Advanced Laparoscopic Associates congratulates our own Dr. Hans Schmidt for a job well done. Dr. Schmidt was an invited lecturer at the 2019 GERD Symposium, which took place on June 9 at Hackensack University Medical Center in Hackensack, NJ.
Dr. Schmidt is an acknowledged expert on the surgical management of gastroesophageal reflux disease (GERD). At the symposium, he spoke to a large group of medical professionals about current surgical treatment options for the condition.
The annual symposium focuses on diagnostic and treatment protocols for GERD. Of special emphasis was minimally invasive surgical management, which Dr. Schmidt and Advanced Laparoscopic Associates specialize in.
GERD affects millions of people each year, leading to a lower quality of life and raising the risk of esophageal cancer. Advanced Laparoscopic Associates is one of the only practices in New Jersey that performs the LINX procedure, a safe option for the management for GERD.
If you are experiencing GERD and have tried more conservative treatment measures without success, request an appointment at Advanced Laparoscopic Associates to see if surgical management is right for you.
A July 2019 study has put a spin on the finding that body shape matters—despite one’s overall body size. We know that a pear-shaped body is better than an apple-shaped body in terms of health risks. That’s because the fat in the abdominal area (the apple shape) is mostly visceral fat, the most dangerous kind. And while it’s customarily been the case that this is true of only overweight people, the study contends that it doesn’t matter if you’re overweight or normal weight: Carrying fat around the middle is a significant mortality risk.
The study, detailed in the July 24, 2019 issue of the JAMA Network Open, included 156,624 postmenopausal U.S. women who are enrolled in the famed Women’s Health Initiative study. The authors state that while current public health guidelines for obesity focus on body mass index (BMI, which is determined by weight-to-height ratio), those guidelines do not sufficiently stress what is termed as central obesity, which is measured by waist circumference and reflected in the apple-shaped body.
Central (waist) obesity was highlighted in a 2010 JAMA Internal Medicine study of almost 105,000 people, which found that both men and women with bigger waistlines (apple-shaped) were twice as likely to die as those with smaller waistlines (pear-shaped). Those with bigger waists also had a greater risk for type 2 diabetes, cholesterol problems and coronary heart disease. The study pointed out that it is the body shape, i.e. where a person carries body fat, is what matters most when it comes to health.
The body size in the 2010 study included apple-shaped participants who had waistlines of more than 47 inches for men and 43 inches for women. Yet the new study findings show that even women of normal weight can carry the same health risks if they have central obesity. In fact, it found that those normal weight (as defined by BMI) post-menopausal women studied who had central obesity had a 30 percent increased risk of mortality over normal weight subjects without central obesity.
Types of Fat
Colors of fat
Although the term “body fat” is widely used, not all body fat is alike. There are several types, and each serves a physiological purpose. Fat is divided into various types and by its color shades. To simplify, there are three basic colors of body fat:
- Brown: Brown fat is considered healthy, but is only present in small amounts in adults. It is mostly a feature of newborn babies. Brown fat helps keep us warm, so it is known as “fat-burning” fat.
- White: White fat, on the other hand, comprises a majority of the body and increases with age. In excess amounts, white fat can be harmful for our bodies.
- Beige: Beige fat is a combination: it is similar to brown fat in that it is energy-burning, but it has its own unique cell type and is embedded (mixed in) in white fat.
Essential fat is necessary for life and health. It is found in the heart, lungs, liver, brain, nerves, intestines, bone marrow, muscles and tissues of the central nervous system. It helps to regulate body temperature, hormones (fertility hormones in women) and cell structure. This is the type of fat you should not lose, as its loss compromises health.
Subcutaneous fat is fat stored under the skin and is a combination of brown, white and beige fat cells. This fat is partially energy-storing, it helps regulate body temperature, is padding to protect muscles and bones and is part of helping nerves and blood vessels to travel between skin and muscles.
However, too much subcutaneous fat can be accumulated due to genetics or lifestyle, such as overeating and being sedentary. Too much of this fat can lead to heart disease and stroke as well as high blood pressure, type 2 diabetes, kidney and liver disease and some cancers.
Visceral fat, also known as “belly fat”, is sometimes also called “active fat” as it can actively increase the risk of various serious health conditions. Visceral fat is white fat, and it is located within the abdominal cavity and surrounds organs such as the heart, liver, pancreas and intestines.
