Weight loss surgery is an option for people who are severely obese and cannot lose weight with diet and exercise alone.
People seeking weight loss surgery may suffer from serious obesity-related health problems such as diabetes, high blood pressure, joint pain, and problems with sleep.
There are three main types of weight loss surgery: Restrictive, Malabsorptive and a Combination of both.
Mark Salcone, D.O. is here to answer questions about Lourdes Medical bariatric/weight loss surgery and the choices available to you.
Necessary Weight Loss? Try Bariatric Surgery
From the Show: Lourdes Health Talk
Summary:
Air Date: 2/1/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Experience is critical when considering any type of surgery. That’s why it’s so important to know that Lourdes Health System is one of the largest providers of bariatric surgery in Southern New Jersey. My guest today is Dr. Mark Salcone. He is a bariatric surgeon with Lourdes Health System. Welcome to the show, Dr. Salcone. Tell us a little bit about bariatric surgery. What is it? What are the different types and who is it for?
Dr. Mark Salcone (Guest): Bariatric surgery has proven to be the most effective treatment for patients who are morbidly obese. Who bariatric surgery is for are patients who have – what we look at is the BMI, the body mass index. When a patient has a BMI of over 35 to 39.9, they are considered a candidate for bariatric surgery when they have at least one medical problem that is associated with being overweight. A list of the common things that are associated with being overweight are high blood pressure, diabetes, sleep apnea, high cholesterol. These patients, if you looked at them, they are roughly about 75 pounds overweight or more and they are considered candidates. When a patient has a BMI of over 40, they are considered to be candidates for weight loss surgery just based upon their weight alone, whether they have medical problems that are associated with being overweight or not. If we had to look at these patients on average, they are patients who generally are about 100 pounds overweight or more. The different types of bariatric surgery that we offer are we offer the lap band, the sleeve gastrectomy, and the gastric bypass operation. All of these operations are done laparoscopically. Really, nowadays, open surgery is obsolete. We have patients with excellent results in patients even who are super morbidly obese and even up to 600 pounds.
Melanie: Dr. Salcone, people have heard the words “gastric bypass” for years and, as you say, these are now becoming much more minimally invasive. What are some of the advantages and/or disadvantages to the different types? Why would someone choose one over the other or do you help them discover which one they are going to choose?
Dr. Salcone: Certainly, I talk to all of the patients about the different options. The way that things have gone both in the United States and worldwide is that the band operation has very much fallen out of favor. If we look at the percentage of the bands that are going in in the United States, in the last year or couple of years, these have dropped off to a great degree. I can tell you that in my practice that I put in very, very few lap bands in the last three years or so and we’re certainly taking a lot more bands out these days. What the Europeans have discovered - who are a little bit further ahead of us in their experience with these things - is that about 50% of them need to be removed at some point. And then, the weight loss has been quite inconsistent with only about 1/3 of patients achieving a weight loss that we consider in weight loss surgery to be acceptable. If someone is going to have surgery for weight loss, we would expect them to lose at least 50% and in my practice I expect people to lose between 50 and 70 percent of their excess weight in one year. So, 50-70% of the amount of weight that they are overweight in one year. Only about 1/3 of people, in reality, achieve that with a band. When I look at that, most people I steer in the direction of considering either a sleeve gastrectomy or a gastric bypass operation. The advantage of both of these operations is that the weight loss has been very, very consistent and the vast majority of patients will lose between 50 and most of them closer to 70% of the amount of weight that they are overweight in a year. Really, the sleeve gastrectomy has become the operation of choice in the United States and I would say, in my practice about 70-75% of the operations that I do are sleeve gastrectomy. The advantage of the operation is that it is simpler to understand than a gastric bypass and it’s much more elegant. What we do with do with this operation is we remove about 70% of the amount of the stomach and we leave the patient with a long banana-shaped tube. The advantage of it is to remove the part of the stomach that really functions as a reservoir and it works primarily the same way that the band operation was supposed to work. It works through restriction. You get restriction in this tube that we create – this long banana-shaped tube. There are nerves that live at the top of the stomach and they are easily challenged and they go up to your brain and fool your brain into believing that you are full. The weight loss has been very consistent. The other big advantage of this operation is that we don’t cut and reroute the intestines. So, you have this small tube rather than the old gastric bypass operation where we had two new connections to heal. I think that the disadvantages of this operation, if any exist, one of them is that sometimes it makes reflux worse. I see that actually quite infrequently and in the vast majority of patients that I operate on even in the people who have had pretty significant reflux, their reflux seems to get better, not worse. The other big advantage of it is that while we retain a normal outlet of the stomach, the pylorus, and people don’t get what’s called the “dumping syndrome” to anywhere near the significance of what they can get with the gastric bypass operation. Just to go and talk about the bypass, I probably still do about maybe 10-15% of the operations that I do for weight loss are for bypass where people still opt to have bypass operations. The weight loss with this has been very, very consistent. We know everything about it. It is a tried and true operation. It’s been around for 25 years. We have data going back for 15 years, so we know that the operation is quite durable in the long term and that the vast majority – 80% of patients--will keep the weight loss or a significant portion of that weight loss off in the long term.
