leaks affect fewer than ¼ percent, Simon says.
The majority of bariatric surgeries today are minimally invasive procedures. Patients who are not candidates, who would require an open surgery, include those who have had previous stomach surgery.
Patients have three main surgery options:
- Gastric bypass, in which the surgeon creates a small stomach pouch and attaches the middle section of the intestine to the pouch, allowing food to bypass a portion of the small intestine.
- Gastric banding, in which the surgeon wraps an adjustable band around the upper part of the stomach.
- Sleeve gastrectomy, in which a thin vertical sleeve of stomach is created using a stapling device while the rest of the stomach is removed.
With each of the surgeries, patients are limited in the amount of food that can be eaten at one time, which helps them feel full sooner and stay full longer. Also, as they eat less food, the body stops storing excess calories and starts using its fat supply for energy.
After surgery, patients start consuming liquids and then soft foods before they are able to eat a regular diet – just smaller portions than they were used to.
Patients have four or five followup appointments the first year, two in the second year, and then annually after that so that surgeons can track progress and measure vitamin levels, which can be impacted by the surgery. Bariatric surgery patients face a slightly increased risk of ulcers, so they must avoid smoking and non-steroidal anti-inflammatory drugs.
Kim says patients on the day of surgery are generally excited about the prospect of improving their lives. The day after, facing nausea and belly pain from surgery, about two-thirds of them experience “buyer‘s remorse” and lament why they chose surgery. Ask those same patients about their decision six months later, Kim says, “and they‘ll tell you ‘this is the best thing I ever did.‘ ”