Weight loss Options

Gastric Sleeve

Men & Women: What are you waiting for? It’s time to connect with Cooper Bariatrics to schedule your new Life.

Bariatric Surgery focuses on helping qualified overweight individuals succeed in losing and maintaining significant long-term weight loss.

Sleeve Gastrectomy

Sleeve Gastrectomy, one of the most popular weight loss procedures for obesity, will help change your life. The procedure offers a rapid weight loss that takes place in the first year, and continues for the next 18 months. Most patients lose between 60% and 75% of their excess weight and often more.
Surgeries are performed as Outpatient or same-day surgeries. A typical hospital stay of less than 24 hours can be expected for most procedures, and an overnight stay for the Gastric Sleeve Surgery. Patients often return to work faster by choosing the Minimally Invasive Techniques with fewer restrictions and advanced results.

According to the National Institute for Health (NIH), candidacy for weight loss surgery is based on several factors including BMI, or Mass Body Index. Most patients fall between ages 18-60 and have a BMI above 40. Click on our BMI calculator to calculate your BMI. Weight loss surgery is not cosmetic surgery but rather surgical treatment for those frustrated patients who have repeatedly gained, lost, and regained weight.

How does it work?

The Vertical Sleeve Gastrectomy (VSG) has replaced the gastric bypass as the most effective and reliable surgical stapling tool offered by BBSA. In this minimally invasive procedure, the camera and instruments are inserted through small incisions to remove the outer 85% of your stomach, converting your stomach into a thin, narrow “sleeve” or tube. No foreign bodies, post-operative adjustments, or re-routing of your intestines is required. Your smaller stomach holds much less food and allows you to get full on small portions. The smaller stomach results in decreased production of Ghrelin, thereby reducing appetite and hunger sensation. The flow of food is normal as there is no re-routing of the intestines like with gastric bypass. Weight loss is rapid in our sleeve patients. Our data suggests sleeve patients lose about 2% more weight after two years than our bypass patients.

Advantages of the Gastric Sleeve Procedure

  • Fast weight loss similar to or greater than gastric bypass.
  • Similar rapid improvement in co-morbidities (including diabetes) as gastric bypass.
  • Safer than gastric bypass in the short- and long-term.
  • Stomach volume is permanently reduced.
  • Decreased hunger and appetite for approximately 6 months(similar to gastric bypass).
  • No Dumping Syndrome.
  • Can be converted to other weight loss procedures (staged).
  • No adjustments required.
  • No foreign body issues (slip or erosion).
  • No need for life-long specialized vitamins and supplements.

Disadvantages

  • Higher incidence of post-operative gastric reflux than bypass.
  • As with any surgical procedures, there are risks that include: wound infection, respiratory complications, bleeding, splenectomy, bowel injury, DVT/Pulmonary embolism, gastrointestinal leaks, stroke, heart attack and death.
  • Diet progression is similar to bypass. Patients start with liquids and protein supplements, and slowly add foods to their diet over the next several months.

Body Mass Index

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What is the Lap Band?
The Lap Band, also known as the adjustable gastric band, involves an inflatable silicone band that is placed around the upper portion of the stomach to achieve weight loss. This creates a small stomach pouch above the band, leaving the rest of the stomach intact below it.
The band can be adjusted to increase or decrease the size of the passageway between the two parts of the stomach. The purpose is to slow down and limit how much food you can eat at any given time.

If you have had Lap Band Surgery or are contemplating having the procedure, please read on:

National Trend of Lap Band Surgery
The Lap band once was the most popular bariatric procedure in United States in early 2010s. However, due to the inadequate weight loss, weight regain, and high long-term complication rate, the use of the Lap band has decreased sharply worldwide and in United States. Nowadays, the Lap band constitutes less than 10% of all bariatric procedures and the number of lap band procedures nationwide continues to go down every year. According to American Society of Metabolic and Surgery (ASMBS), about 35.4% of all bariatric procedures were Lap band in 2011. This number has decreased to 20.2% in 2012, 14% in 2013, 9.5% in 2014 and 5.7% in 2015.

