400,000 Americans die prematurely each year due to obesity-related diseases. This number is increasing rapidly. Soon obesity will replace tobacco and smoking as the number one preventable health problem in the United States. Most people are not successful losing weight with diets. (Up to 97% are unsuccessful) As someone becomes more overweight, the risk of developing other serious diseases dramatically increases. Surgery has proven to be the MOST effective method to treat severe obesity with a 40% drop in mortality for all patients after bariatric surgery. The benefits of weight loss surgery include:

• Improved or eliminated high blood pressure (45%-75% cure)
• Obstructive sleep apnea (90+% cure)
• Diabetes mellitus (80-98% cure)
• Gastroesophageal reflux disease(GERD) (70-100% cure)
• High cholesterol
• Heart disease
• Cancer
• Asthma
• Stress urinary incontinence
• Low back pain
• Degenerative disk disease
• Degenerative joint disease

All patients must enroll in a medical supervised weight loss program prior to being eligible for surgery. The NEW BEGINNINGS program at Virtua continues to offer comprehensive weight management services including: nutritional counseling, behavior therapy, medical evaluation, psychiatric evaluation, support groups, internet web boards, phone and email support.

Many insurance companies will require that you are enrolled into a multi-disciplinary program like New Beginnings. Call your insurance company to ensure that weight loss surgery is a covered benefit. If you switch insurances or have a change in status with an insurance company inform our program.

We are offering all aspects of bariatric surgery including: Laparoscopic Gastric Bypass, the LAP BAND System ®, Laparoscopic Sleeve Gastrectomy, Open Gastric Bypass, Laparoscopic and open revision of bariatric procedures and Endoscopy.

Roux-en-Y Gastric Bypass (RGB)
This operation is the most common and successful combined weight loss surgery in the United States. It can be done laparoscopically for the majority of patients. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs.

Advantages
Greatly controls food intake, leading to rapid weight loss, dumping syndrome dumping conditions to control intake of sweets, reversible in an emergency though this procedure should be thought of as a permanent

Disadvantages
Staple line failure, ulcers, narrowing/blockage of the stoma, vomiting if food is not properly chewed or if food is eaten too quickly, weight re-gain is known to happen if dietary changes are not followed long term

LAP-BAND® (Adjustable Gastric Banding)
In this laparoscopic procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.

Advantages
Simple and relatively safe. Short recovery period and a low rate of major complications. No removal of any parts of the stomach or intestines. No altering of the natural anatomy.

Disadvantages
About 5% failure rate because of balloon leakage, band erosion/migration, deep infection. Identifying patients who will not eat through the operation. Highest rate of failure to lose significant weight.

Sleeve Gastrectomy
It generates rapid weight loss by restricting the amount of food that can be eaten without any bypass of the intestines or malabsorption.

Advantages
Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulates hunger(Ghrelin). No dumping syndrome because the pylorus is preserved. Minimizes the chance of an ulcer occurring. By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated. Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2). Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2). Can be done laparoscopically in patients weighing more than 500 pounds

Disadvantages
Potential for inadequate weight loss or weight regain. While true for all procedures, it is theoretically more possible with procedures without intestinal bypass. Higher BMI patients may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure. Considered investigational by some surgeons and insurance companies.