Thursday, May 29, 2008

Knoxville woman undergoes sleeve gastrectomy, very pleased with results

Knoxville, TN
Sara Trombley tried every kind of diet on the market. She did Weight Watchers, liquid diets, and pills. Nothing seemed to help her lose weight and keep it off. She began researching surgery options. She was originally a lap-band patient, but then learned about the gastric sleeve procedure. Sara also says she had to overcome her mental issues in regards to eating.

"I struggled with binge eating disorder for a few years and that's when my weight I almost doubled my weight," she says.

The new procedure is called a sleeve gastrectomy and it involves removing part of the stomach. Dr. Mark Colquitt is one of the first physicians in East Tennessee to perform this new procedure. "You cut the stomach and you remove the bottom half and what's leftover is a sleeve," he explains.

Sara had the surgery in February of 2008 and is very pleased with the results. "I've lost 45 pounds and I couldn't have done that with any diet," she says. "I have confidence that it is going to stay off I'm not constantly scared that if I look at a bag of chips the weight is going to come back on."

Dr. Colquitt says the surgery isn't as risky as gastric bypass but some patients can benefit more than others. "Anybody who meets certain criteria as far as weight generally, you are looking at someone who is 100 pounds overweight. We used a scaled called BMI weight and it has to be 35 or greater."

Sara is pleased with her results since the sleeve procedure but says success starts in the mind. "I think the most important thing is to address any mental emotional issues you have with food. You have to get those taken care of or our not going to be successful for me it's the most important thing."

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Sunday, May 25, 2008

Probiotics after adult gastric bypass surgery improve GI function and increase weight loss, teen endoluminal vertical gastrop (EVG) study released

Washington, D.C.
A hefty dose of probiotics -- the "good" bacteria found in yogurts and supplements -- helps adult gastric-bypass patients lose even more weight, researchers are reporting.

The researchers didn't set out to see if probiotics could help the patients shed more pounds, said Dr. John M. Morton, associate professor at the Stanford University School of Medicine, who presented the findings this week at the Digestive Disease Week 2008 meeting in San Diego.

Morton wanted to improve the patients' gastrointestinal functioning. "Some patients [after bypass surgery] have a small amount of bacterial overgrowth [in the intestines]," he said, adding that can have an impact on gastrointestinal function and quality of life. So his team evaluated 42 patients who had undergone the bariatric surgery known as Roux-en-Y gastric bypass surgery, giving half of them probiotics daily and the other half no probiotics.

The researchers evaluated GI functioning and other measures and noted the patients' weight before surgery, after surgery, and at three and six months after beginning the probiotics program. The probiotics were given in supplement form -- 2.4 billion colonies of Lactobacillus daily.

The probiotic group fared better in all categories at the six-month mark -- and also lost more weight. The probiotic group lost 70 percent of excess weight, compared to 66 percent for the control group.

The finding initially surprised Morton. "But other research has suggested that part of the obesity problem may be infectious. Some of the weight gain [in obese people] might be associated with bacteria," he said.

Asked if obese people, or those who have had bypass surgery, should eat yogurt, Morton said it probably couldn't hurt, but noted that 2.4 billion colonies ofLactobacillusis a large amount to get from yogurt.

Another study presented this week suggested that for severely overweight teens, a gentler weight-loss surgery may be possible. Dr. Roberto Fogel, of the Hospital de Clinicas Caracas, in Venezuela, presented the results of his pilot investigation of 12 teens, who underwent a surgery called endoluminal vertical gastroplasty, or EVG.

During the surgery, Fogel sutures the walls of the stomach, reducing the volume of the stomach but leaving a passageway for food. The procedure is done through the mouth; a scope containing a needle and sutures is inserted multiple times to perform the procedure.

After 60 to 90 minutes, the patient can go home, said Fogel, who does the surgery on an outpatient basis. Once the procedure is done, the patient gets full on very little food, he said.

At a six-month follow-up, Fogel found that all 12 patients had lost weight. The average body mass index, or BMI, was reduced from 38.1 to 27.8; a BMI of 30 or more is considered obese.

Fogel sees the new procedure, which he has performed on 331 teens since 2005, as a possible alternative to more invasive surgeries, or diet and exercise programs that prove ineffective for some obese teens.

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American College of Surgeons accredits Mini-Gastric Bypass procedure to settle lawsuit filed by surgical group

Greensboro, NC
Doctors with Cornerstone Health Care in High Point again can be reimbursed for bariatric surgeries after the American College of Surgeons agreed to settle a lawsuit and accredit their procedure.

Without accreditation from the group, Dr. Thomas Walsh and Dr. James Dasher could not have billed Medicare or many major private insurers for the weight-loss surgery. Cornerstone and High Point Regional Health System, where they perform the procedure, sued the college Feb. 5 in the Middle District of North Carolina claiming the group was trying to shut them out of the lucrative practice -- which generated more than $5.1 billion nationally for hospitals last year -- by denying accreditation.

