Wednesday, November 18, 2009

Gastric sleeve surgery expected to become more popular

El Paso, TX
Doctors recommend that people battling obesity first turn to diet and exercise to drop their extra pounds.

But conventional weight loss methods aren't enough for some.

Sometimes, surgery is the only option.

For years, gastric bypass surgery and the Lap-Band procedure were among the only surgical options available for weight loss in El Paso. But the gastric sleeve procedure is poised to surge in popularity as patients learn more about the operation.

Dr. Benjamin Clapp, a bariatric surgeon at Sierra Providence Bariatric Center, said the two previous surgical options caused anxiety among patients for different reasons.

"A lot of people are uncomfortable with the aggressive remodeling of your gastrointestinal tract with a gastric bypass, but it has the best weight loss," he said. "A lot of people are also uncomfortable with the Lap-Band, which is a foreign band which stays inside your body."

The new alternative, he said, is the gastric sleeve procedure. In this procedure, the stomach is reduced to about 40 percent of its original size. Its appearance after the procedure resembles a tube or sleeve.

"The gastric sleeve is sort of a nice in-between procedure where you have almost as good weight loss as gastric bypass, but you don't have to rearrange everything and you also don't have to have a foreign body in there," Clapp said.

"The weakness of it would be it's not really adjustable and we don't know what the 10- to 15-year effects are, but we think we
can predict them."

The Sierra Providence Bariatric Center began offering the sleeve procedure in August 2008, but Clapp has performed it elsewhere for about three years.

So far, 10 have been done at his facility.

Of the three surgical techniques most often used today, the gastric bypass was the first to be widely used. In this procedure, doctors reduce the stomach size to only a small pouch, which is then connected to the middle of the small intestine. The procedure limits the amount of food consumed and limits the absorption of nutrients and calories in the small intestine.

The Lap-Band, or laparoscopic adjustable gastric band, also reduces the amount of food the stomach can hold. An inflatable band is placed around the top part of the stomach to create a smaller pouch for food. The patient is forced to eat less and subsequently loses weight.

The band can be adjusted to allow in more or less food, depending on the patient's situation.

Clapp said an advantage of the gastric sleeve is that if the patient does not lose the desired amount of weight, a gastric bypass procedure remains an option.

Michele Collins, director of Sierra Providence Bariatric Center, said the center has completed more than 1,650 weight-loss surgeries since it opened. This year, 300 patients will have received bariatric surgery at the center.

Collins said the center experiences a spike around this time each year as people meet their insurance deductible amounts or have extra vacation time to allow for their recuperation.

Dr. Bruce Applebaum, medical director of the Sierra Providence Bariatric Center, said patients who undergo gastric bypass can expect to lose about 70 percent of their excess body weight over about a year.

"If they're 100 pounds above their ideal body weight, they can expect to lose about 70 pounds in the course of a year," he said.

He said most of the weight is lost in the first six months after the procedure.

The weight loss achieved through the the gastric sleeve procedure is comparable to that of the gastric bypass, he said.

Lap-Band patients can expect to lose up to about 60 percent of their excess weight over the course of about two years.

Alejandro Romero, director of bariatrics at Del Sol Bariatric Center, said patients must be absolutely certain of their decision and be committed to their weight loss when they choose to have the weight-loss surgery.

"Make sure this is really your last resort. Make sure you've really given it your good effort in losing the weight, because it's a lifestyle change, both physically and mentally," he said.

Bariatric surgery providers require their patients first undergo a psychological evaluation as well as several other tests.

Clapp said even a flawless procedure won't work without a patient's commitment, which typically includes sensible diet, regular exercise and a vitamin supplement.

"People can do an amazing amount to overcome what we can do with surgery (with) constant grazing, choosing the wrong kinds of foods, not exercising, not paying attention to a post-operative diet," he said. "Nobody will ever tell these patients this is foolproof, this is some kind of magic button --Êit's not."

For those who do commit and successfully lose their excess weight, the improvements to their health can be vast. Significant weight loss can help alleviate conditions such as diabetes, high blood pressure, high cholesterol and sleep apnea.

"You've got to change for the rest of your life," Clapp said.

Applebaum said the procedures are gaining in popularity as more people become aware of them and more insurance plans cover them.

The current advances in the field are not the end of the road for bariatric surgery.

Clapp said he has begun performing the Lap-Band procedure through a single laparoscopic incision.

Applebaum said an endoscopic method is being studied in other parts of the country and could one day be available in this area.

"We do this because ... when patients come in smiling ear to ear, it provides positive feedback to us that we're doing the right thing for people who are obese," Applebaum said.

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