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Bassett Healthcare's Weight Loss Surgery Program - A designated Center of Excellence

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As documented by both popular press and extensive scientific evidence, obesity has become a growing health problem in the United States. According to recent National Health and Nutrition Examination Survey (NHANES III) between one-third and one-half of US men and women aged 20 years and older are overweight and nearly a quarter are clinically obese. Obesity is defined as a Body Mass Index (BMI) of greater than 30. Obesity becomes clinically severe obesity at the point of being 100 lbs. or more above ideal body weight, or a BMI of 40 or greater. According to the National Institutes of Health Consensus Report (March 1991) clinically severe obesity is a serious disease and must be treated as such. Sustained weight loss for this group is hard to achieve.

Research confirms that clinically severe obesity is a complex, multifactorial chronic disease. The American Society for Bariatric Surgery in it's "Rationale for the Surgical Treatment of Morbid Obesity" (April 1998) indicated that weight loss surgery has demonstrated the longest period of sustained weight loss for patients in whom all other therapies have failed. In addition, the surgery has been found to lead to improvement of or better control of many obesity related health conditions. Most experts, in both medical and surgical fields, feel that the treatment of obesity should have a multidisciplinary approach. When surgery is the only option for long-term weight loss an integrated program that provides guidance on diet, physical activity and psychosocial concerns before and after surgery is necessary.

Obesity related health conditions

• Type 2 Diabetes - obesity may result in insulin resistance
• Certain cancers - uterine, breast, colorectal, kidney, and gallbladder
• High blood pressure - excess fat strains the ability of the heart to function
  properly
• Coronary Artery Disease (CAD)
• Stroke
• Sleep apnea/pulmonary hypertension - fat deposits in the tongue and neck can
  cause intermittent obstruction of the air passage while you sleep
• Back and joint problems - additional weight results in rapid wear and tear on
  joints; back muscles and bones are constantly strained
• Lower extremity venous and lymphatic obstruction
• Gallbladder disease
• Gastroesophageal reflux (heartburn) - stomach acids can escape into the
  esophagus through a weak or overloaded valve at the top of the stomach
• High blood cholesterol
• Menstrual Irregularities/Infertility
• Hirsutism (presence of excess body and facial hair)
• Stress incontinence
• Depression
• Functional limitations (bending, moving, lifting, walking, sleeping,
  hygiene)
• Body image/self esteem issues
• Increased surgical risk

Generally these conditions improve and often go away when significant weight loss is achieved.

What causes obesity?
The exact cause of obesity is unknown. We do know that too many calories eaten and not enough used will result in obesity. However, the disease is not just a problem of eating too much, exercising too little or a lack of will power. Research has shown that obesity involves many factors. These factors include:

• Genetics - sometimes entire families suffer from obesity
• Cultural - eating habits, food preferences
• Psychological - sometimes we eat for emotional reasons
• Endocrine/Metabolic - there are several glands in the body that regulate
  appetite and metabolism, they can affect the development and maintenance of obesity
• Neurotransmitter imbalance - area of our brain that functions as an appetite
  control center

Treatment Options
For initial management, conservative options like controlled calorie diets along with behavior therapy and exercise should be attempted. However, long term results with these strategies are disappointing. Studies have shown that only 5-10 percent of subjects who were successful in loosing a substantial amount of weight maintains the weight loss for more then a few years. Non-surgical weight loss programs combine diet, behavior modification and exercise. The National Institute of Health figures indicate that 90 percent of those successful with these programs regain their weight within a year.

Through a multidisciplinary collaborative approach, the goal of the Bariatric Team at Bassett Healthcare is to evaluate and prepare candidates for weight loss surgery in an effort to assist them in achieving long-term weight loss and improvement or resolution of their obesity related health problems.

Obesity surgery may be an option for you if:
BMI greater than or equal to 40. Click here for a BMI calculator.
BMI greater than or equal to 35 with at least one obesity related health condition.
Age greater than 18.
History of repeated failure of non-surgical attempts to control your weight.
Candidate must have realistic expectations, be motivated, and able to conform to the strict post- op dietary program.
Weight limit of 400 pounds. (We are seeing patients above this limit but will not consider surgery until they have dropped below 400 pounds.)

Surgical Options
This program offers both laparoscopic Roux-en-Y gastric bypass and Lap Band adjustable gastric banding procedures. We welcome you to explore these options with us if you are interested.

Laparoscopic Surgery
Also called minimally invasive surgery. Laparoscopic surgery has become an option to traditional open surgical procedures. Minimally invasive techniques have been applied to these procedures with excellent results. The advantages include less pain, shorter hospitalization, and quicker return to normal activities. The overall complication rate and results are similar for the two approaches. If you are an appropriate candidate, we will offer you a laparoscopic approach. This is a demanding surgical technique, and therefore we cannot guarantee that your surgery will be completed this way. Consequently, you will need to be prepared just as you would for the open procedure. During laparoscopic surgery a small camera is used. The camera and other surgical instruments are passed through several small incisions made in the abdomen. The camera allows the surgeon to see inside the abdomen via a television monitor as the surgery is being performed.

