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an advancement on the standard bypass surgery. Whereas a traditional gastric bypass creates a lemon-sized pouch at the top of the stomach, the Micropouch operation forms a pouch that is even smaller and is limited to the cardia of the stomach. After Dr. Sapala reshapes the stomach, he divides the small intestine in two, with one end linked to the new pouch and one that meets with the distal small intestine. This complete separation ensures that the lower portion of the stomach is no longer involved in food digestion, thus significantly limiting the body's absorption of calories. According to Dr. Sapala, patients can't Mary Zotos, M.S., R.D., discusses protein intake with a bariatric patient. choices after surgery, while also helping them lose weight before surgery. "Our patients have to get away from eating high-density carbohydrates, such as heavy starches and refined sugars. They have to learn how to take the proper supplements. They have to learn how to shop on the walls of the grocery store, not the aisles, and stay away from processed and convenience foods," says Dr. Sapala. "They have to limit trans fats and learn how to eat real food. There's a host of things they have to do lifestyle-wise before surgery, and our program teaches each individual how to do these things." From the Operating Room … The Bariatric and Wellness Program offers open and laparoscopic Roux-en-Y gastric bypass surgery, laparoscopic gastric banding — the LAP-BAND procedure — and a patented gastric bypass surgery known as the Sapala-Wood Micropouch. The gastric banding surgery involves placing an adjustable, silicone band on the upper section of the stomach to form a limited pouch separated from the rest of the stomach. The upper pouch slows the process by which food is digested, as it has to pass through the narrow band opening to reach the larger portion of the stomach. This forces patients to limit meal portions and remain full for much longer than before surgery. Drs. Sapala and Anoosh are able to gradually inflate the band in the office throughout a patient's follow-up care. Gastric bypass surgery limits the amount a patient can eat at a time by not only forming a pouch able to contain less than 2 ounces of food, but also limiting the body's ability to absorb calories by rerouting the gastrointestinal tract to connect the small pouch with the small intestine. The Sapala-Wood Micropouch procedure was developed by Dr. Sapala; Dr. Sapala's father, M. Andrew Sapala, M.D.; and colleague Michael H. Wood, M.D., as tolerate sugar or overeat after undergoing the procedure. Studies of the technique have demonstrated that patients can maintain weights within 25% of their normal body weight after 10 years and very rarely require revision surgery. The Sapala-Wood Micropouch also offers relief from gastroesophageal reflux disease. The innovative surgery can be completed in 90 minutes through a midline incision in the abdomen. Patients typically remain at Brookhaven Memorial Hospital Medical Center for two days and return to work in two to three weeks. The Micropouch operation is the only U.S. patented gastric bypass procedure in America (patent number 20040045562A1). With the exception of the Sapala-Wood Catherine Ortiz, certified medical assistant, calculates the body mass index of a postop patient. MDNEWS.COM ■ MD NEWS Long Island | 9