Tuesday, January 19, 2010

Gastric band surgery can help extend lives of obese people, says study

New York, NY
A new study backs up the belief that bariatric surgery is beneficial for losing weight and extending the lives of obese men and women.

But the precise pluses of the procedure vary by individual and are influenced by many variables, including a patient’s age, weight and gender, according to the Guardian.

The research was carried out at the University of Cincinnati Academic Health Center.

In one type of bariatric surgery, a physician wraps a band around the patient’s stomach, reducing its size. Because they feel full faster, people eat less.

Over time, they shed weight, which helps to prevent heart attacks, strokes and type 2 diabetes, according to The Guardian.

Bariatric surgery is typically given to people whose body mass index (BMI) is over 40.

But because any type of surgery comes with risk, including infection, other complications and even death, the study looked at potential positive outcomes versus the inherent danger of undergoing the knife.

Age was a significant variable, since younger patients undergoing surgery are less apt to die from surgery or develop complications.

Researchers found that for a 42-year-old woman with a body mass index of 45, weight-loss surgery could extend her life by up to 3 years.

A 44-year-old man with a BMI of 45, reaped slightly less dramatic results. He could expect to increase his life by 2.6 years after surgery.
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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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Sunday, September 13, 2009

Patient bleeds to death after gastric band surgery

A mother told to lose weight to avoid serious health problems died hours after surgery to fit her with a gastric band.

Susan Alderson had three litres of blood in her abdomen and had bled to death, a post mortem found.

Experts had advised the 49-year-old to have the band fitted, a procedure which reduces the size of the stomach.

Susan Alderson received gastric band surgery at the former Derby City General Hospital in January. She later bled to death

But after the operation, which was also to repair a hernia, Mrs Alderson suffered internal bleeding, which claimed her life, an inquest was told.

Mrs Alderson, a diabetic who weighed more than 16 stone, was told by dieticians she would need the surgery to help prevent other potentially life-threatening illnesses.

She was admitted to the former Derby City General Hospital in January.

The hearing, attended by Mrs Alderson's husband and son, was told the operation went ahead without complications and Mrs Alderson appeared to be recovering well.

Derby Coroner's Court heard she started bleeding internally hours later, leading to a cardiac arrest and her death the next morning.

Paul Leeder, who carried out the operation, said: 'I had never experienced any problems with patients having severe complications. I had not had a death either before that operation or since.'

He said Mrs Alderson's body mass index (BMI), which determines whether a patient has a healthy body weight by measuring their height and weight, was 44, classing her as morbidly obese.

A patient who weighs too much in comparison to their height is in danger of developing problems such as strokes, heart problems, arthritis and an increased risk of cancer.

Mr Leeder said: 'Mrs Alderson had been on a low-calorie diet but had only lost four kilogrammes (nine pounds).

'The three options were for her to carry on as she was, without surgery, to have a gastric bypass or to have the gastric band.

'The risk of bleeding, risk of death and failure rate of the procedure were explained. But the long-term benefits of sustained weight loss would have far outweighed the risks involved with the surgery.'

After surgery, Mrs Alderson, of Sinfin, Derby, was moved into a recovery area, where her blood pressure started to drop.

Doctors gave her injections to help boost her blood pressure but, later that evening, it started to drop again. She was moved to a higher dependency ward and appeared to be recovering.

Mrs Alderson was later transferred to a 'step-down' ward, where she suffered a heart attack and later died.

Her post mortem examination found between two-and-a-half to three litres of blood collected in her abdominal wall, close to the repaired hernia.

Dr Andrew Hitchcock, consultant pathologist at Royal Derby Hospital, said it was not clear where the bleeding had originated.

Dr Hitchcock said Mrs Alderson's medical cause of death was internal bleeding, related to the hernia repair and gastric band operation.

Recording a narrative verdict, deputy coroner Louise Pinder gave the cause of death as intra-abdominal haemorrhage and incisional repair and gastric band application.

Miss Pinder said: 'She had no particular interest in losing weight for interests of vanity, this was very much a medically-based decision.'

A spokesman for Derby Hospitals, said: 'Our thoughts are with Mrs Alderson's family.

'Any surgery carries a risk and in Mrs Alderson's case the risks were higher due to her high BMI, severe diabetes, liver problems and a hernia repair.

'These factors meant that when Mrs Alderson developed complications, her blood did not clot in the normal way.

'The coroner said that the clinical team could not have foreseen the tragic outcome in Mrs Alderson's case.'

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Saturday, August 22, 2009

Gastric bypass surgery death rates drop, study reveals

Seattle, WA
Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

The study looked at safety results for gastric bands and stomach stapling at 10 U.S. hospitals specializing in these procedures from 2005 through 2007. For every 1,000 patients, three died during or within a month of their surgery, and 43 had a major complication.

That is much better than the 20 or so deaths per 1,000 patients that studies found just a few years earlier. And it's surely lower than the longer term risk of dying of heart disease, diabetes and other consequences of lugging around more pounds than an obese person's organs can handle, experts say.

Many studies have compared those odds, and "all show a higher risk of dying if you do not have surgical treatment than if you do," said Dr. Eric DeMaria, weight loss surgery chief at Duke University Medical Center.

He had no role in the new study, which was led by Dr. David Flum at the University of Washington in Seattle. Results appear in Thursday's New England Journal of Medicine.

About one-third of American adults are obese, with a body mass index of 30 or more. The index is based on height and weight. Someone who is 5-feet-4 is obese at 175 pounds; a 6-foot person is obese at 222 pounds.