The college agreed to accredit the program last week, and Cornerstone and High Point Regional have dropped their suit.

Dasher and Walsh began performing mini-gastric bypass surgery on morbidly obese patients at High Point Regional in 2002 and have done more than 650 operations since. In their suit, High Point Regional and Cornerstone said the average patient lost 120 pounds to 140 pounds and maintained the weight loss for at least 18 to 24 months after surgery.

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Monday, May 19, 2008

ORLive May 29, 2008 webcast: Experts discuss Lap Band(R) and laparoscopic Roux-en-Y bariatric procedures

Marshfield, WI

Live Webcast: From Saint Joseph's Hospital and Marshfield Clinic: May 29, 2008 at 4:00 PM CDT (21:00 UTC)
Bariatric surgery will be featured on the eighth webcast sponsored by Saint Joseph's Hospital and Marshfield Clinic. It is set for 4-5 p.m. Thursday, May 29.

During the webcast, Marshfield Clinic physicians on staff at Saint Joseph's Hospital and other Marshfield Clinic health care professionals will discuss the comprehensive bariatric program at Saint Joseph's Hospital and Marshfield Clinic. The program will feature Timothy Wengert, MD, performing a laparoscopic Roux-en-Y gastric bypass, and Anishur Rahman, MD, placing an adjustable gastric band (LAP-BAND®). There will also be a live panel discussion and analysis moderated by Marvin Kuehner, MD, who has performed bariatric surgery for more than 30 years. Wengert and Rahman will also participate in the discussion, along with David Winemiller, PhD, clinical psychologist; Chrisanne Urban, MS, RD, CD, Nutrition Services; and Sheila Blackmun, RN, BSN, bariatric surgery program coordinator.

Bariatric, or weight-loss surgery, has proven to be an effective tool to lose a large amount of weight, significantly improving one's health and well-being. More than 90 percent of patients are able to reduce or eliminate medications taken for certain obesity-related health problems, such as type 2 diabetes, hypertension and hyperlipidemia. In a Roux-en-Y gastric bypass, surgical staples are used to form a small pouch at the top of the stomach, thus restricting the amount of food that can be comfortably eaten at one time. This small pouch is then connected to the middle portion of the small intestine, bypassing the rest of the stomach and a portion of the small intestine to limit the absorption of calories. The LAP-BAND® also reduces the size of the stomach but because the small bowel is not involved, it does not interfere with absorption. The adjustable silicone band is placed around the upper part of the stomach and a plastic tube runs from the band to an access port placed just under the skin n the abdomen. This allows the surgeon to inject or remove saline to adjust the "tightness" of the band to facilitate weight loss.

The bariatric program at Marshfield offers a multidisciplinary approach to surgical weight loss in a professional, supportive environment. Health care professionals are sensitive to the unique challenges brought on by obesity and strive to care for and meet the individual needs of each patient.

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Doctor recommends gastric bypass as way to prevent diabetes

New York, NY

Research shows weight loss surgery may be able to completely reverse Type 2 diabetes, as close to 90 percent of those with the disease are overweight, but the numbers of people getting the surgery are still small. NY1 Health & Fitness reporter Kafi Drexel has more on why this may be and what doctors are hoping can be done about it.
Before undergoing gastric bypass surgery, Judy Grant, 58, was 306 pounds and suffered from Type 2 diabetes. Now a year later, she's more than 100 pounds lighter and all signs of Type 2 are gone.

"I wasn't insulin dependent yet, but that was coming," she said. "And I knew that I was quickly approaching that because I was just having so much trouble and it took so much to manage me and I was thinking, 'If I continue on, where will I be?'"

Obesity is a leading cause of Type 2 diabetes. Doctors say weight loss surgery, also known as bariatric surgery, works because it leads to long-term weight loss, which helps lower blood sugar levels. Some of the latest research shows that diabetes goes away in many patients who undergo gastric bypass even before they start losing significant amounts of weight.

"In more than 434 patients who underwent gastric bypass, 89 percent of those have completely eliminated diabetes," said Dr. Piotr Gorecki. "We still call it suppression, rather than a cure, because still certain factors may be important there. But for practical reasons, they do not take their medicine, their glucose levels are normal, and they do not have any other features of diabetes as a disease."

Gorecki points out even those patients who are not "cured" so-to-speak are seeing significant improvements.

Despite the successes, there are still relatively few people undergoing the procedure. Guidelines from the National Institutes of Health, written nearly two decades ago, say only the morbidly obese should be eligible, possibly putting up roadblocks for potentially millions of mildly obese patients who could benefit.

Doctors, like Gorecki, who see the benefits in patients say it is time those guidelines start to be re-evaluated.

"Since both of these diseases, obesity and diabetes, are so prevalent and are so epidemic on such a large scale, this will be a major issue for insurance companies, for all third-party payers, including the government, for medical and surgical societies to come up with new guidelines," he said.

