Obesity is a common problem in the United States. In 2002, the Centers for Disease Control and Prevention reported that two-thirds of adult Americans are overweight. The treatment of obesity is very difficult, especially when the patient does not have a correctable endocrine problem. Low-calorie, low-fat balanced diets are usually recommended, along with exercise. "Crash" diets and diet drugs are usually discouraged.

What is morbid obesity?
Patients weighing more than 100 pounds over their ideal body weight or a calculation of the body mass index (BMI) greater than 35 to 40 are considered to be obese.(To calculate your BMI, multiply your weight by 705. Divide the result by your height in inches. Divide by your height again.) Massively obese persons have an increased risk of diabetes, hypertension, heart disease, hyperlipidemia, sleep apnea (temporary stopping of breathing during sleep), and osteoarthritis.

Your doctor will explain BMI in greater detail and carefully assess your need for surgery. You may be a candidate for laparoscopic gastric bypass procedure if attempts at restrictive diets and exercise have failed.

Will my insurance company cover this procedure?
In recent years, research has clearly shown that obese individuals have a shortened life span. Many insurance companies now recognize obesity as a substantial health risk and are paying for laparoscopic bypass procedure. To determine if your insurance company will cover this type of medical care, contact them and enquire about the following CPT codes: 43645 (Roux-en-Y gastric bypass); 43770 (adjustable gastric band); and 49320 and 43843 (sleeve gastrectomy), or speak with a financial counselor at Cleveland Clinic at (216) 445-1745.

How can I benefit from laparoscopic gastric bypass procedure?
The most important benefit you will experience is significant weight loss, which occurs during the first year following surgery. Significant weight loss can make medical problems such as diabetes, hypertension and coronary artery disease easier to treat or may eliminate a problem altogether. You will also benefit from the use of laparoscopy, which requires much smaller incisions than traditional abdominal surgery. Patients generally have less pain and scarring after surgery and recover more quickly. Laparoscopy also reduces your risk of developing hernias, which are more common after traditional abdominal surgery. Though gastric bypass procedure can be reversed, you should carefully consider all of the risks and benefits before electing to have this surgery.

Before surgery:
Persons considered for surgery must be carefully evaluated. Studies are performed to assess the health of the patient’s cardiovascular, pulmonary, and endocrine systems. A psychological evaluation is considered essential by most physicians to determine a potential patient’s response to weight loss and change in body image and ability for permanent lifestyle change. Nutritional counseling is also a must before surgery.

During surgery:
Various laparoscopic (minimally invasive) surgical procedures have evolved in an effort to "shunt" or bypass a portion of the stomach. The procedure we perform at Cleveland Clinic are laparoscopic isolated gastric bypass, adjustable gastric band, and sleeve gastrectomy.

• Four to six small openings (each less than one-half to one inch long) are made in the abdomen. These openings allow the surgeon to pass a light, camera, and surgical instruments into the abdomen.
• The abdomen is inflated with gas (carbon dioxide) in order to allow the surgeon to get a better view of your stomach and internal structures.
• Surgical instruments about the width of a pencil are placed into the abdomen to complete the surgery.
• In a Roux-en-Y gastric bypass, greater than 95 percent of the stomach is "bypassed" and a small portion (the size of an egg) remains functional.
• In an adjustable gastric band procedure, the stomach is restricted or "cinched" by the placement of the band, which can be adjusted after surgery as needed for further weight loss.
• Sleeve gastrectomy is the removal of two-thirds of the stomach with a "bypass" of intestines.

After surgery:
Most patients recover from surgery with no complications.

• The hospital stay is usually 1 to 3 days.
• You may be off work for 2 to 4 weeks.
• Once at home, you will need to follow specific eating guidelines. Your dietitian will assist you in understanding and adjusting to these guidelines.
• Regular follow-up visits are scheduled during the first year after surgery to check your overall physical and mental health, metabolism and nutritional status.
• Many patients will need plastic surgery (abdominoplasty) 1 to 2 years after weight loss to remove skin folds around the abdomen.

For further reading:

1. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222(3): 339-52.

2. Schauer, PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232(4):515-29.

3. Dixon JB, O’Brien PE. Changes in comorbidities and improvements in quality of life after LAP-BAND placement. Am J Surg 2002; 184(6B): 51S-4S

4. Brethauer, SA, Chand B, Shauer PR. Risks and Benefits of Bariatric Surgery: Current Evidence. Cleve Clin J Med 2006, 73(11): 993-1007.

© Copyright 1995-2007 The Cleveland Clinic Foundation. All rights reserved

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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