Indications of Lap band removal:

  • Inadequate Weight Loss or Weight Regain
  • If a patient can’t lose enough weight (about 25-30% of excess their weight) or have significant weight regain, lap band removal and conversion to another more effective bariatric procedure may be indicated. This is the most common reason for lap band removal.
  • Band Intolerance
  • Symptoms of band intolerance can include excessive nausea and vomiting, difficulty swallowing and pain after eating.
  • Band Infection
  • Band or port infection indicates that the band may have eroded into the stomach. If the infection is not responsive to antibiotic treatment, further workup and likely band removal is recommended.
  • Band Slippage
  • Slippage can occur when the Lap band moves down the stomach and creates a bigger pouch above the band. Sometimes this can be treated with removing the fluid from the band or surgical reposition. However, band removal may be necessary in some cases.
  • Severe Heartburn
  • Some patients may develop new heartburn symptoms after lap band procedure. If the heartburn symptoms are severe, this may lead to esophagitis (inflammation of the esophagus). For patients with severe heartburn symptoms that do not respond to anti-acid medications, lap band removal may relieve the symptoms.
  • Esophageal Dysmotility, Dilation or Esophagitis
  • With long-term use of lap band, some patients may develop esophageal dilation (expansion of tissue), dysmotility (lack of movement) or esophagitis (inflammation). Fluid removal or lap band removal may be required for patients with severe symptoms.

Band Removal

Most lap band removal procures can be done laparoscopically. Generally speaking, this is a relatively easy and safe operation depending on existing complications.

The steps of a lap band removal surgery are as follows:
1. Insert laparoscopic instruments through small incisions. In most cases, the old incisions can be used.
2. Cut the scar tissue around the band.
3. Cut the tubing and band.
4. Pull out the band from around the stomach.
5. During the initial operation, the upper part of the stomach (fundus) is usually sutured to the part of the stomach above the band to prevent band migration. Some general surgeons tend to leave the adhesions and those sutures in place during the lap band removal operation. However, it is very important to remove those sutures and lyse the adhesions. This will restore the original anatomy of the stomach and make subsequent or later revisional surgery much easier.
6. After the band is removed, the perigastric capsule (dense scar tissue around the upper part of the stomach or esophagus) should be removed or incised to reduce the chance of obstruction after surgery.
7. The subcutaneous port is removed.
8. For patients who want to convert to a more effective bariatric procedure, the surgeon may proceed with the sleeve gastrectomy or gastric bypass surgery right after the band is removed, or do the revisional surgery 3 months later.

Lap Band Conversion to Sleeve Gastrectomy and Gastric Bypass
If you have intolerance to the gastric band, removal of your band offers immediate symptom relief. However, without another bariatric procedure, many patients will regain weight after Lap Band removal. Cooper Bariatrics offers offer minimally invasive gastric bypass or sleeve gastrectomy surgery, either at the same time your Lap Band is removed or a few months later. Generally the surgery relieves the nausea, vomiting and reflux and causes a significant amount of weight loss.

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Call or email us today and learn how you can Experience Amazing Results for yourself.
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Gastric Bypass

Gastric bypass surgery is a procedure in which a small pouch is connected to the lower segment of the small intestine, making the patient’s stomach smaller. The purpose of gastric bypass surgery is to restrict the intake of food and give the individual a feeling of being full with less food. Also, bypassing part of the intestine results in decreased absorption of nutrients and alteration of the gastrointestinal hormones. The latter changes determine weight loss and have a positive influence on several of the co-morbid conditions, such as diabetes and high blood pressure.

Roux-en-Y gastric bypass is the most common type of bariatric surgery. The surgeon begins by:

  • Creating a small stomach pouch by dividing the stomach and attaching it to the small intestine.

This pouch

  • holds only an ounce of food, causes a feeling of fullness.
  • stretches over time to hold approx. one cup,
  • Causes decreased appetite and improved metabolism by changing the release of various hormones.

Duoednal Switch

Duoednal Switch

This surgical procedure involves a partial Sleeve Gastrectomy. It is used for severe obesity. In a Billiopancreatic diversion with Duodenal Switch , part of the stomach is removed. The remaining part of the stomach is connected to the lower portion of the small intestine.

The surgeon leaves the pylorus intact. The pylorus is the valve that controls food drainage from the stomach. This surgery is high-risk and can cause long-term health problems, because your body has a harder time absorbing food and nutrients. People who have this surgery must take vitamin and mineral supplements for the rest of their lives, which can be expensive. Another name for this surgery is duodenal switch.
These procedures can be done by making a large cut in the belly (an open procedure) or by making a small cut and using small tools and a camera to guide the surgery (laparoscopy).

What To Expect After Surgery
You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore. Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition. Having a duodenal switch reduces the risk of dumping syndrome.
Depending on how the surgery was done (open or laparoscopic), you’ll have to watch your activity during recovery. If you had open surgery, avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks.