Some belly fat is not necessarily visceral fat; it can be subcutaneous fat, the type of fat found in the arms and legs. But visceral fat increases the risk of heart disease and heart attacks, stroke, type 2 diabetes, and breast and colorectal cancer. It is also associated with an increased risk of Alzheimer’s disease.
It is well-established that obesity is connected to a number of health risks. It is also well-established by significant research and the length of time it has been available that bariatric surgery is one of the safest and most effective ways to address obesity. This includes, in particular, the health risks related to obesity, which have been shown to dramatically decrease with the weight loss that occurs as a result of this surgery.
Explore bariatric surgery with one of our experts at Advanced Laparoscopic Associates by requesting an appointment today. We can determine if bariatric surgery is right for you and give you the options for the form of surgery most appropriate for you. We’ll care for you every step of the way, from consultation to postoperative follow-up and beyond.
At Advanced Laparoscopic Associates, we take our responsibilities for training the next generation of doctors seriously. Many of our clinicians hold prestigious teaching posts at area medical schools to ensure future colleagues are well-trained professionals. But just as important is fostering a love of medicine even earlier in prospective physicians’ academic careers. That’s why ALA surgeons Dr. Amit Trivedi and Dr. Sarah Wong hosted undergraduates in the Stewart Alexander internship program on July 24 and 25.
The Stewart Alexander internship program takes place at Pascack Valley Medical Center. Interns are undergraduate college students who shadow working doctors for six weeks in the summer. They are exposed to a variety of medical specialties, including:
- Bariatric surgery
- General surgery
- Orthopedic surgery
On July 24, Dr. Trivedi and Dr. Wong exposed interns to one of the most fundamental skills in surgery: suturing. They set up a suturing lab at Pascack Valley Medical Center and oversaw interns practice suturing on pigs’ feet.
The next day, the interns got to see in action some of the most exciting medical technologies in current use with a full robot simulation lab. Pascack Valley Medical Center is one of only six hospitals in the United States to use the TransEnterix Senhance Surgical System. Students sat at the console and practiced controlling the robot to perform surgical skills.
Dr. Trivedi and Dr. Wong said it was a pleasure to work with the bright, enthusiastic young people in the Stewart Alexander internship program. ALA is proud to work with Pascack Valley Medical Center and the Stewart Alexander program.
If you are considering general or bariatric surgery, request an appointment at Advanced Laparoscopic Associates. With now five locations, we are the most comprehensive surgical practice in northern New Jersey and we can help you choose a path of treatment that is both effective and right for you and your life.
Sugar is sugar, right? Don’t be so sure. Packaging matters, and we’re not talking about 45-calorie packets from Starbucks. White sugar is so processed and refined that almost no nutritional value is left by the time it hits your tea or yogurt.
You have options, though. Forget the synthetic sugar substitutes. For the best nutritional bang for your buck, look to honey.
Watch Your Sugar
No one is saying an excess of sugar is good for you. In fact, overconsumption of sugar (especially added sugar, as opposed to sugar found naturally in foods) is one of the biggest public health risks of the 21st century. The average American consumes more than 150 pounds of sugar per year.
Too much sugar has been linked to:
- Type 2 diabetes
- Heart disease
It is important to cut sugar where you can. But, if you like things sweet, honey is one of the best choices available.
Types of Sugar
Gram for gram, all types of sugar have the same number of calories: 4 calories. That doesn’t mean all sugars are created equal, as we mentioned earlier. Honey’s main advantage here is its chemical structure.
Honey and white granulated sugar both contain glucose and fructose (two forms of sugar), but while white sugar has them both hooked together, in honey they are in separate molecular packets.
Glucose fuels cells. Insulin brings it into the cells where it is used for energy. When it is not immediately used, glucose is converted to glycogen and stored in the liver or muscles. Fructose, on the other hand, has to be converted into a useable form by the liver, and if it is not used immediately, it gets stored as cholesterol and triglycerides, both of which can be harmful to the heart in excess quantities.
Honey having both glucose and fructose present is a clear advantage over regular sugar.
Health Benefits of Honey
Honey is easier on the body than sugar, but the benefits don’t stop there. Because it is less processed, honey can often have more beneficial compounds taken from the plants from which it is made, which are called phytochemicals. Some types of honey can have more than 70 phytochemicals.
