Wednesday, November 26, 2008
Labels: gastric bypass research
Monday, November 17, 2008
Weight loss surgery, also known as bariatric surgery, is big business these days. You've probably heard of gastric bypass and the LapBand procedure. Now, there is another method helping patient's drop pounds, and one San Antonio doctor is performing it through a single, tiny incision.
A patient at Innova Hospital in Southeast San Antonio is having what's called gastric sleeve surgery, which the doctor describes as an intermediate operation between LapBand and bypass.
"It's not quite as invasive as the gastric bypass in that there's no rearrangement of the anatomy. However, it's a little bit more invasive than the band in that we're excising a portion of the stomach," Dr. John Gonzales Jr. said.
Working through a single incision right at the belly button, the doctor inserts a camera and special tools. Then he cuts off the big, round part of the stomach, actually taking out about two-thirds to three-fourths of the organ. Dr. Gonzales leaves a small tube to hold food. Not only will the patient eat less, she'll feel less hungry.
"The major reason it works is by removing the fundus of the stomach, that sort of big, floppy portion, what you're also removing is a hormone called grehlin. And what we think grehlin is is one of the major hunger hormones," Gonzales said.
The procedure takes less than an hour and a half, and when it's over, there's no outward visible sign the patient has had surgery. The scar is hidden in the belly button. Gonzales is one of a handful of surgeons in the country performing the gastric sleeve surgery this way.
No weight loss is a cure-all. It's simply a tool to help patients cut their portions and eat less. Gastric sleeve is just one more option on the menu for people hungry for a drastic lifestyle change.
Labels: sleeve gastrectomy
American Idol's beloved bassist Randy Jackson turned a lot of heads when he joined his legendary colleagues Paula Abdul and Simon Cowell at the judge's table in 2004. The Grammy Award-winning producer was looking a whole lot slimmer than he had in previous seasons of Fox's blockbuster talent search show. Four years later, he continues to keep off his impressive 100-plus pound loss, after peaking at a hefty 350 pounds.
Now hitting the scales at 220 pounds, Jackson admits that over the years he had tried as many diets as there have been Idol finalists. "Liquid fasts. Bee stings. Urine of pregnant women. You name it. I have tried it," Jackson, 55, tells WebMD today, only half kidding. "The problem is that those diets don't work for people who have the disease of obesity."
So what finally did the trick for the Dawg, as Jackson calls himself?
Getting diagnosed with type 2 diabetes in 2001 was the final straw. And although this set him on his current path, there were -- and still are -- some bumps along the way. "The struggle continues." he says. "It never ends."
In 2003, Jackson opted to undergo gastric bypass surgery, a procedure in which a surgeon creates a smaller stomach pouch to curb food intake by stapling a portion of the stomach, to energize his weight loss efforts and step on the path toward good health.
But weight loss surgery is not a magic bullet. Like many people who undergo gastric bypass, Jackson eventually started gaining weight back. That's why Jackson says he committed himself to eating the right foods and kick-starting his fitness routine. Neither of which was easy for this Louisiana boy who loves rich sauces and beignets. "I grew up in the South," he says, "where food and good times were king."
And it's this part of his journey that makes up the heart of his new book, Body with Soul: Slash Sugar, Cut Cholesterol, and Get a Jump on your Best Health Ever.
Labels: celebrity gastric bypass
Saturday, November 8, 2008
Until now shrinking the stomach for weight loss was done through lengthy and risky surgery, but a new procedure can do it in under an hour with no cutting.
When 30-year-old Belinda Guevara's weight peaked at 217 pounds she decided to take action.
"I've heard about gastric bypass," she said. "I've also heard about the gastric banding and I'm really not the type of person that would submit myself to that kind of surgery."
Instead, Guevara opted for a new experimental weight loss procedure that shrinks stomach size without surgery.
It's done by going in through the mouth and down the esophagus.
"We are not removing anatomy were just making the tunnel a little thinner," Dr. Joe Greer said. "This is completely reversible. This is a procedure that takes up to 45 minutes to perform and patients go home within half an hour to an hour after the procedure."
Mercy Hospital in Miami is one of three centers in the U.S. that studies whether vertical gastroplasty is safe and effective.