Roux-en-Y Gastric Bypass
According to the American Society for Bariatric Surgery and the National Institutes of Health, the Roux-en-Y gastric bypass is the "gold standard" procedure of weight loss operations. The Roux-en-Y gastric bypass is a combination restrictive and malabsorptive procedure. During this procedure a small pouch is formed (approximately 30-cc capacity) from the top of your stomach. The remainder of the stomach is stapled shut, but is not removed. It is completely divided from the new stomach pouch. A portion of the small intestine, called the duodenum, is then bypassed. One end is brought up and connected to the newly formed stomach pouch. The other end is connected into the small intestine lower down. The stomach remnant remains attached to the neighboring organs. The acid and fluid secretions from the bypassed stomach, combine with bile from the liver and pancreatic digestive enzymes secreted into the duodenum, rejoin the food stream at which time digestion and absorption occurs.

One year after the surgery the average weight loss is 50 - 80 percent of the excess body weight. Research studies have shown that after 10-14 years, 50 - 60 percent of the weight loss has been maintained and certain obesity related health problems were improved or resolved. There are risks involved, and as a result of the small bowel bypass poor absorption of iron, B12, and calcium can occur, which can result in anemia and metabolic bone disease. These can be managed with proper diet and vitamin/mineral supplements.

Stomach after gastric bypass procedure

Adjustable Gastric Banding
(Lap-Band)
Adjustable gastric banding is a restrictive procedure. The Lap Band system has an adjustable silicone band that is placed around the upper portion of the stomach to create a small pouch (approximately 30-cc capacity). There is no cutting or stapling involved, and your gastrointestinal tract remains intact. The band restricts the amount of food your new "pouch" can hold and the rate at which it empties. Your weight loss success will depend on how motivated you are and how committed you are to long-term life style and dietary modifications. The weight loss is slower after Lap Band surgery, but research is showing that the long-term results can be similar to those of patients undergoing gastric bypass procedure. Because there is no bypass, there is no risk of malabsorption. The band is adjustable and reversible.

  Illustration of Lap Banding

Collaborative Staff

Surgeons
Steven Heneghan, M.D.
James Longhi, M.D.
Wayne Weiss, M.D.

Medical Providers
Amy Freeth, M.D.
Robert McCann, F.N.P.

Dietitians
Leah Usher, R.D.

Physical Therapists
Sandi Preston, P.T.
Mike Quinn, P.T.
Lori Roseboom, P.T.

Psychologists
Patricia Gambitta, Ph.D.
Connie Jones, Ph.D.

Bariatric Clinical Coordinator
Christiane Porter, R.N.  For more information about our program, call 607-547-3373. 

Program Requirements

New patient orientation:
After returning your packet you will receive an invitation to orientation. Orientation is a mandatory class for all weight loss surgery candidates. You must attend an orientation prior to your first visit with our medical providers. You will hear more about the program criteria/requirements, learn more about the surgical options offered, and learn about the post op guidelines/lifestyle.

Medical screening (anticipate two to four visits per candidate):
Discussion, evaluation, and education with candidate by medical doctor or nurse practitioner.
History and physical examination done.
Consider endocrine, pulmonary, cardiac and other evaluations as appropriate i.e. labs, gallbladder ultrasound, desaturation study, etc.

A minimum 15-pound pre-operative weight loss:
Demonstrates ability to conform to dietary program.
Even a 15-pound weight loss will help the surgeon.
Prevents "last supper syndrome" or weight gain prior to surgery.

Support group attendance (attendance is free and the group is held on the first Tuesday evening of each month):
Attend three support group sessions pre-operatively and ongoing involvement post operatively.
Provides ongoing support, education, and answers to people who have had or will have obesity surgery.

Dietary evaluation and treatment (anticipate one to two visits pre-op and one to two visits post-op):
Initial visit to assess patient and begin weight loss program for the mandatory 15-pound weight loss. The goal is to educate and evaluate the patient's understanding of the strict post-op diet.

Physical therapy evaluation and treatment as needed:
Initial evaluation and assess patients' current activity tolerance and works with the patient to design a map that will lead them to incorporating 30 minutes of exercise into their day five to seven days per week.

Psychologist evaluations (anticipate one visit pre-op and follow up as needed):
Screen for alcohol or substance abuses, psychopathology, and evaluates the candidates' expectations and ability to conform to the strict postoperative diet.

Surgical evaluation and discussion (anticipate at least two visits pre-op and as needed post-op):
Candidate meets surgeon and is evaluated and educated for surgery.

Bariatric Board discussion:
Monthly meeting at which members of the team come together to discuss candidates. If team members are in agreement and the candidate has met pre-op requirements surgery will be scheduled.

Pre-op education class:
This is a mandatory class that all candidates must attended prior to surgery. We will review post- op guidelines, diet progression; potential complications and side effects of weight loss surgery and your hospital experience/role in recovery.

FACTSHEET "OFF-PUMP" HEART SURGERY

Robert Lancey, M.D., Chief of Cardiac Surgery; Co-Director Bassett Heart Care Institute To read more about Dr. Lancey click here.

What is "off-pump" heart surgery?

How does "off-pump" surgery work?

Is "off-pump" a new procedure? Is it less safe than the traditional surgery?

What are the benefits of "off-pump" surgery and who is a candidate for it?

FACTSHEET AMBULATORY, OR SAME DAY, SURGERY

Same day surgery at Herkimer

What services are offered in Herkimer?

What are the benefits of same day surgery?

Who would I expect to see if I made an appointment in Herkimer?

Same day surgery at Herkimer

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