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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Friday, January 8, 2010

"Gastric Banding" not a stand-alone weight loss solution

Buffalo, NY
Medical Edge from Mayo Clinic
January 8, 2010
DEAR MAYO CLINIC: Lately, I've seen a lot of advertisements for lap band surgery for weight loss. How is this different from bariatric surgery, which I don't hear as much about lately? Does it work? What are the dangers?

ANSWER: Bariatric surgery is a general term used to describe operations that help a person lose weight more consistently and effectively. The two most common types of bariatric surgery performed in the United States are adjustable gastric banding -- sometimes called lap band surgery -- and gastric bypass surgery.

In general, adjustable gastric banding is safe, and serious complications are uncommon. Gastric banding helps people lose weight by restricting the amount of food they can eat. But it's not a stand-alone weight loss solution. For the procedure to be effective, people must be carefully screened to ensure they are good candidates for gastric banding. Follow-up care, along with exercise and healthy eating, also are key to long-term weight loss for people who undergo adjustable gastric banding.

Adjustable gastric banding involves placing a small, inflatable band around the upper part of the stomach to restrict the amount of food that the stomach can hold. The band is filled with fluid that can be added or removed as needed through a small tube (port) placed under the skin. Fluid can be added to constrict the stomach if the band isn't tight enough and allows in too much food. Or, fluid can be removed if the band is too tight and is causing problems such as vomiting.

In gastric bypass surgery, the surgeon staples the stomach to make a small pouch and then connects the pouch to the small intestine, creating a passage (bypass) around most of the stomach, as well as the first section of the small intestine (duodenum).

Both procedures limit the amount of food that can fit in the stomach. Also, after both procedures, people feel full much sooner than normal, which helps decrease the amount of food they eat. One of the noticeable differences between adjustable gastric banding and gastric bypass -- and the one frequently talked about in advertising for gastric banding -- is that gastric bypass surgery usually requires a two-day hospital stay, whereas adjustable gastric banding can be done as an outpatient procedure.

Adjustable gastric banding is a low-risk procedure that's less complex than gastric bypass surgery. But as with any medical procedure, complications are possible. With adjustable gastric banding, complications can include infection of the band or the port, and movement of a portion of the stomach -- that's supposed to be below the band -- up through the band (slippage). The most serious complication associated with adjustable gastric banding is erosion of the band. This occurs when the band works its way inside the stomach, usually as a result of an infection or ulcer. Erosion is very rare, however, occurring in less than 1 percent of gastric banding cases.

Adjustable gastric banding can be an effective way to help people lose weight. It's not for everyone, though. First, if you're considering this procedure, be aware that people who have adjustable gastric banding generally have a slower rate of weight loss than those who have gastric bypass. There's nothing wrong with this, but it is something to consider prior to undergoing the surgery. Average weight loss is about one-third to one-half of a person's excess weight.

Like all bariatric procedures, gastric banding is intended for people who have a body mass index (BMI) of 40 or above or for those who have a BMI between 35 and 40 with a serious weight-related health problem, such as diabetes, high blood pressure or heart disease. In addition, this surgery isn't recommended for people who have certain medical conditions, such as Crohn's disease, large hiatal hernias or connective tissue disorders.

Finally, adjustable gastric banding isn't a cure-all. Follow-up care is critical because all patients need some adjustment of the band after surgery to ensure optimal weight loss. Even after having this operation, patients still need to consistently make good food and exercise choices in order to lose weight. In essence, gastric banding provides people with an opportunity to consistently take in a smaller amount of calories while they're moving forward with the other healthy steps that are necessary to lose weight. -- James Swain, M.D., Gastroenterologic and General Surgery/Director of Bariatric Surgery, Mayo Clinic, Rochester, Minn.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)
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Sunday, December 6, 2009

Urologist's opinion: Gastric band placement for obesity is not associated with increased urinary risk of urolithiasis compared to gastric bypass surgery

Berkley, CA
As morbid obesity is becoming increasingly prevalent in our western society, the surgical options for management of this disorder are being more widely utilized. These procedures include Roux-en-Y gastric bypass and gastric band surgery. It has been estimated that the number of bariatric surgeries performed has increased ten-fold in the past decade. It has been observed that in some patients undergoing bariatric surgery for obesity, new onset nephrolithiasis can develop.

These two studies very nicely show that patients at greatest risk are those with Roux-en-Y gastric bypass in which the normal gut flow and absorption is interrupted. These patients typically have an elevation in their urinary oxalate and a significant reduction in their urinary volume. Interestingly, patients with gastric banding appear to have a more significant reduction in their urinary volumes compared to the Roux-en-Y group of patients. However, the Roux-en-Y gastric bypass procedure results in a more significant hyperoxaluria and hypocitraturia.

Both of these studies note that due to the small numbers and the limited time of their study, they were unable to demonstrate that the increased urinary risk factors translated into an actual increased risk for renal stone development. However, it would seem prudent to counsel these patients even before they come to their surgical procedure with regards to dietary modifications to reduce their risk factors for renal stone development. These dietary modifications include maintaining an adequate fluid intake to potentiate a 2-liter urine output per day, 1,200 to 1,500 mg calcium citrate with Vitamin D and 500 mcg Vitamin B-12 and B-complex supplementation. Additional citrate supplementation may be important particularly in those patients with a prior history of stone disease.

Further clinical studies are still required to illustrate the effect of nutrition and pharmacologic therapy on the risk of stone development in patients undergoing bariatric surgery.
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Tuesday, October 27, 2009

Beverly Hills bariatric surgeon claims he performs most lap band surgeries

Beverly Hills, CA
Dr. Michael Feiz, lead surgeon at the Beverly Hills Comprehensive Weight Loss Center, has performed more Lap Band surgeries than any other doctor. For overweight Los Angeles residents, Lap Band surgery is the answer they have been looking for to shed the unhealthy weight and return to a more active life. Performed laparoscopic with almost no scarring, Lap Band surgery has the added benefit of enabling the patient to control their weight loss progress. Unlike gastric bypass surgery, Lap Band surgery does not involve the permanent reduction in size of the stomach. Instead, a small cinched section of plastic is placed around the upper area of the stomach, creating a temporarily shrunken stomach area for food to pass through. The other factor that makes Lap Band surgery so unique from gastric bypass is that the Lap Band is connected to a port that enables adjustment of the amount of solid food that can pass through the stomach. Finally, Lap Band
surgery is so attractive because it can be easily reversed by simply removing the Lap Band if something goes amiss.

