Monterey Surgery
 
Surgical 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 2010 we have performed > 1000 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 Metabolic and Bariatric Surgery (www.asmbs.org), 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.surgicalreview.org/locate.aspx


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


 Frequently Asked Questions:

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.
*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 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, 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. 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 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 “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.


What operations do you perform?
We perform only the Roux Y Gastric Bypass, Lap Band procedures, and sleeve gastrectomy.   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 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 > 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, 2010

All lectures and meetings are held at the Community Hospital of the Monterey Peninsula in Conference Rooms A. and B. above the Diagnostic Center.  All are free and open to the public. Family members are welcome.

WEIGHT LOSS SURGERY INFORMATIONAL MEETING.
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.

January 14 February 4 March 4 April 1 May 6 June 3
July 1 August 5 September 2 October7 November 4 December 2

WEIGHT LOSS SURGERY SUPPORT GROUP.
Time: 6:00-8:00 p.m. every second Thursday of the month
Led by a Registered Dietitian from Community Hospital of the Monterey Peninsula, this group focuses on patients considering surgery and who recently had surgery.  It is strongly recommended but not required for all patients who are considering weight loss surgery.

January 21 February 11 March 11 April 8 May 13 June 10
July 8 August 12 September 9 October 14 November 11 December 9

ADVANCED WEIGHT LOSS SURGERY SUPPORT GROUP.
Time 6:30-8:30 p.m. every fourth Wednesday of the month.
Led by a Registered Dietitian from Community Hospital of the Monterey Peninsula, this group focuses on patients who have already had surgery and are at least one-year out from surgery.

January 27 February 24 March 24 April 21 May 26 June 23
July 28 August 25 September 22 October 27 November 17  off
©2008 Montery County Surgical Associates