Endobarrier gastric sleeve eyed as alternative to gastric bypass surgery

Boston, MA

Many people who could potentially benefit from gastric bypass are reluctant to undergo surgery, but some local doctors are testing a new, less invasive procedure that may help patients lose weight.

Geri Jemlitch has struggled with food all her life, but when she weighed in a 382 pounds, she knew she had to do something drastic.

She underwent gastric bypass surgery last year. "It has been remarkable… (It has changed) my life and attitude."

But Geri also decided to undergo a new, less invasive procedure over the summer.

Doctors use an endoscope to place a 2-foot, plastic sleeve called an "endobarrier liner" in the beginning of the small intestine. It allows food to pass through a portion of the tract without being absorbed.

"It prevents digestive juices from coming in contact with the food, thus duplicating the effects of gastric bypass," explains Dr. Dmitry Nepomnayshy of the Lahey Clinic. "Right now we're seeing moderate weight loss – 12 to 24 pounds – during the period of the study, which is 12 weeks."

Researchers are expecting to release the results of the first phase of testing within the next six months, and if the procedure is shown to be safe and effective, then they will begin larger scale studies.

The new device was developed by the GI Dynamics, which is based in Lexington

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On October 30, OR Live to broadcast a laparoscopic adjustable gastric band surgery

Fridley, MN

Allina Hospitals & Clinics' Unity Hospital will present a live weight loss surgery online at 3 p.m. on Thursday, Oct. 30. Jeffrey Baker, MD, will perform a laparoscopic adjustable gastric band surgery, commonly known as Lap-Band® or Realize Band™ surgery, while Frederick Johnson, MD answers viewer questions, and talks about the benefits of adjustable banding procedures.

"This is a great opportunity for individuals contemplating weight loss surgery to learn more about a minimally invasive, proven option for surgical weight loss," said Frederick Johnson, MD, surgeon and co-medical director for the Unity Hospital Bariatric Center.

During the laparoscopic gastric banding procedure, surgeons make several small incisions and use long instruments, called laparoscopes, to place a silicone band around the top of the patient's stomach, creating a small stomach pouch. As a result, the patient feels fuller with smaller amounts of food, resulting in weight loss. The band can be further adjusted to limit or increase the amount of food the stomach can hold, or adapt to future lifestyle changes such as pregnancy.

In addition to weight loss, patients frequently see many other health benefits, including better control or resolution of diabetes, high blood pressure, arthritis, high cholesterol, sleep apnea, asthma, heartburn, cancers and many other illnesses associated with morbid obesity.

This procedure also has significantly shorter recovery times than other weight loss surgeries. "Laparoscopic procedures only require four to six small incisions, rather than the much larger incision required for traditional weight loss surgery," says Jeffrey Baker, MD, surgeon and co-medical director for the Unity Hospital Bariatric Center. "Most of our patients go home after one night in the hospital."

Nationally recognized as a "Bariatric Center of Excellence" by the American Society for Metabolic and Bariatric Surgeons, Unity Hospital's Bariatric Center is dedicated to helping patients achieve significant weight loss, which can lead to a healthier, more active lifestyle.

Unity's Bariatric Center has treated more than 5,000 patients for the disease of morbid obesity since 1996. From its beginning, the center has been a resource for community education, medical training, and patient care. The Center offers a variety of proven weight loss surgery options, including open or laparoscopic Roux-en-y gastric bypass surgery, and the increasingly popular laparoscopic adjustable gastric banding (including LAP-Band® and REALIZE Band™).

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The trouble with gastric bypass surgery

Phoenix, AZ

Many extremely obese people these days, under the mistaken belief that it will be the answer to their health problems, are flocking to get gastric bypass surgery. Now this treatment option may be pushed on even more people. A study published in The American Journal of Managed Care reports that bariatric surgery can "pay for itself" by diminishing the number of insurance claims filed by people who are grossly overweight.

Gastric Bypass Surgery Is No Picnic

However, gastric bypass surgery has many associated risks. The risks, according to a Mayo Clinic article, include death, blood clots in the legs, leaking at the staple lines in the stomach, incision hernia, narrowing of the opening between the stomach and small intestine, dumping syndrome, iron deficiency anemia, vitamin B-12 deficiency, vitamin D deficiency, dehydration, gallstones, bleeding stomach ulcers, intolerance to certain foods, kidney stones, low blood sugar, body aches, fatigue (like when one has the flu), feeling cold, dry skin, hair thinning and hair loss, and mood changes. Of course, there are also the same risks that go along with any surgery, like bleeding, infections, and adverse reactions to the anesthesia. That doesn't exactly sound like a picnic, no pun intended.

Will Surgery Save Insurance Companies Money?

Unfortunately, there is even more reason to be concerned about gastric bypass surgery. Dr. Douglass warns in an article that the funding for the study that purports that this surgery will save insurance companies money came from a company known as Johnson & Johnson's Ethicon Endo-Surgery, Inc., which is a major manufacturer of bariatric surgical instruments. Additionally, Dr. Douglass points out that Dr. Scott Shikora, a co-author of the study, is the president of the American Society for Metabolic and Bariatric Surgery. It's easy to see that the members of this group would clearly benefit if insurance providers would decide that they could save money if more patients were approved for this course of treatment.