A pioneer in successful Lap Band surgery, Dr. Michael Feiz of the Beverly Hills Comprehensive Weight Loss Center has performed the world's most cosmetic Lap Band surgery. With degrees from UCLA, New York Medical College and a residency and fellowship at USC Medical Center and Cedars Sinai, Dr. Feiz is highly trained and skilled in Bariatric and minimally invasive surgery. All prospective Lap Band surgery patients who visit the Beverly Hills Comprehensive Weight Loss Center must first undergo a full 360 degree evaluation of their health - mental and physical - as well as their habits and attitudes toward exercise and food.

Typical Los Angeles Lap Band surgery patients lose multiple pounds per week, but the real success after Lap Band surgery is keeping the weight off. The Beverly Hills Comprehensive Weight Loss Center ensures that their Lap Band surgery patients lose the weight and keep it off. So many people turn to the Beverly Hills Comprehensive Weight Loss Center due to the success rate of this center.

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Wednesday, October 14, 2009

Single-incision gastric sleeve, gastric bypass surgery alternative

Houston, TX
There's a new weight loss surgery option available in Houston that doctors say is less invasive and allows patients a faster recovery. It could offer patients as much weight loss as the "gold standard" weight loss procedure, gastric bypass.

Denise Abrego-Carter is about to undergo a new procedure to help her lose weight. It's called the single-incision gastric sleeve.

She said, "He guarantees me about 70-80 pounds."

The "sleeve" procedure is similar to the more radical gastric bypass. But unlike gastric bypass, the "sleeve" requires only one incision and is a less complicated surgery.

Dr. Sherman Yu, a Memorial Hermann bariatric surgeon, explained, "With this newer procedure people are actually losing just as much weight as a gastric bypass, but the risks are about half the gastric bypass because we're not rerouting any of the intestines."

Surgeons go through the belly button to do the surgery which allows for less pain, faster recovery and better cosmetic results. It was an attractive idea for patients like Rebecca Hammonds. She had the surgery in May.

"I've seen absolutely fantastic results. I'm so thrilled," she said. "I did not like the idea of having an implantable device inside of me so that's why I didn't go with the band."

Hammonds has already lost 70 pounds in about four months and is thrilled. But what really surprised her were the other health benefits she gained from getting the gastric sleeve procedure.

"The increased energy, how much better I feel," Hammonds said. "Before surgery I had a lot of hip pain and I'd come home from work and I could hardly walk, I was hurting so bad. And now I get home and I can deal with my children and play with them."

For the doctors, that's what makes it all worthwhile.

"People are losing, again, 60, 70, 80 percent of their excess body weight," said Dr. Yu. "But more importantly, really what we focus on is that their medical problems get better."

"I haven't been ill. I haven't been really sick," Hammonds said. "I'm losing weight and feeling great."

Dr. Yu and Dr. Terry Scarborough of Memorial Hermann are the only doctors in Houston performing the single incision gastric sleeve procedure. They are currently training other surgeons around the country how to do it.

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Thursday, August 13, 2009

Comedianne Mo'Nique becomes weight loss leader

Philadelphia, PA
Lately, the blogosphere has been blowing up over two big sisters: comedian Mo'Nique and President Obama's pleasingly plump new surgeon general, Dr. Regina Benjamin.

There's so much controversy that I'll need two columns to address it all. First, let's talk about Mo'Nique.

Actress-comedian Mo'Nique Imes Jackson, author of "Skinny Women Are Evil" and "Skinny Cooks Can't Be Trusted," has lost 40 pounds. Rumors have been flying that she had gastric bypass surgery, which she flat- out denies. But that hasn't appeased the size-acceptance camp, whose members are angrily abuzz about the weight loss she disclosed in a recent interview with Jet magazine.

In the interview, Mo'Nique says she knew it was time to lose weight when her husband, Sidney Hicks, watched her step off the scale at 262 pounds and said, "Baby, that's too much, and I want you for a lifetime."

Now the 5-foot-6-inch star is making the necessary sacrifices and has vowed to get her weight down to 200 pounds.

"This was truly making the commitment to watch what I eat and commit to working out," she said. "I stopped eating red meat. I want to say to big people, 'Let's be healthy big people. Everybody can't be a size 0, but let's be healthy.' "

Her efforts are worthy of applause. So why the criticism?

It is true that for years, this fat and fabulous one has been a champion for size acceptance. She has made a generous living dissing so-called "skinny bitches" while encouraging fat women to stay, well, fat.

Mo was always the first to say how proud she was to be representing for the big girls. So is this some sinister plan she's made to unleash an internal skinny bitch who's been dying to get out?

I don't think so.

Quite frankly, it has always stupefied me why the plus-size community feels betrayed when a plus-size celebrity - or a friend, for that matter - decides to slim down. Why are efforts at living a healthier lifestyle viewed as a personal affront?

Mo'Nique shouldn't be shunned for losing weight. Even if she reaches her goal of 200 pounds, she'll have a BMI of 32.3, which still makes her medically obese.

Would size acceptance groups prefer that Mo'Nique eat herself into disease, disability or death?

I suspect that fat advocates' swagger and confidence is really false bravado. Embracing your size does not make your health problems disappear. None of us has the luxury of throwing in the towel on a healthy lifestyle of daily exercise and good nutrition.

From where I sit on the front lines, it's clear we cannot continue this masquerade. And this is especially true for black folks. Black women, who have the highest overweight and obesity levels of any U.S. population, cannot afford false bravado. We need solutions. We need to keep it real with ourselves and take control of our health.

Why can't we be honest with ourselves and admit that being overweight or obese is not healthy? Why don't we understand that this hits the black community especially hard?

It's not healthy to carry an extra 20 pounds, let alone 100 pounds. Our bodies are just not designed for this type of trauma.

I have seen enough premature death, disease and disability in the black community to confirm the truth. I don't even have to cite the statistics on this, but I will.

