MDNews - Long Island

COVER FEATURE "As physicians, we need to take a more proactive role in obesity. We need to treat it as a disease that is beyond patients' control. We need to get on board and help them like we help them eradicate other diseases, even if it's just talking with Dr. Vohra and a new bariatric patient discuss the available surgical options and the components of the multidisciplinary bariatric program. and successful surgical procedures he performs. Sleeve gastrectomy restricts food intake by removing approximately 75% of the stomach and refashioning the stomach's natural balloon shape into a long tubular or sleeve appearance. Part of the excised portion — the fundus at the top of the stomach — reduces the amount of the hunger hormone, ghrelin, resulting in decreased appetite and earlier satiety. This procedure avoids malabsorption and carries a lower associated risk of postoperative complications than other weight-loss surgeries. Dr. Vohra notes that in avoiding malabsorption, sleeve gastrec- tomy avoids common complications such as dumping syndrome and severe nutri- tional and micronutritional deficiencies. Sleeve gastrectomy is rapidly emerging as the potential new gold standard for bariatric surgery. It has a successful long-term outcome similar to the gas- tric bypass, while its safety profile and quicker recov- ery mimics the LAP-BAND. The team at S out h Na s sau C ommu n i t i e s Hospital's Center for Weight and Life Management provides attentive monitor- ing during hospitalization and educates 8 | Long Island MD NEWS s MDNEWS.COM recovering patients about postsurgical risks and symptoms of potential complications. Lifelong follow up is required for patients after any bariatric surgery. After the initial postoperative visit, patients meet Dr. Vohra and his team monthly for the first three months and every three months for the first two years. After the third year following the procedure, follow ups occur annually. The Old Gold Standard: Still Viable Since the 1960s, Roux-en-Y gastric An illustration of the sleeve gastrectomy procedure bypass surgery has been a staple of bariatric surgery, combining restrictive and malab- sorptive properties. Dr. Vohra performs the procedure laparoscopically, creating a small pouch in the stomach to restrict the amount of food consumed at one time and dividing it from the rest of the stomach. Dividing the small intestine just below the duodenum and connecting it to the stomach pouch allows the contents of the stomach pouch to empty into the lower part of the small intestine, bypass- ing the portion of intestine responsible for absorbing calories and nutrients. Although gastric bypass has a long them about their dietary habits and exercise. This is a conversation that needs to occur on a more regular basis. Otherwise, we will see rates of obesity — which are already at epidemic levels — continue to rise." — Rajeev Vohra, M.D., FACS, and Bariatric Surgery at South Nassau Communities Hospital Director of Minimally Invasive track record of success — the procedure typically results in an estimated weight loss of 70%–80% of a patient's excess body weight during the two years fol- lowing the procedure — according to Dr. Vohra, it carries significant side effects. Malabsorption techniques require careful nutritional monitoring to ensure no nutritional deficiencies occur. Although a matter of perspective, dumping syndrome is a constant concern if a patient eats too many sweets. Metabolic Overlap and Associated Cost Benefits Dr. Vohra typically observes drastic improvement in comorbid diseases in patients after bariatric procedures. As

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