Body

Is bariatric surgery right for me?

Diet and exercise may be the healthiest, least invasive way to lose weight, but for so many with life-threatening conditions associated with obesity, this approach has repeatedly fallen short. When traditional methods have failed, weight-loss surgery, also called bariatric surgery, may be the only effective means to achieve permanent weight loss and improve health. Diseases found in the morbidly obese, such as Type 2 diabetes, high blood pressure and sleep apnea are often eliminated in the process.

Our objective at St. Charles is to use weight-loss surgery as one among many tools in your long-term journey towards achieving and maintaining a healthy weight and lifestyle, especially after weight loss surgery.

A comprehensive approach

At St. Charles, our multidisciplinary team is committed to comprehensive care when it comes to surgical weight loss. We address each patient as a whole person embarking on a lifelong path, rather than simply a surgical weight loss case. We've partnered with expert local bariatric surgeons specializing in education, support and post-surgical rehabilitative exercise programs, as well as specialists in weight loss management.

The St. Charles Bend Campus has continued to meet the rigorous requirements to maintain an Accredited Bariatric Center designation. Our bariatric surgeons perform laparoscopic and open surgeries, including gastric bypass and sleeve gastrectomy. Many insurance companies now cover these surgeries. 

Is your body mass index (BMI) greater than 40 or greater than 35 with additional conditions, such as diabetes or high blood pressure?

Our program includes additional services to provide an integrated health team for our bariatric and metabolic surgery patients including physical therapy, expert nursing, physician extenders and social workers to deliver the highest level of care.

Contact us

St. Charles Heath System also offers bariatric informational and support classes in Bend and Redmond, as well as other weight loss programs. To learn more about your options, call our bariatric nurse navigator, Bette Brower, at 541-706-4970.

Bariatric Surgery Procedures

Sleeve gastrectomy limits food intake by reducing the size of the stomach. A stapling device is used to divide the stomach vertically, leaving behind a thin vertical sleeve of stomach. Hormonal changes result in a decrease in hunger while the sleeve increases the feeling of being full since smaller portions of food can fit in the reduced stomach. The excised portion of the stomach is permanently removed.

Advantages:

  • Restricts the amount of food the stomach can hold
  • Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of greater than 50 percent for three to five years post surgery, and weight loss comparable to that of the bypass with maintenance of greater than 50 percent
  • Requires no foreign objects (gastric banding), and no bypass or re-routing of the food stream (gastric bypass)
  • Involves a relatively short hospital stay of approximately one to two days
  • Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages/Risks:

  • This is a non-reversible procedure
  • Has the potential for longterm vitamin deficiencies
  • Surgery risks include complications due to stomach stapling including bleeding, infection, blood clots, gastroesophageal reflex and other risks associated with bariatric surgery. Please speak with your surgeon about these and other risks in more detail

Source: asmbs.org

Stapling is used to create a small, upper stomach pouch that restricts the amount of food that can be consumed. A portion of the small bowel is bypassed thus delaying food from mixing with the digestive juices to avoid complete calorie absorption. Weight loss is induced by hormonal changes that decrease hunger and increase the feeling of being full.

Advantages:

  • Average 77 percent reduction of excess body weight one year after surgery
  • Studies show that after 10 to 14 years, patients have maintained 60 percent reduction of excess body weight
  • Studies show that 96 percent of associated health problems studied were improved or resolved, including back pain, sleep apnea, high blood pressure, Type 2 diabetes and depression
  • In most cases patients report an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat
  • Produces significant long-term weight loss (60 to 80 percent excess weight loss)
  • Restricts the amount of food that can be consumed
  • May lead to conditions that increase energy expenditure
  • Produces favorable changes in gut hormones that reduce appetite and enhance satiety
  • Typical maintenance of more than 50 percent excess weight loss

Disadvantages/Risks:

  • Poor absorption of iron and calcium
  • Chronic anemia due to vitamin B12 deficiency
  • Dumping syndrome can occur when too much sugar or large amounts of food are consumed
  • Bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray of endoscopy
  • Operative risks of bypass include bleeding, infection, blood clots and clots that go to the lung. Please speak with your surgeon to learn more details

Source: asmbs.org

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages

  1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  2. Allows patients to eventually eat near “normal” meals
  3. Reduces the absorption of fat by 70 percent or more
  4. Causes favorable changes in gut hormones to reduce appetite and improve satiety
  5. Is the most effective against diabetes compared to RYGB, LSG, and AGB

Disadvantages

  1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
  2. Requires a longer hospital stay than the AGB or LSG
  3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
  4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

Source: asmbs.org

Metabolic and Bariatric Surgery Accreditation

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Regence BlueDistinction Center+ Bariatric Surgery

Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable healthcare. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.