Federal guidelines say obesity surgery shouldn't be considered unless someone has tried conventional ways to shed pounds and has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

Last year, at least 220,000 obesity surgeries were done in the United States, says the American Society for Metabolic & Bariatric Surgery. The most popular method is a gastric bypass in which a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. This can be done with traditional surgery or laparoscopically, through small keyhole incisions.

Another solution is a gastric band. A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

The new study looked at the safety of these methods in 3,412 gastric bypass patients and 1,198 given stomach bands.

Death, serious complications or the need for another procedure occurred in 1 percent of people receiving bands, nearly 5 percent having laparoscopic gastric bypass, and nearly 8 percent of those given a traditional surgical bypass. Maybe

DeMaria cautioned against comparing the numbers, because healthier people may have been steered toward laparoscopic procedures that may not have been an option for others with more health risks.

Complication rates were greater in people with a history of clot problems, sleep apnea and certain other medical issues, the study found.

The federal government paid for the study. Many of the researchers have ties to companies that make obesity treatments, and several have testified in surgery lawsuits.

The results put the spotlight on cost issues, Dr. Malcolm K. Robinson, a surgeon at Harvard Medical School, wrote in an editorial accompanying the study.

"In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven," he wrote.

Now, the evidence shows that "surgery is safe, effective, and affordable," because it can lower doctor visits, medication use and other medical expenses, Robinson wrote. However, "the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health care system."
On the Net:

* New England Journal: http://www.nejm.org
* National Institutes of Health surgery explanation: http://win.niddk.nih.gov/publications/gastric.htm

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Tuesday, July 7, 2009

ASMBS: Laparoscopic adjustable gastric banding less effective than gastric bypass and sleeve gastrectomy

Dallas, TX
Patients who underwent laparoscopic adjustable gastric banding achieved less weight loss and less improvement in comorbid conditions than those who had gastric bypass or sleeve gastrectomy.

Slightly more than half of gastric banding patients lost more than 50% of excess weight after five years compared with more than 90% of patients who underwent laparoscopic Roux-en-Y gastric bypass, Diego Awruch, MD, reported at the American Society of Metabolic and Bariatric Surgery.

Surgical failure, defined as less than 50% excess weight loss, was almost six times more common with gastric banding.

"Laparoscopic adjustable gastric banding was associated with fewer complications, but the percent weight loss at one and five years was inferior to laparoscopic Roux-en-Y gastric bypass," said Dr. Awruch, of Pontificia Universidad Catolica in Santiago, Chile.

"Surgical failure occurred in more than 40% of patients who underwent gastric banding, and 16% of the patients required surgical revision of the initial procedure," he said.

Similar disparities in weight loss occurred in the comparison of gastric banding and sleeve gastrectomy.

Across the entire range of body mass index (BMI), laparoscopic sleeve gastrectomy led to greater weight loss, said David Schumacher, MD, of Wright State University in Kettering, Ohio.

Dr. Awruch reported outcomes for 91 patients treated with laparoscopic Roux-en-Y surgery and 62 who underwent gastric banding from 2001 to 2003.

Five-year follow-up was available for 73.6% of the gastric bypass patients and 91.5% of the gastric banding patients.

Comparison of baseline characteristics showed that bypass patients weighed significantly more (106.4 versus 97.6 kg, P<0.001) and had a significantly higher BMI (39 versus 35, P<0.001).

Gastric bypass was associated with a higher rate of early complications (14.2% versus 1.6%, P=0.009). In addition, nine bypass patients required reoperation or endoscopic dilatation compared with one patient in the banding group.

Late complications occurred in 37.3% of bypass patients compared with 27.4% of gastric banding patients, but the difference did not reach statistical significance. A higher proportion of gastric banding patients required reintervention (23 of 62 versus 20 of 91).

Percent weight loss at five years averaged 92.9% with gastric bypass compared with 59.1% with gastric banding (P<0.001).

Dyslipidemia, insulin resistance, hypertension, and type 2 diabetes improved or resolved in 80% to 100% of bypass patients compared with 20% to 40% of the gastric banding group.

At five years, 94% of bypass patients and 54.4% of gastric banding patients had maintained >50% excess weight loss.

Dr. Schumacher reported outcome data for 104 patients who underwent laparoscopic sleeve gastrectomy and 227 who had gastric banding from January 2006 through August 2008. Follow-up data were 99% as of January 2009.

Among patients followed for at least 18 months (about half of the total), weight loss averaged 133.82 lb in the sleeve group versus 58.93 lb in the banding group.

For the same time interval, excess weight loss averaged 55.54% with sleeve gastrectomy versus 38.65% with banding.

Stratification of patients by baseline BMI showed that sleeve patients had a greater excess weight loss in patients with BMI more than 50 (50% versus 33%), 40 to 49 (68% versus 40%), and less than 40 (90% versus 43%).

Readmission rates were 6% of sleeve gastrectomy patients and 1.3% with gastric banding. One patient (0.96%) in the sleeve group required reoperation compared with 19 (8.4%) gastric banding patients.

"Laparoscopic sleeve gastrectomy appears to allow greater weight loss in all BMI classifications over time with fewer reoperations," said Dr. Schumacher. "The most efficient weight loss occurred in the lowest BMI classification.

"Laparoscopic sleeve gastrectomy can be used effectively as a primary operation in any weight classification, achieving a greater than 50% excess weight loss in all BMI subsets."

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Saturday, March 21, 2009

Gastric Action: 'Lap-band' surgery for teens gaining acceptance

Charlottesville, VA
Andrew Burrill says that the worst moment occurred last year in his high school cafeteria. Heading for a table, his tray laden with an extra portion of his favorite school lunch, Andrew was intercepted by a teacher who loudly asked, "Are you SURE you should have gotten doubles?" Andrew, who at the time was nearly 5 feet 4 and weighed 260 pounds, burst into tears.