But with no plans in the works to revise guidelines, doctors or patients will probably not see any change to guidelines overnight. They say the hope is that continued evidence pointing to improved health benefits will change the outlook.

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Sunday, May 18, 2008

UC Irvine tests VBLOC implant

Irvine, CA
A weight-loss device placed under the skin is being tested at UC Irvine, KNBC's Dr. Bruce Hensel reported.

College student Jeff Collins, 24, has struggled with his weight his entire life despite trying everything from dieting to weight loss drugs.

"I've been fat, thin, fat, thin, all my life," Collins said.

When medication failed Collins, he considered gastric stapling or bypass until he heard the downsides.

"I went to an information session with 100 other people. They said there was a 1 percent mortality rate with the operation, and I looked around the room and realized one of us in this room would die. That scared me," Collins said.

What didn't scare Collins was a study at UC Irvine on a new weight loss device called VBLOC.

"The VBLOC's completely different. It doesn't alter the anatomy. It doesn't restrict the quantity of food you eat. Essentially, it actually inhibits the signal that runs between the stomach and the brain," said Dr. Ninh Nguyen of UC Irvine Healthcare.

According to VBLOC researchers, two tiny parts are placed under the skin. One turns the other on and it blocks signals to the nerve, which may control hunger signals to the brain.

Results have varied and the device's makers said, "The results of this study and this patient are not a claim for the potential effectiveness of VBLOC Therapy."

Although Collins had his procedure in January, both he and the researchers don't know if he's in the active group that had the device turned on or the inactive group

"I think it is on," Collins said. "I feel a change in my eating habits. I mean, before the surgery I could go to McDonald's and get a super-sized meal and eat all of it and still not feel full. Now, if I try to order it, I feel full before eating everything."

"Some preliminary data from outside the U.S., particularly Australia and Mexico, have shown that the excess weight loss at about six months is relatively good, (and) about 22 percent of excess weight loss at six months," Nguyen said.

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Nutritional deficiencies after Roux-en-Y gastric bypass often cannot be prevented by standard multivitamin supplements, study says

Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation

From the American Journal of Clinical Nutrition, Vol. 87, No. 5, 1128-1133, May 2008
Background: Despite the increasing use of Roux-en-Y gastric bypass (RYGBP) in the treatment of morbid obesity, data about postoperative nutritional deficiencies and their treatment remain scarce.

Objective: The aim of this study was to evaluate the efficacy of a standard multivitamin preparation in the prevention and treatment of nutritional deficiencies in obese patients after RYGBP.

Design: This was a retrospective study of 2 y of follow-up of obese patients after RYGBP surgery. Between the first and the sixth postoperative months, a standardized multivitamin preparation was prescribed for all patients. Specific requirements for additional substitutive treatments were systematically assessed by a biologic workup at 3, 6, 9, 12, 18, and 24 mo.

Results: A total of 137 morbidly obese patients (110 women and 27 men) were included. The mean (±SD) age at the time of surgery was 39.9 ± 10.0 y, and the body mass index (in kg/m2) was 46.7 ± 6.5. Three months after RYGBP, 34% of these patients required at least one specific supplement in addition to the multivitamin preparation. At 6 and 24 mo, this proportion increased to 59% and 98%, respectively. Two years after RYGBP, a mean amount of 2.9 ± 1.4 specific supplements had been prescribed for each patient, including vitamin B-12, iron, calcium + vitamin D, and folic acid. At that time, the mean monthly cost of the substitutive treatment was $34.83.

Conclusion: Nutritional deficiencies are very common after RYGBP and occur despite supplementation with the standard multivitamin preparation. Therefore, careful postoperative follow-up is indicated to detect and treat those deficiencies.

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VBLOC implant therapy in a nutshell

Stomach signals: In VBLOC therapy, two electrodes are surgically implanted at the top of the stomach to block signals from the vagus nerve. In the illustration above, green arrows indicate neural signals traveling from the brain to the digestive system, while blue arrows indicate signals traveling from the stomach and intestines to the brain. A small regulator (shown at right) that controls the frequency and amplitude of electrical signals is implanted beneath the skin and connected to the electrodes (shown here in gray) via wires. The electrical signals can be changed at the physician’s office via a wireless controller. The device is currently being tested in clinical trials and has not yet been approved by the FDA. Credit: Enteromedics

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VBLOC implant: Gastric bypass surgery alternative

Researchers believe that they might be able to combat obesity by blocking the nerve that helps regulate digestion, the vagus nerve.
An implantable device that uses electrical signals to block the vagus nerve, which helps regulate digestion, has shown early success in clinical trials. The experimental therapy, developed by Enteromedics, a medical-device company based in St. Paul, MN, is part of a growing trend to develop alternatives to gastric bypass surgery, an often highly successful but invasive procedure to curb obesity.

