Weight Loss Surgery

Weight Loss Surgery at Community Hospital Monterey Peninsula
Community Hospital of the Monterey Peninsula, along with Monterey County Surgical Associates and Dr. Steven Chang and Dr. Mark Vierra are all recognized as being a part of the Bariatric Surgery Center of Excellence in 2006 — one of the first on the West Coast.  Our program was established by Dr. Mark Vierra, MD, FACS, who started the Obesity Surgery program at Stanford in 1991 and directed the program there until he moved to Monterey in September of 2001. With over 20 years of experience in bariatric surgery, Dr. Vierra is among the most experienced bariatric surgeons in the US.
Dr. Vierra and Dr. Chang, with the help of the dedicated PA, Deirdre Hamilton, perform gastric bypass, sleeve gastrectomy, and laparoscopic adjustable band surgery and provide continuous coverage for these patients within our group.  As of January 2015 we have performed >2000 weight loss operations at Community Hospital and have some of the best safety experience anywhere.

Who Are We?
chang stevenSteven Chang M.D. is a graduate of University of California, Irvine and Northeast Ohio Medical University and completed his residency in General Surgery at Santa Barbara Cottage Hospital 2013.
Following residency he completed a fellowship in Minimally Invasive / Bariatric Surgery at University of California, San Francisco-Fresno and is Board Certified in General Surgery. He is a member of the American Society of Metabolic and Bariatric Surgery, and he is the Director of the Bariatric Surgery program at Community Hospital of the Monterey Peninsula.

Mark Vierra MDMark Vierra, MD has performed weight loss surgery for over 20 years.  He started the weight loss surgery program at Stanford in 1991 and directed the program until 2001, when he left Stanford to start the program at Community Hospital.  In the mid-1990s he was one of the first surgeons in the US to perform laparoscopic weight loss surgery.  He is a member of the American Society of Metabolic and Bariatric Surgery, and the Surgical Society of the Alimentary Tract.


Michael Lurie MD

Mike Lurie, MD has performed and assisted > 1200 weight loss operations since the program was started at Community Hospital in 2001.  He has a special interest in pediatric surgery and laparoscopic surgery, and he helps to provide coverage for the weight loss surgery patients.

 


Deirdre HamiltonDeirdre Hamilton, PA has been a Physician’s Assistant for > 20 years and she has dedicated her practice to weight loss surgery since 2005, when she directed a large weight loss surgery practice in New York.  She joined our practice in January of 2010.

 

 

Our program consists of surgeons, nurses, anesthesiologists, psychologists and psychiatrists, dietitians, physical therapists, insurance authorization specialists, and the many patients who participate in our support groups.

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 2 associated serious obesity related conditions such as diabetes, sleep apnea, severe degenerative joint disease.
  • BMI > 40 without requirement of obesity related medical condition.
The operation should be performed in a center with a multidisciplinary program that includes the expertise and experience of surgeons, anesthesiologists, dietitians, psychologists, physical therapists, and the backup of specialists including but not limited to cardiologists, pulmonologists, gastroenterologists, and intensivists.
Hear more about this surgery from one of our patients.
How do I go about being evaluated for 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 informational meeting presented by Dr. Vierra that is given 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, you can review a much drier version of the lecture in our office by DVD, but this is not nearly as useful.
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. Click here to go to our Lecture calendar.
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.
How long does the 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 long time to get them in shape to safely undergo surgery.  Some patients may not be certain they want to proceed, and will “kick 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.  We have worked with some patients for years before they were ready for surgery.
What operations do you perform?
We perform only the Roux Y Gastric Bypass, Lap Band procedures, and sleeve gastrectomy, and of course revisional surgery.   We can perform these by open or laparoscopic surgery, but in practice > 98% of our operations are performed by laparoscopy.  Dr. Vierra was among the first surgeons in the world to perform laparoscopic weight loss surgery, and in his practice conversion to laparotomy occurs in < 1/500 cases.
We do not perform the Duodenal Switch procedure, Pancreaticobiliary bypass (Scopinaro Procedure) or Distal Gastric Bypass procedures.
Does insurance cover the surgery?
In general, most of the major insurers cover weight loss surgery, though often with restrictions.  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.  For the most part, Blue Cross, Blue Shield, Medicare, Aetna, Cigna, UHC and most major carriers do cover weight loss surgery but within these plans there may be exclusions or special requirements.
How do I decide between a laparoscopic roux en y gastric bypass, sleeve gastrectomy and Lap Band?
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.
Gastric Bypass Sleeve Gastrectomy Lap Band
Roux-en-Y stomach surgery for weight loss

Performed worldwide for over 30 years, it is the most commonly performed operation for weight loss in the United States today.
Performed as a primary weight loss operation for only about the last 10 years, it is the surgical option with the least track record, but based on experience with other weight loss operations there is reason to believe that long-term durability will have some of the same advantages — and disadvantes — of many other weight loss procedures. Adjustable gastric banding

