MDNews - Greater Boston

Tools for Success The three most common surgical weight- loss procedures are gastric bypass, sleeve gastrectomy and laparoscopic adjustable gastric banding. Laparoscopic gastric bypass, the gold standard of the procedures, reduces the size of the stomach and limits the amount of food patients can eat. The smaller stomach is connected directly to the small intestine, partially preventing absorption of calories and nutrients. Reducing food intake and caloric absorption, and bypassing the pancreas, leads to significant loss of excess weight. The procedure is so effective that bariatric surgeons use another procedure, sleeve gastrectomy, to help exceedingly obese patients begin losing weight so that surgeons can later perform gastric bypass. "Gastric bypass provides the most weight loss — at one year, patients have typically shed 70–72 percent of their excess weight," Dr. Pecquex says. "However, if a patient comes to us with a BMI of over 60, we commonly use sleeve gastrectomy as a staging tool to facilitate weight loss before performing gastric bypass as their final weight-loss procedure." Patients who need sleeve gastrectomy as a staging procedure typically enter Dr. Pecquex's care with multiple pre- existing comorbidities, as well as a number of undiagnosed comorbidities sometimes identified during patient histories and physical exams. After physicians gain a complete picture of a patient's health, a full preoperative health plan is constructed that might include evaluation or tests by cardiologists, interventional cardiologists, gastroenterologists, pulmonologists, endo- crinologists and radiologists. "Staging with sleeve gastrectomy allows us to follow patients for over one year as they lose weight," Dr. Pecquex says. "Patients typically lose enough to make it safer for them to undergo gastric bypass. After a year and a half, we're able to convert the sleeve gastrectomy into a gastric bypass, ultimately giving them enhanced weight- loss potential." Sleeve gastrectomy is effective on its own for patients who enter the care of Steward Centers for Weight Control with a BMI of less than 50. They typically lose 60–62 percent of their excess weight within one year. The minimally invasive, laparoscopic procedure consists of removal of about 75 percent of the stomach and requires only a few small incisions. Patients are able to return to work in three to four weeks. Laparoscopic adjustable gastric banding is the least invasive of the weight- loss surgeries offered by Steward Centers for Weight Control. The completely reversible procedure, for patients with a BMI of more than 40 (or more than 35 with at least one severe obesity-related condition), results in the loss of as much as 40–60 percent of excess weight two years following surgery. "This procedure is especially popular among younger patients because it is revers- ible," Dr. Glasgow says. "In addition, because we aren't rerouting the intestines, it provides even greater safety at the time of surgery." A Commitment Surgery is only one component of the process, however. Whereas patients can go from informational session to surgery in as little as 10 weeks, postsurgical care is a lifetime commitment. In the first year, follow-up appointments are scheduled at two weeks, six weeks, three months and six months, according to Dr. Pecquex. Thereafter, they occur annually. There are also twice-monthly support groups, as well as access to psycholo- gists, nutritionists, exercise counselors and social workers, and — at many centers — a yearly patient showcase or reunion is held to celebrate patient weight-loss successes. That extensive network of care makes local access all the more valuable. By eliminating the need for patients to travel to Boston for many appointments and for support, Steward Centers for Weight Control help ensure patients remain on a successful postoperative trajectory. "Steward cares about the patients in its network and wants to deliver the highest- quality bariatric care to every person who needs it," Dr. Pecquex says. "The goal is to deliver that care as close to home as possible." Visit www.Steward.org/Weight-Loss-Centers for more information about Steward Centers for Weight Control. ■ LOCATIONS FOR STEWARD CENTERS FOR WEIGHT CONTROL ST. ELIZABETH'S MEDICAL CENTER + 736 Cambridge St., Brighton, MA 02135 + Tel: 617-562-7474 + Weight Loss Surgery Center: Lap-Band, gastric bypass, sleeve gastrectomy + Anthony McCluney, MD, bariatric surgeon + Nicole Pecquex, MD, bariatric surgeon, Surgical Director NORWOOD HOSPITAL + 800 Washington St., Norwood, MA 02062 + Tel: 877-2WT-LOSS (298-5677) + Weight Loss Surgery Center: Lap-Band, sleeve gastrectomy + Adam Glasgow, MD, bariatric surgeon, Medical Director MORTON HOSPITAL + 88 Washington St., Taunton, MA 02780 + Tel: 508-823-1101 + Weight Loss Surgery Center: sleeve gastrectomy + Bruce Bodner, MD, bariatric surgeon GOOD SAMARITAN MEDICAL CENTER + 235 North Pearl St., Brockton, MA 02301 + Tel: 508-427-3990 + Weight Loss Clinic + Anthony McCluney, MD, Director HOLY FAMILY HOSPITAL + 70 East St., Methuen, MA 01844 + Tel: 978-687-0156, Ext. 2555 + Weight Loss Clinic + Nicole Pecquex, MD, Director M D N E W S . CO M ■ MD NEWS Greater Boston | 1 1

• Cover