"We need an approach to this that is safer than current alternatives and efficient to perform," says Christopher Thompson, a surgeon at Brigham and Women's Hospital who tests new surgical tools and methods.

As the obesity epidemic booms, so has the number of people undergoing gastric bypass surgery, a procedure in which the stomach is surgically reduced to about the size of a lemon. The American Society for Metabolic and Bariatric Surgery estimates that gastric bypass rates have doubled in the United States in the past five years, from about 100,000 in 2003 to approximately 200,000 in 2007.

While gastric bypass often leads to dramatic weight loss, only a small percentage of people eligible for the surgery--those with a body mass index (BMI) of more than 35--actually choose to do it. That may be because the procedure comes with some serious risks and is irreversible, requiring permanent dietary restrictions and nutritional supplements. "Many people who really need the procedure don't seek out medical attention because they're worried about potential medical complications," says Thompson. "We're only treating a small fraction of eligible patients."

A new option is on the horizon. At a neurotechnology conference in Boston last week, Enteromedics described positive preliminary results from a European trial of its vagal blocking therapy, called VBLOC.

The device uses an electrical stimulator to block signals from the vagus nerve, which connects the brain to the gastrointestinal organs, regulating hormones and other factors involved in satiety and hunger. "It controls how the stomach expands when we start to eat," says Mark Knudson, chief executive officer at Enteromedics. "If it doesn't expand, we become full after a few bites."

In the procedure, two small electrodes are laparoscopically implanted next to vagal nerve fibers at the top of the stomach. A regulator implanted under the skin sends high-frequency pulses of electricity to the electrodes, which are thought to block the signals coming from the vagus nerve. While scientists don't know exactly how it works, they theorize that the device blocks signals that would normally tell the stomach to expand to accept food, as well as trigger the release of digestive enzymes and gastric acid, potentially slowing digestion. Many patients report feeling less hungry and feeling fuller earlier, says Knudson.

An analysis of nine patients who were among the first to receive the implant shows that they lost almost 30 percent of their excess body weight after nine months. And preliminary data from a larger group indicates that following the procedure, patients ate an average of 500 fewer calories per day. "That's less than you'd see for a lap band or a gastric bypass, but it's still pretty good," says Janey Pratt, a surgeon at Massachusetts General Hospital, in Boston. More >>

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Gastric bypass surgery for teens

Creve Coeur, IL
Obesity in Children
Researchers report 30 percent of children in the U.S. are overweight or obese. The excess weight increases the risk for a number of health problems. About 69 percent of obese children have one risk factor for cardiovascular disease (like high blood pressure, high cholesterol or diabetes). 25 percent of obese children have two or more risk factors for cardiovascular disease. Overweight children are also at higher risk for developing asthma, back and joint pain, sleep apnea, depression and social stigmatization/isolation. In addition, overweight children often don’t lose the extra pounds and remain obese as adults.

Gastric Bypass for Weight Loss

In order to lose weight, a person must take in fewer calories and/or use up more calories in activity. Traditionally, that means eating a healthy, low-fat diet and getting more regular exercise.

Sometimes, diet and exercise aren’t enough. Obese patients who have failed traditional weight loss programs may be candidates for surgery. One surgical option for obesity is gastric bypass. Surgeons use staples to partition off the upper stomach into a very small section. Next, a cut is made into the lower intestine. Then the far end of the intestine is brought up to the new, scaled down stomach pouch. The procedure promotes weight loss in two ways. First, the size of the stomach is greatly reduced – limited to holding only a few ounces at a time. Thus, the patient becomes full very quickly. Second, the food goes directly from the new stomach section into the lower end of the intestine, bypassing most of the intestine and limiting the amount of calories that can be absorbed into the body.

Gastric Bypass for Teens

Traditionally, gastric bypass has been reserved for adults. However, more physicians are offering the treatment to obese teens. The National Institutes of Health says gastric bypass should only be offered for obese adolescents and teens who have tried to lose weight for at least six months and have not had success with traditional methods. Candidates need to have reached skeletal maturity (i.e., full adult height) and have weight-related health problems.

Carroll Harmon, M.D., a Pediatric Surgeon with the University of Alabama at Birmingham (UAB), says gastric bypass is not a procedure that should be taken lightly. Patients must be carefully selected and fully aware of the benefits, risks and permanent lifestyle changes associated with the treatment. Once the surgery is done, patients will initially be on a puree diet. After that, the amount of food that can be eaten at one meal is very small. Often a few bites will fill the stomach. Protein shakes are needed to ensure the teen gets enough protein and nutrients. Traditional teen foods, like hamburgers and french fries, need to be avoided. Sodas are discouraged because the carbonation makes the stomach feel full without getting any nutrients. So teens need to learn how to cope with the social consequences of their new food limitations. They must also understand the surgery requires a lifelong commitment to a change in dietary and lifestyle behaviors.