Up to Five Percent Die Within a Year of Surgery

The sad truth of the matter is that, according to Dr. Douglass, up to five percent of the patients who undergo this course of treatment are dead within a year. (That's certainly one way to trim down future medical costs.) While Dr. Douglass believes that surgery should always be a last resort, many other doctors believe that the current requirement by insurance companies that people first try to lose weight by a six-month doctor-supervised weight loss program is unreasonable. Says Douglass: "People like Shikora would prefer that patients go right from the dining room table to his operating table." While natural health advocates might not agree with Dr. Douglass on all of the issues, most certainly appreciate his acerbic wit. Hmmm... was the guy who said that "the way to a man's heart is through his stomach" a bariatric surgeon?

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Stanford study: Gastric bypass may boost smarts

San Francisco, CA

In the United States, with most Americans overweight or obese, the demand for gastric bypass surgery is booming. The procedure often results in dramatic weight-loss, but a study now suggests it could also lead to increased brain power.

Stanford researchers found that gastric bypass surgery improved a patient's ability to remember, think through problems, and pay attention to details. The findings were reported Tuesday at the American College of Surgeons annual meeting held this year in San Francisco.

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Robot-assisted gastric bypass lowered risk for gastrointestinal leaks

Houston, TX

The use of a robot to assist with laparaoscopic Roux-en-Y gastric bypass surgery appears to significantly lower a patient’s risk for gastrointestinal leaks compared with gastric bypass performed by a surgeon alone.

Minimally invasive surgeons at The University of Texas Medical School at Houston analyzed operative times, length of hospital stay and complications in 605 patients who underwent laparoscopic Roux-en-Y gastric bypass either performed solely by a surgeon (n=356) or with robot assistance (n=249).

Main outcome results were similar between groups. Robot-assisted surgery took 17 minutes longer than the surgeon-only procedure. Hospital stays were an average of three days in both groups, and the overall complication rate was 14% in each group, with fewer than 4% classified as major complications. In the five-year study, there were no deaths in either group.

No patient in the robot-assisted surgery group experienced a gastrointestinal leak; however, six in the other group experienced the complication within 90 days after the surgery. The rate for gastrointestinal leaks and other complications was slightly lower than what has previously been reported in other scientific journals, according to the researchers.

“While robotic surgery may take slightly longer and be more costly to use than traditional laparoscopy, we believe that the improved outcome and decreased leak rates may offset the cost to some extent,” Erik B. Wilson, MD, director of the University of Texas Medical School at Houston Minimally Invasive Surgeons of Texas group, said in a press release.

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Weight loss surgery without an incision: The toga procedure

Knoxville, TN

When diet and exercise are not enough some people are turning to surgery to help those lose weight.

But those involve cutting into the stomach and changing anatomy.

Now there's a new, less invasive, option.

Yo yo diets are nothing new for Liliana Gomez-Guerrero.

"Ever since I hit puberty my weight was up and down," said Gomez-Guerrero.

But as a mother with young children, she can't take the issue lightly especially with a family history of health problems.

"One of my uncles passed away two years ago from coronary artery disease, he also had diabetes, so I don't want to fall into that category," said Gomez-Guerrero.

She considered gastric bypass, but then she heard about a less invasive way to do it.

An experimental procedure at Cedars Sinai called toga.

"Well the toga procedure is a very exciting step forward. There has been a lot of interest in continuing our journey to less invasive procedures. And one of the least invasive ways to perform surgery is to go through the mouth, a natural orifice that doesn't involve cutting or scars or incisions," said surgeon Dr. Edward Phillips.

A flexible device is passed through the mouth and down to the stomach.

Once in the stomach, it staples part of the stomach together to create a small pouch.

"It's like having a big room, like the stomach, and putting in a partition or a wall in the room, separating it into two rooms," said Phillips.

It keeps food inside that new tubularized stomach and allows them to feel full," said Bariatric Surgeon Dr. Kai Nishi.

Unlike gastric bypass, no part of the stomach is removed and there is no rerouting of the intestinal tract is done.

That means fewer side effects.

"Overseas the results range from 40-50 percent excess body weight loss in a 6 month to 1 year period, which is equivalent the adjustable band," said Dr. Nishi.

"Little bit of discomfort in my throat but other than that, no pain in the abdominal area," said Gomez-Guerrero.

A month after the procedure and a strict diet, lily has lost 20 pounds.

She is selling her old clothes at a yard sale!

"I feel great. I feel good especially with the clothes fitting a lot better," said Gomez-Guerrero.

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Study: Gastric bypass not effective diabetics

San Francisco, CA

Gastric bypass has helped thousands of people effectively lose weight, but a new study finds diabetics who undergo the surgery are less likely to see good results.

Researchers at the University of California San Francisco studied over 300 gastric bypass patients a year after their procedure.

They found patients with diabetes were unable to lose more than 40-percent of their excess body weight.

Researchers believe the medications diabetics take like insulin actually stimulate the body's production of fat and cholesterol.

They say changes in the use of these medications could give diabetics a better chance to achieve better weight loss results after gastric bypass.

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