Eating after surgery
Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.
Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, your stomach may stretch. If your stomach stretches, you will not benefit from your surgery.
This surgery removes the part of the intestine where many minerals and vitamins are most easily absorbed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. It’s important to make sure you get enough nutrients in your daily meals to prevent vitamin and mineral deficiencies. You may need to work with a dietitian to plan meals. And you may need to take extra vitamin B12.

Why It Is Done
Weight loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.
Most surgeons will not perform duodenal switch surgery unless you are extremely obese (body mass index (BMI) of 50 or higher) and your weight is causing serious health problems.

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Call or email us today and learn how you can Experience Amazing Results for yourself. plutarc@protonmail.com 
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BODY CONTOURING

Body Sculpting Options
Cooper Bariatrics partners with qualified Plastic Surgeons offering patients Body Contouring options after major weight loss. Body Contouring improves the shape and tone of your underlying tissue that supports fat and skin and removes excess sagging fat and skin. As a part of your new body enhancement program, many qualified candidates opt for an Arm Lift, Breast Lift, Tummy Tuck, or Body Lift.

Arm Lift
Also known as brachioplasty, an arm lift reshapes the under portion of the upper arm, and reduces excess skin and fat between the underarm and the elbow, and reshapes your arm to result in smoother skin and contours, resulting in a more toned and proportionate appearance. Fluctuations in weight, growing older and even heredity can cause your upper arms to have a drooping, sagging appearance. Exercise may strengthen and improve the underlying muscle tone of the upper arm, but it cannot address excess skin that has lost elasticity or underlying weakened tissues and localized fat deposits. If the underside of your upper arms are sagging or appear loose and full due to excess skin and fat, an arm lift may be right for you.

An Arm Lift:

  • Reduces excess skin and fat between the underarm and the elbow
  • Reshapes your arm to result in smoother skin and contours
  • Results in a more toned and proportionate appearance

Is it right for me? In general, candidates for an arm lift include:

  • Adults with significant upper arm skin laxity
  • Adults of any age whose weight is relatively stable and who are not significantly overweight
  • Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
  • Non-smokers
  • Individuals with a positive outlook and realistic expectations

Tummy Tuck
Also known as abdominoplasty, a tummy tuck removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

A flat and well-toned abdomen is something many of us strive for through exercise and weight control. Sometimes these methods cannot achieve our goals.

Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes of this include:

  • Pregnancy
  • Aging
  • Significant fluctuations in weight
  • Heredity
  • Prior surgery

Tummy tuck surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

A Tummy Tuck is a good option for you if:

  • You are physically healthy and at a stable weight
  • You have realistic expectations
  • You do not smoke

Although the results of an abdominoplasty procedure are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone abdominoplasty surgery.

What a tummy tuck won’t do: Tummy tucks are not a substitute for weight loss or an appropriate exercise program. Also, tummy tuck operations cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally the treated areas below the belly button.

Breast Lift Surgery
Commonly referred to as a “breast lift” or “boob lift”, mastopexy surgery raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.
A woman’s breasts often change over time, losing their youthful shape and firmness. These changes and loss of skin elasticity can result from:

  • Pregnancy
  • Breastfeeding
  • Weight fluctuations
  • Aging
  • Gravity
  • Heredity

Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well. A breast lift can rejuvenate your figure with a breast profile that is youthful and uplifted.

What breast lifts don’t do Breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. If you want your breasts to look fuller, consider breast lift and augmentation surgery. If you want smaller breasts, consider combining breast lift and reduction surgery.

Is it right for me? Breast lift surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

A Breast Lift is a good option for you if:

  • You are physically healthy and maintain a stable weight
  • You do not smoke
  • You have realistic expectations
  • You are bothered by the feeling that your breasts sag, have lost shape and volume
  • Your breasts have a flatter, elongated shape or are pendulous
  • When unsupported, your nipples fall below the breast crease
  • Your nipples and areolas point downward
  • You have stretched skin and enlarged areolas
  • One breast is lower than the other

SAIDS

A cutting-edge surgical procedure for weight loss.

The SADI-S is a type of bariatric surgery with a single anastomosis. It has a restrictive component when reducing the greater curvature of the stomach, but specially a malabsorptive component, as the common channel is also reduced. The objective of this surgical technique is to lessen the intestinal loop where nutrients are absorbed.

The single-anastomosis duodenal switch, also called stomach intestinal pylorus sparing surgery (SIPS), or the single loop DS, is very similar to the standard duodenal switch operation, except that the small intestine is only transected at one point instead of two. With this operation, the majority of the most stretchable portion of the stomach is permanently removed (as in a sleeve gastrectomy) but basic stomach function remains the same. In addition, roughly half of the upper small intestine is bypassed, resulting in a moderate decrease in calorie absorption. Weight loss is achieved both through restriction of food consumption and malabsorption, which results in very good long-term weight loss maintenance.

