Monterey County Surgical Associates

Sugical Services We Provide

Obesity Surgery
In conjunction with Community Hospital of the Monterey Peninsula we are a Center of Excellence Bariatric Surgical Program offering weight loss surgery since 2001.

Our program was established by Dr. Mark Vierra, MD, FACS, who directed the obesity surgery program at Stanford for over a decade until he moved to Monterey in September of 2001.

Dr. Vierra and Dr. Lurie together perform laparoscopic gastric bypass and laparoscopic adjustable gastric banding and provide continuous coverage for these patients within our group. As of January 2007 we have performed nearly 700 weight loss operations at Community Hospital and have some of the strongest safety experience anywhere.

What is a Center of Excellence?
Community Hospital was established as a Center of Excellence by the Surgical Review Corporation in 2006, among the first on the West Coast to receive this designation. This organization is an offshoot of the American Society for Bariatric Surgery, the major professional society representing surgeons and patients involved in weight loss surgery. Only hospitals, surgeons, and practices with this designation can care for Medicare patients.

This designation, “Center of Excellence,” is not to be confused with what insurance companies have referred to as “Centers of Expertise.” These Centers of Expertise have been designated because they are willing to provide deep discounts to insurers such as Blue Cross. It is hoped that the terms “Centers of Excellence” and “Centers of Expertise” sound close enough to one another to confuse the public, but the terms do not imply the same meaning, at all.

To go the Center of Excellence website follow this link: http://www.asbs.org/html/excellence.html

Links:
BMI Calculator
American Society of Bariatric Surgery
SAGES
Lap Band site

Frequently Asked Questions:

Who is a candidate for weight loss surgery?
How do I go about being evaluated if I am interested in weight loss surgery?
How long does the whole process take?
What operations do you perform?
Does insurance cover the surgery?
How do I decide between a laparoscopic gastric bypass and a laparoscopic adjustable gastric band (Lap Band TM)?
How do I calculate my BMI?
Weight loss surgery introductory lecture calendar.
Weight loss surgery support group calendar.

Who is a candidate for weight loss surgery?
Different insurance programs may have different criteria, but in general, it is recognized that surgery should be considered for highly motivated, well informed patients who have made honest attempts to control their weight with diet and exercise if the meet the following criteria:

BMI > 35 with associated serious obesity related medical condition such as diabetes, sleep apnea, severe degenerative joint disease.
BMI > 40 without requirement of obesity related medical condition.
*Find your BMI

The operation should be performed in a center with a multidisciplinary program that includes the expertise and experience of surgeons, anesthesiologists, dieticians, psychologists, physical therapists, and the backup of specialists including but not limited to cardiologists, pulmonologists, gastroenterologists, and intensivists.

How do I go about being evaluated if I am interested in weight loss surgery?
In general we ask that patients be referred by a primary care physician. If you do not have one, we can assist you with recommendations for a local physician.

Everyone is then asked to attend a lecture that we give one evening each month that outlines the medical reasons for obesity, the rationale for treatment, and the surgical options. It is free and open to the public, and family members are encouraged to attend, as well. Most people find this lecture enormously helpful, as it presents the scientific basis for a problem that is often oversimplified. Alternatively, we hope to soon have a place at the hospital where patients can view a DVD of the lecture.

At the lecture you will be given an information packet that includes a health questionnaire and a dietary diary. These should be completed prior to your first visit with us.

After the lecture or you have viewed the DVD we will make you an appointment to be seen in the surgical clinic where we will initiate the evaluation, schedule consultations as needed, and address insurance issues as needed.
Click here to go to our Lecture calendar.

How long does the whole process take?
The short answer is 5 years – that is, we consider this a process only one part of which is surgery itself. We don’t take a full breath until you are five years out from surgery, and we consider good follow up and availability to our patients to be essential to optimal outcomes.

The process from your first visit with us to surgery can be as little as one month in some instances. Some patients may be so ill that we may have to work with them for a prolonged period in order to get them in shape to safely undergo surgery. Some patients may not be certain they want to proceed, and will “kid the tires,” try a few more diets, and then return to us. On occasion, insurance issues may require postponement of surgery. In general we would like the entire process to take place within 3 months but this is not always possible, and we are perfectly happy to take as much time with you as you need, and as we need to make the operation safe and effective.

What operations do you perform?
We perform only the Roux Y Gastric Bypass and Lap Band procedures. We can perform these by open or laparoscopic surgery, but in practice > 98% of our operations are performed by laparoscopy.

We do not perform the Duodenal Switch procedure, Pancreaticobiliary bypass (Scopinaro Procedure) or Distal Gastric Bypass procedures.

Does insurance cover the surgery?
Does insurance cover anything?

In general, most of the major insurers cover weight loss surgery, though often with restrictions that are clearly intended to make the surgery as difficult as possible to obtain. We can help you to understand this process, but it will be important for you to check with your Benefits representative about the details or your specific plan.

How do I decide between a laparoscopic gastric bypass and a laparoscopic adjustable gastric band (Lap Band TM)?
There is no easy answer to this question. We can help you make the decision, or even make it for you, if you would like. Rarely, however, will we insist on one or the other operation for you. Below is a brief summary of the two procedures.