UAB's Center for Weight Management brings together a group of medical experts to help determine if gastric bypass is an appropriate option for a teen. Prior to selection, the teen must be on a medically supervised diet for at least six months. Several weeks before surgery, the teen is placed on the post-op diet and exercise program. The goal of this part of the treatment is to ensure the teen is comfortable with and will stick to the post-op diet and exercise requirements. Harmon says family members play a big role in ensuring the teen’s follow-through with long-term treatment. So patients must have a good family support system.

UAB is studying the safety and long-term effectiveness of gastric bypass for teens. The participants will be followed for five years. Other sites are located at Cincinnati Children’s Hospital, Texas Children’s Hospital and the University of Pittsburgh.

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Woman sheds 800 pounds after gastric bypass surgery

Mount Vernon, OH
Flowers will bloom outside Mindy Sheriff's home this summer for the first time in 15 years.

"Life is sweet" now for Sheriff, 47, since gastric bypass surgery two years ago allowed her to lose more than 800 pounds.

It probably saved her life. At her heaviest, Sheriff, 47, weighed about 1,000 pounds. She is now at 191. "In 1993, I got really sick and had a lot of fluid retention," she said. "I was just raising my kids at the time, and so I was already staying at home and rarely going out."

That lifestyle would continue for another 13 years. "My legs started getting really bad, and I was having a lot of ulcers, which is common in obese people," Sheriff said. "I just couldn't get around good, so I started gaining weight."

In April 1998, Sheriff was admitted to MedCentral/Mansfield Hospital with breathing problems. "My doctor walked into my hospital room one day and said to me, 'Mindy, if you don't lose weight, I can't promise you another six months,' " she said. "It was devastating, and a rude awakening. When you gain weight, when you're heavy, you see yourself as you want other people to see you. You don't see yourself as you really are."

At the time, Sheriff's registered weight was 961. "I was bigger than that, but for a long period of time they couldn't weigh me," she said. "It's pretty embarrassing to be taken down to the laundry to get weighed, but even that scale didn't go any higher."

Along with health issues, Sheriff said being stubborn added to her problems. "Everyone kept trying to get me to seek help and my mother always told me, 'The Lord helps those who help themselves,' " she said. "But I wouldn't listen. I wasn't motivated. I didn't care about myself and I had very low self-esteem."

For a while, Sheriff said, she was in the care of a nursing facility. She lost 113 pounds there, but she regained most of it after she was dismissed. On Christmas Eve 2005, Sheriff was taken back to the hospital by ambulance. "I didn't even know I was going," she said. "My daughter and doctor decided I should go. I was mad at everyone for a while."

The next stop was The Medical University Center of Ohio in Toledo. "They asked if I was willing to talk to a bariatric surgeon up there," she said. "On Martin Luther King Day 2006, a doctor came in and told me what I needed, and within three weeks I was approved for the surgery."

On May 3, 2006, she had gastric bypass surgery. Her stomach was stapled, creating a much smaller food pouch and allowing food to bypass part of the small intestine. The net effect was feeling full more quickly and a reduction of food and caloric intake.

Sheriff's new life had begun. "The weight came off quickly," she said. "For a long time, I was losing 10 to 15 pounds a week. I am now down to 191 and am a hundred times more active. I used to have to use a cane, walker or wheelchair to get around, but now I don't use any of those.

"This past winter, I actually went outside and shoveled snow. I do my own housework and laundry now. I just planted vegetable and flower gardens for the first time in years. It's wonderful."

Sheriff said she exercises and goes to therapy three times a week. She and her ex-husband have gotten reacquainted and have been dating now after being apart for 25 years. "There are so many everyday things people take for granted that I am just now rediscovering," she said. "Life is sweet."

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Wednesday, May 14, 2008

StomaphyX: Gastric bypass surgery without the incision

Miami, FL
Doctors have announced a ground-breaking procedure. It allows them to perform surgery without making an incision, anywhere. CBS4's Dr. Sean Kenniff explains how it works.

Darlene Dillard lost 100 pounds with gastric bypass. But like 1/4 of people who undergo obesity surgery, a few years later she started to gain weight back.

"I had gained about 30 pounds outside of my range of weight," said Dillard.

Instead of operating again, doctors did something drastically different. It's called Stomaphyx--a natural orifice surgery.

"It is going to be a totally different new era of surgery," said Dr. Michel Gagner from Miami's Mount Sinai Medical Center.

He says it really is a surgical revolution -- with no incisions surgical instruments are inserted through natural orifices. In this case: Darlene's mouth, to make her stomach pouch smaller.

CBS4's Dr. Sean Kenniff said natural orifice surgery isn't limited to obesity procedures. Doctors are now perfecting techniques to treat everything from appendicitis to cancer."

"Removal of part of the liver, removal of adrenal, removal of part of the stomach, doing bowel connections," explained Dr. Gagner.