If you are still on the fence about where black women are on the obesity front, then check this out:

_ African Americans, particularly African-American women, need to protect themselves against the ravages of obesity, which strikes us harder than any other group.

According to the Centers for Disease Control and Prevention Web site, 31.2 percent of African Americans were obese in 2001, up from 19.3 percent from the previous decade. That's a whopping increase in just 10 years. And experts say that today, half of all African-American women are obese.

_ African Americans suffer disproportionately from heart disease, hypertension, and diabetes, among other lifestyle-related diseases.

Surely, Mo'Nique is aware of all this. Now she's on the precipice of change.

Mo'Nique has the extraordinary potential to save some lives. Her decision to tackle her weight may influence more women to take charge of their health.

Can you imagine it? Maybe, just maybe, Mo'Nique is going to help lead the battle against obesity. Could she be the one to kick-start Obama's new health initiative? And will she get some help, perhaps, from a recent Obama appointee?

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Saturday, November 8, 2008

Gastroplasty: New bariatric procedure for shrinking the stomach

Miami, FL
Until now shrinking the stomach for weight loss was done through lengthy and risky surgery, but a new procedure can do it in under an hour with no cutting.

When 30-year-old Belinda Guevara's weight peaked at 217 pounds she decided to take action.

"I've heard about gastric bypass," she said. "I've also heard about the gastric banding and I'm really not the type of person that would submit myself to that kind of surgery."

Instead, Guevara opted for a new experimental weight loss procedure that shrinks stomach size without surgery.

It's done by going in through the mouth and down the esophagus.

"We are not removing anatomy were just making the tunnel a little thinner," Dr. Joe Greer said. "This is completely reversible. This is a procedure that takes up to 45 minutes to perform and patients go home within half an hour to an hour after the procedure."

Mercy Hospital in Miami is one of three centers in the U.S. that studies whether vertical gastroplasty is safe and effective.

Dr. Roberto Fogel of Mercy Hospital came up with this procedure in Venezuela.

Using a device that's FDA-approved to treat reflux, he stitches together parts of the stomach to make it smaller.

The procedure has been found to reduce levels of the hormone that controls hunger.

"So you have a little pouch that actually drips the food in one by one," Greer said. "You eat smaller amounts, you're not as hungry and so you lose weight."

Fogel said there have been no serious complications so far.

"We had in Venezuela maybe six or seven patients from the almost 400 with a small bleeding but a bleeding that was controlled in the moment," Fogel said.

Fogel provided before and after photos showing some impressive results.

The procedure costs $8,900 and insurance companies will not cover it because it's considered investigational.

Candidates for the study are people with a body mass index or BMI between 28 and 40, needing to lose less than a hundred pounds and have no chronic health conditions.

"Morbidly obese patients still should go for gastric bypass surgery," Greer said.

Two days after her gastroplasty, Guevara said she felt great and has noticed a big difference in her appetite.

"I'm not hungry, which is great because you don't have the urge and you don't have the sensation to just eat," she said. "It's incredible because you would never think that you would feel full having soup and having a small amount of soup. I'm already full."

Guevara said her goal is to lose 60 pounds.

Her doctors said most of that should be gone in six months.

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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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Wednesday, October 22, 2008

Endobarrier gastric sleeve eyed as alternative to gastric bypass surgery

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

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

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

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

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

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

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

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

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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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Tuesday, October 14, 2008

Robot-assisted gastric bypass lowered risk for gastrointestinal leaks

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

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

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

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

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

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Monday, October 13, 2008

Weight loss surgery without an incision: The toga procedure

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

But those involve cutting into the stomach and changing anatomy.

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

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

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

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

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

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

An experimental procedure at Cedars Sinai called toga.

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

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

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

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

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

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

That means fewer side effects.

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

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

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

She is selling her old clothes at a yard sale!

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

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Sunday, September 28, 2008

Gastrc byass surgery last resort after pills, diets

Lumberton, NC
Bernice Wilson sits in a hospital bed, listing the names of the diets and pills she’s tried in attempts to lose weight over the years.

The words trip off her tongue as though she’s naming her children: Slimfast; Weight Watchers; Atkins; South Beach; D-12; Adipex; Phen-Phen; Xenacal.

She’s sure there are more, but she can’t remember them all.

Now she’s trying something else — the laparoscopic adjustable gastric banding procedure, or lap-band — in which a band is wrapped around the upper part of her stomach to control the amount of food she can eat.

Wilson, who is 54, was the first person to undergo the procedure at Southeastern Regional Medical Center on Aug. 15.

Dr. Barry Williamson, who performed the laparoscopic surgery, said 30 patients are already lined up to receive it. He expects to do about three surgeries a week, or more than 150 a year.

The surgery is not cheap. At Southeastern Regional, lap-band costs between $15,000 and $20,000, depending on the length of hospital stay and other factors. It also doesn’t include the surgeon’s fees, said Faith Ferguson, bariatric program coordinator at the hospital.

Weight-loss surgeries, such as gastric bypass and gastropexy, can cost $30,000 or more in the United States. In some cases, insurance will pay for a portion. Medicare will pay when a hospital has been approved as a Bariatric Center of Excellence, Ferguson said.

Being obese can be even more costly.

Williamson estimated that it costs about $18,000 a year, per person, in doctor and hospital visits, diet plans and dining out, as well as the side effects from diabetes such as long-term dialysis resulting from kidney failure.

Fresh start

For Wilson, health concerns were only part of the reason she decided to have the procedure.

Mostly, she just wants a fresh start — a chance to try for a better life.

Wilson has been overweight for more than 30 years, since she had her twins. As she’s gotten older, it has been harder to lose weight, she said.

“When you hit your 40s and 50s, man, this stuff is like glue,” she said.

The excess weight has caused health problems such as high blood pressure. Wilson said she worries about developing diabetes like her grandmother, who eventually went blind after her kidneys failed.

“I want to get off the blood pressure pills,” Wilson said. “Stuff really hides in this fat — diseases, illnesses.”

But she also wants to lose weight and experience the little things about life that she quit enjoying years ago.

