Roux-en-Y Gastric BypassRoux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption. During the procedure, the surgeon creates a smaller stomach pouch. The surgeon then attaches a Y-shaped section of the small intestine directly to the pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.
Gastric banding is a restrictive surgical procedure. During this procedure, two medical devices are implanted in the patient: a silicone band and an injection port. The silicone band is placed around the upper part of the stomach and molds the stomach into two connected chambers. The injection port is attached to the abdominal wall, underneath the skin. The port is connected to the band with soft, thin tubing.
Sleeve gastrectomy is a restrictive bariatric surgery. During this procedure, the surgeon creates a small, sleeve-shaped stomach. It is larger than the stomach pouch created during Roux-en-Y bypass—and is about the size of a banana.
- Program offers board-certified surgeons who specialize in bariatric surgery
- A multidisciplinary team addresses all aspects of weight loss: physicians, surgeons, nurses, dietitians, health educators, and fitness experts specializing in bariatric patient care
- Medically monitored to ensure safe and effective weight loss
- A recovery team, trained in the specialized needs of bariatric patients, is available on a highly skilled nursing unit that features private rooms
- One point of contact – our nurse navigators will help “navigate” you through the entire process – from insurance approvals to pre- and post-surgery appointments to long-term maintenance support
- All surgeries are minimally invasive laparoscopic procedures, meaning less pain and scarring and a quicker recovery
- Collaborations with other specialties, including cardiology, internal medicine, psychology, psychiatry, and pulmonary medicine to ensure the full-continuum of care
- Bi-Monthly educational seminars for program candidates
- Monthly post-operative patient support groups
- Long-term patient follow-up, with educational and nutritional support
Meet Our Bariatric Surgeons
Dr. Michael Hovey
performs adjustable gastric banding, Roux-en-Y gastric bypass surgery
and the sleeve gastrectomy.
Dr. Kalyana C. Nandipati
is specially trained in foregut and bariatric surgery, general surgery,
minimally invasive solid organ surgery (adrenals, spleen and pancreas)
and gastrointestinal laparoscopic procedures. He also has expertise in
single incision laparoscopic procedures (SILS).
Dr. Pradeep K. Pallati
joined Alegent Creighton Clinic as a general
surgeon in the Department of Surgery. He also serves as an instructor
of surgery at Creighton University School of Medicine. His clinical interests
include advanced minimally invasive surgical techniques, robotics and
bariatric surgery. Dr. Pallati earned his bachelor of medicine and bachelor
of surgery degree in 2001 at Osmania Medical College, NTR University of
Health Sciences in Hyderabad, India. He completed surgery residencies
at All India Institute of Medical Sciences in New Delhi, India in 2005
and Creighton University Medical Center in 2011.
|Dr. Thomas White
performs adjustable gastric banding, Roux-en-Y gastric bypass surgery and
the sleeve gastrectomy.
Dr. White was born and raised in Milford Nebraska. He obtained his undergraduate degree from Nebraska Wesleyan University in Lincoln, Nebraska in 1986.
His medical training includes a medical doctor degree from the University Of Nebraska Medical Center in Omaha, Nebraska. After graduating from medical school in 1990, Dr. White completed a general surgery residency in 1995.
Alegent Creighton Health Immanuel Medical Center has been named a Fully Accredited MBSAQIP (Metabolic and Bariatric Surgery Accredited Quality Improvement Program) by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). The MBSAQIP Accreditation recognizes surgical programs with a demonstrated track record of favorable outcomes and a complication rate of less than one percent in bariatric surgery.
The ASMBS and ACS MBSAQIP was created to recognize bariatric surgery centers that meet the highest standards in the industry and to help surgeons and hospitals continue to improve the quality and safety of care provided. As a fully-accredited program, Alegent Creighton Health Immanuel Medical Center agrees to continue to share information on clinical pathways, protocols and outcomes data.
Alegent Creighton Health Immanuel Medical Center is also recognized as
a CIGNA Certified Hospital for Bariatric Surgery.
Support GroupsOur monthly support groups provide a secure, warm setting for patients undergoing the process of lifetime diet and lifestyle changes that can improve surgery outcomes and are necessary to achieve enduring weight loss.
Support sessions have been shown to directly increase the chances of short- and long-term patient success following bariatric surgery. Regardless of where a person is in relation to the bariatric surgery process—just considering it or at any point prior to or after the weight loss procedure—he or she is welcome to attend the sessions.
Group members, surrounded by people who understand and support their goals, receive up-to-date weight loss information, consider issues in context of the history of obesity, and have the opportunity to discuss personal or professional issues that arise from losing weight. Group members also learn and are given reinforcement for nutrition, exercise, and behavior modification skills.
