Bariatric Surgical Care at Highland Hospital The Bariatric Surgery Center at Highland Hospital is committed to providing comprehensive, high-quality care for your patients who are struggling with obesity. Earn CME Credit on Your Own Time. The Bariatric Surgery Department presents Perioperative Care of the Bariatric Patient Led by the region’s most experienced bariatric care team, we’re able to offer the insights you need to make an informed decision about whether or not bariatric surgery is right for your patient. Please review the information below for answers to your questions and concerns. Or feel free to contact our office at 585-341-0366 for further discussion. Why Bariatric Surgery? A Proven Approach Obesity can wreak havoc on patients’ bodies, their personal relationships, and their mental well-being. Many patients struggle to improve their condition with standard weight-loss protocols like diet and exercise, but only have marginal success. At Highland Hospital, we strongly recommends bariatric surgery for patients with a BMI of 40+, or 35+ with the presence of comorbid conditions. Bariatric surgery – especially as part of a comprehensive weight-loss program like the one offered at Highland Hospital – has been proven to help patients lose 50-75% of their excess body weight in as little as one year after having surgery. Improved Methods The Bariatric Surgery Center at Highland Hospital uses state-of-the-art techniques and treatments including: Laparoscopic surgery. All bariatric surgeries are performed laparoscopically by one of our experienced bariatric surgeons to reduce the risk of post-surgical complications. Best-practice guidelines. We follow best-practice guidelines that have been developed based on thousands of procedures across the nation. This ensures both safety and effectiveness. Extensive pre-operative preparation. All patients are required to meet with a dietician and other specialists in the months leading up to surgery to ensure they are ready for the life changes following bariatric surgery. Extensive post-operative follow up. We provide extensive follow up to ensure both adherence to post-operative meal plans and surgical complication risk reduction. Benefits and Risks The benefits of bariatric surgery go beyond simple weight loss. For example, approximately 80% of patients with type II diabetes are cured of this condition and can stop taking insulin and other diabetic medications following their surgery. Bariatric surgery either improves or solves a plethora of comorbid conditions: Migraines Depression Obstructive Sleep Apnea Type II Diabetes Atherogenic Dyslipidemia Hypertension Pseudotumor Cerebri Fatty Liver Cardiovascular Disease Stress Urinary Incontinence Degenerative Joint Disease Venous Stasis Disease Gout GERD Polycystic Ovarian Syndrome Following surgery, patients require fewer medications, report more energy and higher self-esteem, and better quality of life. Their 5-year mortality also drops 89%. Meanwhile the risks and side effects associated with bariatric surgery are minimal. And the benefits far outweigh them. Some of the minor risks associated with bariatric surgery include the following: Bleeding Typical blood loss is less than 2 Tbsp <1% of patients require a blood transfusion Blood Clots Affect <2% of patients Prophylactic measures reduce the risk of blood clots Infections Minor wound infections affect <2% of patients Peritonitis affects <0.1% of patients Side effects of surgery can include hernias, bowel obstruction, nausea, and occasional malnutrition. Roughly 10-20% of patients also experience some form of weight regain. Why Highland Hospital? Our Accreditation Highland Hospital is nationally accredited, meeting the highest standards of excellence. The rating as a Comprehensive Bariatric Center was granted by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). This group was formed when the American College of Surgeons (ACS) and the American Society for Metabolic and the Bariatric Surgery (ASMBS) combined their respective national bariatric surgery accreditation programs into a single unified program to achieve one national accreditation standard for bariatric surgery centers. Our Specialized Facilities Highland Hospital opened the region’s first bariatric surgery center in 2006. This specialized facility allows us to thoughtfully accommodate the size of our patients – instead of making them use furniture and equipment designed for lower-weight individuals. Our state of the art, multimillion-dollar outpatient facility includes: Exam tables the size of twin beds 2.5’ x 4.5’ x 2” scale – digitally accurate to 1200lbs High-capacity, state-of-the-art CT scanners Specialized operating rooms Extra large chairs throughout our facility – and the rest of the hospital Stretchers, wheelchairs, doors, and rest rooms that have been designed to accommodate obese patients In addition to our Bariatric Surgery Center, the entirety of Highland Hospital has been redesigned and retrofitted