"There were times when I felt I just couldn't go on," recalled Andrew, a sophomore, who lives near Charlottesville, Va. At 15, already a veteran of numerous failed diets, exercise programs and summer "fat" camp, Andrew became convinced that weight-loss surgery, which had transformed the physique of a family friend, was his only hope. He pleaded with his mother for help.

"I had to do this for him, no matter what," recalled his mother, Cheryl Burrill, an IT executive. But when she called hospitals around the country to find a surgeon who would reduce Andrew's stomach from the size of a large grapefruit to the size of an egg, she was told that he was too young and should come back when he turned 18.

Worried about his increasing girth, high blood pressure and severe sleep apnea, Cheryl Burrill said she didn't think her son could wait three years. Scouring the Internet, she found surgeon Eric Pinnar in Reston, Va., who specializes in "lap-band" surgery. Unlike gastric bypass, which involves stapling the stomach and permanently rerouting the intestines, lap-band surgery is reversible and involves the use of an adjustable band to bisect and shrink the stomach.

Last September, Andrew became Pinnar's youngest patient. Since then the surgeon has operated on four other youths under 18; more are planned.

These youths are part of a growing vanguard of extremely obese teenagers who are undergoing bariatric surgery, as the last-ditch weight-loss operations are known. The procedures, designed for those who are 100 pounds or more overweight, have increased dramatically among adults, from 14,000 in 1998 to nearly 178,000 in 2006.

Although a handful of doctors have operated on children and teenagers, some weighing more than 700 pounds, bariatric surgery has been regarded by many doctors as too risky and drastic for patients younger than 18. A 2007 study estimated that 2,744 teens underwent weight-loss surgery between 1996 and 2003, a number that more than tripled between 2000 and 2003. Many pediatricians and pediatric surgeons have been leery of the procedures, which have not been studied in children, require lifetime adherence to a strict dietary regimen, and can cause hazardous nutritional deficiencies and, in rare cases, death.

That opposition appears to be ebbing. Spurred by improvements in technique and studies in adults showing increased longevity and reversal of Type 2 diabetes and other problems, some influential opponents have softened their resistance. At the same time, the National Institutes of Health is financing a study of gastric bypass involving 200 teenagers, while the Food and Drug Administration is sponsoring a trial of the lap band in patients 14 to 17.

Skeptics say they are intrigued by the possibility that early intervention, before years of disordered eating and metabolic damage have taken their toll, might benefit some severely obese teenagers for whom other treatments have failed. Those hopes were buoyed by a small study published last month in the journal Pediatrics, which reported a resolution of Type 2 diabetes among 10 of 11 teenagers who underwent gastric bypass.

Two other factors are fueling the re-evaluation of weight-loss surgery: the relentless increase in childhood obesity and the dismal results of behavioral treatment, consisting of some combination of diet, talk therapy and exercise. Behavioral treatment has a long-term failure rate estimated at roughly 95 percent.

"We know that the vast majority of morbidly obese adolescents become morbidly obese adults and that medical and behavioral therapy doesn't work for them," said Evan Nadler, the director of New York University's minimally invasive pediatric-surgery program who is involved in the FDA lap-band study. "These kids are sick. This is truly a disease, a problem we can treat with the best means we know how. (Surgery) is the only known mechanism for sustained and significant weight loss."

Kurt D. Newman, the surgeon-in-chief at Children's National Medical Center in Washington, says that until recently he regarded weight-loss surgery as "kind of wrong -- more so in a kid." Prodded by his hospital's obesity specialists and faced with a growing number of 13 year olds weighing 300 pounds and a population that has one of the highest rates of pediatric obesity in the country, Newman has reconsidered. He is recruiting a bariatric surgeon for Children's new Obesity Institute.

David Ludwig, a pediatric endocrinologist at Boston's Children's Hospital and one of the nation's most prominent obesity experts, has also tempered his opposition. For carefully selected patients who have been treated consistently with other methods and failed, Ludwig said, surgery with appropriate safeguards may be an option. But, he warns, these operations are neither a solution to an urgent public-health problem nor a panacea. Bariatric surgery, he said, "can result in horrendous complications, require repeat surgeries and create a whole new set of medical problems.

Thomas Inge, the chairman of the NIH teen bypass study, directs the nation's oldest weight-loss surgery program, at Cincinnati Children's Hospital Medical Center. Since 2001, 110 adolescents have undergone surgery there, under guidelines issued by the American Academy of Pediatrics.

They must have a body mass index, or BMI, of at least 40 (the equivalent of someone who is 5 feet 4 and weighs 235 pounds) and a serious weight-related health problem such as Type 2 diabetes or high blood pressure. Referral by a pediatrician is required. Patients younger than 18 must have failed organized weight-loss attempts and have achieved most of their growth. All must demonstrate preoperative weight loss on a liquid diet and pass psychological screening tests.

The majority of Inge's patients are girls. One year after surgery, they had lost on average one-third of their excess weight, about 30 pounds for someone 100 pounds overweight, for example. Many remained obese but were no longer morbidly so.

Unlike gastric bypass, which is generally covered by insurance and costs about $25,000, lap-band surgery in teenagers is considered experimental, which means that parents typically must finance it.

To pay for Andrew Burrill's 45-minute procedure, his parents sold a vacation time-share.

Andrew, who has lost 52 pounds since the surgery and now weighs 184, said that the required changes in his diet have not been as difficult as he initially imagined. He said he does not miss the daily two-liter bottle of Mountain Dew he used to chug. And he has learned the hard way that if he eats too much -- more than about a half-cup of food at a time -- he vomits.