Melanie: What a great description. You describe it so well and so understandably. Dr. Salcone, what do you tell patients before they make the decision? Is there something they have to do? Do you encourage them to get counseling before? Are there things that they have to do--the perimeters under which you will do the surgery for them only after they’ve done these things?
Dr. Salcone: When I counsel patients in the office, I tell them, “Look, three things have to happen to have weight loss surgery.” The first thing is that we have to fulfill insurance requirements. That is just the reality. The next thing is that I have to feel comfortable that I am offering the safest operation that I can possibly offer them. Then, the third thing is that they have to feel comfortable that all of their questions have been answered and that they are ready to go forward and have the operation. All insurance companies require a psych evaluation. I also tell them that this is valuable to be able to talk to somebody who is a communicator. Of course, with weight loss there always is a psychological component and communication is important. When you talk to people that are professional communicators, I think that can be a very valuable thing. Other than that, we have an educational component to our program where I have patients meet with our dietician at least twice prior to being scheduled for surgery. We have true multi-disciplinary team approach where when we schedule patients for surgery, they meet with our coordinator again and our dietician. They have them prepare for surgery and, of course, in addition to that, we do check some lab work on the patients to make sure they don’t have any nutritional deficiencies or vitamin deficiencies. Then, I look at the patients on a case by case basis and try to determine their needs to see any other specialists. As I said, the patient has to trust me that I’m really trying to do my best to make sure that I am offering them the safest operation that I can possibly offer them. I do get upper GI studies on my patients to just look at their anatomy where they can just drink a bit of contrast material and we can get some X-rays and just take a look at their esophagus and their stomach and just to ensure that their anatomy is intact and to see if I need to talk about anything else with the patient prior to surgery. Other than that, as I said, I meet the patient in the office and make sure that they feel comfortable. I answer all of their questions and then, when everything is in align, we submit everything to the insurance company and we schedule surgery.
Melanie: We don’t have a lot of time, Dr. Salcone, but it’s such a great topic with so much information. I’d really like to have you on again. Tell us a little bit about what happens after the surgery. What do you want your patients to learn after this surgery?
Dr. Salcone: My personal philosophy with weight loss surgery is that these operations, what they really allow people to do is reclaim their own lives. What I always try to reinforce to my patients is that when you have a good year when the first 6-8 months, you can really lose weight rapidly and then maybe to round out the year and a couple months, you can get some really steady weight loss. In that period of time, what I constantly reinforce to my patients and with the frequent follow up that we have in the office – and, theoretically, with bariatric surgery, this is a lifetime follow up, a life time relationship – is that you have to really establish the habits that are going to keep you successful for the rest of your life and for years to come after weight loss surgery. I just think it’s heartbreaking when you see patients do so well, they go through having surgery and then, they either fall off or they fall back into old habits and they are not successful in the long term. What I really want them to learn is to have a good protein based diet and have a very good whole foods, heart healthy diet and to be able to increase their exercise capacity. When the operation is really working as a very powerful tool to allow you to be able to do that. Then, when you get down to a new baseline body weight at a year and a few months after surgery, you are really ready to keep things going in a positive direction for a long time to come. That’s why I think that follow up is really important. What I also encourage our patients to do is participate in our support group because you have other patients that have gone along the same journey and can then provide each other support in the long term.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Salcone: I think that at Lourdes, we really do have a multi-disciplinary team approach. I think we prepare our patients very, very well for the journey. I can say for my own part, that I know that I offer people as good or a better operation than other people out there. I feel very, very confident. Our outcomes are tremendous. I think for all of those reasons Lourdes Health System is the best choice in bariatric surgery in the area.
