Treatment Options at New Image Bariatric Surgical Associates in Riverside, California

The Operations
Procedures we do not perform
Am I a Candidate for Surgery?
Surgery Approval Process
Benefits and Expectations of Obesity Surgery

The Operations

There are several bariatric surgery options available today. Dr. Coon primarily performs laparoscopic Roux-en-Y gastric bypass surgery and LAP-BAND® surgery. He also performs revisional bariatric surgery for some patients. Read below for more information about your treatment options and the surgery approval process. For detailed information about weight loss surgery, visit our Patient Resources page.

Roux-en-Y Gastric Bypass Surgery

Gastric Bypass Surgery is a procedure that involves stapling the stomach to create a small stomach pouch. The pouch is then connected to the lower part of the small intestine. This means that food bypasses much of the stomach and intestine as it moves through the digestive system. Gastric bypass surgery helps patients lose large amounts of weight because it not only restricts how much they can eat, but also limits absorption of some calories.

Proximal vs. Distal Gastric Bypass Surgery

Proximal Gastric Bypass Roux-en-Y is considered an excellent operation for weight loss. However, it allows for some weight regain over the first five years after surgery. Extended (Distal) Gastric Bypass Roux-en-Y is similar to Proximal Gastric Bypass Roux-en-Y except that more of the intestine is bypassed. This leads to more permanent weight loss. However, it also requires more attention by the patient to follow-up care. We will discuss both types of surgery when you visit our practice for a consultation.

Open vs. Laparoscopic Gastric Bypass Surgery

At New Image Bariatric, we perform both open and laparoscopic bariatric surgery. The more invasive method, open Roux-en-Y surgery, involves making an incision in the upper abdomen, and performing surgery through that incision. The less invasive approach, laparoscopic Roux-en-Y surgery, involves making five to six very small incisions (1/4 to 1/2 inch long). A small fiber optic tube, connected to a video camera, is then inserted inside the incisions. Dr. Coon performs surgery through the small incisions while viewing the internal organs on a television screen. Laparoscopic surgery can lead to a reduced hospital stay, shorter recovery time, less scarring, and lower risk of hernia than traditional open surgery. Possible complications include bowel obstruction and leaks. Not every patient is a good candidate for laparoscopic surgery. When you visit our practice we can help determine whether laparoscopic or open surgery is right for you.

Laparoscopic Adjustable Gastric Band or Lap-Band®

The Laparoscopic Adjustable Gastric Band or Lap-Band® is basically an inflatable ring/band that encircles the upper most part of the stomach and squeezes it into an hourglass shape. The band can be adjusted to permit food to pass through faster or slower. The upper compartment of the stomach, which has been created by the LapBand®, is much smaller than the rest of the stomach. As such, it will fill up quickly and eliminate the feeling of hunger. One of the great advantages of the Lap-Band is that it is adjustable. This "adjustment" is done in the office and is effective immediately. While weight loss with the Lap-Band® is slower than with a Roux en Y Gastric Bypass, it tends to continue over a longer period of time, often allowing for almost as much ultimate weight loss as the bypass does.

Vertical Banded Gastroplasty

Unlike Gastric Bypass Surgery, Vertical Banded Gastroplasty does not permanently alter the anatomy of the digestive system. When performing this procedure, Dr. Coon staples the upper part of your stomach near the esophagus to create a small pouch. A band is then put in place to restrict access from this small pouch to the rest of the stomach. Food moves slowly from the pouch, causing patients to feel fuller, sooner. While this procedure has proven to be very safe, it does not typically maintain initial weight loss. One main disadvantage is that the band does not prevent patients from consuming unlimited amounts of high calorie beverages. Because it has a much lower success rate than bypass surgery, vertical banded gastroplasty is rarely performed. However, we will perform this operation in a very few carefully selected cases.