And many other procedures are being performed through the rectum, esophagus and vagina.

" It's just the beginning, it's going to explode in the next five years, you're going to be hearing a lot more about this," said Dr. Gagner.

With Darlene's weight loss, her medical problems disappeared.

"There was borderline diabetes, borderline hypertension," explained Darlene. "I had stress fractures of my feet."

And she hopes the new no-incision surgery will keep the pounds, and those problems away.

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Tuesday, May 13, 2008

Stompaphyx gastric bypass revision

Miami Beach, FL
A quarter of a million obese Americans undergo gastric bypass surgery for weight loss every year, but 20 percent of those surgeries will fail with time, doctors said.

That's what happened to Darlene Dillard, who regained 30 pounds after losing 100.

"My gastric bypass started failing five to six years out of the surgery," she said. "Increased appetite, the urge to eat constantly."

So, Dillard became the first South Florida patient to have Stomaphyx, a natural orifice surgery performed without any incisions.

"There's a suction apparatus that sucks the inside of the pouch, then we fire this double T fastener," said Dr. Michel Gagner of Mount Sinai Medical Center.

The suction creates folds that reduce the stomach size. In Dillard's case, doctors said they had to use 18 T fasteners around her stomach.

"I do have some discomfort in the lower chest area," Dillard said. "Not pain, just discomfort."

Dillard's doctors said they worry about bleeding from inside from the fasteners.

"They can create a little amount of bleeding," Gagner said.

Dillard said 24 hours after the procedure she was ready to go home.

Stomaphyx is for patients who have regained weight after bariatric surgery.

"It's going to be more for the 100 pounds or less of weight loss," Gagner said. "Because it is a restrictive operation. It restricts the volume in the inside of the stomach."

Mount Sinai Medical Center is one of only two hospitals using Stomaphyx for gastric bypass revision.

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Monday, May 12, 2008

Vagotomy: Is cutting the vagus nerve the answer to weight loss?

Las Vegas, NV
Last year, 200,000 Americans had weight loss surgery and while gastric bypass surgery can significantly reduce weight, the surgery comes with risks.

Now a procedure that was once commonly used to treat ulcers is being tested as a safe alternative to weight loss surgery.

Action News reporter Kimberly Tere has the details.

The vagus nerve controls your feeling of hunger.

Some even say every single thing the vagus nerve does is designed to make you gain weight.

That is why San Francisco Doctor Robert Lustig is testing laparoscopic vagotomy, a surgery in which the vagus nerve is cut.

Cutting the vagus nerve can reduce the amount of fat stored in the body and can increase energy levels.

"Every patient in the study said their hunger was gone, just gone. One comment I got from one patient was this is the first time in her life that she was not a prisoner to food," said Dr. Lustig.

It worked for Garth Michaels who after years of standing out, ballooned up to 340 pounds.

"I was eating the wrong stuff. I was eating too much of it. I was eating too fast and I was not exercising," said Garth.

Garth decided to stand up and wage a battle against the bulge.

"Moving would hurt, it just hurt and my ankles could not take my weight," explained Garth.

After 20 years of battling the physical and mental strains of obesity, Garth had a vagotomy done.

With the help of the procedure and exercise, Garth lost more than 100 pounds.

"When I started exercising all of a sudden, you know I was doing it three or four times a week and the switch turned on," said Garth.

Now a study is underway to find out whether it is a viable alternative to the traditional gastric bypass.

15 patients have had vagotomies done at University of California at San Francisco Medical Center.

One of the main differences is a vagotomy only takes 20 minutes under conscious sedation with a breathing mask or under general anesthesia.

It is also an outpatient procedure.

On the other hand, gastric bypass generally takes four hours to perform and requires a hospital stay of at least three days.

Now two years after having the vagotomy done and after a lifetime of hiding under big clothes, Garth is finally comfortable in his own skin.

"I would say I look in the mirror right now and feel 75% better than when I looked in the mirror before," said Garth.

The majority of the patients who underwent vagotomy lost weight and were able to keep it off.

But for others, there was little or no effect.

While hunger was curbed, Dr. Lustig says they kept eating out of stress or habit.

"This is not a procedure for the reward pathway or for the stress pathway. It seems to be a procedure strictly related to hunger," said Dr Lustig.

Patients in the study did lose an average of 20% of their weight.

For Garth it was a life altering surgery that gave him the push he needed to win the battle on weight for good.

The vagotomy is still experimental when it comes to being used for weight loss.

Dr. Lustig says more research needs to be done before it is ready for widespread use.

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Friday, May 9, 2008

Vagotomy: Doctors studying safer alternative to gastric bypass surgery

Seattle, WA
More than 177,000 Americans had weight loss surgery in 2006. This can mean massive weight loss, but the surgery doesn't come without risks. Now, there's an investigational approach that's helping patients shed pounds a whole lot safer.

Losing weight was never easy for Garth Michaels.

