Issue link: http://viewer.e-digitaledition.com/i/643923
MORBID OBE SIT Y HA S reached epidemic proportions in the United States. A staggering 68 percent of adults over the age of 20 are overweight (with a Body Mass Index [BMI] of 25–29.9), and more than 35 percent are obese (BMI of 30 or higher), according to an ongoing CDC-supported study. A number of serious health problems are linked to obesity including heart disease, type 2 diabetes, high blood pressure, high cholesterol and sleep apnea. "Weight-loss surgery is more eŸective for patients with obesity than the typical regimen of diet, exercise and pharmacologic therapies in improving, and sometimes even resolving these conditions," says Aviv Ben-Meir, MD, Director and founder of Lake Health Bariatric Surgery Center. Dr. Ben-Meir has been performing bariatric surgery in north- eastern Ohio longer than any other local surgeon. Since 2002, he has performed more than 4,000 weight-loss operations. He is board-certified in general surgery and fellowship-trained in advanced laparoscopy and bariatric surgery. BARIATRIC SURGERY COMBINED WITH DIAPHRAGMATIC HERNIA REPAIR As many as 80 percent of patients who qualify for bariatric sur- gery have hiatal hernias. A subset of these patients will develop conditions such as Barrett's esophagus or paraesophageal hernias. These conditions pose treatment challenges if weight reduction is not part of the treatment plan because one of the underlying causes, namely, high intra-abdominal pressure, is not addressed. For this reason, obese patients referred for treatment of Barrett's esophagus or paraesophageal hernia should consider bariatric surgery. The weight loss associated with bariatric surgery will decrease intra-abdominal pressure and reduce recurrence of these hernias. As Dr. Ben-Meir explains, "The concern with repairing hiatal hernias for gastroesophageal ref lux symptoms and paraesophageal hernias in patients with morbid obesity is the higher recurrence rates secondary to the higher intra-abdominal pressures in these patients. Patients who have weight-loss surgery at the time of paraesophageal hernia repair will likely have decreased recurrence rates." According to Dr. Ben-Meir, studies have shown that patients who undergo bariatric surgery at the time of treatment for Barrett's esophagus are more likely to show improvement or remission in their Barrett's on follow-up surveillance endoscopies. At the 2010 annual meeting of the American Society for Metabolic and Bariatric Surgery, Dr. Ben-Meir presented his results of performing Roux-en-Y gastric bypass in patients that were morbidly obese with a biopsy-proven diagnosis of Barrett's esophagus. A retrospective study indicated that 50 percent of patients identified with Barrett's esophagus prior to Roux-en-Y gastric bypass had no evidence of Barrett's on surveillance endoscopy performed less than 12 months after surgery. An additional 25 percent of patients had visual regression of disease. This finding has been supported by several other smaller studies.* Roux-en-Y gastric bypass is the preferred operation to combine with paraesophageal hernia repair or with hiatal hernia repair in 1 8❱❱❱❱❱ H O S P I TA L S P O T L I G H T PHOTO © JOE SMITHBERGER, SMITHBERGER PHOTOGRAPHY, NORTH CANTON, COURTESY OF LAKE HEALTH Bariatric surgeon Aviv Ben-Meir, MD, is shown here (front row, second from the left) with several members of his Lake Health Bariatric Surgery Center team. In the front row (L-R) are Heather Adams, RNFA; Dr. Ben-Meir; John A. Talerico, CSA; and Kim Cole, RN. In the back row (L-R) are Beth Cadiou, RN; Jen Lauderback, CST; Courtney Clarke, CST; and Mark Farmer, MD. Bariatric Surgery at Lake Health * Sarr, et. al., SOARD, 2008; Csendes, et.al., J. Gastrointestinal Surgery, 2006; Braghetto, et. al., Obesity Surgery, 2012 1 8