Adjusting to his dramatic weight loss has been somewhat tougher. Andrew, whose waist size has dropped from 44 to 34, said he still thinks that he looks enormous when he looks in the mirror.

The best thing has been the reactions of other people. "I haven't had one person stare at me since I got the surgery," he said. "And in PE, it's the first time in my life I don't come in last."

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Saturday, November 8, 2008

After gastric byass surgery, some patients choose adjustable banding procedure

If at First You Don't Succeed . . .
. . . Maybe It's Time For a Different Type Of Gastric Surgery

By Larry Lindner
Special to The Washington Post Washington, D.C.

"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."

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."

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Sunday, October 19, 2008

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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Thursday, September 25, 2008

Lap-Band touted as effective alternative to gastric bypass surgery

Lakeland, FL
Obesity is a nationwide epidemic in the United States.
LAP-BAND surgery, with a device like this, is much less risky and not as invasive as gastric bypass.

Additional heath problems associated with obesity compound the problem. Usually, an improved diet along with regular exercise can reverse this trend. When diet and exercise are not enough to lose weight, however, surgery might be an answer.

Gastric bypass surgery has been the most common type of weight-loss surgery.

The purpose is to give the patient a satiated feeling more quickly. To do this, a portion of the small intestine is bypassed, so fewer calories are digested and absorbed. This allows the patient to lose weight, but it is major surgery and carries certain associated risks.

Possible setbacks could come from infection of the incisions or a leak from the stomach into the abdomen, which can result in peritonitis. There is also a potential for gallstones problems to develop. Recovery can take as long as six weeks.

Another procedure that offers similar results is much less invasive and dramatically reduces patient recovery time.

Laparoscopic Louxen-Y - or Lap-Band - surgery is much less risky and not as invasive as gastric bypass, said Dr. Ravindra Mailapur, a bariactric surgeon practicing in Huntsville, Ala.

The Lap-Band is made of silastic - a brand of flexible silicone - and is implanted around the upper part of the stomach. This creates about a 1-ounce pocket, dividing the stomach into two parts. This restricts the amount of food allowed to pass into the stomach, creating a sense of fullness and reducing the caloric intake, thereby allowing the patient to lose weight, Mailapur said.

"The Lap-Band comes in a variety of sizes and can be adjusted by way of a port that is implanted below the skin," he said.

Mailapur said to qualify for Lap-Band, you must have a body mass index, or BMI, of at least 40 or a BMI of 35 if you have two or more health problems related to your weight.

The advantages of the Lap-Band surgery over gastric-bypass are many.

Lap-Band is a restrictive-type surgery and can be done by laparoscopy, a procedure that uses smaller incisions and is conducted usually on an outpatient basis. The results are less tissue damage, shorter operating times and quicker recovery periods. It is adjustable, so can be manipulated laparoscopically to make the stomach larger or smaller as the patient loses weight.

There is, however, a down side - the risks.

"Any time you perform surgery, there are risks involved, and Lap-Band surgery is no different," Mailapur said. "After all, you are introducing a foreign body into the patient."

Potential problems can include infection, the kinking of the Lap-Band and the band moving out of place, he said, in which case the band must be removed. To reduce such risks, it's important to select a surgeon who regularly performs this type of surgery and who works out of a facility with multiple specialties.

The gastric band was developed and patented in Sweden in 1985. The Lap-Band procedure came about in Europe in 1993. It has been readily available throughout Europe and since 2001, has had approval from the Food and Drug Administration for use in the United States.

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Monday, September 1, 2008

Teens turning to gastric banding weight-loss surgery

Wilmington, DE

Gastric banding isn't just for adults anymore -- many young obese patients at Alfred I. duPont Hospital for Children have found the procedure a success.
For most of her young life, forgetting to eat was not something Nicole Herman ever worried about. She often woke up with hunger pangs so intense they made her nauseous.

But these days, Herman has to remind herself to grab breakfast. Otherwise, it may be the afternoon until she gets those familiar stabs in her stomach to signal her body needs food. That feeling of always being hungry is gone.

So is 77 pounds -- and counting -- from her 5-foot-3 frame. After spending most of her teen years trying to lose weight, Herman has finally found success by exercising, watching what she eats -- and by having a silicone band inserted around her stomach to restrict the amount of food she can eat.

The 19-year-old college sophomore is one of 11 teenage patients who have undergone gastric banding surgery at the Alfred I. duPont Hospital for Children in the last year. The hospital is one of four nationwide participating in a five-year study by the Food and Drug Administration to evaluate the safety and effectiveness of gastric banding, also known as LAP-BAND, in teens.

"I wanted to have it done because I've been overweight ever since I was little," said Herman, who lives in Middletown when she's not attending the University of South Carolina in Columbia. "I had it done in hopes of trying to lose weight and keep it off."

Of the patients who have had the gastric banding procedure at A.I. duPont -- including Herman -- all have had similar levels of success with weight loss, said Dr. Kurt Reichard, a pediatric surgeon who performs the minimally invasive procedure at the hospital. About 50 more children ages 14 to 17 are in some stage of preparation for the surgery.

Although the LAP-BAND can radically change the life of a morbidly obese teen, it's not for everyone, Reichard reminds prospective patients and their families. The actual surgery is only one aspect of a multidisciplinary weight-loss effort that also includes psychological counseling, fitness assessments and training with an exercise physiologist, and extensive education in food nutrition with a registered dietitian before and after the operation.

"It's about what the kids can do for themselves," said registered dietitian Michell Fullmer, who works with teens in the weight management program. "The LAP-BAND, it's not a magic bullet. It's a tool. I hope we give them what they need to use this tool well."

