"It’s not about what you lose. It’s about everything you gain!"

An estimated 97 million adults in the United States are overweight or obese, a condition that substantially raises the risk of serious illness from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, as well as endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with an increase in early death. As the second leading cause of preventable death in the United States, obesity poses a major public health challenge.

The Bariatric Weight Loss Surgery Program at Cedar Park Regional Medical Center (CPRMC) is designed to assist people with improving their health and quality of life by using surgical intervention for weight reduction. Although bariatric surgery has shown to be an effective tool in weight loss, it is important for patients to remember that the surgery is only a tool. A successful outcome is dependent on a patient’s commitment to long-term lifestyle change.

There are several methods available for the surgical treatment of obesity. Surgeons at CPRMC perform the Laparoscopic Roux en-Y Gastric Bypass Surgery, Laparoscopic Sleeve Gastrectomy in select patients, gastric band removals, and revisional bariatric surgery on a case by case basis. We do not advocate, perform, or adjust gastric bands, or perform the biliopancreatic diversion/duodenal switch.

You are encouraged to gather as much information on weight loss surgery by researching information on the internet, talking with the team members, and attending support groups. By developing your own knowledge base about this treatment method, you will be empowered to reach your goal of long-term weight loss.

We encourage you to attend as many support groups as possible prior to and after surgery. These meetings will equip you with information and provide you with tools to assist in the lifestyle changes needed to obtain long-term success.

Surgical Weight Loss Options
Get ready for a whole, new YOU!

Roux-en-Y Gastric Bypass Surgery
Roux en Y Gastric Bypass Surgery (RYGB) is considered the "gold standard" of all bariatric surgical procedures. It is a time-tested operation dating back to the late 1960’s and has shown durable results.

During normal digestion, food moves into the stomach from the esophagus. While in the stomach, the food is broken down by digestive juices in the stomach. This process takes about twenty to thirty minutes, after which the stomach contents move to the first segment of small intestine. Most of the iron and calcium in the foods we eat are absorbed at this time. The remaining segments of the small intestine complete the absorption of almost all calories and nutrients. The remaining food particles that cannot be digested in the small intestines are stored in the large intestine until eliminated.

The Roux-en-Y operation provides both restriction and malabsorption for weight loss as both the stomach and small intestines are reconfigured. First, a "mini stomach" is created by permanently dividing the stomach, creating a pouch that can hold about 2-3 bites of food. The intestine is then cut approximately one and one half feet beyond the stomach and is attached to the pouch to provide an outlet for the food. The pouch gives a sensation of fullness for a longer period of time. Digestive juices are still produced in the lower part of the stomach and are released into the intestines further downstream where they help the food digest. Nutrients and calories can still be absorbed but in a delayed fashion. Bypassing the distal stomach and proximal intestine, furthermore, alters the normal hormonal milieu, promoting weight loss in ways that are still being studied.

Surgeons at CPRMC perform the Roux-en-Y Gastric Bypass Surgery laparoscopically. The "laparoscopic" approach, also known as "minimally invasive" surgery is performed through 5-6 small keyhole incisions in the abdomen. The surgeon uses a camera and several small instruments to perform the surgery. Previous abdominal surgeries are not a contraindication to laparoscopic bariatric surgery. Traditional "open" gastric bypass is rarely performed and only in cases where the laparoscopic approach becomes technically impossible to perform safely.

Sleeve Gastrectomy
Sleeve Gastrectomy is a laparoscopic restrictive procedure which removes a large part of the stomach. This procedure is being performed throughout the world and has been very successful in achieving weight loss and resolving/reducing comorbidities, such as diabetes, heart disease, high blood pressure, and many others. There is no "bypass" performed as in the RYGB so there is no malabsorption caused. If the desired weight loss is not achieved by the sleeve gastrectomy a second procedure may be performed to convert this procedure to a RYGB (see next section).

Two-stage Gastric Bypass: Sleeve Gastrectomy & Large Pouch RYGB
In very large or high risk patients, the RYGB may have to be performed in two stages to prevent complications and even death. The two stage operations include either a sleeve gastrectomy or a large pouch gastric bypass followed by another surgery a few months later. These options are usually reserved for patients with very high BMIs or significant medical comorbidities that preclude a safe performance of the gastric bypass. They are both performed laparoscopically, result in a 40-50% excess weight-loss, and are advocated as a bridge to a more definitive operation which can subsequently be done on a ‘healthier’ patient. You doctor may discuss this option with you.

Which surgery is right for you?

For patients who remain severely obese after non-surgical approaches to weight loss have failed or for patients who have obesity-related diseases, surgery may be the next best step. The type of surgery you choose is not only a very personal decision that should be discussed between you and your family, but also one that requires the professional expertise and knowledge of your surgeon. Patients who have had surgery require not only close monitoring, but also life-long use of special foods and medications. Surgery to promote weight loss is a serious undertaking and typically not reversible.

Remember, there are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with your fullest cooperation and commitment to behavioral change and medical follow-up.

Eligibility Criteria

Patients must meet specific criteria before they will be considered for an evaluation with our surgeons and internists. Selection is based on guidelines established by the National Institute of Health, which defines morbid obesity as:

• A Body Mass Index (BMI) of greater than 40, or a BMI of 35 accompanied by other issues related to health (co-morbidities).
• Have documented failure of at least one medically supervised weight reduction program within the last two years.
• Generally be between the ages of 18 and 65.
• No documented history of bi-polar disease, schizophrenia, multiple personality disorders, or other psychoses which will interfere with the informed consent process as well as the ability to follow instructions.
• Be physically active.

Screening Evaluation

Once a patient meets the specified criteria and has attended a bariatric seminar the next step is to schedule a consultation with a surgeon. Prior to the scheduled consultation, it is important to become as well educated as possible regarding bariatric surgery. Please utilize the list of resources (see end of booklet) to obtain as much knowledge and information prior to the surgical consultation.

During the surgical consultation appointment, the patient will meet with the surgeon, bariatric coordinator and nutritionist. The surgeon will review the patient’s health history, and conduct an in-depth discussion regarding surgical techniques and risks. The surgeon will inform the patient of further consultations or tests needed to determine candidacy for surgery. You will be provided with a checklist of pre-operative requirements which must be completed prior to having surgery. The sooner these pre-operative requirements are completed the sooner we can schedule your surgery.

Your case will be reviewed by all members of the team the week of the consultation. You will subsequently be notified of your surgery date and whether additional material is needed. Bariatric surgery is not always the appropriate choice, so the screening process assists the team in determining the best steps for the patient to take.

Attend a Free Bariatric Weight Loss Surgery Seminar

Free seminars are held on an ongoing basis. Learn about your options for surgical weight loss by calling (512) 260-3444 today.

Special thanks to Nicole Basa, MD, and Alan Abando, MD, and the staff at Cedar Park Surgeons for their significant contributions to the development of the Bariatric Weight Loss Surgery Program. Many thanks also to our implementation team who made this program a reality and who proudly improve the health and wellness of our community each and every day.