Laparoscopic gastric bypass provides better results

New York, NY

Performing gastric bypass surgery to reduce the weight of morbidly obese patients using a laparoscopic method, rather than the conventional more invasive "open" abdominal method, reduces postoperative complications, the need for a second operation, and shortens hospital stays, new research shows. Nevertheless, laparoscopic gastric bypass is more expensive.

Obesity surgery, also called bariatric surgery, is growing in popularity and more and more of these operations are being done using a laparoscope, note co-authors Dr. Wendy E. Weller, from the University at Albany in New York, and Dr. Carl Rosati, from Albany Medical Center.

This is done by placing one or more small incisions in the abdomen, through which a hollow tube is inserted. This allows very small instruments to be inserted to perform the gastric bypass. The entire procedure is visualized on a screen. In contrast, the more invasive "open" procedure involves making an incision to open the abdomen so the procedure can be performed.

The current study, reported in the Annals of Surgery, involved an analysis of data from 19,156 subjects who underwent gastric bypass surgery in 2005 and were logged in the Nationwide Inpatient Sample, the largest all-payer inpatient database in the U.S.

Slightly less than 75 percent of the patients underwent laparoscopic gastric bypass, the report indicates.

Laparoscopic gastric bypass was linked to a reduced risk of several complications. With open surgery, the risk of pulmonary complications was increased by 92 percent, for cardiovascular complications it was 54 percent, for sepsis, a serious system-wide infection, the risk was more than doubled and the risk of anastomotic leak, leakage from the operative site, 32 percent higher.

On average, performing laparoscopic rather than open gastric bypass reduced the hospital stay by about 1 day.

The average total charges were similar for the two procedures, but median total charges were significantly higher with laparoscopic gastric bypass: $30,033 vs. $28,107 respectively.

After accounting for various patient and hospital factors, laparoscopic surgical patients were less likely than their open-surgery counterparts to require reoperation, the investigators found.

While these findings suggest some advantages with the laparoscopic operation, "most reassuring for the bariatric surgery community is that the hospital outcomes were excellent overall in both the laparoscopic and open procedures," Dr. Michael G. Sarr, from the Mayo Clinic in Rochester, Minnesota, comments in a related editorial.

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Intestinal barrier may be alternative to gastric bypass

Burlington, MA

Doctors at Lahey Clinic are investigating a new device that may prove a non-surgical alternative to gastric bypass and a route for resolving type 2 diabetes -- a disease that plagues nearly one in 10 American adults and nearly 250 million people around the world.

The EndoBarrier Gastrointestinal Liner -- a two-foot plastic sleeve with a nickel-titanium anchor at one end that adheres to the soft tissue in the duodenum -- nestles within the first two feet of the small intestine, allowing food to pass through a portion of the tract without being absorbed.

The effect mimics gastric bypass -- a procedure that reduces stomach size and surgically reroutes first few feet of the small intestine -- but without going under the knife. It's currently being tested in 40 gastric bypass patients at four U.S. medical centers, including Lahey, who are required to lose weight before surgery.

There are few options for the nearly 70 million American adults who are either obese or morbidly obese, defined as a BMI of 35 and 40, respectively. They're often beyond making dietary changes, and exercise -- given the physical limitations of their size -- is often out of the question.

For many, it's surgery or facing life with the debilitating effects of obesity -- everything from heart disease to cancer, depression to diabetes. Obesity is considered the second leading cause of preventable death in the U.S., after smoking.

And while gastric bypass is increasingly

popular -- one study found a six-fold increase in the surgeries between 1998 and 2002 -- Lahey surgeon Dmitry Nepomnayshy said roughly one percent of obese people eventually choose it. About 200,000 Americans had the surgery in 2007.

"A lot of people are afraid, and rightfully so," said Nepomnayshy, the chief investigator in the EndoBarrier trial.

"There's pain and suffering associated with surgery, risk of complications, even though it's the most effective treatment for obesity. But obesity is dragging down our health care system like a big anchor. Right now (other than surgery), all we can tell you is go out and exercise, eat right. This is another tool for treatment, another option."

Inserted through the mouth while the patient is under general anesthesia, the EndoBarrier is nudged into place and then deployed into the intestine like an unraveled parachute. The procedure takes 30 minutes. Patients are kept on a liquid diet for a week, purees for another, finally progressing to normal meals thereafter.

"Percentage-wise, the device isn't covering a big portion of the small intestine," explained Nepomnayshy, "but the results are impressive and we think it's because it's the area -- that first part -- where the absorption of nutrients takes place."

While there's not complete scientific agreement on how the body processes food, most doctors agree that the first couple of feet of intestine are critical both for nutrient absorption and spurring hormonal shifts that stimulate the pancreas to produce insulin.

