Weight loss surgery is a life-altering decision — one of
the most important decisions a person will ever make.
Special to the Journal By John Mecenas, M.D. Cayuga Medical Center.
Dr. Mecenas did his fellowship training in minimally invasive
surgery and minimally invasive weight-loss surgery at NYU Medical
Center. We first discussed the local availability of weight-loss
surgery in the Journal's biweekly Health Watch column in September
2003. One year later, approximately 75 people with clinically
severe obesity have undergone one of two types of weight-loss
surgery performed at Cayuga Medical Center.
Nearly fifty men and women have had laparoscopic roux-en-y gastric
bypass surgery, (which received extensive news coverage at the
time Al Roker of The Today Show underwent the procedure). Gastric
bypass both reduces the size of the stomach (limiting the amount
of food that can be eaten) and redirects the flow of food to a
different part of the intestine, (where less food and fewer nutrients
are absorbed). Twenty-five more patients have undergone LAP-BAND
surgery, in which a silicone band is placed around the top of
the stomach to significantly reduce the amount of food they can
consume.
At the same time we initiated the weight-loss surgery program
at Cayuga Medical Center, we also began a local support group
for weight-loss surgery patients. This group has now expanded
into two separate groups (one for each of the two different surgical
procedures) facilitated by their members. People who are considering
weight-loss surgery are required to attend a support group prior
to surgery, both to meet people who have had the procedure and
to learn about various issues related to the surgery.
Criteria for weight-loss surgery As the effectiveness of this
approach to treating severe obesity becomes more widely known
and accepted, a review of the criteria for surgery can inform
people's thinking as they consider the possibility of surgery.
There are several criteria a patient must meet to undergo weight-loss
surgery at Cayuga Medical Center. These criteria include the national
(NIH) guidelines, as well as additional recommendations of surgeons
expert in weight-loss surgery. My goals—and those of medical
center caregivers—are patient safety first, followed by
successful weight loss. The risk of complications from surgery
may differ depending on the individual. Since no surgery is risk-free,
we must do everything we possibly can to ensure a good outcome
for each and every patient.
Candidates for weight-loss surgery must either have a body-mass
index (BMI) greater than 40 or a BMI greater than 35, with a life-threatening
or disabling condition related to obesity, such as high blood
pressure, cardiac illness, or type 2 diabetes. Body mass index
is a measure of weight for height and it correlates with the amount
of body fat a person is carrying.
In addition, weight-loss surgery candidates:
- must have made several attempts at medical weight loss and
failed in those attempts
- cannot have alcohol or drug abuse problems or untreated psychiatric
illness
- must be non-smokers.
- should be between the ages of 18 and 65
- must have no absolute contraindication to major abdominal
surgery
- must have a long-standing obesity problem
- must understand the need for lifelong post-surgical changes
in lifestyle and dietary habits
- have been fully counseled on the risks and benefits of weight-loss
surgery.
Patients who are extremely obese (i.e. BMI greater than 50 or
weighing more than 400 lbs.) or who have serious health issues
may be poor candidates for surgery initially. These patients may
require medical interventions and non-surgical weight-loss prior
to being considered for surgery or may be referred to a tertiary
care center.
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