Weight Loss (Bariatric) Surgery

The Mount Sinai Program for Weight Loss Surgery offers a minimally invasive surgical treatment for morbid obesity. We are one of the largest on the east coast, boasting a team of experts in the field including world-class surgeons and a multidisciplinary staff of physician assistants, nurses, nutritionists, psychiatric specialists, medical assistants, and support staff.

Are you a candidate for weight loss surgery?

Weight loss surgery is a very effective tool to help the body lose weight. However, surgery is not for everyone. This program uses the criteria recommended by the National Institutes of Health (NIH) as guidelines to determine who is a candidate for surgery.

1) Body Mass Index (BMI) above 40 or above 35 with comorbidity (click here for our on-line BMI Calculator)
2) Attempts to lose weight by other "sound" methods
3) The ability to understand the surgery and its risks
4) Obesity not caused by endocrine (gland) problems
5) Commitment to long-term follow-up

A healthy BMI is 19-24, with obesity beginning at a BMI of 30, morbid obesity at a BMI of 40, super morbid obesity at a BMI of 50, and super super morbid obesity at a BMI above 60. Health risks increase as BMI values rise above 25. Medical conditions related to obesity, also called comorbidities, which might make you a candidate for weight loss surgery include: diabetes, high blood pressure, joint problems, circulatory problems, heart disease, sleep apnea, polycystic ovary syndrome, urinary incontinence, and infertility.

See Your Primary Care Doctor

Before making an appointment to see a surgeon who specializes in weight loss surgery, you should discuss your weight loss options with your primary care doctor. If you do not have a primary doctor, we strongly recommend that you get one before beginning the process of undergoing surgery.

This doctor should also help to oversee your care both before and after you have surgery. They may suggest joining a weight loss program, consulting with a registered dietitian or nutritionist, or prescribing medication for you to help with weight loss.

Keep in mind that insurance companies often require detailed documentation of your prior attempts at losing weight. Please bring this information with you when you come to see the surgeon for the first time.

Your primary care doctor may suggest surgery as an option if these other weight loss methods have failed. The decision to undergo surgery should not be made lightly; it should be a "last resort" after other methods of weight control have proved to be unsuccessful.

You will have to undergo an evaluation with a psychiatrist or psychologist before you have surgery.

Types of Weight Loss Surgery

Weight loss surgery will help bring about weight loss in two different ways, with "restriction" and with "malabsorption". In a procedure that uses restriction, the size of the stomach is made smaller so that you can eat only a small amount of food at a time. In a procedure which uses malabsorption, a portion of the intestines are bypassed. In this way, food and digestive juices are only mixed together in a shorter part of the intestine. This allows for less of the vitamins, minerals, and/or calories from the food to be absorbed.

Three types of obesity surgeries are offered at The Mount Sinai Program for Weight Loss Surgery:

Roux-en-Y Gastric Bypass
Adjustable Gastric Banding
Biliopancreatic Diversion with Duodenal Switch

All of these procedures can be performed "laparoscopically". This means that small incisions, a small camera, and special instruments are used to view the inside of the abdomen on a TV monitor.

Benefits

The advantages of using this minimally invasive approach are less pain, quicker recovery, fewer post-operative complications (such as hernia and wound infection) and a better cosmetic result. In some cases these surgeries are performed in the traditional, open manner with an abdominal incision.

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Laparoscopic Roux-en-Y Gastric Bypass

The gastric bypass is a surgical weight loss procedure that was introduced by Dr. Ed Mason in 1967. This procedure has been modified to be performed laparoscopically. It is considered primarily a restrictive procedure, but it is widely believed that a small amount of malabsorption also occurs.

A surgical stapler is used to create a 30 cc (1 ounce) gastric pouch from the upper part of the stomach. A relatively short intestinal bypass, about 15o centimeters, is then performed and connected to the small pouch through a Y-shaped connection. As a result, you eat less food and somewhat less food is absorbed.

In some people this type of surgery can cause a syndrome called "dumping syndrome". Eating sweet foods or drinking sweet drinks can lead to a dizzy, sweaty, queasy feeling followed by diarrhea for those who are prone to this syndrome. Patients therefore will be less likely to eat sweets, which are high in calories and usually low in nutrition.

This surgery takes from 1 to 3 hours and most patients will be able to leave the hospital on the second or third day after surgery.

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Laparoscopic adjustable gastric banding

Laparoscopic banding (or Lap-Band â) is a procedure which uses restriction. A FDA-approved inflatable silicone rubber band is placed around the top portion of the stomach to create a small pouch just below the esophagus (or food pipe). It is stitched into place to help prevent it from moving.

Only a small amount of food can be eaten before the pouch is full. The food then passes through the small opening created by the band and is digested normally. The band has an adjustable "balloon" that is filled by injecting fluid into a port placed under the skin. Injecting this fluid into the port will decrease the size of the opening. Extracting fluid from the port will increase the opening.

About one month after the band is placed, most people will have to come back to the hospital for their first band adjustment. The number of adjustments needed varies from person to person, but most need between 3 and 5 before the band is at the ideal tightness.

Having a laparoscopic adjustable gastric band placed takes about 1 to 2 hours and you will usually go home from the hospital on the first or second day after surgery.

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Laparoscopic Biliopancreatic Diversion with Duodenal Switch

The biliopancreatic diversion is a weight loss surgery introduced by Dr. Nicola Scopinaro in 1976. This operation has been modified to be performed laparoscopically and to include a duodenal switch.

This is primarily a malabsorptive procedure, but also uses some restriction. The larger curved area of the stomach is removed, creating a "sleeve-like" or banana-shaped stomach. The normal opening in the stomach through which food usually exits (called the pylorus) is retained. Most of the small intestine is then bypassed and reconnected to the stomach leaving a very short length of intestine in which food and digestive juices are mixed. This last part of the small intestine where food and digestive juices mix is called that common channel. It is about 100 centimeters (about 3 feet) long. As a result, much less food is absorbed and somewhat less food can be eaten.

This surgery takes between 2 and 4 hours. Most patients will be able to go home from the hospital on the third or fourth day after surgery.

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