For Herman, it was the right tool at the right time. After years of yo-yo dieting and feeling frustrated by her lack of success, she was ready for the challenge. "I realized it would be a big life change, but I was ready," she said. "I realized I have enough self-discipline to make this work."
A national problem

Nationwide, more than 1 million teens -- about one in six -- are obese. The effects of carrying that extra weight are more than just bigger waistbands. Many obese children also have other health problems such as diabetes, high blood pressure, sleep apnea and even worn-out joints.

The majority of obese teens can lose the extra weight through a combination of diet and exercise. But when an obese person becomes more than 100 pounds overweight, they are considered morbidly obese, and for them, it's much harder to lose the weight through traditional means.

Fortunately for Herman, she never suffered from high blood pressure, diabetes or other associated health problems. She ate well and got regular exercise as a dancer. "I was a healthy fat person," she said.

But she also has Ehlers-Danlos syndrome, a connective-tissue disorder that affects the joints and makes them more prone to dislocation. She has undergone 12 surgeries to address tissue and joint problems. Her most recent was this summer on her right ankle.

While the Ehlers-Danlos isn't directly affected by her weight, the excess pounds put pressure on her joints. For that reason, any weight loss would help her.

Still, losing weight proved to be a challenge over the years. By the time Herman was 9, she was considered obese. The last time she and a friend could wear matching clothes was the fifth grade. Among her family, she was the only one with a weight problem.

As a teenager, Herman tried Weight Watchers, Jenny Craig and NutriSystem. Such diets worked in the beginning, but soon she got bored and hungry. "It was like a roller coaster," she said. "I think probably I got frustrated with not succeeding."
'Off-label' use in teens

Gastric banding was approved by the FDA in 2001 for use in adults. In teenagers, it's considered an "off-label" use, meaning the operation wasn't intended for that purpose. The FDA trial, in which duPont Hospital is participating, aims to discover if gastric banding can be an effective tool in helping morbidly obese teens shed the weight that threatens to shorten their lives.

In the cases where gastric banding may be an option for teens, their youth may actually be a benefit. "Although there's a perception that teenagers are noncompliant and uncooperative, I don't find that to be the case," Reichard said. "Kids are more open to lifestyle changes."

Health professionals don't know what kind of long-term effects await obese teenagers as they age, particularly if they have other health problems, Reichard said. That's why it's important for them to try to lose any amount of weight they can.

Earlier this summer, Morgan Stanley Children's Hospital of New York-Presbyterian released preliminary data showing that teens who underwent gastric banding had improvements in their obesity-related medical complications just six months after the operation. The six boys and eight girls in the study lost an average of 20 pounds and saw significant reductions in abdominal fat, triglyceride and blood-sugar levels. Their liver function also improved.

Some of the teens who saw improvements in their blood-sugar and cholesterol levels didn't have excessively high numbers to begin with, said Dr. Ilene Fennoy, a pediatric endocrinologist with New York-Presbyterian, which is also part of the FDA study. That their health data were already within a normal range and still improved reaffirms that weight loss has beneficial effects beyond dropping a few clothing sizes, she said.

More data are needed to fully understand the benefits of gastric banding in teens and what potential long-term effects may result, but so far the results are mirroring the success found in adults, said Fennoy, lead author of the study and clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons.

"This is early on but it's reassuring," said Fennoy, who presented the results in June to an annual meeting of the Endocrine Society in San Francisco. "It's showing we're already seeing changes in [symptoms of other ailments], even with not a huge amount of weight loss."
Making it work

In April 2007, after not finding success with any other weight-loss plans, Herman and her parents attended an informational meeting on gastric banding at A.I. duPont. She wasn't immediately sold. She was hesitant about having an operation to help her eat less, but the healthy eating and exercise components convinced her it could work if she believed in what she was doing. Her parents and friends pledged their support no matter the outcome.

"It helped that everyone was behind me on this," she said. "My family, especially my mom, has been so supportive of me."

Although her daughter has an outgoing personality, Sue Herman knew there were occasions where she felt singled out because of her size. She also she worried that her daughter's weight would impede her success in college and beyond.

"To watch her struggle was hard," she said.

When Nicole said she wanted to consider LAP-BAND, her mom went online and looked up information about the procedure. After extended discussions with the family's insurance company, which eventually agreed to cover the cost of the operation, they decided to pursue it.

Gastric banding works by making the stomach smaller. Unlike gastric bypass surgery, the stomach is not cut. Instead, a silicone band -- about the size of a shower curtain ring -- is inserted laparascopically around the top of the stomach. The band creates a small, egg-sized pouch for food consumption. It can be tightened or loosened by adding or removing saline solution into the band.

Compared with other weight-loss operations, gastric banding is less invasive. It also can be reversed, unlike gastric bypass surgery, which cannot. Still, like any operation, gastric banding carries some risks, including infection at the site of the incision. Gallstones also can occur in patients who undergo the surgery. Once the band is inserted, there is a small risk that it can slip out of place and cause pain and discomfort.

After the band is on, patients usually can eat only about 4 ounces of food at a time, far less than what they had been eating. Most of their meals are high in protein to prevent the loss of muscle mass. One of the first signs of not eating enough protein is hair loss, but later on, lost muscle mass from protein deficiency can effectively halt calorie loss.

Fullmer, the dietitian, holds monthly information meetings for prospective patients considering gastric banding. She said the first question asked is usually about the post-surgery diet.

"When I pull out a plate of what their diet is going to look like after surgery, I routinely get a gasp from the whole audience," she said. "It's sort of disbelief."

The first week after surgery, Herman was on an all-liquid diet while her swollen stomach adjusted to the band. She was still eating only liquids when she moved into her dorm. For the first months, she ate most of her meals in her room. She shared details of her surgery with only a few close friends.