Bariatric Surgery Support Groups are available at Immanuel Medical Center, Lakeside Hospital, and Mercy Hospital – Council Bluffs. The support group meets monthly with a new topic for education and conversation each session. For more details, please see our schedule.
Understanding Morbid ObesityThe original definition of morbid obesity was any individual who was greater than or equal to twice their ideal body weight, or greater than or equal to 100 pounds above their ideal body weight as determined by the 1983 Height and Weight Standards of the Metropolitan Life Insurance Company. Morbid obesity could also be defined by the amount of total body fat although this value is not easily obtained. Normally 20 to 25 percent of body weight is fat.
The modern definition of obesity is based on body mass index (BMI) as presented
in the Practical Guide to the Identification, Evaluation and Treatment of Overweight
and Obesity in Adults, a joint publication of the National Institutes of Health
National Heart, Lung, and Blood Institute, and the North American Association
for the Study of Obesity.1 Body mass index compares body weight (in kilograms)
to height (in meters) (BMI = weight/height2). "Normal" values are less than
24.9 kg/m2, and "overweight" individuals have a BMI between 25 and 29.9 kg/m2.
"Obese" patients are placed in three classes: Class 1 = BMI 30 to 34.9 kg/m2,
Class 2 = BMI 35 to 39.9 kg/m2, the "Morbidly Obese" Class 3 = BMI 40 to 49.9,
and "Super Obese" BMI > 49.9 kg/m2.
The biological basis for severe obesity remains unknown. Recent investigations, however, have identified multiple abnormal proteins present in the brain and peripheral blood of morbidly obese patients and experimental animals. These proteins, many of which are known to alter appetite, satiety, and energy conservation, are being associated with genetic abnormalities as well. Whatever the final pathogenesis is found to be, it is certain that morbid obesity is truly a disease -- not just a disorder of willpower -- and indeed a most complex disease. At a minimum, contributing causes are inheritance, environmental, cultural, socioeconomic and psychological.
Are You a Candidate for Surgery?
- Adults who have a BMI over 40, thus being greater than 100 pounds overweight.
- Adults with a BMI between 35 and 40, thus being approximately 75 pounds overweight, who have obesity-related medical complications, such as diabetes, heart disease, or sleep apnea.
- Those who have failed to lose weight by non-surgical means (weight loss programs, diets, etc). Some insurance companies may require documentation of participation in at least one weight loss program.
- Those willing to commit to a lifelong change of proper diet, exercise, and medical follow up.
Helpful BenefitsIt’s obvious to many people who have lived with morbid obesity for years that the disease has a severe negative impact on quality of life. Because of morbid obesity, you may choose not to participate in certain activities. You may feel that you have limited career choices. What you may not know is that morbid obesity has been found to affect the quality of your health and the length of your life.1
Morbid obesity has been linked to several serious and life-threatening diseases. These co-morbid conditions include type 2 diabetes, heart disease and high blood pressure, acid reflux/GERD, and cancer. Most of these conditions do not develop for years. So many people living with morbid obesity may have one or more of these health issues without even realizing it.
Bariatric surgery may offer you a whole new outlook on health. One study found that gastric bypass surgery reduced the total number of co-morbid conditions of participating patients by 96%.2 Many surgeons recommended bariatric surgery as a treatment option for type 2 diabetes.3 In some cases, resolution of type 2 diabetes occurred within days of the surgery.1 A meta-analysis stated that several studies found that bariatric surgery patients felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.1
1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A Systematic Review and Meta-Analysis. JAMA 2004;292(14):1724-37.
2. Wittgrove A, Clark G. Laparoscopic Gastric Bypass, Roux-En-Y 500 Patients: Technique and Results, with 3-60 Month Follow-up. Obes Surg 2000 Jun;10(3):233-9.
3. Pories W, Swanson M, Macdonald K, et al. Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Ann Surg 1995;222(3):339-52.
Things to ConsiderCan you comply with the follow up that is required after surgery?
You have to follow the directions of your surgeon, especially diet, exercise, labs and office follow up. Surgery alone will not take care of your weight or health issues. We have an extensive follow-up routine for all our bariatric surgery patients in order to successfully maintainDoes your insurance cover the surgery?
Check with your insurance company and see if bariatric surgery or weight loss surgery is a covered benefit under your policy. If your insurance policy includes a specific exclusion for the surgical treatment of obesity you will not be covered for surgery, no matter your current health issues.
Are you looking to surgery for the right reasons?
Bariatric surgery is NOT done for cosmetic reasons. It is done to improve failing health, and is for those 100 pounds or more overweight. If you meet the medical criteria, you are doing it for health reasons.
Do you have the emotional support you need?
It is crucial that you have a strong support network of family and friends that will be there to help you through the decision making process, and especially as you recover after surgery. We suggest that not only the patient, but also their close friends and family become educated about the risks and benefits of weight loss surgery.