Dr. Roberto Fogel of Mercy Hospital came up with this procedure in Venezuela.
Using a device that's FDA-approved to treat reflux, he stitches together parts of the stomach to make it smaller.
The procedure has been found to reduce levels of the hormone that controls hunger.
"So you have a little pouch that actually drips the food in one by one," Greer said. "You eat smaller amounts, you're not as hungry and so you lose weight."
Fogel said there have been no serious complications so far.
"We had in Venezuela maybe six or seven patients from the almost 400 with a small bleeding but a bleeding that was controlled in the moment," Fogel said.
Fogel provided before and after photos showing some impressive results.
The procedure costs $8,900 and insurance companies will not cover it because it's considered investigational.
Candidates for the study are people with a body mass index or BMI between 28 and 40, needing to lose less than a hundred pounds and have no chronic health conditions.
"Morbidly obese patients still should go for gastric bypass surgery," Greer said.
Two days after her gastroplasty, Guevara said she felt great and has noticed a big difference in her appetite.
"I'm not hungry, which is great because you don't have the urge and you don't have the sensation to just eat," she said. "It's incredible because you would never think that you would feel full having soup and having a small amount of soup. I'm already full."
Guevara said her goal is to lose 60 pounds.
Her doctors said most of that should be gone in six months.
Labels: gastric bypass surgery alternatives, Transoral Gastroplasty (TOGA)
"For the first time in my life I felt like a normal person," says Josh Thayer, who dropped from 367 pounds to 230 within a year of undergoing gastric bypass surgery in 1998. No longer did he always have to buy the aisle seat at the theater because "you feel guilty hanging over the person sitting next to you." No longer did he have to endure humiliations such as breaking a chair at his brother's wedding.
The best part, says Thayer, a Boston area professor, was not having to "think about food for the first time in my life. It was fantastic. I ate when I was hungry, stopped when I was full. I didn't feel like I was fighting an uphill battle."
Until five years later, when the weight started creeping back on.
When the 6-foot Thayer edged up to 310 earlier this year at age 45, he decided to go for a second operation: adjustable banding, more commonly known as lap-band surgery, which allows for repeated stomach-tightening and thereby offers a new opportunity for reining in appetite. Reactions to his decision vary, he says. While some people close to him worry about his going under the knife again, others have asked, "What the hell did you do wrong?"
Second surgeries to combat obesity are on the rise. The American Society for Metabolic and Bariatric Surgery doesn't keep statistics on repeat customers, but obesity surgeons are reporting upticks. Dennis Halmi, a member of the Bluepoint Surgical Group in Woodbridge, says that in 2002 "we did a handful" of second operations on obesity patients, "maybe five, six. This year we are doing probably 30." Scott Shikora of Tufts Medical Center in Boston says that until recently he hadn't performed a second obesity operation on anybody but is already up to about a half-dozen patients. Thayer was one of them.
George Fielding, whose obesity surgery practice at the NYU Medical Center in New York has gone from two or three second operations in 2004 to "probably 20 or 25 this year," isn't surprised at the trend. "There was a huge surge in gastric bypass from 1998 to 2001," he says. "Going into the early 2000s, everyone thought the gastric bypass was the best thing since Eric Clapton picked up a guitar. Then they went and hid, then they came in for help."
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The second time around, many, like Thayer, are opting for the adjustable band, which works differently from the bypass. With a bypass, 95 percent of the stomach is closed off with a stapling device. What could once stretch to the size of a football is reduced to the size of an egg that can't hold more than a tablespoon or two of food. In addition, the small intestine, where food goes when it leaves the stomach, is cut into two pieces. The lower piece, two to three feet down from the upper piece, is connected to the new, tiny stomach pouch. Thus, when food empties from the stomach, it bypasses a few feet of upper intestine, which means that fewer nutrients (including fewer calories) are absorbed by the body.
Obesity surgeons, Fielding included, report a high success rate for the bypass. Bypass patients lose some 60 to 80 percent of their excess weight, and 60 to 80 percent of those patients keep off at least two-thirds of the weight they lose. Such people often experience a near-complete reversal of diabetes, sleep apnea, high cholesterol, high blood pressure, arthritis pain and a host of other health-compromising problems, frequently going from several prescription drugs a day to none.
