How would you describe bariatric treatment?
I like to explain it as a three-legged stool, which includes diet, exercise and surgery. The aim isn’t just weight loss, but better overall health allowing patients to live a life where they’re unencumbered by some of the physical issues they have. I always set clear expectations that surgery is not a cure-all.
Do bariatric patients have options other than surgery?
It’s important to note that we don’t just rush off to surgery as a primary solution to any chronic illness or weight issue. There’s a process where patients meet with dietitians, mental health professionals and their primary care doctors. We’ve had success with weight management clinics and working on diet and exercise programs.
What advice would you give someone who is anxious about having surgery?
I would encourage them not to diminish those feelings of anxiety, but I would reassure them they’re in capable hands. It’s not just me; I’m surrounded by a team whose goal is to treat them to the best of our abilities.
Who is a candidate for bariatric surgery?
An indication of someone being a good candidate for bariatric surgery is someone with a BMI, or body mass index, over 35, or a BMI over 30 with comorbidities associated with their obesity.
What is the most common procedure you perform?
Sleeve gastrectomies are the most common procedure I do. The sleeve gastrectomy seems to have fewer side effects; there are certain complications with a gastric bypass that I don’t necessarily see with sleeve gastrectomies. Patients with a BMI over 50 might be better served by a Roux-en-Y gastric bypass, but for most patients sleeve gastrectomy is a good option.
Do patients undergo bariatric surgery for reasons other than weight loss?
I always tell patients the number on the scale is not the goal. The goal is how you feel when you wake up in the morning, being able to do the activities that you want to do and lead a healthy life for years to come. We can also look to reduce high blood pressure, hypertension, heart disease, lung disease and diabetes in addition to weight loss.
What is the da Vinci roboticassisted surgery system?
It’s a system which takes the principles of standard laparoscopic surgery and applies them to a totally different platform. It allows us as surgeons to have the same functional mechanics of motion with our hands but miniaturized to a tenth of the size. It also lets us have greater visibility of tissue, which increases our ability to offer minimally invasive care.
How does the use of robotic technology assist in bariatric surgery?
The increased visualization, greater ergonomics and functionality in terms of fine motor skills enable me to perform procedures as effective as open surgery while offering a minimally invasive procedure. I’ve seen an improvement in patient outcomes including less pain and quicker healing times.
What do you want patients to know about robotic technology when considering surgery?
It’s a common misconception that it’s the robot performing the procedure, and that is not the case at all. All the procedures are performed by a surgeon sitting at the console. I tell patients that the da Vinci is simply another tool at our disposal, like a scalpel or hemostat. This is a time-tested and proven technology that’s been shown to be a benefit for patients.
What lifestyle changes can patients expect after surgery?
Most of the lifestyle changes center around diet and exercise. Some patients have difficulties with exercise because of excess weight; hopefully in three to six months after surgery they lose that weight and can keep it off because of less joint pain and greater ability to exercise. Restrictive surgery decreases the amount of food you can take in, which leads to smaller meal sizes; I give patients expectations that meals will go from a large plate to a little bigger than a walnut at first.
What are the most common complications you see? How can patients prevent them?
There is always risk in surgery, but we reduce complications by making sure patients don’t have a hiatal hernia or significant reflux disease, for example. We also see a lesser risk profile with the sleeve gastrectomy, which is why I favor that procedure. Patients also need to know that if they don’t make changes in diet and exercise, they can regain weight after initial success in losing it.
David Fromm, M.D. General Surgeon Monument Health Rapid City Clinic A da Vinci robotictrained general surgeon who provides a variety of surgeries including hernia repair, bariatric and metabolic surgery.
Irony C. Sade, M.D. General Surgeon Monument Health Rapid City Clinic A da Vinci robotictrained general surgeon specializing in a variety of robotic surgeries including bariatric, hernia and antireflux, in addition to other open and laparoscopic procedures.
Andrew VanOsdol, M.D. General Surgeon Monument Health Spearfish Clinic A fellowship-trained bariatric surgeon who focuses on minimally invasive diaphragmatic hernia, anti-reflux and bariatric surgery.
Jacob Weasel, M.D. General Surgeon Monument Health Rapid City Clinic A da Vinci robotictrained general surgeon who provides a variety of surgeries including thyroid and parathyroid, gallbladder removal and bariatric.
To learn more about bariatric surgery options at Monument Health, visit www.monument.health/services/bariatrics.
