A bariatric surgeon answers questions about common procedures and their safety and effectiveness.
Nearly half of all Americans are obese and are at increased risk of heart disease, stroke, type 2 diabetes and 13 types of cancers, including brain, breast and colorectal, according to the Centers for Disease Control and Prevention. In 2017, 228,000 people had bariatric surgery to slim down, according to the American Society for Metabolic and Bariatric Surgery. David Ward, MD, a bariatric surgeon at Robert Wood Johnson University Hospital (RWJUH) Somerset, explains the procedures he performs and the results patients can expect.
Which bariatric procedures do you perform most frequently?
Two procedures are at the top of the list: sleeve gastrectomy and gastric bypass. Most often, I perform sleeve gastrectomy, in which about 80 percent of the stomach is removed. The remaining section is shaped liked a banana. This surgery helps patients feel full after eating small amounts of food and causes gut hormone levels to drop so they’re not as hungry. With gastric bypass, the stomach is divided into two sections. The top part becomes a small pouch the size of a walnut—limiting the amount of food that can be eaten—and is connected to the middle of the small intestine. The remaining parts of the stomach and intestinal tract don’t absorb food. Like the sleeve gastrectomy, gastric bypass leads to hormonal changes that reduce appetite.
Who are the best candidates for bariatric surgery?
Adults with a body mass index (BMI, a weight-height ratio) of 40 or greater and those with a BMI of 35 to 39 who have a health condition such as diabetes, sleep apnea, hypertension or severe joint disease are good candidates. The type of surgery we recommend depends on a patient’s health. Sleeve gastrectomy is generally advised as long as a patient doesn’t have severe acid reflux or esophagitis (inflammation of the esophagus). We steer those patients—as well as those with poorly controlled diabetes—toward gastric bypass. Smokers require a sleeve gastrectomy because they’re at higher risk for ulcers.
How safe is bariatric surgery?
Sleeve gastrectomy and gastric bypass, which require only a few tiny incisions, carry a 1 in 10,000 chance of death, similar to gallbladder surgery. The risk of experiencing other complications, such as bleeding, bowel obstruction or intestinal leakage, is also low. Patients stay overnight in the hospital so we can monitor them.
What results can patients generally expect?
They can lose 8 percent to 10 percent of their body weight in the first month after surgery. The majority of weight loss usually occurs in the first nine months. Many patients also experience significant health improvements, such as being able to stop taking medications for high blood pressure. Type 2 diabetes and sleep apnea may resolve. Our nutritionists and psychologists can help patients maintain their weight loss.
For more information on bariatric surgery at RWJUH Somerset, visit www.rwjbh.org/weightloss.