Considering Bariatric Surgery?

By Brian Bollo, MD

Bariatric surgery is a tool for weight loss that can be helpful for people with clinically severe obesity who have developed other health problems related to their weight. A number of obesity-related conditions, such as type 2 diabetes and high blood pressure, often improve following bariatric surgery, enabling patients to discontinue medication.

What should I look for in a bariatric surgery program?

It is important to look for surgeons who have additional surgical training in bariatric procedures. They should be affiliated with a comprehensive hospital-based program that includes nutritionists, nurse practitioners, and lifestyle management experts with experience in bariatric weight loss. Successful weight loss with bariatric surgery requires a strong commitment on the part of the patient and a skilled team of medical experts to provide guidance and support both before and after the surgery.

Will I be asked to lose weight before the surgery?

Everyone has to go through a medically directed weight loss program prior to surgery. Insurance companies may require that you attempt to lose weight, in part to establish your commitment to weight loss. Bariatric surgeons also require preoperative weight loss because it helps make the surgery safer for the patient, and is shown to improve outcomes. The liver, which is located next to the stomach, responds to weight loss by becoming smaller, improving visualization of the operative area.

Is bariatric surgery minimally invasive?

Yes, bariatric surgery is minimally invasive, which means that the surgery is performed through small incisions. We use cameras and specialized instruments to gain access to the stomach and small intestine. The benefit of this approach is less post-operative pain, a shorter hospital stay, and a faster return to your normal activities.

How do I know which bariatric procedure to have performed?

When deciding which bariatric procedure to have, you will need to consider your eating habits, weight loss expectations, medical conditions and your body mass index (BMI). Each procedure has its own safety profile and risks, which your surgeon is happy to discuss with you. The bariatric surgeons at Cayuga Medical Center perform laparoscopic gastric bypass surgery, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy.

Currently, laparoscopic gastric bypass (roux-en-Y) is considered to be the gold standard. It is both restrictive, in that it limits how much you eat, and it decreases absorption of nutrients because parts of your gastrointestinal tract are bypassed. Laparoscopic adjustable gastric banding, also known as the Lap Band, limits the amount you can eat by placing a band at the top of the stomach. This is adjustable after the surgery, which enables your surgeon to optimize the amount of restriction. In the laparoscopic sleeve gastrectomy, the surgeon removes a large portion of the stomach, which restricts the amount of food you can eat, but does not bypass the intestines.

Will my health insurance cover bariatric surgery?

The position of most heath insurance companies is that they will cover bariatric surgery if you have a body mass index (BMI) of 40, or if you have a BMI of 35 or more with obesity-related conditions such as type 2 diabetes, elevated blood pressure, heart disease, or sleep apnea. BMI is calculated from your height and weight and is a useful way to identify weight problems.

Dr. Bollo is board certified in general surgery and has fellowship training in minimally invasive and bariatric surgery. He is on staff at Cayuga Medical Center and can be reached at Surgical Associates of Ithaca at (607) 273-3161. To learn more about bariatric surgery, visit

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