Melanie: Thank you so much, Dr. Salcone. It really is great information. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Experience is critical when considering any type of surgery. That’s why it’s so important to know that Lourdes Health System is one of the largest providers of bariatric surgery in Southern New Jersey. My guest today is Dr. Mark Salcone. He is a bariatric surgeon with Lourdes Health System. Welcome to the show, Dr. Salcone. Tell us a little bit about bariatric surgery. What is it? What are the different types and who is it for?
Dr. Mark Salcone (Guest): Bariatric surgery has proven to be the most effective treatment for patients who are morbidly obese. Who bariatric surgery is for are patients who have – what we look at is the BMI, the body mass index. When a patient has a BMI of over 35 to 39.9, they are considered a candidate for bariatric surgery when they have at least one medical problem that is associated with being overweight. A list of the common things that are associated with being overweight are high blood pressure, diabetes, sleep apnea, high cholesterol. These patients, if you looked at them, they are roughly about 75 pounds overweight or more and they are considered candidates. When a patient has a BMI of over 40, they are considered to be candidates for weight loss surgery just based upon their weight alone, whether they have medical problems that are associated with being overweight or not. If we had to look at these patients on average, they are patients who generally are about 100 pounds overweight or more. The different types of bariatric surgery that we offer are we offer the lap band, the sleeve gastrectomy, and the gastric bypass operation. All of these operations are done laparoscopically. Really, nowadays, open surgery is obsolete. We have patients with excellent results in patients even who are super morbidly obese and even up to 600 pounds.
Melanie: Dr. Salcone, people have heard the words “gastric bypass” for years and, as you say, these are now becoming much more minimally invasive. What are some of the advantages and/or disadvantages to the different types? Why would someone choose one over the other or do you help them discover which one they are going to choose?
Dr. Salcone: Certainly, I talk to all of the patients about the different options. The way that things have gone both in the United States and worldwide is that the band operation has very much fallen out of favor. If we look at the percentage of the bands that are going in in the United States, in the last year or couple of years, these have dropped off to a great degree. I can tell you that in my practice that I put in very, very few lap bands in the last three years or so and we’re certainly taking a lot more bands out these days. What the Europeans have discovered - who are a little bit further ahead of us in their experience with these things - is that about 50% of them need to be removed at some point. And then, the weight loss has been quite inconsistent with only about 1/3 of patients achieving a weight loss that we consider in weight loss surgery to be acceptable. If someone is going to have surgery for weight loss, we would expect them to lose at least 50% and in my practice I expect people to lose between 50 and 70 percent of their excess weight in one year. So, 50-70% of the amount of weight that they are overweight in one year. Only about 1/3 of people, in reality, achieve that with a band. When I look at that, most people I steer in the direction of considering either a sleeve gastrectomy or a gastric bypass operation. The advantage of both of these operations is that the weight loss has been very, very consistent and the vast majority of patients will lose between 50 and most of them closer to 70% of the amount of weight that they are overweight in a year. Really, the sleeve gastrectomy has become the operation of choice in the United States and I would say, in my practice about 70-75% of the operations that I do are sleeve gastrectomy. The advantage of the operation is that it is simpler to understand than a gastric bypass and it’s much more elegant. What we do with do with this operation is we remove about 70% of the amount of the stomach and we leave the patient with a long banana-shaped tube. The advantage of it is to remove the part of the stomach that really functions as a reservoir and it works primarily the same way that the band operation was supposed to work. It works through restriction. You get restriction in this tube that we create – this long banana-shaped tube. There are nerves that live at the top of the stomach and they are easily challenged and they go up to your brain and fool your brain into believing that you are full. The weight loss has been very consistent. The other big advantage of this operation is that we don’t cut and reroute the intestines. So, you have this small tube rather than the old gastric bypass operation where we had two new connections to heal. I think that the disadvantages of this operation, if any exist, one of them is that sometimes it makes reflux worse. I see that actually quite infrequently and in the vast majority of patients that I operate on even in the people who have had pretty significant reflux, their reflux seems to get better, not worse. The other big advantage of it is that while we retain a normal outlet of the stomach, the pylorus, and people don’t get what’s called the “dumping syndrome” to anywhere near the significance of what they can get with the gastric bypass operation. Just to go and talk about the bypass, I probably still do about maybe 10-15% of the operations that I do for weight loss are for bypass where people still opt to have bypass operations. The weight loss with this has been very, very consistent. We know everything about it. It is a tried and true operation. It’s been around for 25 years. We have data going back for 15 years, so we know that the operation is quite durable in the long term and that the vast majority – 80% of patients--will keep the weight loss or a significant portion of that weight loss off in the long term.
