Bariatric surgery designated Center of Excellence

Bariatric Surgery Program Physicians Bell, Robert, MD, MA Surgery / General Surgery - Gastrointestinal Duffy, Andrew J., MD, FACS Surgery / General Surgery - Gastrointestinal Formica, Jr., Richard N., MD Internal Medicine / Nephrology (Kidneys) Helgeson, Lars E., MD Anesthesiology / Anesthesiology, OB/GYN Hendler, Rosa E., MD Internal Medicine / Endocrinology & Metabolism Kulkarni, Sanjay, MD Surgery / Transplant & Immunology Lim, Joseph K., MD Internal Medicine / Digestive Diseases / Hepatology Mohsenin, Vahid, MD Internal Medicine / Pulmonary & Critical Care Medicine Perrino, Jr., Albert C., MD Anesthesiology / Anesthesiology, Cardiac Popescu, Wanda Maria, MD Anesthesiology / Anesthesiology, Cardiac Roberts, Kurt Eric, MD Surgery / General Surgery - Gastrointestinal Thomson, J. Grant, MD, MSc, FRCS, FACS Surgery / Plastic Surgery

Bariatric Surgery Information Surgical Treatment for Obesity Gastric Bypass Surgery

Most bariatric surgeries at Yale are performed with minimally invasive techniques, which lead to shorter recovery times and fewer complications.

Morbid obesity afflicts approximately 9 million American adults, and for many of them the traditional strategies of diet and exercise will not lead to significant weight loss. The five-year-old Bariatric Surgery Program at Yale offers those people hope for a healthy, active life.

Kurt E. Roberts, MD, the newest of three physicians in the program, calls the surgery “lifechanging.” It offers patients a permanent loss of about 70 percent of their excess weight and a renewed wealth of everyday pleasures, ranging from being able to sit in a theater seat to hiking with a friend. The medical advantages include decreased risk of heart disease, diabetes and hypertension.

The Bariatric Surgery Program at Yale-New Haven Hospital was recently designated as a Center of Excellence by the American Society of Bariatric Surgeons. “The designation recognizes the quality of care and the excellent outcomes in our program,” said Robert L. Bell, MD, director of bariatric surgery. Andrew Duffy, MD, who does laparoscopic bariatric surgery, rounds out the team.

Robert Udelsman, MD, chair of the Department of Surgery, believes Yale’s program is distinguished by the preparation of its surgeons. All are fellowship-trained in bariatric surgery, whereas other programs frequently use doctors with only general surgical training. The Yale team’s elite skill in minimally invasive techniques greatly increases safety and patient convenience, he added.

The quality of the interdisciplinary team that serves bariatric patients at Yale contributes to the program’s success, Bell said, citing the anesthesiologists, psychologists and nutritionists who work along with the surgeons. Finally, surgeons do their own direct follow-up with patients, a task that is often delegated to a physician associate or nurse practitioner in other practices.

The vast majority of bariatric surgeries at Yale are performed with minimally invasive techniques that allow for shorter recovery time and reduced complications. Most are laparascopic gastric bypasses, in which the surgeon creates a small gastric pouch then attaches a Y-shaped limb of small bowel to form the outlet to the intestines. After surgery the patient’s appetite is sated by very small amounts of food. Levels of the appetite stimulating hormone ghrelin, which spikes prior to a meal and dips after a meal, stay consistently low in gastric-bypass patients. This may hold some clue as to why these patients generally avoid the “yo-yo” dieting syndrome that plagues many who try to lose weight by nonsurgical means.

With the arrival of Roberts, the program is also offering laparoscopic gastric banding, known commercially as LAP-BAND, in which an adjustable band is placed around the upper part of the stomach, creating a smaller pouch. Patients seeking weightloss surgery have typically researched procedures extensively. Many had been coming to Yale specifically asking for LAP-BAND surgery, which was approved by the FDA in 2001. Yale nutritionists and physicians developed a special diet for gastric banding patients, whose dietary needs are somewhat different from those of gastric bypass patients, Roberts said.

Unfortunately, the benefits of weight loss surgery have been available to fewer patients in Connecticut as insurers have dropped coverage of these procedures, said Bell. Large employers with policy riders will often cover the surgery, as will Medicare and Medicaid. Multiple studies have shown weight loss surgery to be cost-effective over a three-year period, said Bell, but the average enrollment period with a private insurer is only two years.

“There is a reason that Medicare and Medicaid cover it,” Bell said. “The surgery gets people off disability and makes them employable. Yale Health Plan, which people tend to stay with for a long time, was covering bariatric surgery even before Yale was performing it. The long-term benefits are clear.”

Patients who have benefited from the surgery are often reluctant to discuss it. Bariatric surgeons themselves, therefore, must be more assertive in making their case to state lawmakers, said Bell, in hopes of getting coverage mandated in Connecticut, as it is in other states.