“I want to walk up steps and not be out of breath,” she said. “I just hope I keep losing forever and ever. As long as I’m maintaining that healthy weight, I’ll be satisfied.”
Staff writer Jennifer Calhoun can be reached at calhounj@fayobserver.com or 486-3595.

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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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Wednesday, September 10, 2008

Gastric bypass alternative Stomaphyx involves no Incisions, no stitching

Denver, CO
Imagine surgery without incisions. No cutting, no stitching -- all the work is done through the patient's mouth. A doctor at one local hospital says it can mean a quicker recovery with fewer complications.

CBS4's Kathy Walsh went to Presbyterian/St. Luke's Medical Center to follow a woman who had a gastric bypass in 1999. It seemed like any other operation. Doctors and staff worked in a sterile environment on a patient who was closely monitored.

"She lost a fair amount of weight but then started to gain some weight back," Dr. Matthew Metz said.

Her stomach had stretched and she came in for a gastric bypass revision; a procedure called Stomaphyx, making the stomach smaller. But in this surgery there was no cutting, no incisions at all; it was all done through her mouth.

"We actually have a sewing machine that we mount on the end of a scope that goes down the mouth and we're able to re-sew the stomach and the connection to the small intestine without making any incisions in the abdomen," Metz said.

Metz says he is the first in the region to offer the operation.

"Doing this through the mouth enables you to do the procedure much faster," Metz said. "The recovery time is much shorter."

Metz said the potential for bleeding and infection with a traditional revision surgery can be as high as 60 percent. Through the mouth it's just 3 percent. With another incision, a patient can spend 5 days or longer in the hospital, according to Metz.

The woman went home the same day, ready to get back on track managing her weight.

The Stomaphyx device was approved by the Food and Drop Administration in 2007.

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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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Saturday, July 26, 2008

First transoral gastroplasty bariatric procedure performed in St. Louis

St. Louis, MO
A Granite City, Illinois woman has become the first patient in the country to undergo a new obesity procedure that can restrict the size of the stomach without an incision.

Inserting instruments through Carrie Williamson's mouth and down her throat, doctors at Barnes-Jewish Hospital on Wednesday created a small pouch in her stomach that will make her feel full after eating only a small amount of food.

The procedure was performed as part of the TOGA (transoral gastroplasty) Pivotal Trial, a multicenter national study that is evaluating the investigational, nonsurgical procedure.

"This is a shift in the way we approach the surgical treatment of obesity," said Dr. J. Christopher Eagon, a Washington University bariatric surgeon. "If this technique provides results close to those achieved with more traditional surgery, it may be an option for people who need to lose a great deal of weight but don't want to have surgery."

In the TOGA procedure, doctors insert a set of flexible stapling devices through the mouth and into the stomach. Then, watching through a scope, they use the staplers to create a restrictive pouch to help limit food intake. In the traditional surgery, surgeons work through incisions in the abdomen.

Between February 2006 and July 2007, 47 patients who were an average of 120 pounds overweight had the TOGA procedure in a pilot study at medical centers in Mexico and Belgium. After a year, they had lost an average of 40 percent of their excess weight.

"That's not as great a loss as we see with gastric bypass surgery, which is still the gold standard for weight-loss procedures," said Dr. Sreenivasa Jonnalagadda, the co-principal investigator at Washington University.

"The key benefits ... are quicker recovery period, shortened hospital stay, decreased risk of complications and an incision-free procedure. And if the restrictive pouch becomes bigger over time, as has been the experience with some obesity surgery patients, it may be possible in the future to further decrease the size of pouch with this new generation of devices."

Williamson's procedure was done under general anesthesia and required an overnight stay at Barnes-Jewish Hospital for observation. Eventually, Eagon and Jonnalagadda expect it could be done on an outpatient basis under sedation, depending on the results of the study.

The current study will involve at least 275 patients at centers across the country. Washington University will enroll at least 27 volunteers. Those eligible must be 18 to 60 years old, at least 100 pounds overweight and have no history of heart attack, stroke, chest pain or severe reflux disease. Lighter patients may be considered if they have type 2 diabetes or high blood pressure.

Because she was the first, Williamson knew she was getting the actual treatment, but during the study, one of every three volunteers will receive only anesthesia and an examination of the stomach, not the procedure itself.

However, these "control" patients will be offered the TOGA procedure after 12 months if it proves effective. Doctors will evaluate weight loss along with related health problems such as diabetes, cholesterol and blood pressure.

"In patients undergoing gastric bypass surgery, it's common to see blood lipids and blood glucose levels normalize in the days after surgery, even before they lose any weight," Eagon said. "We may see similar benefits from this procedure, but we need to test that hypothesis."

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Monday, July 7, 2008

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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Sunday, May 18, 2008

UC Irvine tests VBLOC implant

Irvine, CA
A weight-loss device placed under the skin is being tested at UC Irvine, KNBC's Dr. Bruce Hensel reported.

College student Jeff Collins, 24, has struggled with his weight his entire life despite trying everything from dieting to weight loss drugs.

"I've been fat, thin, fat, thin, all my life," Collins said.

When medication failed Collins, he considered gastric stapling or bypass until he heard the downsides.

"I went to an information session with 100 other people. They said there was a 1 percent mortality rate with the operation, and I looked around the room and realized one of us in this room would die. That scared me," Collins said.

What didn't scare Collins was a study at UC Irvine on a new weight loss device called VBLOC.

"The VBLOC's completely different. It doesn't alter the anatomy. It doesn't restrict the quantity of food you eat. Essentially, it actually inhibits the signal that runs between the stomach and the brain," said Dr. Ninh Nguyen of UC Irvine Healthcare.

According to VBLOC researchers, two tiny parts are placed under the skin. One turns the other on and it blocks signals to the nerve, which may control hunger signals to the brain.

Results have varied and the device's makers said, "The results of this study and this patient are not a claim for the potential effectiveness of VBLOC Therapy."

Although Collins had his procedure in January, both he and the researchers don't know if he's in the active group that had the device turned on or the inactive group

"I think it is on," Collins said. "I feel a change in my eating habits. I mean, before the surgery I could go to McDonald's and get a super-sized meal and eat all of it and still not feel full. Now, if I try to order it, I feel full before eating everything."