Melanie: What a great description. You describe it so well and so understandably. Dr. Salcone, what do you tell patients before they make the decision? Is there something they have to do? Do you encourage them to get counseling before? Are there things that they have to do--the perimeters under which you will do the surgery for them only after they’ve done these things?
Dr. Salcone: When I counsel patients in the office, I tell them, “Look, three things have to happen to have weight loss surgery.” The first thing is that we have to fulfill insurance requirements. That is just the reality. The next thing is that I have to feel comfortable that I am offering the safest operation that I can possibly offer them. Then, the third thing is that they have to feel comfortable that all of their questions have been answered and that they are ready to go forward and have the operation. All insurance companies require a psych evaluation. I also tell them that this is valuable to be able to talk to somebody who is a communicator. Of course, with weight loss there always is a psychological component and communication is important. When you talk to people that are professional communicators, I think that can be a very valuable thing. Other than that, we have an educational component to our program where I have patients meet with our dietician at least twice prior to being scheduled for surgery. We have true multi-disciplinary team approach where when we schedule patients for surgery, they meet with our coordinator again and our dietician. They have them prepare for surgery and, of course, in addition to that, we do check some lab work on the patients to make sure they don’t have any nutritional deficiencies or vitamin deficiencies. Then, I look at the patients on a case by case basis and try to determine their needs to see any other specialists. As I said, the patient has to trust me that I’m really trying to do my best to make sure that I am offering them the safest operation that I can possibly offer them. I do get upper GI studies on my patients to just look at their anatomy where they can just drink a bit of contrast material and we can get some X-rays and just take a look at their esophagus and their stomach and just to ensure that their anatomy is intact and to see if I need to talk about anything else with the patient prior to surgery. Other than that, as I said, I meet the patient in the office and make sure that they feel comfortable. I answer all of their questions and then, when everything is in align, we submit everything to the insurance company and we schedule surgery.
Melanie: We don’t have a lot of time, Dr. Salcone, but it’s such a great topic with so much information. I’d really like to have you on again. Tell us a little bit about what happens after the surgery. What do you want your patients to learn after this surgery?
Dr. Salcone: My personal philosophy with weight loss surgery is that these operations, what they really allow people to do is reclaim their own lives. What I always try to reinforce to my patients is that when you have a good year when the first 6-8 months, you can really lose weight rapidly and then maybe to round out the year and a couple months, you can get some really steady weight loss. In that period of time, what I constantly reinforce to my patients and with the frequent follow up that we have in the office – and, theoretically, with bariatric surgery, this is a lifetime follow up, a life time relationship – is that you have to really establish the habits that are going to keep you successful for the rest of your life and for years to come after weight loss surgery. I just think it’s heartbreaking when you see patients do so well, they go through having surgery and then, they either fall off or they fall back into old habits and they are not successful in the long term. What I really want them to learn is to have a good protein based diet and have a very good whole foods, heart healthy diet and to be able to increase their exercise capacity. When the operation is really working as a very powerful tool to allow you to be able to do that. Then, when you get down to a new baseline body weight at a year and a few months after surgery, you are really ready to keep things going in a positive direction for a long time to come. That’s why I think that follow up is really important. What I also encourage our patients to do is participate in our support group because you have other patients that have gone along the same journey and can then provide each other support in the long term.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Salcone: I think that at Lourdes, we really do have a multi-disciplinary team approach. I think we prepare our patients very, very well for the journey. I can say for my own part, that I know that I offer people as good or a better operation than other people out there. I feel very, very confident. Our outcomes are tremendous. I think for all of those reasons Lourdes Health System is the best choice in bariatric surgery in the area.
Melanie: Thank you so much, Dr. Salcone. It really is great information. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