These phytochemicals, especially the ones known as antioxidants, may provide a range of benefits. Antioxidants such as polyphenols fight against free radicals, which cause a process called oxidation that destroys cells’ DNA.
Although definitive scientific evidence is hard to come by when discussing the medicinal effects of food, some studies have suggested that honey can cut the risk of certain dangerous diseases. A 2008 study in Scientific World Journal examined data from 55 obese or overweight people, some of whom took 70 grams of honey a day for 30 days.
The patients in the study who took honey saw a slight reduction in weight and body fat. They also had reductions of total cholesterol levels and LDL cholesterol levels (the “bad” kind of cholesterol), and an increase in HDL cholesterol (the “good” kind).
Another study, this one published in 2016 in Journal of Food Biochemistry, identifies a number of phytochemicals in honey that may protect against colon cancer, and concluded that honey may decrease colon cancer cells’ tendency to reproduce. A 2018 study in Food and Function suggests honey may induce cell death in colon cancer cells.
What Type of Honey Is Best?
You want your honey to be as minimally processed and as fresh as you can get it, and it doesn’t get any fresher than straight from the hive. Watch as our own Dr. Trivedi sets up his new beehive!
Advanced Laparoscopic Associates (ALA) is proud to announce that we are opening a new location in Wayne, NJ. We will begin seeing patients at the Wayne location in August 2019.
With offices in Paramus, Jersey City, Westwood, North Bergen and now Wayne, we now provide coverage for most of northern New Jersey.
Our new office’s address is:
246 Hamburg Turnpike
Wayne, NJ 07470
Adding a fifth location allows our patients to obtain the appointment they need at the time and location most convenient to them. Now patients all over New Jersey can schedule time with one of our surgical pioneers easier than ever.
ALA has been at the forefront of bariatric and general surgery since our founding. We offer procedures for weight loss and abdominal surgery that are both innovative and stand the test of time. If you are ready to take control of your health through weight loss surgery, or if you have a health condition that needs treatment, request an appointment at ALA today.
Advanced Laparoscopic Associates is proud to have sponsored the ASMBS Foundation’s Walk From Obesity event, held June 9 at Saddle River County Park in Saddle River, NJ. The event itself raised more than $9,000 for the ASMBS Foundation, and our ALA team was able to raise 205 percent of our goal, thanks to our generous donors and dedicated team members.
The ASMBS Foundation’s Walk From Obesity walkathon series is the only walkathon dedicated to raising awareness of the obesity epidemic currently affecting the United States. More than two-thirds of American adults are estimated to be overweight or obese, which can lead to dangerous health conditions such as:
- Heart disease
- Type 2 diabetes
- Obstructive sleep apnea
…and many more.
The ASMBS Foundation’s mission is to raise funds for obesity research and treatments, increase awareness of the dangers of obesity and improve access to care and treatment for obesity. ALA is dedicated to supporting this mission in any way we can, including participating in our local Walk From Obesity event.
The event took place in the beautiful 577-acre Saddle River County Park. Although the park’s path is an approximately 6-mile loop, the Walk From Obesity event was noncompetitive, meaning participants chose to walk as much or as little as they wanted.
ALA is proud of and grateful to all Walk From Obesity participants both for getting outside and getting healthy on a Sunday afternoon to provide awareness and raise funds for the ASMBS Foundation’s critical mission.
Please join Advanced Laparoscopic Associates in congratulating our own Dr. Amit Trivedi. Pascack Valley Medical Center named him 2019’s Provider of the Year during the facility’s National Hospital Week celebration on May 16.
Dr. Trivedi is chair of the Department of Surgery at Pascack Valley Medical Center. He has been instrumental in bringing the Senhance Robotic Surgical System to the medical center. Pascack Valley’s Senhance system—only the sixth in the United States—represents the future of laparoscopic and minimally invasive surgery.
This award, now in its third year, recognizes an outstanding physician who embodies all aspects of the hospital’s standards of performance and values. According to the medical center, Dr. Trivedi upholds its mission and vision every day and puts quality patient care as his top priority.
National Hospital Week is an opportunity for medical centers to recognize the outstanding staff—from physicians, nurses and other clinicians to administrators, operations staff and volunteers—who make a hospital run and change patients’ lives.
Advanced Laparoscopic Associates is proud to be represented by Dr. Trivedi and all of our dedicated clinical and administrative staff. Dr. Trivedi embodies our philosophies of patient-first care and relentless attention to the art and science of surgery.