Procedures we do not perform

Biliopancreatic Diversion

The Biliopancreatic Diversion and Biliopancreatic Diversion with “Duodenal Switch” are performed by only a few bariatric surgeons. Some people consider these procedures experimental and most insurance companies will not approve them. Time will tell whether the biliopancreatic diversion is an effective operation. Currently it does hold promise and there is a reasonable possibility that we will offer that operation in the future.

Jejunal-ileal Bypass

The Jejunal-ileal Bypass provided for good weight loss but was associated with kidney stones, liver cirrhosis, and premature death. No surgeon has performed this operation for years.

Am I a candidate for surgery?

You may be a candidate for obesity surgery if:

You have a BMI (body mass index) of 40 or more (about 80 pounds overweight for women, 100 pounds overweight for men)
You have a BMI between 35 and 40 and a serious obesity-related disease (such as diabetes, high blood pressure, high serum lipids, high cholesterol, asthma, sleep apnea, GERD, arthritis, or coronary artery disease)
You do not have a history of severe uncontrolled psychiatric problems or addiction to drugs or alcohol
You understand the lifestyle changes that weight loss surgery will require you to make
You have been unsuccessful at losing weight through diet and exercise

Surgery Approval Process

Contact our office

The approval process begins when you first contact our office. At that time, a member of our office staff will talk with you about your obesity and your general health. If your health is reasonably good and you seem to satisfy the criteria for bariatric surgery, we will set up an in-office consultation to discuss surgery in greater detail. If you are suffering from obesity related illnesses, you will not be disqualified from having surgery. In fact, such illnesses may make you an even better candidate for surgery. Before you visit our office, we will ask you to fill out a health questionnaire, which can be found on the patient resources page of this website.

Consultation

At your consultation, you will meet with Dr. Coon to discuss your health, ask questions, and decide if weight loss surgery is a good choice for you. At this time, you will submit your health questionnaire. If you decide to proceed further with the approval process, a program of testing will be undertaken.

Testing

Our practice completes a series of tests to determine the risks and benefits surgery may present to you.

Testing consists of:

A group of lab tests
An EKG
An ultrasound of the gallbladder
In women, an ultrasound of the internal female organs
A chest x-ray
A consultation with a psychologist
Possible consultations with a Cardiologist, an Internal Medicine specialist, a Pulmonary (lung) specialist, and other specialists.

Request Submitted to Insurance Company

After you have undergone testing, we will submit your request for surgery to your insurance company. If we obtain approval for your surgery, we will call you to schedule your pre-op history and physical and your surgery.

If the insurance company disallows your request, we will review the denial so you can appeal to the insurance company to reconsider their decision. Some insurance companies require patients to adhere to a physician-supervised diet for six months to see if it will lead to weight loss. If the diet fails, then they may allow surgery.

Approval for Surgery

Once approval occurs, we will make all efforts to schedule your surgery to meet your needs and desires. Please call and let us know when you have completed all of you pre op testing and consultations so we can check to make sure that we have all necessary documentation.

Benefits and Expectations of Bariatric Surgery

Following surgery, most patients will lose weight for up to about 24 months. Most of the weight loss will occur in the first nine months after surgery. Depending on your operation, you can expect to lose and keep off 60 to 80 percent of your excess weight. Some patients will lose 100 percent of their excess weight. In rare cases, patients will not lose very much weight at all.

Illnesses that can be improved by drastic weight loss include:

Diabetes (both insulin and non-insulin dependent types)
Hypertension (high blood pressure)
Elevated serum lipids and elevated cholesterol
Asthma
Sleep apnea
Heartburn (GERD)
Arthritis
Depression
Coronary Artery Disease

Weight loss surgery is not right for all patients. It is a serious procedure that involves considerable commitment. As with any type of surgery, there is a risk of complications. However, when performed on the right individual, Bariatric Surgery can increase longevity and lead to a better quality of life. Even though Bariatric Surgery may be considered an extreme measure, it has helped many patients beat obesity for life.

Please browse our Life After Surgery page for more about what to expect from surgery. Also visit our Patient Resources page for informational guides about obesity surgery along with weight loss surgery diet plans.