The thing is, for about 20 to 40 percent of patients, the operation fails over the long term. It's not always clear why. In a number of people, the stomach pouch softens, as does the opening between the stomach and the small intestine. That allows more food through more quickly, and the person's old level of hunger begins to return. As Joseph Moresca, a New York nurse who initially went from 440 pounds to 220 with a bypass, put it, "instead of being able to eat a quarter of a sandwich, I was eating three-quarters of a sandwich." He regained 45 pounds by the time he decided to go for banding.
In contrast to the bypass, the band does its work by separating the stomach into two parts: a tiny upper pouch and a larger pouch below the band. The tighter the band, the more slowly food goes from the upper part of the stomach to the lower, reducing hunger dramatically. The operation is far safer than bypass surgery because organs are not being cut and sewn. In addition, there's no nutrient malabsorption as there is with the bypass, because the small intestine is left intact; banding patients do not have to take nutrient supplements for the rest of their lives, the way bypass patients do.
But the biggest difference is that when hunger starts to return, the banding patient can go in to his doctor's office for a tightening. The band is shaped like a little life preserver that can fill and go slack. Saline solution injected into it through a portal just beneath the skin makes it more taut. The tighter the band, the less hungry you are, the less food you can get down comfortably, and the less you eat.
But in that advantage lies the band's disadvantage. If the patient doesn't go in for adjustments, the whole thing won't work. Also, you can eat around, or rather, through, the band. Ice cream shakes and other very soft or liquid foods can go through even a tight band, and every obesity surgeon can point to band patients who have sabotaged their operations by eating foods that slip right through. The ability to control the tightness is presumably part of the reason that patients who opt for banding lose less weight, at least initially, than gastric bypass patients -- an average of 50 to 65 percent of their excess weight in the first three years.
Another difference between the band and the bypass that proves both a plus and a minus is that the band doesn't cause the dumping syndrome. That's an often frightening attack of sweating, nausea, faintness, diarrhea, cramps and rapid pulse that bypass patients sometimes suffer after eating just a bite of a sugary food -- a deterrent to consuming certain calorie-dense items.
Of course, a second obesity surgery comes with increased risk. After a gastric bypass, there's often scarring that causes organs to adhere to one another. "The liver, stomach, spleen and diaphragm -- they all get drawn in together in a big blob of scar," says NYU surgeon Fielding. Thayer says his banding operation, which would typically take about an hour, kept him under general anesthesia for 3 1/2 hours because his surgeon "ran into a lot of adhesions."
Along with the risk comes the uncertainty of how well people will be able to lose -- and keep off -- weight the second time around. Not enough time has elapsed since the advent of second operations to get a long-term assessment.
What obesity surgeons do feel confident saying is that no matter which type of surgery is chosen, and whether it's the first or second time, the patient has to meet the operation halfway. You "still have to follow some semblance of dietary compliance," says Tufts's Shikora. "You also have to be more physically active, take care of your health. And you have to follow up."
In other words, anyone who sees obesity surgery as a solution in itself is chasing weight-loss rainbows.
Thayer, who was down 30 pounds a month after having had his band inserted, gets it. "You still have to diet," he says. "You still have to commit to an exercise plan." No obesity operation is "a magic bullet." But what he misses is that the bypass operation initially let him maintain his weight loss without putting extraordinary focus on his efforts.
Like a lot of other obese people, he says, he "had always been a person who could lose 100 pounds. I did it many, many times. The problem is, I'm not a great maintainer." The bypass, at least at first, let him not only achieve but also maintain the weight loss without thinking much about it. "I didn't have to count calories. I exercised,o but I didn't have to exercise two hours a day in order to stay at that weight."
He wants the new procedure to return his appetite to a more manageable level so that it helps the pounds stay off. "I'm hoping that this band will not allow me to eat a whole pizza anymore," he says. "Last summer I was able to eat a whole pizza again, and I was like, this can't be right."
Labels: gastric bypass surgery alternatives, Lap-Band surgery
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