The FDA has approved the device for a 12-week period, and patients in the trial have lost between 11 and 26 pounds. The next stage, said spokesman Jonathan Hartmann from Lexington-based GI Dynamics, will be to test the device's efficacy over three, six and 12 months. There are no plans, Hartmann added, to ever permanently implant the EndoBarrier.

Though the device requires further testing, Nepomnayshy called the device promising.

"Right now, obesity is one of the biggest health problems out there, and not just obesity itself but the diseases it causes -- cancer, diabetes, joint pain," he said. "People not choosing surgery still need help; we have to offer them something else. This is an example of something that's down the road that may just help them."

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Gastric Bypass study at targets obese teens

Cincinnati, OH

It's arguably one of the most controversial weight loss options currently available -- gastric bypass surgery.

When it works, patients often lose hundreds of pounds that they would be hard pressed to get rid of in other ways.

When it doesn't work, it can lead to serious illness or death.
Click here to find out more!

Cincinnati Children's Hospital is one of five running a 10-year study of the procedure and its effectiveness on a segment of the population that often feels the brunt of weight shame -- teenagers.

"No one likes to see teenagers get to this point of this level of obesity that they can't go to school, they don't have friends," Dr. Meg Zeller said. "Their medical health resembles an adult's medical health, but the surgery and the weight loss that follows can alter that trajectory."

"We are seeing kids with average weight of nearly 400 pounds. The range is 250 to 650," Dr. Thomas Inge said.

Kylie Crovo said she can tell you about the benefits. She came to Children's Hospital at age 15 weighing 255 pounds. Now 17, she's lost 110 pounds in 18 months.

"It just feels great to live life not having to worry about any potential medical problems," she said.

Inge said he knows the procedure has its critics, especially when it involves teenagers.

"I think the average person who is hearing about weight loss surgery for teenagers and thinks, 'Oh my gosh, what are (they) thinking?' are not able to put themselves in the shoes of the people we are seeing," he said.

Amanda Munson has lost 100 pounds so far.

"The study means to me, basically I'm helping everyone else. We can give more information to other people," she said.

Doctors said they will follow all the patients over the next 10 years to study the long-term effects of the procedure.

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Obesity epidemic leading to rise in gastric bypass surgery

Longview, TX

As advancements continue to change the field of medicine, patients continue to benefit. Average life expectancy is still rising, and new medicines are increasing the quality of life for patients with chronic conditions.

In spite of these medical advancements and a cultural shift emphasizing the importance of exercise, one particular area that remains unsettling is the growing number of overweight or obese Americans. Using measured heights and weights, the 2003-2004
National Health and Nutrition Examination Survey (NHANES) reported that 66 percent of American adults are either overweight or obese.

For many obese or overweight Americans, shedding weight has led them to lifestyle changes, such as a healthier diet and a new exercise regimen. Many others go the surgical route, as 177,000 Americans opted for weight loss surgery in 2006 alone. The vast majority of those surgeries were Roux-en-Y gastric bypass surgery. While gastric bypass can seem like a quick fix that enables patients to shed weight almost overnight, the surgery and its ramifications are in fact quite complicated, and should never be looked at as an easy way to drop weight.

What Is Gastric Bypass?

Roughly 80 percent of the weight loss surgeries performed in America this year will be gastric bypass procedures. This is a two-part procedure.

· Stomach pouch: The creation of a stomach pouch is the portion of the procedure many people refer to as “stomach stapling.” During this part of the surgery, the stomach is divided unequally, with one large pouch and one much smaller pouch. After this division, the smaller pouch is sewn or stapled. That pouch can only hold a very small amount of food (roughly one cup). Such a small holding capacity is designed to make people feel full faster, which in turn will make them eat less.

· Bypass: In the second stage the surgeon will employ the Roux-en-Y technique, in which the smaller pouch is disconnected from the first part of the small intestine (the duodenum). The surgeon will then reconnect the stomach to a lower portion of the intestine (the jejunum). Once that has occurred, any food consumed will pass directly from the stomach into this lower portion, where fewer calories and nutrients are absorbed.

What Happens After the Surgery?

While patients can expect to lose weight after gastric bypass surgery, there are negative consequences as well. Though not all patients will experience such consequences, and death is extremely rare (especially when surgery is performed by an experienced gastric bypass surgery), some of the following might occur after surgery.

· Wound infections

· Problems with digestion

· Bleeding

· Ulcers

Those are some of the more common complications after surgery. Some of the less common, though extremely serious and potentially life-threatening, complications include the following.

· Pulmonary embolism (blood clot)

· Serious infection and persistent bleeding

· Heart attack

· Leakage in the surgical connections in the intestines

Because of the nature of the surgery, in which food is re-routed into the jejunum where less nutrients are absorbed, certain health problems can arise as a result. For example, the human body needs a certain amount of iron and calcium to remain healthy. However, the jejunum does absorb these nutrients well, and therefore conditions such as anemia and osteoporosis can arise as a result. Iron and calcium supplements, as well as routine blood tests, can lower the risk of developing such conditions.