Performed for approximately 20 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 > 350,000 bands placed worldwide.
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). Stomach is divided to make a long, narrow tube about the size of a slender banana.  The stomach volume, therefore is smaller, and food empties into the small intestine more quickly.  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 probably comparable, though perhaps not quite as good as with gastric bypass.  Most weight loss occurs within first year after surgery. Weight loss slower but may continue for 3 or even more years postoperatively.
Quicker and most reliable resolution or improvement in diabetes. Resolution of diabetes between that of Bypass and Band. Slower improvement in diabetes and generally not as reliable as with bypass.
Riskier surgical procedure; complications may be catastrophic. Riskier surgical procedure; complications may be catastrophic, but may be easier in high risk patient than bypass.

Lowest longterm complication rate of any procedure, however.
Fewer risks associated with the surgery, itself, though they may occur even years later, and in many series the cumulative risk of complications may be higher than with the other procedures.
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. Risk of same nutritional deficiencies as with bypass, but risks not as great. Nutritional deficiencies very uncommon.
Operation not adjustable.  Reversal can be performed, but requires extensive surgery.  No foreign body remaining inside the body. Not reversible, as part of stomach has been removed, and revision requires major surgery. Operation is adjustable, and generally reversible, though reversal requires surgery.
Long term follow up with surgeon is mandatory. 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). Being covered by more insurance companies, though insurance coverage least of all procedures. Covered by most insurances, including Medicare (Medicare and Tricare can only be cared for at Centers of Excellence).
To Find your BMI:  BMI Calculator.
Weight Loss Surgery and Support Groups 2013
All lectures and meetings are held at Community Hospital of the Monterey Peninsula (CHOMP).  They are not held at our office.  All are free and opened to the public. Family members are encouraged to attend.
For a calendar of lectures and support groups go to:
Weight Loss Surgery Lecture and Support Group Calendar
Weight Loss Surgery Informational Seminar — for everyone.
When:  First Thursday of the month (except July — second Thursday)
Time: 7-8:30 p.m.
Where:  CHOMP CONFERENCE ROOM A/B/C.
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. This class is also a good refresher for post op patients!
Jan 2
Feb 6
March 6
April 3
May 1
June 5
July 10
Aug 7
Sept 4
Oct 2
Nov 6
Dec 4
Basic Support Group — for everyone.
When:  Every second Thursday of the month.
Time:  6:30-8:30
Where:  CHOMP CONFERENCE ROOM A/B/C.
Led by a Registered Dietician from CHOMP, this group focuses on patients considering surgery and who are recently had surgery.  It is strongly recommended but not required for all patients who are considering weight loss surgery. Pre operative, post operative patients and family members for all procedures welcomed. This CAN be part of your “Supervised diet”.
Jan 9
Feb 13
March 13
April 10
May 8
June 12
July 10
Aug 14
Sept 11
Oct 9
Nov 13
Dec 11
Advanced Weight Loss Surgery Support Group — for Gastric Bypass and Sleeve
When:  4th Monday of the month at CHOMP
Time:  6:30-8:30
Where:  Cancer Center Classroom
Led by a Registered Dietician from CHOMP, this group focuses on patients who have already had surgery and are at least one year out from surgery for gastric bypass and gastric sleeve.
Jan 27
Feb 24
March 24
April 28
May 19
June 23
July 28
Aug 25
Sept 22
Oct 27
Nov 24
Dec:  No meeting
Lap Band Support Group
When:  Fourth Thursday of each month at CHOMP
When:  7:00-8:30
Where:  Radiology Conference Room
Led by D Hamilton RPA-C, this support group meeting is for Post operative patients with adjustable gastric bands (Lapband and Realize.) Meetings include peer to peer support with professional guidance and education for the Banded lifestyle and meeting weight loss goals after surgery.
Jan 23
Feb 27
March 27
April 24
May 22
June 26
July 24
Aug 28
Sept 25
Oct 23
Nov — To Be Announced – please call our office.
Dec To Be Announced – please call our office.
Back On Track:  Re-engaging after weight loss surgery
When:  Fourth Saturday of each month
When:  10:00-11:30
Where:  CHOMP Conference Rooms A/B. YOU MUST RSVP to 831-649-0808
Postoperative lecture series given by D Hamilton RPA-C. Topics vary but are intended to help patients re-engage in the weight loss process if they have drifted off.  Intended to help us get back the basics and use our tools effectively.  Seating is limited please call to reserve space 831-649-0808 or email us at DrVierrasoffice@monterysurgery.com.
Meetings are also posted on www.montereysurgery.com, www.CHOMP.org andwww.LAPBAND.com.
Community Hospital location: 23625 Holman Highway Monterey, CA 93940-5902 From Hyw 1 SOUTH from Monterey, take exit 399A, exit Right, hospital is on Right in .2 miles. 24 hour phone (831) 624-5311
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