GASTRIC BYPASS (Roux-En-Y)

Gastric bypass is the most common surgical procedure for morbid obesity in the United States.

It involves dividing the stomach to create a new stomach pouch that holds less than half an ounce, so that one can only eat small amounts of food. The intestine is then rerouted in such a way that it affects the absorption of calories and causes significant discomfort when eating sweets.

This procedure can be performed open with a single incision, or laparoscopically by using several small incisions and long instruments.

LAP-BAND
Lap-Band is a laparoscopic procedure which involves wrapping an inflatable cuff, or band, around the top of the stomach.  This severely restricts the amount of food one can tolerate.

All patients are screened for medical and psychosocial appropriateness for obesity surgery.  The procedure offered may depend on medical issues, in addition to the following guidelines regarding Body Mass Index (BMI):

BMI > 50	Open gastric bypass
BMI < 50	Open gastric bypass or laparoscopic gastric bypass
BMI < 45	Lap-Band
BMI = 35-40	Possible candidate with severe weight-related medical conditions

              Click here for a BMI Calculator from the National Institutes of Health 

THE CARE TEAM

The surgeon reviews all patient application materials for consdieration in the Bariatric Surgery program.  The surgeon discusses with each patrient the surgical option that would be most appropriate for them, discussing the benefits and risks of that option.  In collaboration with the other members of the care team, the surgeon intitiates and then reviews the progress of all medical screenings.

The surgeon meets with patients prior to surgery to ensure that they are medically ready, and after performing the procedure, the surgeon monitors the patient's success while screening for any complications that may arise.

NURSE PRACTITIONER (NP)
The Nurse Practitioner completes the patient’s medical screening prior to surgery.  Patients should expect to have four to six visits with the nurse practitioner.  These visits will include discussions, evaluation, and education.

The NP will also complete the patient’s medical history and physical examination and will make appropriate patient referrals to an endocrinologist, pulmonologist, cardiologist, nephrologist, and/or others.

REGISTERED NURSE (RN)
The Registered Nurse provides health education and patient support.  The RN is the first contact the patient has for evaluation of complications, general questions, and medication management during the collaborative process with the surgeon, nurse practitioner and dietitians.  The RN also provides prompt responses to the patient’s health care issues.

After Surgery, the RN provides ongoing monitoring, diagnosis, and management of possible long-term, post-operative complications, including nutritional deficiencies.  The RN will also coordinate a patient’s involvement with a support group.

REGISTERED DIETICIAN (RD)
Prior to Surgery, the Registered Dietician meets with the patient for a nutrition assessment and to begin the process of completing the patient’s mandatory 5% weight loss.  Your surgery will not be scheduled if you do not reach the majority of this weight loss.

The RD also educates and evaluates the patient about the strict pre-and post-op dietary changes, including the required diet of blenderized food/liquids for the first four weeks after surgery.  After the patient is discharged, the RD will continue to focus on healthy eating habits, as foods are introduced throughout the patient’s life.

PSYCHOLOGIST
The patient will meet at least once with the clinical psychologist before surgery to undergo a screening for psychological issues, expectations, and the ability to conform to the strict post-op diet and exercise requirements.  The patient may also be required to undergo ongoing counseling to prepare for the emotional and psychological adjustments that often occur with rapid loss of a large amount of weight.