"Some preliminary data from outside the U.S., particularly Australia and Mexico, have shown that the excess weight loss at about six months is relatively good, (and) about 22 percent of excess weight loss at six months," Nguyen said.

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VBLOC implant therapy in a nutshell

Stomach signals: In VBLOC therapy, two electrodes are surgically implanted at the top of the stomach to block signals from the vagus nerve. In the illustration above, green arrows indicate neural signals traveling from the brain to the digestive system, while blue arrows indicate signals traveling from the stomach and intestines to the brain. A small regulator (shown at right) that controls the frequency and amplitude of electrical signals is implanted beneath the skin and connected to the electrodes (shown here in gray) via wires. The electrical signals can be changed at the physician’s office via a wireless controller. The device is currently being tested in clinical trials and has not yet been approved by the FDA. Credit: Enteromedics

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VBLOC implant: Gastric bypass surgery alternative

Researchers believe that they might be able to combat obesity by blocking the nerve that helps regulate digestion, the vagus nerve.
An implantable device that uses electrical signals to block the vagus nerve, which helps regulate digestion, has shown early success in clinical trials. The experimental therapy, developed by Enteromedics, a medical-device company based in St. Paul, MN, is part of a growing trend to develop alternatives to gastric bypass surgery, an often highly successful but invasive procedure to curb obesity.

"We need an approach to this that is safer than current alternatives and efficient to perform," says Christopher Thompson, a surgeon at Brigham and Women's Hospital who tests new surgical tools and methods.

As the obesity epidemic booms, so has the number of people undergoing gastric bypass surgery, a procedure in which the stomach is surgically reduced to about the size of a lemon. The American Society for Metabolic and Bariatric Surgery estimates that gastric bypass rates have doubled in the United States in the past five years, from about 100,000 in 2003 to approximately 200,000 in 2007.

While gastric bypass often leads to dramatic weight loss, only a small percentage of people eligible for the surgery--those with a body mass index (BMI) of more than 35--actually choose to do it. That may be because the procedure comes with some serious risks and is irreversible, requiring permanent dietary restrictions and nutritional supplements. "Many people who really need the procedure don't seek out medical attention because they're worried about potential medical complications," says Thompson. "We're only treating a small fraction of eligible patients."

A new option is on the horizon. At a neurotechnology conference in Boston last week, Enteromedics described positive preliminary results from a European trial of its vagal blocking therapy, called VBLOC.

The device uses an electrical stimulator to block signals from the vagus nerve, which connects the brain to the gastrointestinal organs, regulating hormones and other factors involved in satiety and hunger. "It controls how the stomach expands when we start to eat," says Mark Knudson, chief executive officer at Enteromedics. "If it doesn't expand, we become full after a few bites."

In the procedure, two small electrodes are laparoscopically implanted next to vagal nerve fibers at the top of the stomach. A regulator implanted under the skin sends high-frequency pulses of electricity to the electrodes, which are thought to block the signals coming from the vagus nerve. While scientists don't know exactly how it works, they theorize that the device blocks signals that would normally tell the stomach to expand to accept food, as well as trigger the release of digestive enzymes and gastric acid, potentially slowing digestion. Many patients report feeling less hungry and feeling fuller earlier, says Knudson.

An analysis of nine patients who were among the first to receive the implant shows that they lost almost 30 percent of their excess body weight after nine months. And preliminary data from a larger group indicates that following the procedure, patients ate an average of 500 fewer calories per day. "That's less than you'd see for a lap band or a gastric bypass, but it's still pretty good," says Janey Pratt, a surgeon at Massachusetts General Hospital, in Boston. More >>

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Wednesday, May 14, 2008

StomaphyX: Gastric bypass surgery without the incision

Miami, FL
Doctors have announced a ground-breaking procedure. It allows them to perform surgery without making an incision, anywhere. CBS4's Dr. Sean Kenniff explains how it works.

Darlene Dillard lost 100 pounds with gastric bypass. But like 1/4 of people who undergo obesity surgery, a few years later she started to gain weight back.

"I had gained about 30 pounds outside of my range of weight," said Dillard.

Instead of operating again, doctors did something drastically different. It's called Stomaphyx--a natural orifice surgery.

"It is going to be a totally different new era of surgery," said Dr. Michel Gagner from Miami's Mount Sinai Medical Center.

He says it really is a surgical revolution -- with no incisions surgical instruments are inserted through natural orifices. In this case: Darlene's mouth, to make her stomach pouch smaller.

CBS4's Dr. Sean Kenniff said natural orifice surgery isn't limited to obesity procedures. Doctors are now perfecting techniques to treat everything from appendicitis to cancer."

"Removal of part of the liver, removal of adrenal, removal of part of the stomach, doing bowel connections," explained Dr. Gagner.

And many other procedures are being performed through the rectum, esophagus and vagina.

" It's just the beginning, it's going to explode in the next five years, you're going to be hearing a lot more about this," said Dr. Gagner.

With Darlene's weight loss, her medical problems disappeared.

"There was borderline diabetes, borderline hypertension," explained Darlene. "I had stress fractures of my feet."

And she hopes the new no-incision surgery will keep the pounds, and those problems away.

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Monday, May 12, 2008

Vagotomy: Is cutting the vagus nerve the answer to weight loss?

Las Vegas, NV
Last year, 200,000 Americans had weight loss surgery and while gastric bypass surgery can significantly reduce weight, the surgery comes with risks.

Now a procedure that was once commonly used to treat ulcers is being tested as a safe alternative to weight loss surgery.

Action News reporter Kimberly Tere has the details.

The vagus nerve controls your feeling of hunger.

Some even say every single thing the vagus nerve does is designed to make you gain weight.

That is why San Francisco Doctor Robert Lustig is testing laparoscopic vagotomy, a surgery in which the vagus nerve is cut.

Cutting the vagus nerve can reduce the amount of fat stored in the body and can increase energy levels.

"Every patient in the study said their hunger was gone, just gone. One comment I got from one patient was this is the first time in her life that she was not a prisoner to food," said Dr. Lustig.

It worked for Garth Michaels who after years of standing out, ballooned up to 340 pounds.