Laparoscopic Gastric Bypass (Roux en Y)	Laparoscopic Adjustable Gastric Band (Lap Band TM)

Performed worldwide for over 30 years, it is the most commonly performed operation for weight loss in the United States today.	Performed for approximately 15 years, though the modern bands are far superior to earlier bands. Approved for use by the FDA for use in the United States in 2001, there have been > 250,000 bands placed worldwide and it is currently the most commonly performed weight loss procedure worldwide outside of the United States.
Operation involves stapling to divide the stomach and small intestine, and attachment of the small intestine to a very small upper gastric pouch. Food now bypasses the main body of the stomach and goes directly into small intestine. Operation probably works by a combination of restriction of how much patients can eat comfortably and by producing hormonal changes that may blunt hunger, as well as inducing a feeling of satiety (fullness).	Operation involves placement of an inflatable silicone band around the upper stomach. This is attached by a long, slender tube to a small port which is buried beneath the skin. A thin needle can be introduced into the port and used to inject fluid into the band, or deflate it, making the opening from the pouch larger, or smaller, as needed until a sense of fullness is appreciated. Appears to work by inducing a feeling of satiety (fullness).
Weight loss generally very good, and is complete within 12-18 months of surgery.	Weight loss slower but may continue for 3 or even more years postoperatively.
Quicker resolution or improvement in diabetes.	Slower improvement in diabetes but longterm outcomes may be similar.
Riskier surgical procedure; complications may be catastrophic.	Fewer risks associated with the surgery, itself, though they may occur even years later.
Iron, calcium and some vitamins not as easily absorbed; can lead to nutritional deficiencies if not supplemented but these are generally avoidable and not common.	Nutritional deficiencies very uncommon.
Operation not adjustable. Reversal can be performed, but requires extensive surgery. No foreign body remaining inside the body.	Operation is adjustable. The band can be deflated allowing unrestricted eating almost immediately; removal (reversal) is generally a much less extensive process. Mechanical device remains around the stomach forever.
Long term follow up with surgeon is mandatory.	Long term follow up with surgeon is mandatory. Quality and intensity of follow up may impact quality of weight loss more than with gastric bypass.
Covered by most insurances, including Medicare (Medicare and Tricare can only be cared for at Centers of Excellence).	Covered by most insurances, including Medicare (Medicare and Tricare can only be cared for at Centers of Excellence).

To find your BMI:
Find your height in inches in the first column and locate the BMI across the top which corresponds to your weight in pounds.

You may also use this BMI Calculator.

BMI	36	37	38	39	40	41	42	43	44	45	46	47	48	49	50	51	52	53	54
Ht (in)	172	177	181	186	191	196	201	205	210	215	220	224	229	234	239	244	248	253	258
59	178	183	188	193	198	203	208	212	217	222	227	232	237	242	247	252	257	262	267
60	184	189	194	199	204	209	215	220	225	230	235	240	245	250	255	261	266	271	276
61	190	195	201	206	211	217	222	227	232	238	243	248	254	259	264	269	275	280	285
62	196	202	207	213	218	224	229	235	240	246	251	256	262	267	273	278	284	289	295
63	203	208	214	220	225	231	237	242	248	254	259	265	270	278	282	287	293	299	304
64	209	215	221	227	232	238	244	250	256	262	267	273	279	285	291	296	302	308	314
65	216	222	228	234	240	246	252	258	264	270	276	282	288	294	300	306	312	318	324
66	223	229	235	241	247	253	260	266	272	278	284	291	297	303	309	315	322	328	334
67	230	236	242	249	255	261	268	274	280	287	293	299	306	312	319	325	331	338	344
68	236	243	249	256	262	269	276	282	289	295	302	308	315	322	328	335	341	348	354
69	243	250	257	263	270	277	284	291	297	304	311	318	324	331	338	345	351	358	365
70	250	257	264	271	278	285	292	299	306	313	320	327	334	341	348	355	362	369	376
71	257	265	272	279	286	293	301	308	315	322	329	338	343	351	358	365	372	379	386
72	265	272	279	287	294	302	309	316	324	331	338	346	353	361	368	375	383	390	397
73	272	280	288	295	302	310	318	325	333	340	348	355	363	371	378	386	393	401	408
74	280	287	295	303	311	319	326	334	342	350	358	365	373	381	389	396	404	412	420
75	287	295	303	311	319	327	335	343	351	359	367	375	383	391	399	407	415	423	431
76	295	304	312	320	328	336	344	353	361	369	377	385	394	402	410	418	426	435	443

Weight Loss Surgery Lectures and Support Groups, 2008

All lectures and meetings are held in Conference Rooms A. and B. above the Diagnostic Center. All are free and opened to the public, and family members are welcome.

WEIGHT LOSS SURGERY LECTURE.

Time: 7-8:30 p.m.

This lecture is given by Dr. Mark Vierra. All patients wishing to be considered for weight loss surgery should attend this meeting prior to making an appointment to be considered for surgery. Topics include the biological basis for obesity, a review of strategies for weight loss, surgical options, outcomes and complications. Family members are encouraged to attend.

February 13	February 20	March 6	April 3	May 1	June 5
July 3	August 7	September 4	October 2	November 6	December 4

WEIGHT LOSS SURGERY SUPPORT GROUP.

Time: 6:30-8:30 p.m. every second Thursday of the month

Led by a Registered Dietician from Community Hospital of the Monterey Peninsula, this group focuses on patients considering surgery and who are recently postop. It is strongly recommended but not required for all patients who are considering weight loss surgery.

January 17	February 14	March 13	April 10	May 8	June 12
July 10	August 14	September 11	October 9	November 13	December 11

ADVANCED WEIGHT LOSS SURGERY SUPPORT GROUP.

Time 6:30-8:30 p.m. every fourth Wednesday of the month.

Led by a Registered Dietician from Community Hospital of the Monterey Peninsula, this group focuses on patients who have already had surgery and are typically months to years out from surgery. Other patients are always welcome to attend, however.

January 23	February 27	March 26	April 23	May 28	June 25
July 23	August 27	September 24	October 22	November 19