to accommodate obese patients. From new operating rooms to the hospital floors – Highland is utterly dedicated to giving bariatric patients the best experience possible. Our Years of Experience Bariatric surgery at Highland Hospital is not a part-time pursuit. We have been performing bariatric surgery since 1995. Our three bariatric surgeons perform, on average, 630 operations annually. Each of our bariatric surgeons has been recognized as among the best in New York State. Your patient is guaranteed an experienced and dedicated bariatric surgeon and care team. Highland Hospital is a state leader in revisional bariatric surgery. When patients have issues following a procedure performed at other facilities, their doctors often refer them to Highland. Highland Hospital has garnered recognition by the Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program for excellence. Our Team Approach to Bariatrics Our facility employs a complete bariatrics team, including: Three full-time surgeons Three full-time dieticians A nurse practitioner Two physician assistants A call center Unlike other hospitals, a team – not just a surgeon – makes the decisions regarding your patient’s care plan. And we will work with your patient to ensure the best possible outcome. Patient preparation is a huge part of bariatric surgery at Highland Hospital because it is pivotal to long-term weight loss. Surgery does not change lifelong habits like compulsive or emotional eating. While other programs are relatively in-and-out, we work closely with patients to: Help change unhealthy eating habits. Provide education on the benefits of a proper diet. Prepare them for the lifestyle changes that come with bariatric surgery. Also, to ensure the best possible outcomes, only patients who are ready to commit and take full advantage of their surgery are permitted to undergo surgery. This helps ensure the greatest likelihood of success. Following surgery, patients meet with their care team five times in the first year, then once annually to review their progress and assess further options. We are fully committed to giving patients all they need to succeed for the rest of their lives. Our Strong Relationships with Referring Physicians We are committed to working with primary care providers to create a support network for post-operative bariatric patients. In the months and years following their procedure, patients can face physical and mental challenges: Discomfort Potential malnutrition Discouragement Weight regain We are committed to addressing these challenges before they become serious issues by maintaining open communication with primary care providers. Procedures The majority of procedures performed at Highland Hospital are Gastric Sleeve and bypass procedures. We do perform a minimal amount of gastric band procedures, but this procedure has become less popular with patients and their physicians in recent years. Roux-En-Y Gastric Bypass The Roux-en-Y Gastric Bypass is the gold standard in bariatric surgery. None of the stomach or intestine is removed. Instead, the surgeon creates a smaller stomach pouch and attaches a Y-shaped section of the small intestine directly to the pouch. Both restrictive and mal-absorptive, this procedure results in the highest amount of weight loss – up to 75% of a patient’s excess weight. Duodenal Switch The Duodenal Switch is a variation of the gastric bypass that removes a portion of the stomach to create a sleeve-shaped pouch. This pouch is then connected to the lower portion of the small intestine. Since a much larger portion of the small intestine is bypassed in this procedure, it results in a very high percentage of weight loss – typically 60-70% or higher. This procedure is more extreme than the others – and will require further commitment on the part of your patient to avoid malnutrition. Gastric Sleeve Initially intended to help patients with a BMI of 50+ down to a safe weight for a bypass procedure, the Gastric Sleeve has since been applied to regular bariatric patients with a BMI of 40+. This procedure takes a more moderate approach. It removes 75% of the stomach to restrict food intake, but does not reconfigure the intestine to affect absorption. For these reasons, this procedure has gained popularity among patients in the past four years. Gastric Sleeve surgery results in a loss of up to 50% of a patient’s excess weight. Gastric Band The Gastric Band is the least invasive surgery of the four. None of the stomach is removed and there is no intestinal bypass. Instead, the surgeon places a small silicone band around the patient’s upper stomach. This band can then be filled with water to make the entrance to the stomach smaller and create a tiny pouch. The Gastric Band procedure has seen a decline in popularity recently – mainly due to patients’ discomfort with the permanent implant. It is restrictive, like the sleeve, but more costly – in terms of both time and money – due to band fill appointments and maintenance.