MDNews - Long Island

Dr. Atwa also stresses the importance of attending monthly support groups. "We recommend that people attend the support group for the rest of their life," he says. "We have found that people who attend regularly lose more weight and have a better chance of keeping it off." Dr. Atwa says learning about the mistakes other people have made after surgery, as well as hearing about their positive experiences, can be very helpful. "People can share their successes and struggles, and when they see the benefits of the group, they want to keep coming back." When noninvasive measures fail, Dr. Atwa recommends revisional surgery for some patients. While revisional surgeries have a slightly higher complication rate, most can be performed robotically, minimizing risk. About 80% to 90% of these surgeries are successful. "Most people are very happy," Dr. Atwa says. "But surgery is not meant to replace healthy nutrition, healthy lifestyle and exercise. It is only done when other treatments have not been successful or if there is an anatomical problem." ■ To learn more about bariatric surgery options at Long Island Laparoscopic Doctors, visit journeytothenewyou.com. Revisional Surgery Options A BOUT 10% TO 15% of the bariatric surgeries Hesham Atwa, MD, FACS, FASMBS, Founder and Clinical Director of Long Island Laparoscopic Doctors, performs are revisional procedures. The type of surgery he recommends for each patient depends on several factors, including the original type of procedure the patient had and the reasons it was not successful. SLEEVE GA STRECTOMY The most common type of bariatric surgery, sleeve gastrectomy has a revision rate of about 20%. For weight regain, revision options include: + Re-sleeve if the sleeve is diffusely dilated or there is segmental dilatation with a retained fundus + Conversion to a gastric bypass + Conversion to a single anastomosis duodeno ileostomy For acid reflux, options include gastric bypass; re-sleeve; radiofrequency ablation and augmentation of the lower esophageal sphincter; implantation of a magnetic sphincter augmentation (LINX device); ligamentum teres cardiopexy ("Sling"); and hiatal hernia repair. GA STRIC BYPA SS Several options are available for patients who had gastric bypass, including pouch and anastomosis reduction, revision of the anastomosis for marginal ulcers or gastrogastric fistula or stricture, and distalization of the alimentary limb to increase the malabsorption effect. GA STRIC BANDING (L AP-BAND) While the Lap-Band procedure was once the most popular bariatric surgery, it now makes up less than 1% of bariatric surgeries due to its 40% revision rate. If the band has eroded, it must be removed. In the case of prolapse or band slippage, the band may be removed or repositioned. If the patient has experienced inadequate weight loss, the procedure can be converted to a sleeve or bypass after removal of the Lap-Band. M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 1 5

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