How It Works
With this operation, the surgeon permanently removes the stretchy outer and upper 85 percent of the stomach, leaving a small, tube-shaped stomach. Stomach capacity is reduced from about a quart (1,000 ml) to roughly 3-4 ounces (120 ml). Depending on the size of the tube that is created, patients generally report feeling full after eating 3-4 ounces of solid food.

The important functional elements of the stomach are preserved, including the antrum (the pump that pushes food through the valve at the bottom of the stomach), the pylorus, and the nerves that control stomach function. The result is a much smaller stomach that functions very similar to a normal stomach. Patients are able to enjoy a relatively normal diet and feel satisfied (in much smaller quantities), without experiencing “dumping” syndrome.

In addition, the surgeon will re-route the intestines so that calorie absorption is moderately reduced. The duodenum (the first section of the small intestine) is transected after the pylorus. Rather than transecting the lower intestines (as is done with the standard duodenal switch), the surgeon simply attaches the small intestine at point approximately 8-10 feet or 250-300 cm from the colon to the duodenal stump just beyond the pyloric valve. This creates a loop that diverts the food stream from the top half of the small intestines. The top half of the intestine now carries just digestive juices (bile and pancreatic juices) is called the bilio-pancreatic limb (BPL). The last segment of the intestine where the food and digestive juices mix is referred to as the common channel (CC). Absorption of nutrients and calories is determined by the length of the common channel, so a shorter channel helps decrease the chance of weight regain by decreasing calorie absorption.

Technique
It can be performed by laparotomy or laparoscopy. A small gastric sleeve is created, by sectioning the greater curvature of the stomach, such as in the Sleeve technique. Subsequently, the duodenum is transected respecting the pylorus. A duodenum-intestinal anastomosis is carried out, 250 centimetres (98 in) from the ileocecal valve. Therefore, the common channel, where nutrients are absorbed becomes 2.5 metres (8.2 ft) long..

Advantages
The SADI-S is a single anastomosis bariatric surgery. It is different from the classic duodenal switch, the gastric bypass (RNY) or sleeve gastrectomy. It is type of bariatric surgery carried out to lose weight.

Disadvantages
Patients may need to take vitamin supplements: A, D, E, K and minerals throughout life. Analytical monitoring is necessary to prevent malnutrition. Stones in the gallbladder, flatulence and diarrhea are more frequent. The surgical risks are the same as in other bariatric techniques, including intestinal perforation, anastomotic leaks, infection, abscess, venous thrombosis and pulmonary embolism. In the long term it can produce a bowel obstruction.

Long-Term Weight Loss created by a decrease in appetite hormone
One reason that good long-term weight loss has been reported with the duodenal switch with single anastomosis is likely due to a dramatic decrease in the appetite-producing hormone known as ghrelin. The tissue that produces the hormone is almost completely removed with the stretchy outer portion of the stomach. Patients typically report a significant decrease in hunger and food consumption after this operation. In addition, re-routing the intestines helps bring food to the lowest portion of the small intestines earlier than usual which releases important appetite-suppressing hormones such as polypeptideYY (PYY) and glucagon-like peptide 1 (GLP1). This may explain the superior weight loss, weight maintenance and diabetes resolution associated with this surgery.

Outcomes
⦁ Approximately 70% excess weight loss (EWL) has been reported.  (Excess weight is the amount of weight over what is considered the “ideal body weight” for a person’s height [Current Weight – Ideal Weight = Excess Weight]. The percentage of excess weight loss (%EWL) is the percentage of weight loss from this excess weight.)
⦁ Improvement/resolution in all major co-morbidities, including type 2 diabetes, sleep apnea, hypertension, high cholesterol and depression.)
⦁ There is very little risk of “dumping” syndrome—which occurs when a patient consumes sugar or carbohydrates, or eats too quickly, causing nausea, cramping, diarrhea, sweating, vomiting and heart palpitations.  Preservation of the pyloric valve provides for a more physiologic emptying of solid foods from the stomach enabling people to tolerate normal foods and reducing dumping syndrome.
⦁ This is a pill-friendly operation. NSAIDS and Aspirin are well tolerated.
⦁ Because weight loss is achieved through stomach restriction as well as malabsorption, this surgery typically provides very predictable weight loss with great long-term weight loss maintenance.
⦁ Patients report experiencing significantly less malabsorptive symptoms compared to a standard duodenal switch because the common channel length is almost twice that of a standard DS.