"I was eating the wrong stuff. I was eating too much of it. I was eating too fast and I was not exercising," said Garth.

Garth decided to stand up and wage a battle against the bulge.

"Moving would hurt, it just hurt and my ankles could not take my weight," explained Garth.

After 20 years of battling the physical and mental strains of obesity, Garth had a vagotomy done.

With the help of the procedure and exercise, Garth lost more than 100 pounds.

"When I started exercising all of a sudden, you know I was doing it three or four times a week and the switch turned on," said Garth.

Now a study is underway to find out whether it is a viable alternative to the traditional gastric bypass.

15 patients have had vagotomies done at University of California at San Francisco Medical Center.

One of the main differences is a vagotomy only takes 20 minutes under conscious sedation with a breathing mask or under general anesthesia.

It is also an outpatient procedure.

On the other hand, gastric bypass generally takes four hours to perform and requires a hospital stay of at least three days.

Now two years after having the vagotomy done and after a lifetime of hiding under big clothes, Garth is finally comfortable in his own skin.

"I would say I look in the mirror right now and feel 75% better than when I looked in the mirror before," said Garth.

The majority of the patients who underwent vagotomy lost weight and were able to keep it off.

But for others, there was little or no effect.

While hunger was curbed, Dr. Lustig says they kept eating out of stress or habit.

"This is not a procedure for the reward pathway or for the stress pathway. It seems to be a procedure strictly related to hunger," said Dr Lustig.

Patients in the study did lose an average of 20% of their weight.

For Garth it was a life altering surgery that gave him the push he needed to win the battle on weight for good.

The vagotomy is still experimental when it comes to being used for weight loss.

Dr. Lustig says more research needs to be done before it is ready for widespread use.

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Friday, May 9, 2008

Vagotomy: Doctors studying safer alternative to gastric bypass surgery

Seattle, WA
More than 177,000 Americans had weight loss surgery in 2006. This can mean massive weight loss, but the surgery doesn't come without risks. Now, there's an investigational approach that's helping patients shed pounds a whole lot safer.

Losing weight was never easy for Garth Michaels.

"I've felt fat all my life, really," he said.

Michaels reached 320 pounds.

"I really was just up against a wall," he said. "I was praying daily. I didn't know where to turn."

Then, he found Dr. Robert Lustig, an endocrinologist at the University of California-San Francisco.

"Everyone in the world seems to think that obesity is just one problem," said Lustig. "You eat too much, exercise too little and it couldn't be further from the truth."

Lustig says the vagus nerve plays a big role in obesity.

"Every single thing the vagus nerve does is designed to get energy into your fat cells," said Lustig.

He's testing a new surgery called laparoscopic vagotomy, where he actually cuts the vagus nerve.

"The severe hunger that many obese patients report seems to be just completely obviated. It goes away completely," said Lustig.

So far, the 20 minute procedure is resulting in an average 18 percent excess weight lost.

"The weight loss that the patients have achieved appears to be durable and we're very happy about that," said Lustig.

Michaels has lost more than 100 pounds since having the procedure nearly two years ago.

"Definitely life-saving," said Michaels. "I think I added at least 10 to 20 years to my life… It's a whole new life, a whole new lease on life and at age 56. That's pretty good."

And after a lifetime of big clothes, Michaels is proud to finally shed that image.

Compared to gastric bypass surgery, this procedure is about one-fifth the cost, has fewer side effects, but patients will not lose as much weight. This technique is still being studied and not yet widely available.

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Saturday, April 19, 2008

Laparoscopic vagatomy: Gastric bypass surgery alternative

Rochester, NY
Thousands of people have weight loss surgery each year. This can mean massive weight loss, but the surgery doesn't come without risks. News 10NBC has the latest on an investigational approach that's helping patients shed pounds a whole lot safer.

Losing weight was never easy for Garth Michaels. “I've felt fat all my life, really,” he said. He topped out at 320 pounds.

“I really was just up against a wall. I was praying daily. I didn't know where to turn,” Garth said. Then, he found Doctor Robert Lustig.

“Everyone in the world seems to think that obesity is just one problem, you know, you eat too much, exercise too little and it couldn't be further from the truth,” Dr. Lustig said.

Lustig says the vagus nerve, which tells the brain when the body's full, plays a big part in obesity.

“Every single thing the vagus nerve does is designed to get energy into your fat cells,” Dr. Lustig said.

He's testing an easy-on-the patient surgery called a laparoscopic vagotomy where he actually cuts the vagus nerve.

“The severe hunger that many obese patients report seems to be just completely obviated. It goes away completely,” said Dr. Lustig.

An early study shows the 20-minute procedure led to an average 18 percent excess weight lost. More >>

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VBLOC: Gastric bypass surgery alternative

New York, NY
There may be new hope for people struggling with obesity.

It's called VBLOC therapy and it works by stopping the impulse to overeat by blocking the vagal nerves. Those nerves communicate feelings of hunger and fullness from the brain to the stomach.

With the new approach, doctors insert a VBLOC device just beneath the skin. It's a receiver. Electrodes are hooked up to the vagal nerves. And the patient wears a belt that transmits electronic impulses to confuse or block the nerves' signals. The desired result - pangs of hunger are reduced, and patients eat less.

A nationwide trial of VBLOC therapy is under way.

The treatment is considered less invasive than bariatric surgeries, which usually involve shrinking the stomach by wrapping a tight band around it - a so-called lap-band - or bypassing large sections of the stomach altogether and going directly to the rest of the digestive tract - commonly referred to as gastric bypass surgery.

On "The Early Show" Friday, Dr. Scott Shikora, chief of bariatric surgery at Tufts University Medical Center in Boston and one of the current study's principal investigators, showed a VBLOC device, explained how it works, and outlined the new therapy's possible benefits.

And Jeff Collins, who had the device implanted in Los Angeles in December, said he's lost 20 pounds and now weighs 285. "I would recommend it to anybody who's (trying) to lose weight."

"The risk with the other two gastric bypass procedures right now is too high, especially with people my age," Collins said.

"With gastric bypass," Shikora pointed out to CBS News, "we're dividing the stomach and bowel, and it's fraught with potential risks, such as infection. With the VBLOC, we're not dividing the stomach, we're simply attaching electrodes to two very prominent nerves."

