Bariatric Surgery
“Morbid obesity is not just a health
issue; it is a “relationship” issue,” says Carol Miller,
bariatric nurse practitioner. “It affects the way a person
relates to themselves, their spouse, children and friends.”
At the Montana Center for the Treatment of Obesity (Center),
located at St. Patrick’s Hospital, a multi-specialty team is
helping to change people’s lives for the better. The team
consists of two surgeons, Drs. Bradley Prickhard and Charles
Swannack, a nurse practitioner, psychologist and dietician.
Each patient is evaluated and educated about the different
options available to them. A body mass index is done to
determine their level of obesity. Those patients with a BMI
of greater than 40 are candidates for bariatric surgery. 
A major part of the Center’s
comprehensive bariatric program deals with changing their
patients’ nutritional habits and physical activities. “We
teach our patients to read and understand food labels. They
develop new eating patterns that lead to long-term
behavioral changes,” said Miller.
The team helps each patient select
specific and the realistic goals of physical activity to
ensure their success. The patients use their rate of
perceived exertion (RPE) to self-assess their level of
physical capacity. This allows them to individualize their
training. Physical activities are incorporated into their
daily living and become part of their routine. “It is also
important that the patient’s whole family is involved with
this program in order for it to work,” said Miller. “They
need to be supportive and understand the importance of their
role.”
Patients are selected for bariatric
surgery according to the guidelines set by the National
Institute of Health (NIH). The Center offers two types of
surgery. The more traditional and invasive procedure is
gastric bypass. It works by restricting the amount of food
the stomach can hold and decreases the absorption of
calories. A newer procedure, the “Lap-Band” system uses
laparoscopic surgery instead. A small silicone ring is
placed around the upper part of the patient’s stomach to
form a band. A tube connects the ring to a fixed port just
beneath the abdominal skin. The surgeon can inflate or
deflate the ring, after surgery, by instilling or removing
saline solution directly into the port. Once the Lap-Band
ring is inflated, it creates a new smaller stomach pouch
that restricts the amount of food the stomach can hold. It
does not affect the absorption of nutrients through the
intestinal tract. The Lap-Band was developed in the 1990s
and approved for use in 2001. “Laparoscopic banding is less
invasive, safer, adjustable and removable. Patient's
recovery is quicker with fewer side effects,” said Miller.
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Patients who undergo
bariatric surgery may lose 100 to 180 pounds. Two weeks
before surgery they are placed on a liquid diet and may lose
10-20 pounds. This weight lost causes their liver to shrink.
During laparoscopic surgery, a smaller liver allows easier
access to the upper portion of the stomach.
Post-operatively, the patient remains on a liquid diet for
about three weeks. They continue to be seen at the Center as
they re-learn eating patterns.
“Our role doesn’t end with surgery,”
says Miller, “our Center is committed to their success, just
as our patients have committed themselves a permanent change
in their lifestyle and relationships.”
The Montana Center for the Treatment of
Obesity
500 West Broadway
Missoula, Montana 59806
Phone: 406.543.7271
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