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opt for procedures that involve less drastic rearrangement of the diges- tive tract, such as banding or sleeve gastrectomy. Both procedures are viable options for weight loss. "Procedures w ithout a ny bowel m a n i p u l a t i o n a r e a t t r a c t i v e ," Dr. Barkan says. "In sleeve gastrectomy, for instance, we reduce the stomach by about 70 percent, resulting in a 'banana' shape." A newer procedure, sleeve gastrec- tomy, has been available for about 10 years and, by the hands of a skilled sur- geon, can be performed laparoscopically. "The effectiveness of sleeve gas- trectomy is close to that of gastric by pa ss," Dr. Ha ll says. "However, success as it relates to resolution of comorbidities — such as hypertension and diabetes — is still more significant with the bypass procedures." A n o t h e r p r o c e d u r e p e r f or m e d laparoscopically, gastric banding, has fa llen out of favor in recent yea rs, Dr. Barkan says. "There is no way to predict whether it will be successful," he notes. "Studies show banding does not correlate with bypass or sleeve procedures in terms of weight loss over time." However, banding can be quite effec- tive for some patients, Dr. Hall says. "We use banding for a select patient population," he offers. "Typically, we identify patients who have had no previ- ous abdominal surgery. Prior surgeries lead to multiple abdominal adhesions, limiting the mobility of the bowel and making the procedure more difficult. Ideal candidates are those who have lower BMIs and are interested in the cosmetic outcomes of bariatric surgery." For patients who include improved cosmesis as a desirable outcome of weight loss, gastric banding may be the right choice, as it results in extremely l i m i t e d s c a r r i n g. A t W i nt h r o p - University Hospital, gastric banding can be performed through a single incision, resulting in an operative scar that is almost invisible. "We utilize the belly button, making a single incision in the skin," Dr. Barkan says. "Then we make a larger incision in the muscle below the umbilicus and place a device that allows us to use our trocars, or working ports. Resembling a spindle of yarn on a spinning wheel, this device allows us to access the abdo- men and place several instruments through a single incision." St ud ies have fou nd t hat single- incision banding results in considerably less postoperative pain than other mini- mally invasive banding procedures. Sorting through the Options: Expertise in Conversation With so many procedures to choose from, patients may desire guidance balancing the pros and cons and decid- ing which surgery best suits them. A preoperative bariatric seminar answers many of their questions, including ones about the complications, risks a nd advantages of each procedure. "Our educational seminars are an importa nt mea ns of disseminating information to patients," Dr. Ha ll says. "They serve as a platform where patients can ask questions. We pass a sample gastric band around the room so they can examine it. We show videos depicting what each procedure entails. At the end of each seminar, previous bariatric surgery patients talk about their experiences. We find that is the most effective way of communicating with potential patients. They respond well to a familiar approach." Karen Norowski, RN, CBN, Winthrop's Bariatric Care Coordinator, discusses a case with Dr. Barkan. ALEXANDER BARKAN, MD, FACS ON STAFF AT Winthrop-University Hospital since 2008, Dr. Barkan earned his medical degree from St. George's University School of Medicine in the West Indies. He pursued a postgraduate degree in internal medicine at Hahnemann University Hospital, followed by a surgical residency at Maimonides Medical Center. He later completed a fellowship in laparoscopic bariatric surgery at Princeton University. The Director of the Minimally Invasive Fellowship at Winthrop-University Hospital and Assistant Professor of Surgery at Stony Brook University School of Medicine, Dr. Barkan came to Winthrop in order to be close to Brooklyn, where he grew up. "Collin Brathwaite, MD, who is Chair of the Department of Surgery and Chief of Minimally Invasive Surgery at Winthrop, was recruiting people to work in his practice," Dr. Barkan recalls. "This was a great opportunity to practice close to home, and with my attraction to teaching as well, I pursued it." SPECI A L FE AT UR E 1 8 | Long Island MD NEWS ■ M D N E W S . CO M