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Bariatric Surgery

Surgical expertise and effective patient education are keys to excellent bariatric surgery outcomes

03/01/2009

BariatricSurgeryNearly one in three U.S. adults is considered obese, but only a small percentage of individuals who attempt weight loss realize long-term success. The UCLA Bariatric and Metabolic Surgery Program, which has performed more than 1300 surgeries, promotes patient commitment to major lifestyle changes before and after surgery in order to support significant, long-term weight loss.

High program standards

The UCLA Bariatric and Metabolic Surgery Program sets high patient selection criteria. Patients must be at least 18 years old and have a body mass index (BMI) greater than 40 or BMI greater than 35 if accompanied by co-morbid conditions such as diabetes and high blood pressure. Patients must be able to pursue some level of physical activity and have recently attempted a medically supervised weight-loss program. Patients must also be psychologically stable with an adequate support system to help them through surgery and the postoperative period. UCLA offers diet, exercise and support programs to assist patients with meeting these standards.

Comprehensive interactive classes

The UCLA team promotes successful outcomes by providing patients with one of the most distinguished preoperative education, preparation and support programs in Los Angeles. The program begins with a mandatory one-hour patient information seminar with UCLA’s bariatric surgery program director to learn about advantages and disadvantages of surgical options, including expected outcomes and possible complications.

Preoperative patients must also participate in a four-hour interactive class in preparation for surgery and life after surgery. Patients learn what to expect in the hospital and how to monitor and address potential problems in the days and weeks following surgery. Patients discover how to appropriately select food and portion sizes, read food labels, begin exercise programs given physical limitations and stay motivated while practicing new diet and exercise habits. The course includes a test and homework, which patients must complete before graduating to surgery.

In addition to education and coping tools provided in class, patients may attend a two-hour monthly support group meeting and access an interactive web-based education program regarding bariatric surgery.

Laparoscopic surgical expertise

More than 90 percent of UCLA bariatric surgery patients undergo Roux-en-Y gastric bypass (RYGB), considered the gold standard of weight loss surgeries. UCLA surgeons perform RYGB laparoscopically, with or without robotic assistance, through five small incisions. Surgeons create a small pouch at the top of the stomach, re-routing part of the small intestine and attaching it directly the pouch. This bypass promotes weight loss by restricting the amount of food that can be comfortably contained in the stomach and limiting the body’s ability to absorb calories. RYGB patients lose approximately 60 to 80 percent of their excess body weight in the year following surgery.

Alternatively, a laparoscopic sleeve gastrectomy (SG) can be performed for individuals who are not good candidates for gastric bypass, approximately 10 percent of UCLA bariatric surgery patients. This includes patients who are extremely obese or who have co-morbidities that preclude the more demanding surgery. SG involves partitioning and removing approximately two-thirds of the stomach. The digestive tract, however, is not modified, which avoids the risk for nutrient malabsorption. Some SG patients later undergo RYGB once their weight and co-morbidities have been sufficiently controlled. On average, SG patients lose 50 to 70 percent of their excess body weight in the first year.

UCLA has a 99.7 percent laparoscopic bariatric surgery completion rate — one of the highest in the nation — including patients with previous abdominal or bariatric surgeries. Compared with traditional open surgery, laparoscopy is associated with less blood loss, scarring and pain; faster recovery; shorter hospital stays and fewer wound-related problems, including infection.

Personal responsibility critical to weight loss success

UCLA’s comprehensive education program identifies patients who are willing and able to comply with the long-term commitment required for safe, effective weight loss following bariatric surgery. The patient education and evaluation process usually ranges from eight to 12 weeks.

“Significant, long-term weight loss is a process, and patients must be willing to take personal responsibility,” explains Amir Mehran, M.D., director of bariatric surgery. “We tell them the steps they need to take, they decide if they’re willing to do so.” The need for a strong support network is also important, says Dr. Mehran, including an actively involved primary care physician to assist in evaluating the patient’s medical stability before surgery and to perform routine tests and consults after surgery.

The UCLA Bariatric and Metabolic Surgery Program has earned Center of Excellence designations from the American Society for Bariatric Surgery, as well as from several health insurance companies.

Program Physicians

Amir Mehran, M.D., FACS
Assistant Clinical Professor of Surgery
Director of Bariatric Surgery

Erik Dutson, M.D.
Assistant Clinical Professor of Surgery
Director of Minimally Invasive
and Bariatric Surgery Fellowship
Co-Director of the Center for Advanced
Surgical & Interventional Technology

Contact Information
UCLA Bariatric and Metabolic Surgery Program
(310) 206-7235 Physician Referral
(310) 825-7163 Bariatric Program
(310) 267-4632 Fax
http://bariatrics.ucla.edu/





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