MDNews - Long Island

Hospital. During this procedure, which is performed through the SILS approach, 80 percent of the stomach is removed through an incision made in the navel and the remaining portion of the organ is fashioned into a tube rather than a pouch. This drastically restricts the amount of food the patient can ingest and also a‚ects the presence and activity of gut hormones, such as ghrelin, that play a role in appetite regulation. Dr. Angstadt notes this procedure is popular because it poses a reduced risk of malabsorption and nutrient deficiency than gastric bypass as well as a lower overall risk of complications. "The procedure is very low-risk, takes 45 minutes or less to perform, and allows patients to walk around within two hours," Dr. Sekhar adds. "Several patients have asked me the following morning if I actually performed surgery on them because of how well they feel." Revisional surgery is also a growing trend on Long Island. Revisional surgery may be performed in cases where the original bariatric procedure failed to produce results or the patient regained weight. Revisions are often more complex due to the presence of scar tissue, especially if the original procedure was a gastric bypass performed through an open approach. Patients undertaking the revisional surgery process present unique considerations for management. "Weight loss surgery is a tool, and revisional surgery can be helpful for a subset of patients who, for one reason or another, have stopped successfully using their tool," Dr. Angstadt says. "Such patients have already gone through the long and rigorous evaluative process, had the procedure, and lost and regained a substantial amount of weight. They often come to us with underlying psychological issues that complicate their medical care because they feel like they're back at square one after going through an intense process. We have developed methods for helping these patients overcome these psychological obstacles through meaningful education a nd re-education." FULL-SPECTRUM SURGICAL SERVICES Currently, the Weight Loss Surgery Center at St. Charles Hospital o‚ers the full complement of bariatric procedures, ranging from adjustable gastric banding to more complex procedures such as sleeve gastrectomy, Roux-en-Y gastric bypass and revision surgery. Weight-loss surgeons at the facility also perform minimally invasive single-incision laparoscopic surgery (SILS) for gastric banding and sleeve gastrectomy. Laparoscopic sleeve gastrectomy is the most popular form of bariatric surgery on Long Island and accounts for three of every four weight-loss surgeries Dr. Angstadt performs at St. Charles Innovation Spotlight: Intragastric Balloon ONE OF THE latest advances in bariatric technology is the intragastric balloon. This silicone device is inserted endoscopically into the stomach and inflated with 400–700 cubic centimeters of saline. Once expanded, the balloon restricts the total space within the stomach, limiting food intake during meals and reducing the sensation of hunger. The balloon is removed after six months. In a clinical study of 255 patients, the 125 participants who received the device lost an average of 10.2 percent of their body weight and maintained this weight loss within one to two pounds for at least three months after the balloon was removed, compared with an average 3.3 percent body weight reduction among participants who followed a behavior modification program. St. Charles Hospital has offered the intragastric balloon since November 2015, and several patients have already experienced significant weight loss using the device. Patients at the Weight Loss Surgery Center who receive the intragastric balloon undergo a 12-month monitoring program that includes monthly visits with a nutritionist on staff. Dr. Angstadt says the balloon is an ideal solution for patients with a body mass index between 30 and 40 and without comorbidities, as it offers a more aggressive intervention for these patients who may not yet qualify for bariatric surgery. Dr. Sekhar shows a model of an FDA-approved gastric balloon. St. Charles now offers the gastric balloon as a weight-loss option. Dr. Angstadt counsels a patient prior to weight-loss surgery. 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 ■ 2 016 0 9

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