But, he cauutioned, "Remember: This is research. We don't know yet how this device will perform, how consistent it will be long-term. It could prove to be a better alternative for some. Also, gastric bypass has a 40-year track record. We know it works."

Shikora says it takes 45 minutes to an hour to implant the device and patients can often go home the same day. More >>

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Friday, April 18, 2008

Sleeve gastrectomy: Gastric bypass surgery alternative

Miami, FL
Gastric bypass surgery has been a life-saving procedure for many morbidly-obese people. During the preparation for that surgery, a patient's stomach may have to be stapled. Now, doctors at UCLA Medical Center say the stomach stapling alone may be very effective to help the patient lose weight.

The procedure is called a "sleeve gastrectomy." It involves trimming down the stomach over a special calibrating tube to 1/3 or ¼ the current size. The surgery is typically reserved for those patients considered to be morbidly obese.

UCLA doctors say the new procedure is still major surgery and the more research is needed, but believe it could become more common than a gastric bypass.

Candidates for most of the new bariatric surgeries must be at least 100 pounds overweight and have medical problems like diabetes, arthritis, or high blood pressure.

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Wednesday, April 16, 2008

Stanford in study on vagal nerve blocking, gastric bypass surgery alternative

San Francisco, CA
Stanford researchers are participating in a national study to test a new weight-loss therapy that blocks the nerves that tell people when they're hungry and control how the body stores fat.

The treatment is considered a less invasive alternative to bariatric surgeries, which typically involve shrinking the stomach by wrapping a tight band around it or bypassing large sections of it and going straight to the rest of the digestive tract.

In the new treatment, which has been tested overseas, a device inserted just beneath the skin emits electronic impulses that confuse signals sent on the vagal nerves from the brain to the stomach. In early studies, the impulses made people feel full and satisfied when they'd otherwise be hungry.

"It starts in the brain, and works down to the stomach. We're not cutting or sewing or rerouting the anatomy here," said Dr. John Morton, a bariatric surgeon leading the study at Stanford. "It has a lot of potential to help patients lose weight."

The treatment is called VBLOC therapy, for vagal blocking. Stanford is one of 13 sites around the country participating in the study, being funded by medical device company EnteroMedics. Researchers hope to sign up 250 to 300 volunteers, about 50 of them in the Bay Area, and study them for five years.

It is a blind study - all volunteers will have the device implanted, but it will be turned on in only two-thirds of them, and neither researchers nor patients will know whether it is on or off. After the first year, the device will be turned on in all patients. More >>
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Monday, April 14, 2008

The Realize Band a new alternative to Lap Band and gastric bypass surgery

Birmingham, AL
Dr. Lee A. Schmitt, a surgeon at St. Vincent's East, last week began using the Realize Band, a new medical device that offers patients another option for weight-loss surgery.

The Realize Band was approved in December by the FDA as an alternative to the popular Lap-Band.

Both stomach bands have been shown to be effective in helping patients lose weight. They are wrapped around the stomach and squeeze down its size, thus restricting food intake. The devices can be adjusted for tightness by pumping fluid through a port.

Another type of weight-loss operation, commonly called a gastric bypass, requires more extensive surgical remodeling of the stomach and intestine.

Schmitt is one of Alabama's busiest weight-loss surgeons and puts about 100 stomach bands a year in patients. He said the new Realize Band is slightly different from the Lap-Band, and had three patients scheduled last week for the new band.

"I don't know which band is going to be better," he said. "I think it's like a pickup truck. What's better, a Ford or a Chevy? Both of them have little differences. Both of them carry you from A to B, and you can carry a ton of stuff in the back."

The new band is wider, which could keep it from slipping out of place. Slippage occurs in only about 2 percent of his cases, said Schmitt.

The most common complication with a stomach band involves the port that is just under the skin's surface and attached to the abdominal wall. Doctors use a needle to pump a saline solution into this port, which adjusts the stomach band.

Schmitt said sometimes the port comes loose, flips around and can't be accessed. The Realize Band has a different way of attaching the port. It's quicker to put in, and may secure enough to prevent complications, Schmitt said.

The Realize Band also exerts a slightly lower pressure on the stomach, which may reduce a rare complication called erosion. This occurs when the band erodes into the stomach.

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Friday, March 28, 2008

New device test, alternative to gastric bypass surergy

Portland, OR
Oregon Health and Science University is testing a new implantable device that promises to reduce or eliminate hunger pains.

The device is implanted just underneath the skin near the stomach.

Normally, a particular nerve in your abdomen tells your brain if you're hungry. But this new device sends signals up certain wires, blocking the message of hunger.

OHSU doctors say 15 million obese people in the U.S. could benefit from what's called VBLOC therapy.

The surgery is less risky than gastric bypass and should be less expensive.

Previous studies show obese people lost about 20 percent of their weight after using the device for one year.

Dr. Bruce Wolfe, the OHSU surgeon in charge of the study, said the device is only for the obese rather than just someone who wants to lose 10 or 15 pounds.

"It still is surgery," Wolfe said. "General anesthesia is required. There are incisions made. So it's possible to have a complication. By virtue of it being a less invasive procedure, it's reasonable to predict that serious or life-threatening complications will be quite few."

OHSU is now looking for candidates for the experimental trial. Doctors will see how well it works over the course of five years.

Right now, people with the device must also wear a battery pack outside their body, shaped like a small ring. Doctors expect it to be completely implantable in the future.

If you want to be part of the study, informational meeting will begin Wednesday and will be held through April 2 at OHSU. Call 1-866-356-4199 for more information.
Click here to find out more!
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Saturday, March 8, 2008

Bariatric patients find more options than just gastric bypass surgery

Wausau, WI
Local weight-loss surgery programs are facing competition for patients from an eastern Wisconsin program.

Midwest Bariatric Solutions and Theda Clark Medical Center in Neenah will hold a bariatric surgery information session Thursday. Dr. Raymond Georgen, a member of the practice, said it holds seminars outside the Fox Valley on a regular basis.