Nowadays, a typical breakfast for Herman is a container of yogurt mixed with protein powder. Lunch may be a salad with half a piece of chicken. Dinner is a small portion of chicken or fish and vegetables. Post-surgery, she discovered she can no longer eat red meat, bread or rice because it upsets her digestion. She takes vitamin and calcium supplements to get enough nutrients and omega-3 fatty acids.

In addition to changing her diet, Herman has made exercise a priority. At school, the pre-med major fits in a workout no matter how crammed her schedule is, penciling it in as she would a class. The importance of working out was hammered in by exercise physiologist Lauren Falini, who tells patients exercise will not only help them lose weight but tone their bodies.

"Exercise is the other half of the equation," said Falini, who has patients keep track of their workouts with an exercise log. "It's about energy in and energy out."

The weight started disappearing rapidly within a month of Herman's surgery. By the time she stepped off the plane to visit her family in October, she was 40 pounds lighter. And she had already reached her first goal -- to fit in a size 18 pair of American Eagle jeans, something she had never done.

For Sue Herman, who hadn't seen her daughter since she left for college, the sight of her trimmer daughter was more than she expected.

"Beforehand I thought, 'What am I going to say if she's the same size? How am I going to inspire her to keep going?' " she said. "When I saw her, I couldn't stop looking at her."
A new person -- on the outside

Reichard attributes the early success of the gastric banding program to the extensive preparation the teens undergo before the procedure. Teens participating in the study spend about six months learning how to eat better, move their bodies more and understand the underlying emotional issues that may affect their success at keeping the weight off long term.

"We spend a huge amount of time getting to know them and their environments," he said. "It's the most important part of the program."

As part of the preparation, teens are expected to lose or maintain their weight before they have the gastric banding done. When the time comes for surgery, they must write a letter to the team requesting the procedure and laying out the reasons why they're a good candidate.

Working with the therapists in the weight management program, teens begin to realize the impact of the lifestyle changes they're incorporating, said Meredith Lutz Stehl, a clinical psychologist who works in the program. They begin to feel they have control over their weight, provided they follow the steps outlined by the weight management staff.

"It's such a crucial time to be able to get some hope, to believe they can feel like they can make some changes," Lutz Stehl said. "It's such a pivotal time for that, as opposed to people who have perhaps waited until their 20s or 30s to consider this."

In her letter, Herman spelled out some of the challenges in her path -- her Ehlers-Danlos, heading to college and adjusting to dorm life. But it's clear those are just small hurdles she intended to overcome.

"When I first heard about the LAP-BAND, I was a little skeptical and I wondered if it would really work and how hard it would be," she wrote. "You all changed that for me and made me believe that if I really want this as bad as I do, that I can work hard and get to where I want to be."

A year later, there's no denying Herman has changed from the 291-pound young woman who used to succumb to aching hunger pains. Now down eight pant sizes, she shops with friends at Old Navy and American Eagle, stores she bypassed on the way to plus-size clothier Lane Bryant. At her latest doctor's appointment this month, she weighed 214 pounds, down another 25 pounds from when she left school in May. She hopes to lose enough to wear a size 12 or 14 pants, about two sizes away.

Her megawatt smile is the same as it was before, but there's a new confidence that radiates from her, a self-assuredness strengthened by her weight-loss success. She feels healthy, strong, energized.

"Being overweight wasn't a big thing in my life. I've never wanted to be a size 2," she said. "I've always felt pretty good in my own skin."

But even she's surprised sometimes by the changes she sees.

"You catch a glimpse of yourself in the mirror, and you can't believe it's really you," she said.

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Wednesday, August 27, 2008

What Are The Risks Of Lap Band Surgery?

Best Syndication
No doubt you've been reading a lot more about lap band surgery, adjustable gastric band surgery and gastric bypass surgery in the past few years than ever before. Although weight loss surgery has been around for many years, newer procedures and techniques have made it safer and more common. However there are many risks of lap band surgery, complications and side effects to be aware of.

If you've been thinking about a gastric banding procedure to lose weight, such as lap band surgery, which is a safer alternative than permanent gastric bypass surgery, you may be wondering what the health risks are or what possible complications can develop from this procedure.

When doing your research online you'll no doubt read on the lap band websites that are promoting lap band surgery some of the risks and complications but you need to find out all of the risks and possible complications. You'll also want to know what side effects to expect and if you can handle these. And will you lose weight and if so at what pace?

Of course one of the best ways is to read articles like this and to go to lap band forums where you can discuss your concerns. You particularly want to find forums that are comprised of people who have had lap band surgery and see what they have to say, good and bad, and what testimonials you can find.

Any surgery can be risky and many have more risks than others. In any event elective surgery is always something that should not be taken lightly. As a nurse I've been present at many surgeries and although most of the surgeries go well, there are those that have complications. If a patient is obese or overweight or are carrying a lot of extra fat tissue, there can be some serious health problems present that may or may not be evident or known about and may have serious health consequences regardless of the type of surgery the patient is having.

Some of the risks to be concerned about are those that are general to any surgery and are influenced by your age, weight, how you react to the anesthesia and what diseases you may have and whether they're related to your weight problem or not. I won't go into all the risks of general surgery here but focus on the specifics risks and complications for lap band surgery.

The biggest risk of lap band surgery is the possibility of gastric perforation during the surgery, which happens in about one percent of the surgeries. Gastric perforation is a tear in the wall of the stomach.

Following lap band surgery there are numerous complications that can develop over the next few months or so. These can range from the lesser mild to more serious. Directions after surgery must be followed closely, as solid food eaten too early can cause a medical emergency. This mistake is made if the weight loss surgery patient eats solid food in the day or two after surgery or if they have traveled to Mexico or another country and fly home soon after surgery and think it's okay to indulge a little. Make sure you understand the lap band diet and understand liquid food and solid food restrictions.

