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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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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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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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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