MDNews - Long Island

A LESS INVASIVE METHOD As part of Dr. Vohra's proactive bariatric protocol, Jill Siegel M.S., CDN, discusses the importance of meal planning and healthy choices with a patient before her surgery. severely obese patients lose weight, comor- bidities often resolve or improve. Typically, he sees hypertension reduce within three to six months after surgery, while type 2 diabetes resolves much quicker, he says, around four to five weeks following surgical intervention. Between three and six months after surgery, many of Dr. Vohra's patients are off most medications for diabetes, hypertension and hypercholesterolemia. Outcome studies show increasing ben- efits of bariatric surgery for non-obese patients with metabolic disease, and because of these benefits, Dr. Vohra notes that metabolic and bariatric surgeries are beginning to coalesce. In the future, non- obese patients with type 2 diabetes may be offered the same benefits as obese patients. In the last year, two studies published in The New England Journal of Medicine showed that bariatric surgical procedures can better control glucose in patients with type 2 diabetes than conventional medical therapies. Authors of the single-center study "Bariatric Surgery vs. Conventional Medical Therapy for Type 2 Diabetes" report 75% diabetes remission rates in gastric bypass patients, compared to 0% remission rates in medical therapy patients at two-year follow up. Additionally, surgical groups showed enormous decreases in BMI — gastric bypass patients shrunk from an average 44.85 to 29.31, versus a change from 45.62 to 43.07 in the medical therapy group. In "Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes," researchers show that one year of medical therapy in conjunction with gas- tric bypass or sleeve gastrectomy resulted in better glycemic control and weight loss than medical therapy alone. Surgical patients lost, on average, 48 pounds more than the strictly medical group. As comorbidities resolve, patients discont inue medicat ions, result- ing in significant cost savings on medication alone. How to Replace the Weight Dr. Vohra has seen patients replace addiction to eating with other addictions and has constructed his team at South Nassau Communities Hospital with the right personnel to help curb this trend. Dr. Nishimura consults with a bariatric patient. RESULTING IN NO intestinal rerouting or cutting or stapling of the stomach, the LAP-BAND procedure is the least invasive procedure offered by the bariatrics program at South Nassau Communities Hospital. By placing an adjustable silicone band around the top portion of a patient's stomach — creating a pouch that holds a small amount of food — surgeons restrict the amount of food patients can consume. Patients reach satiety sooner because the band slows the rate at which food empties from the stomach. Unlike other weight-loss surgeries, physicians may adjust the amount of food intake by injecting fluid into a subdermal port or removing fluid from it, which results in a tightening or loosening of the band around the stomach. Although insurance coverage varies and weight loss can be less than other procedures, LAP-BAND surgery provides patients another minimally invasive option that carries a reduced risk of complications compared to more invasive procedures like gastric bypass. Because there are no intestinal bypass or rerouting, dumping syndrome and malabsorption are avoided. Unlike other procedures, gastric banding is not permanent, and the band may be removed at any time. The LAP-BAND has recently been approved by the FDA for patients with a BMI greater than 30 with associated comorbidities.

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