Side effects can affect many patients such as nausea and vomiting and some will experience regurgitation. Some patients will find that the band has slipped and it'll need to be adjusted and some find that the passage is blocked between the two sections of the banded stomach.

The extended list of risks include ulceration, gastritis, which is irritated or inflamed stomach tissue, GERD (gastroesophageal reflux), which is regurgitation, heartburn, bloating from flatulence (gas), difficulty swallowing, dehydration, constipation, regaining of weight and rarely death but needs to be mentioned. If the surgery is done laparoscopically rather than a full open surgery then there are other problems that can develop such as liver damage or spleen damage (requiring removal of the spleen), damage to the blood vessels, lung problems, blood clots, the rupture of the incision and perforation of the esophagus or stomach during surgery.

Following surgery there are problems that can develop with the lap bad system type of gastric banding and they include: a deflating of the band causing leakage, which can come from the tubing band or the reservoir, slippage of the band or stomach, an enlargement of the pouch and the stomach outlet can be blocked, or the band can erode directly into the stomach.

Be aware that the cost of lap band surgery may rise if you have after-surgery and ongoing complications that are not fully covered under your health insurance plan or affect your pocketbook if you are paying cash out of your pocket. So you want to research this also.

Although lap band surgery is typically done laparoscopically, in some cases the surgeon may have to switch to a more open method of surgery, which has happened in about 5% of the cases as reported in a U.S. clinical study.

Make sure that you completely understand all the risks of lap band surgery and adjustable gastric banding and discuss them fully with your bariatric or weight loss surgeon before undergoing this surgery. Although safer than the more permanent gastric bypass surgery it does come with risks, possible complications and side effects. What is not known are the long term effects of this surgery. This is true whenever you tamper with nature. So it's better to be safe than sorry. Make sure you do plenty of research before you commit.

By: Helen Hecker

No doubt you've been reading a lot more about lap band surgery, adjustable gastric band surgery and gastric bypass surgery in the past few years than ever before. Although weight loss surgery has been around for many years, newer procedures and techniques have made it safer and more common. However there are many risks of lap band surgery, complications and side effects to be aware of.

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Saturday, August 9, 2008

Gastric bypass alternative: Lap band procedure

Texoma, KS
We continue our Special Report on Fighting Obesity with a look at Laproscopic Adjustable Gastric or Lap Band Surgery. This operation does not interfere with the normal digestive process, but doctors say it's not for everyone because it does require a higher level of self discipline.

It's performed by placing a hollow band around the stomach. A small pouch is then created along with a narrow passage into the rest of the stomach. The band can be loosened or tightened over time by injecting saline into a small port placed underneath the skin. After the operation, patients can no longer eat large amounts of food at one time. At first, the pouch holds about 1 ounce of food, later most patients can eat about a cup of food without feeling sick.
"Some patients will say you know doctor that's really all that I need is to reduce the volume that I'm eating. And that will be adequate and indeed it does for some patients it will work very satisfactory." said Bariatric Surgeon Dr. Kenneth Warnock.
With any Bariatric Surgery comes the concern of life threatening risks. But Dr. Warnock says the reality is, the problems are often highlighted more than the success.

"Large studies show if compared to patients who have had surgery to those who have not at the end of approximately 8 years the mortality rate goes down 50% and that number includes all the risks and side effects of the operation itself." said Warnock.
In fact the medical risks of not having the surgery often far outweigh any concerns of having surgery! Both the Lap Band and Gastric Bypass are reversible but as you can imagine most patients never want to look back. In fact to keep from gaining the weight back, many join support groups.

"If they are going to do well they need life long professional support by someone who really understands."
Patients also get check ups from Dr. Warnock every six months for their rest of their lives. Patients say it's just another way to help hold them accountable.

"They say the doctor knowing I'm going to be back to see you in some fixed time helps me stay on the straight and narrow!"
The cost of the Lap-Band Procedure runs around $16,000. That price includes doctor and hospital fees.
We will continue our look into Bariatric Surgery every Wednesday at Five, Six and Ten through out the month.
Next week we take a closer look at two women who had Bariatric Surgery and how it's completely changed their lives.

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Monday, May 19, 2008

ORLive May 29, 2008 webcast: Experts discuss Lap Band(R) and laparoscopic Roux-en-Y bariatric procedures

Marshfield, WI

Live Webcast: From Saint Joseph's Hospital and Marshfield Clinic: May 29, 2008 at 4:00 PM CDT (21:00 UTC)
Bariatric surgery will be featured on the eighth webcast sponsored by Saint Joseph's Hospital and Marshfield Clinic. It is set for 4-5 p.m. Thursday, May 29.

During the webcast, Marshfield Clinic physicians on staff at Saint Joseph's Hospital and other Marshfield Clinic health care professionals will discuss the comprehensive bariatric program at Saint Joseph's Hospital and Marshfield Clinic. The program will feature Timothy Wengert, MD, performing a laparoscopic Roux-en-Y gastric bypass, and Anishur Rahman, MD, placing an adjustable gastric band (LAP-BAND®). There will also be a live panel discussion and analysis moderated by Marvin Kuehner, MD, who has performed bariatric surgery for more than 30 years. Wengert and Rahman will also participate in the discussion, along with David Winemiller, PhD, clinical psychologist; Chrisanne Urban, MS, RD, CD, Nutrition Services; and Sheila Blackmun, RN, BSN, bariatric surgery program coordinator.