"I've felt fat all my life, really," he said.

Michaels reached 320 pounds.

"I really was just up against a wall," he said. "I was praying daily. I didn't know where to turn."

Then, he found Dr. Robert Lustig, an endocrinologist at the University of California-San Francisco.

"Everyone in the world seems to think that obesity is just one problem," said Lustig. "You eat too much, exercise too little and it couldn't be further from the truth."

Lustig says the vagus nerve plays a big role in obesity.

"Every single thing the vagus nerve does is designed to get energy into your fat cells," said Lustig.

He's testing a new surgery called laparoscopic vagotomy, where he actually cuts the vagus nerve.

"The severe hunger that many obese patients report seems to be just completely obviated. It goes away completely," said Lustig.

So far, the 20 minute procedure is resulting in an average 18 percent excess weight lost.

"The weight loss that the patients have achieved appears to be durable and we're very happy about that," said Lustig.

Michaels has lost more than 100 pounds since having the procedure nearly two years ago.

"Definitely life-saving," said Michaels. "I think I added at least 10 to 20 years to my life… It's a whole new life, a whole new lease on life and at age 56. That's pretty good."

And after a lifetime of big clothes, Michaels is proud to finally shed that image.

Compared to gastric bypass surgery, this procedure is about one-fifth the cost, has fewer side effects, but patients will not lose as much weight. This technique is still being studied and not yet widely available.

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Wednesday, May 7, 2008

Star Jones lashes out at Barbara Walters over gastric bypass surgery comments in her memoir

New York, NY
Nearly two years after Star Jones left "The View" on rocky terms, the 46-year-old TV personality has criticized former boss Barbara Walters for writing about her.

In Walters' new memoir, "Audition," she discusses how Jones wouldn't acknowledge her gastric bypass surgery on the air. She also writes about Jones' lavish wedding, which wound up alienating viewers as Jones accepted gifts in return for promotion.

"It is a sad day when an icon like Barbara Walters, in the sunset of her life, is reduced to publicly branding herself as an adulterer."

Walters reveals in the book that she had a past affair with married U.S. Sen. Edward Brooke that lasted several years in the 1970s.

The details about Jones are less juicy, but shed light on what happened behind the scenes on "The View" when Jones refused to publicly acknowledge the gastric bypass surgery she had in 2003.

Walters says Jones, who'd dropped 160 pounds in three years, changed her mind after telling Walters she'd talk about the procedure on the program. Walters says she didn't want to be the "poster child" for the procedure.

"I understood that, but it put us all in a terrible position," Walters writes. "It meant we virtually had to lie for Star, especially when she said again and again on the air that her weight loss was due primarily to portion control and Pilates. ... Joy (Behar), in particular, resented having to go along with the lie that implied that all one needed to do was sit-ups and ingest one cookie instead of two."

Jones confirmed her surgery last year in a first-person essay in Glamour magazine. She said she "was scared of what people might think," and "ashamed at not being able to get (herself) under control without this procedure."


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What to do when gastric bypass surgery obesity fails

Los Angeles, CA
The number of people getting obesity surgery has more than doubled in the past eight years. But the highly popular and risky procedure doesn't always work for everyone. So can these patients be helped? One local doctor offers a high-tech solution.

When 47-year-old Patricia Weiss gets on a scale these days, she smiles.

"I've lost about 35 pounds since I had it. It's been a year almost a year," said Patricia.

It's been a year since her second time around with an obesity procedure. The first time was in 2002 -- Patricia underwent a gastric bypass and lost 150 pounds. But then the weight started to creep back on.
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"I put on about 30 to 40 pounds, and I said, 'No, no, going the wrong way.' I didn't do all this to have this come back," said Patricia.

In 2007, there were about 160,000 to 200,000 gastric bypasses performed -- that's at least double the number performed in 2000. Of those surgeries, doctors say about 15 percent fail.

Often patients regain because they start to over eat again and stretch out their reconstructed pouch. Patricia went to see Dr. Jeremy Korman. He says standard x-rays and endoscopes don't give doctors the whole picture and this makes it difficult to proceed. He says he may be the only surgeon in the U.S. to use the 64 slice CT scan technology on obesity surgery patients.

"Now once we understand accurately the size of the pouch, we can plan what kind of operation would be appropriate, what size of revision operation is appropriate," said Dr. Korman.

Dr. Korman says he can either redo the original surgery, implant a LAP-BAND to restrict the pouch growth, or perform a new minimally invasive endoscopic procedure in which he sews up and shrinks the pouch from the inside.

Patricia opted for the LAP-BAND. More >>

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Sunday, May 4, 2008

Gastric bypass surgery shows promise for treatment of diabetes

Washington, D.C.
Rocco Turso was injecting himself with insulin three times a day, swallowing pills twice daily and restricting his diet. But his diabetes was still out of control, blurring his vision, making his feet numb and sapping his energy. So he decided to try an experimental operation. Within days, his blood sugar was normal and he was off all his medications.

