Introduction

Thank you for your interest in the Duke Center for Metabolic and Weight Loss Surgery Center.

Let us begin by stating that serious obesity is a disease. It is not due to any weakness or laziness on your part. Medical research is showing that obesity is a genetic abnormality that is expressed to variable degrees -- even between individuals of the same family. When the genetic abnormality is weakly expressed and obesity is only a mild problem, medical risks are minimal and the multitude of diet programs available are usually effective and satisfactory.

When, however, the genetic abnormality is strongly expressed and weight increases in excess of 100 pounds above one's ideal weight, medical implications become very important with increased risk for cardiac and pulmonary diseases, diabetes mellitus, and most importantly, a 10- to 20-fold increased risk of early death.

For this population of patients, structured dietary programs have universally been unsuccessful. Patients report whatever weight loss occurs to be only followed by weight regain and all efforts are associated with guilt feelings and depression. It is this population of seriously obese patients that weight loss surgery is intended to help.

Current surgical procedures have consistently resulted in 80 to 140 pound weight loss in properly selected patients. As you might expect, such significant weight reduction has a tremendous impact on all aspects of life. As you begin to lose weight, the way you feel about yourself, your family, and friends will all change.

Weight loss surgery, however, cannot accomplish or maintain the necessary weight loss without your cooperation. To accomplish and maintain weight loss after surgery, you must eat less food, change the types of food you eat, and increase your exercise. The operations will create a very small stomach.

Although you might continue to get hungry, one or two bites will satisfy your appetite and make you feel full. You must accept this fact and overcome the urge (habit) to overeat. Once you have recovered from surgery, liquids will not be as effective in satisfying your appetite and you must avoid large amounts of liquid calories.

We currently offer several surgical approaches for the management of obesity: the most common primary procedures are the laparoscopic Roux-en-Y gastric bypass procedure and the laparoscopic adjustable gastric banding procedure.

The Roux-en-Y gastric bypass is recognized as the “gold standard” surgical procedure and is the only procedure to have demonstrated long-term (12+ years) maintenance of weight loss.

The adjustable gastric banding procedure results in less weight loss, requires more frequent office visits for adjustment, and has not yet had long-term follow up. The adjustable gastric banding procedure, however, is a less invasive surgical procedure and is associated with fewer major complications.

Other surgical options include sleeve gastrectomy, which generates weight loss by removing 85 percent of the stomach; and duodenal switch, which alters the digestive process and limits food absorption.

It is very important for you to carefully consider all surgical options and for us to conduct a complete evaluation before surgery to make sure surgery is right for you. This evaluation will include completion a questionnaire, a physical exam, an evaluation by one of our eating disorder psychologists, and a nutritional evaluation.

It is important for you to read and understand the information in this Web site before you make an application to our surgery program. We also encourage you to have your family read this information.

Note: To qualify for insurance coverage, you must have a body mass index of 40 or more or 35 or more with major co-morbidity (such as type 2 diabetes, breathing problems, chronic arthritis pain, high blood pressure, or high cholesterol). Calculate your body mass index before you consult with your physician or insurance company.

Patient Manual Index

• Introduction
• Questions to Ask Your Insurance Company
• Your Health Care Team
• Roux-en-Y Gastric Bypass
• Gastric Banding Procedure
• Sleeve Gastrectomy
• Duodenal Switch
• Revisional Procedures
• Path to Surgery
• The First Clinic Visit
• The Preoperative Surgical Clinic Visit
• The Preoperative Educational Clinic Visit
• Preparation Instructions for Surgery
• Day of Surgery and Postoperative Stay
• Hospital Course Following a Roux-en-Y Gastric Bypass
• Hospital Course Following an Adjustable Gastric Banding Procedure
• Post Surgery Follow-up Care
• Potential Complications of Surgery