Bariatric, or weight-loss surgery, has proven to be an effective tool to lose a large amount of weight, significantly improving one's health and well-being. More than 90 percent of patients are able to reduce or eliminate medications taken for certain obesity-related health problems, such as type 2 diabetes, hypertension and hyperlipidemia. In a Roux-en-Y gastric bypass, surgical staples are used to form a small pouch at the top of the stomach, thus restricting the amount of food that can be comfortably eaten at one time. This small pouch is then connected to the middle portion of the small intestine, bypassing the rest of the stomach and a portion of the small intestine to limit the absorption of calories. The LAP-BAND® also reduces the size of the stomach but because the small bowel is not involved, it does not interfere with absorption. The adjustable silicone band is placed around the upper part of the stomach and a plastic tube runs from the band to an access port placed just under the skin n the abdomen. This allows the surgeon to inject or remove saline to adjust the "tightness" of the band to facilitate weight loss.

The bariatric program at Marshfield offers a multidisciplinary approach to surgical weight loss in a professional, supportive environment. Health care professionals are sensitive to the unique challenges brought on by obesity and strive to care for and meet the individual needs of each patient.

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Monday, March 3, 2008

Would you get gastric bypass surgery, Lap-Band surgery?

From CNN - Paging Dr. Gupta
A few weeks ago, a good friend told me that she'd be getting a Lap-Band procedure done.

She told me about her upcoming weight-loss surgery over a sushi lunch and very excitedly explained all aspects of the procedure. It would be minor surgery -- minimally invasive, take about an hour, no major side effects, covered by insurance for a mere co-pay of $20.

She wouldn't need to stay overnight in the hospital, she told me, but her doctor liked to be safe. "I have the same doctor as Al Roker for when he had it done," she added.

To be honest, I was stunned, when I know I shouldn't have been. After all, we do weight-loss stories of all kinds as part of the Fit Nation series. Lap-Bands, which restrict the size of the stomach, really do work for a lot of people. In fact, in a January issue of the Journal of the American Medical Association, one small study found that 75 percent of people who got Lap-Band surgery experienced a remission of their type 2 diabetes -- possibly because of fewer calories being consumed. In the group that just tried diet and exercise, only about 14 percent experienced remission. More >>
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Thursday, February 28, 2008

Live webcast of LAP-BAND® bariatric surgery on March 4, 2008

Kansas City, MO
NewHope Bariatrics announced today a free Web cast of a LAP-BAND® System weight-loss surgery performed by Dr. Stephen Malley, Medical Director of NewHope Bariatrics of Kansas City, followed by a live chat with the surgeon on March 4 at 11 a.m. EST.

This is a free event but registration is required. The live event will include: 1) An interview with a patient; 2) Real-time surgeon's explanation during the procedure; and 3) Live questions from online viewers to an experienced bariatric surgeon.

The surgery will last approximately one hour, followed by the live chat.
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Wednesday, February 20, 2008

Gastric bypass surgery may help cure diabetes

Alexandria, LA
A lot of people would consider surgery a drastic measure for treating diabetes.

But, a well-respected study, finds gastric lap-band or gastric bypass surgery may help cure the disease.

Even though 50 year old Ben Hunter was obese he didn’t get gastric bypass surgery to lose weight.

“I did it because I had diabetes that was out of control.” said the one time 313 pounder.

And it worked.

According to a new study of 60 diabetic patients, weight loss surgery controls and cures diabetes in 80 percent of the people who had it done.

That compares to about 10% who got treated with medication.

Dr. Alan Whittgrove a bariatric surgeon said, “Very few of them got control of their diabetes with medical treatment whereas with the weight loss from the adjustable band almost 80% lost their diabetes along with loosing their weight.”

It works like this, a lap-band is tightened around the stomach to make it smaller, so you eat less food and lose weight, which controls diabetes.

In gastric bypass surgery, the intestine is cut and re-attached to the stomach, so food is not absorbed in the usual way which also controls and sometimes cures diabetes. More>>

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Gastric bypass surgery may help cure diabetes

Alexandria, LA
A lot of people would consider surgery a drastic measure for treating diabetes.

But, a well-respected study, finds gastric lap-band or gastric bypass surgery may help cure the disease.

Even though 50 year old Ben Hunter was obese he didn’t get gastric bypass surgery to lose weight.

“I did it because I had diabetes that was out of control.” said the one time 313 pounder.

And it worked.

According to a new study of 60 diabetic patients, weight loss surgery controls and cures diabetes in 80 percent of the people who had it done.

That compares to about 10% who got treated with medication.

Dr. Alan Whittgrove a bariatric surgeon said, “Very few of them got control of their diabetes with medical treatment whereas with the weight loss from the adjustable band almost 80% lost their diabetes along with loosing their weight.”

It works like this, a lap-band is tightened around the stomach to make it smaller, so you eat less food and lose weight, which controls diabetes.

In gastric bypass surgery, the intestine is cut and re-attached to the stomach, so food is not absorbed in the usual way which also controls and sometimes cures diabetes. More>>

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Wednesday, February 6, 2008

Teens having gastric bypass surgery and lap band procedure to lose weight

Chicago, IL
On yesterday’s ‘Oprah’ TV show we got to see teens that underwent either lapband or gastric bypass surgery in order to lose weight. Gastric Bypass and lapband procedure are similar in that they goal is to reduce the size of their stomachs to lose weight. The lapband procedure is more reversible in that they do not create a smaller stomach; they use a band to constrict the flow of food. Gastric bypass is a permanent procedure that the surgeons create a smaller stomach.

One teenager underwent lapband surgery in Tijuana Mexico at the age of 13. The mother said that she would have done it in the US, but nobody would do this procedure for someone this young. The daughter seemed to be happy with the results and has trimmed down. More >>
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