"It's been truly amazing," said Turso, 62, a construction superintendent from Harrison, N.Y. "I use the word 'miracle.' The diabetes was killing me. It's given me back my life."

Turso is one of a handful of Americans who have undergone a novel procedure that proponents say appears to offer the most important advance since the discovery of insulin in treating one of the most common chronic diseases.

"It's extremely promising," said Madhu Rangraj, chief of laparoscopic surgery at the Sound Shore Medical Center in New Rochelle, N.Y., who performed the operation bypassing part of Turso's small intestine in March. "It's a surgical solution to diabetes."

While many surgeons share Rangraj's enthusiasm, and some diabetes experts agree that the operation and similar ones may lead to fundamental new insights into the disease, other experts remain cautious. Much more research is needed, they say, to validate the effectiveness of the procedures. They worry that the operations will start to proliferate before their long-term safety and effectiveness have been proven, as often occurs with novel surgeries.

"I'm skeptical," said R. Paul Robertson, president-elect of the American Diabetes Association. "It bothers me to see this message being put out there that we can now cure diabetes through surgery. They have to prove that to me."

Turso's operation is a variation of a procedure developed to treat severe obesity. Known as bariatric surgery or gastric bypass, the standard operations reduce the size of the stomach and bypass part of the intestine. That limits the amount of food a person can eat and the calories that can be absorbed. The procedures have soared in popularity as the obesity epidemic has spread and clinical trials have validated their safety and effectiveness. More >>

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Thursday, May 1, 2008

Hospital surgeon first in North Carolina to implant gastric band

Southern Pines, NC
A surgeon at FirstHealth Moore Regional Hospital who specializes in treating morbidly obese patients is the first in North Carolina to implant a recently approved adjustable band around a patient's stomach to help with weight loss.

Bariatric surgeon Dr. Kenneth Mitchell Jr. first used the device on Feb. 18. Since then, he has laparoscopically placed the Realize adjustable gastric band in several other patients.

Certain patients who are morbidly obese, meaning their weight poses a serious risk to their health, are candidates for the procedure in which the adjustable gastric band is placed laparoscopically around the top of the stomach.

"There is a balloon on the inside of the band, and we can adjust its size by injecting or removing saline through a port that we place underneath the skin," Mitchell says. "It is a portion-control device, limiting the amount a person can eat. Patients don't feel it around their stomach; they just start feeling full a lot sooner."

To be a candidate for placement of an adjustable gastric band, a patient must meet the same strict standards for gastric bypass surgery. Both treatments are only for patients who meet the clinical criteria for morbid obesity.

The goal of both is not only to help patients lose weight, but also to help control obesity-related conditions such as diabetes, high blood pressure, high cholesterol and sleep apnea.

According to Mitchell, people who have a gastric band implanted typically lose less weight and lose it more slowly than those who have gastric bypass surgery.

Whichever treatment a patient chooses -- gastric band or gastric bypass -- it shouldn't be considered a cure for obesity, Mitchell says. Permanent lifestyle changes, especially those involving diet and exercise, are essential to long-term weight loss.

"Bariatric procedures just provide an opportunity for patients to control their health problems associated with obesity and to control and maintain their weight loss," Mitchell says.

The Realize adjustable gastric band that Mitchell has begun using was developed by a Swedish company and has been used successfully in Europe for a number of years. The U.S. Food and Drug Administration (FDA) approved it for use in this country only last October.

The Realize device is very similar to the LapBand, another adjustable gastric band that received FDA approval in 2001. Both are made of silicone; the primary difference involves the size and width of the balloons.

"The two bands function the same way, and they are both good options," Mitchell says. "As a state and nationally recognized Center of Excellence for Bariatric Surgery, we are committed to providing all available surgical options to our bariatric patients.

"We feel this is in the best interest of our patients, and we will continue to use both adjustable gastric band systems. Some patients might prefer one over the other, and that's a decision we make together. It's nice that we now have a choice."


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Gastric bypass surgery may also relieve low back pain

Los Angeles, CA
Obese people who underwent surgery that reduced the amount of food they could ingest not only lost weight, they also lost some of their lower back pain, according to a new report.

Thirty-eight morbidly obese patients with low back pain who underwent gastric bypass surgery reported that their pain decreased by an average of about 44 percent six months after surgery, according to researchers at the University of Southern California. The average amount of individual weight loss among the group of 30 women and eight men was about 85 pounds.

"This study provides evidence that substantial weight reduction following bariatric surgery results in moderate reductions in pre-existing back pain within six months of weight loss. While this initial research is promising, larger long-term trials are needed to prove the efficacy of this treatment," Dr. Paul Khoueir said in a prepared statement.

Khoueir was expected to present the findings in Chicago April 29 at the annual meeting of the American Association of Neurological Surgeons.More >>


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