If you have a hernia, which occurs when abdominal material pushes through a weak spot or hole in the surrounding muscle or connective tissue, you are far from alone. In fact, you are among an estimated five million Americans who have an abdominal hernia. This condition may be caused by straining or weakness in the area, but in the majority of patients, it has no known cause.
Once you’ve had a hernia, you’re more susceptible for another at the same site. The muscles or connective tissue is still weak. Surgeons have a solution, however—it’s called hernia repair, and it helps keep all your insides where they belong: on the inside.
Types of Hernias
There are various types of hernias, depending on their location. These include:
- Inguinal hernia: Considered the most common type of abdominal hernia, it is caused when intestines push through a weak opening in the abdominal wall or groin area.
- Femoral hernia: This is an uncommon type of hernia that results in a painful lump in the groin or inner thigh.
- Umbilical hernia: A bulge at the belly button.
- Incisional hernia: This type of hernia occurs on a healing surgical scar.
- Epigastric hernia: This appears as a lump located between the belly button and sternum (upper chest).
- Hiatal hernia: This type of hernia happens when the upper part of the stomach bulges through the large muscle (diaphragm) that separates the abdomen and the chest.
In some cases, there are no symptoms of a hernia. But when there are, these symptoms may include:
- Bulge or swelling on either side of the pubic bone, made more obvious when coughing or straining
- Pain in the pelvis, abdomen or testicle
- Abdominal distension
- A bulge in the abdomen or the belly button
- For a hiatal hernia, heartburn or trouble swallowing
While millions of people have hernias, less than 15 percent of them seek medical treatment annually. However, an untreated hernia can lead to more serious conditions, which can even become life-threatening.
Often, patients fear surgery, but hernia surgery can be done as an outpatient procedure. Recovery depends on the size of the hernia but is usually minimal. The use of hernia mesh can strengthen the site of hernia and help prevent recurrence.
Patching the weak area of a hernia or closing up a hole with loosely woven flexible mesh is a stronger option than simply stitching the area. Since hernias have a high probability of recurrence, surgeons use hernia mesh to strengthen the repair and lessen the chances of that recurrence.
The advantage of the surgical mesh is that it allows the tension created by the repair to be spread across the abdominal wall, which in turn allows the patient to have normal movement after surgery.
In fact, 90 percent of the one million hernia repairs done annually in the U.S. use mesh. The mesh used for this surgery is usually the synthetic variety, made of polypropylene (petroleum) plastic. It is considered a permanent implant.
There has been some recent controversy due to the recall of surgical mesh by the Food and Drug Administration (FDA), but if you have or need a mesh implant, we are here to discuss the options with you.
Most of the mesh controversy stems from the use of transvaginal mesh. Surgical transvaginal mesh is used in urogynecologic repair of conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Because these are different conditions in different areas of the body than hernias, using mesh in these repairs can lead to side effects and complications not seen in hernia repairs.
On April 16, 2019, the FDA ordered a halt to the sale and distribution of the two remaining companies that manufacturer transvaginal surgical mesh, stating that there is insufficient evidence to assure that probable benefits outweigh the probable risks in use of this mesh.
According to the FDA, any complications from mesh hernia repair have been associated with mesh products used in the past, which have been recalled and are no longer on the market. If you have had or will have a hernia repair using surgical mesh, this recall doesn’t pertain to abdominal wall hernias.
Conferring With Your Doctor
Like all surgical procedures, use of surgical mesh has some risks. That is why a qualified expert can help determine the best course of action for you, and the best surgical options. For certain hernias, and when the procedure is done correctly, experts say hernia mesh is very safe.
At Advanced Laparoscopic Associates, our experienced team of experts can help you determine the best treatments depending on your individual hernia condition. Request an appointment today with one of our team of qualified experts.
us in congratulating the dedicated surgeons of The Bariatric Surgery Center at Hackensack
Meridian Health Hackensack University Medical Center for earning a 5-star Bariatric
Surgery Excellence Award from Healthgrades. The surgery center is staffed
primarily by surgeons from Advanced Laparoscopic Associates, and our own Dr.
Hans Schmidt is the chief of the bariatric program.
rates hospitals and hospital departments based on safety and clinical outcomes.
The Bariatric Surgery Center received five stars, easily beating out the
three-star national average. Its actual rate of complications was a mere 1.7
percent, more than 50 percent lower than the national average.
