Dr. Buchin is a leader in weight-loss treatments for the New York metropolitan area, specializing in revisional bariatric surgery, vertical sleeve gastrectomy, gastric bypass and more.
Bariatric surgery has come a long way since its inception in the 1950s, becoming more widely accepted among patient populations and the medical community at large. With obesity and extreme obesity on the rise in the United States since 1980, according to the U.S. Department of Health and Human Services, new weight-loss treatments and bariatric surgical techniques have been introduced to better care for patients who are trying to reach a healthier weight.
“People who have a BMI of 35 with comorbidities or those with a BMI of 40 or greater should definitely look into bariatric surgery and other treatment options,” Dr. Buchin says. “Minimally invasive laparoscopic surgery has allowed for huge advancements in the field, with less pain, smaller incisions and shorter recovery times for patients.”
Sleeve Gastrectomy and Gastric Bypass
Dr. Buchin introduces new technologies and procedures to his Long Island practice in order to bring more treatment options to people within the New York metropolitan community. All of Dr. Buchin’s surgeries are performed laparoscopically, and vertical sleeve gastrectomy is the most popular surgical procedure among his patients. Dr. Buchin was the first bariatric surgeon on Long Island to perform this procedure.
David Buchin, MD, FACS, FASMBS, performs biannual follow up with patients for continued support.
“Sleeve gastrectomy is the top bariatric surgical procedure in the country,” Dr. Buchin says. “It’s a very simple operation that can help the average patient lose around 75 percent of his or her excess weight.”
The Vertical Sleeve Gastrectomy decreases the size of the stomach, which makes patients feel full sooner. The procedure also decreases the amount of ghrelin in the body, a product of the gastric fundus of the stomach, which is removed in the procedure. Ghrelin is a hormone that serves as an appetite stimulant and reduces fat utilization in individuals.
Another benefit of sleeve gastrectomy is that it leads to fewer complications involving nutrient malabsorption and vitamin deficiency in patients as compared to other bariatric procedures.
“Sleeve gastrectomies are as effective as gastric bypass surgery in terms of controlling comorbidities like diabetes, high blood pressure, high cholesterol and sleep apnea, but is as easy to perform as the LAP-BAND procedure,” Dr. Buchin says. “Meanwhile, LAP-BAND procedures are increasingly recognized by surgeons as treatments that are not particularly effective.”
While sleeve gastrectomy has overtaken Roux-en-Y gastric bypass as the most commonly performed bariatric surgery in the U.S., certain patients may still require gastric bypass or prefer other procedures that are better suited for their needs. Dr. Buchin makes sure to accommodate his patients, especially when it comes to complications from past treatment or conditions such as gastroesophageal reflux disease.
“People with moderate or severe reflux should consider gastric bypass surgery over sleeve gastrectomy,” Dr. Buchin says. “Sleeve gastrectomies can cause acid to enter into the esophagus because of the increased pressure in the now-smaller stomach, creating gastric reflux or making existing reflux symptoms worse.”
For patients with existing reflux symptoms, gastric bypass surgery may help with more than weight loss and comorbidities — gastric bypass has been found to cure reflux symptoms in more than 90 percent of patients who undergo the procedure.
Erin Nastro, physician assistant, discusses patient education in the perioperative period.
Decline of LAP-BAND
Though gastric bypass surgery and sleeve gastrectomies continue to improve with the help of new technology, procedures involving the LAP-BAND have fallen out of favor with many bariatric surgeons.
Dr. Buchin discusses plans for his Endoscopy suite with his Director, Helene Buchin.
“I personally haven’t performed a band procedure in over five years,” Dr. Buchin says. “We are finding that patients do not do as well with their bands as with other procedures. They can develop complications or feel sick all the time.”
Complications and side effects of the LAP-BAND can include dysphagia, vomiting, nausea and intolerance of certain foods. In order to keep food down, some patients must eat soft carbohydrates instead of harder protein, which is not helpful for losing weight.
“The band is an obstructive device and can cause pain in the middle of the chest,” Dr. Buchin says. “Many patients come to me to have their bands removed. The majority of them choose to have revisional surgery and convert to a sleeve or gastric bypass during the same operation.”
Recent variations of band procedures, including gastric plication, may also require revisional surgery in order to provide patients with more desirable results. Gastric plication was studied as a possible alternative to the sleeve gastrectomy procedure but was proven not to work as well as sleeve gastrectomy. Other procedures like vertical banded gastroplasties may also be appropriate for revisional surgery.
“Not many people know that vertical banded gastroplasty can be revised,” Dr. Buchin says. “It’s rare to see a patient with this particular procedure, but it can be revised.”
Revisional bariatric surgery is not a common practice on Long Island. Dr. Buchin is one of the few surgeons capable of performing revisions.
Dr. Buchin assesses post-surgical changes for potential revision candidate.
“Revisions are appropriate for patients who are experiencing inadequate weight loss or pain and complications due to the initial procedure,” Dr. Buchin says. “Even for major complications, revision can be a viable option.”