"Our practice is statewide," Georgen said, noting he has had several patients travel from Wausau, central Wisconsin and Michigan's Upper Peninsula for gastric bypass surgery and a procedure using an adjustable band to reduce the stomach's capacity. 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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Tuesday, January 29, 2008

Diabetes cure linked to lap band surgery

Columbia, MO
A year and a half ago, John Dorsey was suffering from obesity and Type 2 diabetes. He was taking 50 units of insulin, two oral antibiotics and another prescription drug every day to keep his blood sugar under control.

He also weighed 406 pounds.

"If I hadn’t done something, I probably would have died," said Dorsey, 49, who works as a nurse in Cooper County.

So Dorsey had a medical procedure called Lap-Band surgery, where doctors insert a patented device to narrow the top of the stomach and forcibly reduce food intake. Within a month, Dorsey was no longer taking insulin, and within two months he was off all diabetes medication.

"I consider it a huge benefit," Dorsey said. "Losing weight helped me get rid of diabetes. I know it’s not going to work exactly the same for everybody. But for me, my blood sugar and high blood pressure were both related to my weight, so when I lost weight they fell back in line."

These days he says he’s 140 pounds lighter and his diabetes has vanished.

During each bariatric surgery, doctors insert a silicone band known as a Lap-Band to constrict the top of the patient’s stomach. After surgery, patients who previously ate large amounts report being full after meals of about 6 ounces. The size of the band can be increased or decreased as needed after surgery, and patients report being able to return to work in as little as two days.

The surgery is similar in its results to gastric bypass (sometimes known as stomach stapling), but proponents of the 45-minute Lap-Band procedure say it is less risky than the two-hour bypass surgery, which requires surgeons to staple a portion of the stomach closed and attach it to the small intestine. More >>
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Tuesday, January 15, 2008

Sleeve gastrectomy: New bariatric procedure turns stomach into small pool

Indianapolis, IN
Question: Describe the sleeve gastroectomy, a new bariatrics surgery option.

Answer: This is just another version of what's already out there. You can break down weight-loss surgical procedures into two categories: One is called restrictive and restricts how much you can take in, such as the lap-band; the other one is called malabsorption and bypasses portions of the intestine or stomach to keep food from getting absorbed as calories.

This is a new restrictive technique. Basically, it's taking off a large portion of the stomach and making the stomach into a small, narrow tube instead of a boot-shaped pouch. We're basically making your stomach into a very small reservoir. More >>
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Saturday, January 12, 2008

New bariatric device: Endobarrie gastric sleeve

Seattle, WA
Imagine reaping the benefits of gastric bypass without the risks of surgery. Early results from the study of a new device are finding just that potential.

Weighing in isn't such a bad thing anymore for Barbara McMackin ever since she became the first person in the United States to get an experimental device called Endobarrier.

"Endobarrier is a sleeve that is placed without surgery into the patient's small intestine to help them achieve weight loss," said Dr. Keith Gersin, Chief of Bariatric Surgery, Carolinas Medical Center.

The gastric sleeve, or Endobarrier, is placed endoscopically through the mouth and lines the first two feet of the small intestine where it prevents food from being absorbed.

Early results from the study show patients who got the device lost more weight. More >>

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Tuesday, November 27, 2007

Gastric Bypass: Star Jones Opens Up About Her Weight Loss

November 22, 2007
For years, Star Jones Reynolds refused to reveal how she lost half of her body size, but now a confident and secure Star is talking in detail about her gastric bypass surgery --- to Access Hollywood’s Tim Vincent.

“The only reason I am talking to you today is to help other women understand they are not by themselves. They are not alone,” Star told Tim.

“Do you regret not having said something earlier?” Tim asked.

“I really wished, god, I could have. I really do. If there’s a regret that’s it,” Star said. “The regret is I wish I was stronger.”

Undergoing gastric bypass surgery in 2003, it wasn’t until August of this year that Star Jones Reynolds finally went public on how she dramatically lost 160 pounds. More >>

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Luqaimat Diet or Gastric Bypass Surgery

November 16, 2007

Thousands of obese people who had gastric bypass surgeries achieved long-term weight loss. In contrast, the majority of the millions who did dieting, exercise, and used weight-loss drugs failed to maintain their achieved new weights. The scientific reasoning for that observation was described in a medical article at New England Journal of Medicine, May 23rd, 2002.

British scientists found that hunger hormone (Ghrelin) blood levels were raised in those who perform dieting, while it was sharply low at those who had gastric bypass. The lead author David E. Cummings, MD, postulated that if we can block Ghrelin medically we will not feel hunger pains, hence will keep weight off for long. Gastric bypass surgery, works because of two reasons. First, it dramatically reduces the active gastric size to only 5% of the original pre-operative size; therefore, it reduces the food intake volume dramatically. Second, it suppresses the gastric mucosal cells secretion of Ghrelin, due to the contact of food with a very small gastric surface area. more >>

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Sunday, November 18, 2007

Allergan, Covidien to Market Lap-Band Gastric Bypass Surgery Alternative

Nov. 12, 2007, 9:28AM
IRVINE, Calif. — Allergan Inc., which makes Botox and sells surgical weight-loss devices, said Monday it will co-promote its Lap-Band product with health care products provider Covidien Ltd.

The Lap-Band is an adjustable gastric band, a device surgically implanted around the stomach to help severely obese patients lose weight by forcibly limiting food intake. The procedure is an alternative to more invasive gastric bypass surgery, commonly known as stomach stapling.

Under the multi-year agreement, which became effective Nov. 9, Covidien will co-promote Allergan's Lap-Band to bariatric and other surgeons in the United States. Pembroke, Bermuda-based Covidien makes medical devices and pharmaceutical products.

Covidien's sales representatives will help educate and train surgeons on the Lap-Band procedure, which costs roughly $12,000 to $20,000. Irvine, Calif.-based Allergan said it will continue to recognize revenue from the Lap-Band. Other financial terms of the deal weren't disclosed.

Allergan acquired the Lap-Band with its 2006 purchase of Inamed.

In late September, the Food and Drug Administration cleared Johnson & Johnson's Realize gastric band, effectively ending Allergan's dominance in the adjustable gastric banding market.

Shares of Allergan rose 47 cents to $65.25 in morning trade, while Covidien's stock rose 12 cents to $39.56.

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