Dan Scott, M.D. Answers Questions On: Bariatric Surgery

One of the difference-making advantages of being a big academic center is that we can and do take a multidisciplinary approach – any specialist a patient might need, we have right here and can easily get. And then, too, our strategy is that we try to really educate, counsel, and follow-up our patients so that they stick with the program even when their body starts adapting to their operation two years or so later. You don’t really find that elsewhere.

All of our patients go to a pre-op and post-op dietary class and meet regularly with our team, including the surgeon, the physician assistant, and the dietitians, and we also host support group meetings.

To have good, long-term results, it definitely takes commitment and a lot of patient compliance. From one angle, surgery is kind of the last resort, and that’s the way I put it, but so many prospective patients are at that point where they desperately need help. So, it’s a drastic step, and we explain it is serious business. It’s surgery, so there are risks, and there are potential complications, but, frankly, it’s also lifesaving.

Bariatric surgeries are proven to extend longevity and to make a significant impact in all of the medical problems that afflict these patients, like hypertension, diabetes, sleep apnea, osteoarthritis, stress incontinence, gastroesophageal reflux disease, fatty liver disease, and hyperlipidemia – and those are just kind of the top problems that we see all the time.

Laparoscopic surgery has really revolutionized the field and gives patients the same effective results as open surgery but with much fewer wound problems such as infections or hernias and much less pain, fewer pulmonary complications, shorter hospital stays, and shorter intervals before they can return to work and full activities. And so because of that we really try to do the procedures laparoscopically whenever it’s feasible. Very rarely do we have to do open operations because we’ve got the tools and the teams to facilitate these advanced procedures.

One simple exception is when patients have had many prior operations, which sometimes makes an open procedure preferable. I’m particularly interested in helping obese people with hernias, and sometimes I might do open procedures with those – performing first the weight-loss surgery and then coming back for the second stage six months later and doing the hernia repair. It’s kind of a niche offering.