Although there can be complications, many gastric bypass patients experience positive results. Weight loss is often dramatic, especially for patients who were considerably overweight.

Another benefit of gastric bypass is that patients who have obesity-related health problems often see improvements in those conditions after surgery. Such conditions include diabetes, sleep apnea and high blood pressure.

While the benefits of gastric bypass surgery are numerous and have helped many a public figure, it’s important to recognize the surgery is not a one-size-fits-all solution, and each case needs to be examined on an individual basis.

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ASMBS: Bariatric Surgery Found Superior to Drugs in Controlling Diabetes

Washington, D.C.

For morbidly obese patients with type 2 diabetes, bariatric surgery led to more improvement in glycosylated hemoglobin than standard treatment, a retrospective analysis showed.

Those who underwent Roux-en-Y gastric bypass had an average drop in hemoglobin A1c of 21% within a year (P<0.001), compared with an increase of 11% with conventional treatment (P<0.05), which included oral hypoglycemics and insulin, according to Daniel Mumme, M.D., of Gundersen Lutheran Medical Center in La Crosse, Wis.

Body mass indices fell from an average of 47.3 to 30.9 kg/m2 (P<0.05) in the surgery group and did not change significantly from 44.9 kg/m2 in the conventional-treatment group, he reported at the American Society for Metabolic & Bariatric Surgery meeting here. More >>

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Post-gastric byass body lift surgery, only way to lose excess skin

New York, NY

Tipping the scale at 330 pounds, 47-year-old Cindy Schreiner decided to get gastric bypass surgery in 2002.

“I was downtown on 9-11,” Schreiner recounted. “And I couldn’t run … I had a colleague pulling me down the street saying come on, you can run, you can run and I just thought, I can’t move anymore and I was so huge.”

It was turning point for Schreiner, who has lost 185 pounds to date.

But working out daily and changing her eating habits has not helped Schreiner obtain the body she has always wanted.

“I would grab the skin and go I want this gone,” she told FOXNews.com. “Because I had worked so hard to lose the weight and I didn’t see all the benefits because the skin was hanging.”

Click here to watch Schreiner tell her story.

Dr. Lyle Leipziger, chief of plastic surgery at Long Island Jewish Medical Center and North Shore University Hospital, said weight loss surgery is only half the battle for patients like Schreiner.

The majority of patients have excess skin, which could weigh five to 10 additional pounds. As a result, psychological and physical issues often plague patients after weight loss surgery.

“We've had patients that have excess abdominal skin almost hanging down to their knees,” said Leipziger, adding that the skin sometimes makes it difficult for patients to walk or move. “Patients can come in and sometimes they can get infections in the area underneath that abdominal extra skin.”

Body lift surgery was the answer to Schreiner’s problems. Sort of like a tummy tuck for your whole body, Leipziger said, a body life is the only way for these patients to get rid of the extra, baggy skin.

“You feel self-conscious about it,” she said. “You feel like you have, you’re flattening it, pushing it down … to hide it.”

But even with surgery, results do not happen overnight.

“The patient should have most importantly realistic expectations, understand that we can do a lot, we can’t turn people into supermodels, but we can certainly improve their appearance and quality of life.”

Schreiner has undergone five body lift procedures to contour her tummy, breasts, outer thighs, buttock and back. With one more surgery left to go, Schreiner is excited to finally have her "dream body". “I feel like I’ve been given a new life,” admitted Schreiner. “I’ve always dreamt of looking like this. I really did. And it’s like, I’m here.”

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Soprano Deborah Voigt lost 120 pounds after gastric bypass surgery

New York, NY

Deborah Voigt chuckles when I ask her about the brouhaha over the skimpy frock she couldn't fit into that delighted the often dull world of grand opera.

In 2003 Voigt was obese, as she herself admits, and was dropped from a revival of Richard Strauss's ``Ariadne auf Naxos'' at the Royal Opera House in London. ``Inappropriate casting in this particular production,'' said the house, and paid off her contract.

In Christof Loy's staging, the character of Ariadne wears a silky and close-fitting outfit, and is required to roll on the floor. In fairness to the Royal Opera, Voigt had been booked to sing before the staging had been designed.

``In terms of the production, it was the right decision to drop me from the role,'' says the American soprano with a shrug. ``I still think it could have been worked through however. We could have come to a mutually satisfying result.''

When Voigt went public, the media had a field day about the rights and wrongs of realism in opera. The uproar became known as ``the affair of the little black dress.''

Voigt, 47, is now 120 pounds lighter after gastric bypass surgery, and has been invited back to London to sing Ariadne in the same staging. The soprano says she hopes that certain ghosts now will be laid to rest. More >>

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