Removing LAP-BANDs and then converting to gastric bypasses or sleeve gastrectomy are common revisions that Dr. Buchin performs. Some band slippage or erosion patients can also be treated with revisional surgery.
In one case, Dr. Buchin treated a patient who was no longer experiencing restriction from her LAP-BAND and gained back the weight she had lost. During an endoscopy, Dr. Buchin found that the band had eroded through the outer stomach wall and was sitting in the patient’s stomach. He was able to remove the band endoscopically, through the patient’s mouth, and performed a gastric bypass surgery a few months later, allowing her to begin losing weight again.
“The patient experienced severe gastroparesis due to nerve damage caused by erosion of the band,” Dr. Buchin says. “Her gastroparesis has successfully resolved and she continues to lose weight.”
Patricia Balducci-Espiritu, registered dietitian, provides counseling to pre- and post-surgical patients to ensure long-term success.
Inadequate weight loss can occur from bariatric procedures other than the band. In some cases, patients with vertical sleeve gastrectomies may benefit from revisions. For example, some sleeve gastrectomies do not limit the size of the stomach enough to be effective for weight loss, while other patients may actually stretch the stomach to a larger size through overeating. In these instances, re-sleeve gastrectomies can be performed to make sleeve gastrectomies tighter. If the sleeve gastrectomy is already tight enough prior to a revision, a single-anastomosis duodeno-ileal bypass (SADI-S) is an option to introduce more elements of malabsorption to a patient’s treatment. The SADI-S procedure bypasses a large portion of the small intestine, reconnecting the last 250 centimeters of the small intestine to the stomach, which results in malabsorption.
Patients who experience increased gastric reflux from a sleeve gastrectomy can have the sleeve gastrectomy converted to a gastric bypass to relieve symptoms and cure their reflux.
Likewise, in the case of inadequate weight loss, gastric bypass can be revised as well. If the stomach pouch or connection to the small intestine is left too large after a gastric bypass, patients may not feel satisfied with their meals and become hungry quickly after eating. The stomach pouch or intestinal outlet can be redone during a revisional surgery, making the pouch or intestinal opening smaller to allow patients to feel fuller after eating.
Other revisions for gastric bypass include converting the bypass into a distal bypass, which increases malabsorption and weight loss, and an endoscopic procedure that utilizes the OverStitch endoscopic suturing system. Dr. Buchin was the first bariatric surgeon to use the OverStitch for gastric bypass revision on Long Island.
“The OverStitch procedure can place stitches to make the outlet to the intestine smaller,” Dr. Buchin says. “When that outlet is made smaller, the patient feels restriction again and doesn’t feel hungry as often. The OverStitch is an outpatient procedure. The patient can go home the same day as the procedure and return to work the following day.”
Staff, from left to right: Helene Buchin, Director; Meaghan Salzone, Medical secretary; and Sara Levine, Medical secretary, discuss upcoming surgical cases.
“Bariatric surgery is a tool to help people lose weight. It’s a very effective tool, but patients have to aid in the process by changing their lifestyle, modifying their behavior, eating properly and exercising. At Long Island Obesity Surgery, P.C., we provide our patients with the education and support they need to ensure long-term success on their weight-loss journey.”
— David Buchin, MD, FACS, FASMBS, Director of Bariatric Surgery at Huntington Hospital
Most patients will find success with primary bariatric surgery, but for those who do not, revisional surgery presents many options for continued weight loss.
“There are multiple modalities and revisions that can be done to get rid of excess weight,” Dr. Buchin says. “Weight loss is difficult, and many patients are unaware that their procedures can be revised to better serve them.”
ORBERA Gastric Balloon
In addition to bariatric surgery, Dr. Buchin performs endoscopic procedures such as placement of the ORBERA Intragastric balloon, which was recently approved by the FDA in 2015.
“Initially I was skeptical of the balloon, because I thought the sleeve and bypass were more effective solutions,” Dr. Buchin says. “However, we have seen very good results with this device.
The ORBERA gastric balloon provides a good option for patients who are looking to jump-start their weight loss regimens and are committed to making lifestyle changes in their diet and exercise habits. The ORBERA gastric balloon takes 15 minutes to implant within the stomach through an endoscopic, ambulatory procedure, where it is then inflated with a sterile saline solution. The balloon stays in the stomach for six months, taking up space and making the patient feel less hungry. When it’s time to remove the balloon, another short outpatient procedure is performed, requiring no surgery.
“The patient is sedated for the procedure,” Dr. Buchin says. “Once the sedation wears off, the patient can go home.”
The ORBERA gastric balloon has many advantages, such as its temporary nature and the fact that the balloon has no malabsorptive effects. Patients’ bodies are able to absorb nutrients from food without the risk of vitamin deficiencies. The ORBERA gastric balloon carries a small risk of ulcers and migration and can be an attractive option for patients who do not want to undergo surgery. The indication for the procedure is a body mass index of 30–40.
Dr. David Buchin and the Long Island Obesity Surgery staff. From left to right: Meaghan Salzone, Erin Nastro, Sara Levine, Patricia Balducci-Espiritu, Lacey Crawford, Helene Buchin
For more information on bariatric surgery, visit liobesitysurgery.com.