Laparoscopic Associates offers a wide range of bariatric and general surgery
procedures. We specialize in—and are one of the only practices in the region to
offer—advanced surgical and nonsurgical techniques such as LINX
for gastroesophageal reflux disease and AspireAssist
for weight loss. If you need surgery to correct a medical condition or are
seeking bariatric surgery, request
an appointment today.
Nearly 10 percent of Americans have a form of diabetes, a condition that affects the ability to regulate blood sugar. Add in the number of people with prediabetes—high blood sugar—and that number jumps to more than 100 million, or about one-third of the U.S. population.
There are two main types of diabetes:
- Type 1: the immune system mistakenly destroys cells in the pancreas that produce insulin, which brings sugar from the bloodstream into the cells
- Type 2: through repeated exposure (i.e., a diet high in sugar), the body becomes resistant and eventually immune to the effects of insulin
The outcome of both types of diabetes is that sugar remains in the bloodstream, where it can damage cells and blood vessels. Diabetes is associated with heart disease, kidney disease, liver disease and even vision and hearing problems. In addition, most people with type 2 diabetes are obese.
No Cure for Diabetes… or Is There?
Currently there is no cure for diabetes, but the condition can and does go into remission, which means that blood sugar is normal and there are no signs or symptoms of diabetes. However, because blood sugar fluctuates based on a number of factors, it’s possible the disease will come back.
But what if there really is a cure? Evidence is beginning to mount that a simple, safe, effective weight loss surgery procedure may also be a true cure. You’ve probably even heard of the procedure: gastric bypass.
What Is Gastric Bypass?
Roux-en-Y gastric bypass—or simply gastric bypass—was, until recently, the most popular bariatric surgery procedure in the U.S. (it has since been overtaken by vertical sleeve gastrectomy). It’s been performed since the 1960s, and its benefits for obesity are well-established.
Gastric bypass surgery has two parts. First, the stomach is sectioned off, creating a small pouch that can hold much less food than an unmodified stomach. Then, the intestines are rerouted to connect directly to that pouch, which bypasses part of the intestines. This reduces the number of calories the body absorbs. So, not only do people with gastric bypass eat less food due to a smaller stomach, they absorb fewer calories.
How Does Gastric Bypass Help Diabetes?
Gastric bypass is known to have a strong effect on type 2 diabetes. The American Society for Metabolic and Bariatric Surgery estimates that 80 percent of people who have gastric bypass will achieve complete type 2 diabetes remission. Other estimates are similar.
In fact, bariatric surgery is so promising for diabetes improvement that in 2016, an international group of diabetes authorities voted to include surgery as standard treatment for type 2 diabetes in clinical guidelines.
“This change is supported by documented clinical efficacy and by the evidence of an important role of the gut in metabolic regulation, which makes it an appropriate target for anti-diabetes interventions,” wrote Dr. Francesco Rubino, one of the authors of the consensus statement on clinical guidelines.
Dr. Rubino, a bariatric surgeon who practices in the U.K., was featured in a fascinating 6-minute video by The Economist, which you can view below.
In the video, Dr. Rubino stated that he believes that the section of the intestines that is bypassed in a gastric bypass procedure figure heavily into the development of diabetes. Bypassing this section of the intestines can change a large number of factors independent of weight loss, such as:
- Bile metabolism
- Glucose metabolism
- Intestinal flora (bacteria, etc.)
Dr. Rubino and others believe these changes can combine to permanently send diabetes into remission.
Who Is a Candidate?
The selection criteria for bariatric surgery to treat obesity are clear and simple. People who want weight loss surgery must have either:
- A body mass index (BMI) of 40 or greater
- A BMI of 35 or greater and co-morbid conditions related to obesity, such as diabetes, heart disease or obstructive sleep apnea
The 2015 guidelines (published in 2016) for surgery to treat diabetes are more complicated. In addition to BMI, bariatric surgeons must also take into consideration:
- Heart disease risk
- How long the person has had diabetes
- How well the diabetes is controlled
If you are considering treatment for diabetes, request an appointment at Advanced Laparoscopic Associates. We can tell you if you meet the criteria for bariatric surgery, and we’ll give you options and advice on the best form of surgery to choose. We’ll be with you every step of the way, from consultation to postoperative follow-up and beyond.