Bariatric Surgery

(Gastric Bypass, Lap Band Surgery, or Sleeve Surgery)

There has been a dramatic increase in recent years in the number of individuals who are considered to be morbidly obese. The National Institutes of Health definition of morbid obesity is a body mass index (BMI) of 35-40 with co-morbid conditions, or a BMI over 40 even without other conditions. Co-morbid conditions include diabetes, hypertension, sleep apnea, and arthritic conditions in weight-bearing joints.

The guidelines established by the NIH indicate that morbidly obese individuals may be candidates for bariatric surgery. The three types of bariatric surgery most commonly used in the United States are gastric bypass and vertical banded gastroplasty (lap band)or sleeve surgery.

In gastric bypass surgery, the surgeon creates a small pouch at the top of the stomach, using a stapling device. The small intestine is then divided and a limb of the small intestine is brought up to the stomach pouch so that the food comes down the esophagus, transiently goes into the small pouch, and then goes into the small intestine, where it mixes with bile and pancreatic juices so that the food can be properly absorbed and digested. Candidates who are deemed eligible have laporoscopic surgery, whereby small incisions are made in the midline area, long instruments are inserted, and a miniature TV camera guides the surgery.

In the vertical banded gastroplasty (lap band surgery), the surgeon makes a small pouch out of the bottom part of the esophagus and the upper part of the stomach, then restricts the outlet of the pouch so that everything one eats has to go through an opening the size of a toothpaste tube before it can go on to the rest of one’s intestinal tract. The banding is adjustable and even reversible.

Surgeons performing bariatric surgery ask their patients to go through a number of tests and to consult a dietician, a nutritionist, and a mental health professional prior to scheduling the surgery. The mental health professional interviews the prospective patient, ideally after he/she has undergone the testing and consulted with the other professionals. The mental health professional assesses the patient’s readiness for the surgery, taking into account the patient’s specific reasons for requesting the surgery, his/her working understanding of the nature of the surgery and awareness of the specific risks of the surgery, the nature of the patient’s support network, and his/her preparation to commit to the major lifestyle changes necessary to maintain the weight loss and proper health following the surgery.

Dr. Silikovitz consults with a number of surgeons in the New Jersey – New York area and performs pre-surgery psychological evaluations culminating in written reports. He charges a fee for this service and assists the patients in obtaining reimbursement from their major medical insurance carriers. To schedule a pre-surgery psychological evaluation, please contact Dr. Silikovitz.