Heavier patients carry increased risk in gastric bypass and other bariatric surgery

Higher risk for heavier patients in bariatric, gastric bypass surgery

Chattanooga, TN

For someone who weighs more than 500 pounds, the options for reaching a healthy weight can seem slim, but local bariatric surgeons say there is hope.

Dr. Jaime Ponce, medical director of bariatric surgery at Chattanooga's Gastric Band Institute, said special measures must be taken to operate on patients classified as super-obese and super-super-obese -- who have a body mass index above 50 and 60, respectively -- but it can be done.

"You have to take a totally different approach," Dr. Ponce said.

That means measuring to ensure the patient can fit on the operating table, working in a hospital certified to handle such patients and putting the person on a strict diet before surgery, he said.

Dr. Ponce performs about 300 bariatric surgeries each year, and he said 25 percent of those are on patients who have a BMI above 50.

Before the procedure, it's essential the patient is clear on what to expect from the experience, he said. Weight loss results often are less in patients with BMIs above 50, compared to those who are in the 35 to 45 range, Dr. Ponce said.

"They need to understand there is more risk," he said. "Every time the BMI goes up, there is more risk of bleeding because you're pulling fat to be able to see, and fat can start bleeding. There's more risk of damaging internal structures, more risk of having a breathing problem when trying to put the patient to sleep."

Despite the increased danger, for some patients the rewards are worth the risks.

Ducktown, Tenn., resident Sonya Standridge, 38, became one of Dr. Ponce's patients two years ago when she had Lap-Band bariatric surgery. She had a BMI of 63 before the surgery, which has dropped to 34 since the procedure.

With the Lap-Band, a small silicone tube is fastened around the upper stomach to create a tiny stomach pouch, slowing digestion and making the person feel full with less food.

Ms. Standridge said she has good days and bad days, but ultimately the surgery was the right choice for her. Being a nurse, she said she knew the risks beforehand and felt it was her "last resort option."

WHAT IS BMI?

Body mass index is a measure of body fat based on height and weight that applies to both adult men and women, according to the U.S. National Institutes of Health.

"If you asked me today would I have the surgery again, the answer is absolutely, 100 percent, no questions asked," Ms. Standridge said. "I had never felt the feeling of fullness before, so I would literally eat until I was gluttoned."

Local bariatric surgeon Dr. Jack Rutledge said there are two main factors that put high BMI patients at a greater risk than other patients.

The first, he said, is that people who fall into that category generally are unhealthy. Secondly, the additional weight creates a situation where it is more difficult to move instruments inside the body.

What he suggests to patients who are super-obese or super-super-obese is to first lose weight.

"I think they do have hope, but it's going to be expensive and it's going to be complicated," Dr. Rutledge said. "But there is a way to lose 100 pounds."

That's what 50-year-old Rossville resident Jimmy Allmond is trying to do now. After being told the increased risks of performing procedures on his 510-pound body, he decided to try to lose weight the old-fashioned way.

But he's still not sure on whether he'll eventually have surgery.

"With all that going on, I'm still not sure," he said. "If I can lose it without it, that would be good."

BARIATRIC SURGERIES

* Gastric band: A ring is fastened on the top of the stomach, creating a small pouch. The ring has a balloon portion that can be filled with fluid to limit the amount of food the patient can eat. The apparatus acts as an hourglass, and food sits on top and slowly trickles down into the stomach. This is the least invasive of the bariatric surgeries.

* Gastric bypass: The top portion of the stomach is cut and stapled to create a small pouch. The rest of the stomach and the first portion of the intestines are then re-routed. The patient can eat only small portions, and some of the food does not get absorbed. This is the most invasive of the bariatric surgeries.

* Sleeve gastrectomy: About 80 percent of the stomach is taken out, creating a small, banana-like sleeve. It allows patients to eat less and feel less hungry because the procedure removes some hormones that signal hunger. This is the newest of the bariatric surgeries.

Source: Dr. Jaime Ponce, medical director of the Gastric Band Institute

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Da Vinci gastric bypass surgery: Robot assisted surgical system for weight loss

Knoxville, TN

More and more these days, Dr. Michael Fields is taking a hands-off approach to surgery.

Since he began using it in 2006, Fields, an obstetrician/gynecologist at St. Mary's Medical Center, has been one of the da Vinci surgical robot's biggest proponents. He quickly adjusted to the console that allows a surgeon, via a joystick-and-magnified-view-screen system, to manipulate various surgical instruments mounted on robot arms inside small spaces. He touted the advantages of needing only 1- to 2-centimeter incisions for many surgeries: less blood loss, less chance of infection, weeks knocked off of recovery time.

By the end of 2009, Fields had performed more than 400 of the robot-assisted surgeries, including the first hysterectomy in the nation using a new laser-robotic tool. He believes the robot has rendered open surgery in his specialty all but obsolete, necessary in just a "fraction of a percent" of cases.

Now he's ready to give a hand to others who want to learn robot-assisted surgery.

Last month, St. Mary's became the only hospital in Tennessee to be named a Robotic Epicenter for training physicians in robot-assisted gynecological surgery. Mercy Health Partners, which owns the hospital, spent $2.1 million for an upgraded teaching model robot, with two control consoles. It was used for the first time with three Dec. 15 cases.

"The guest physician can sit at the second console and look, with 3-D vision, at what I'm doing" during a procedure, Fields said. "This learning technique is very visual because you don't have touch feedback with the robot" as a surgeon using his hands during an open surgery would.

Fields, who has already trained some area surgeons on robot-assisted procedures, now will train physicians from around the country at St. Mary's, traveling to their hospitals afterward to proctor their first robot surgeries. He expects colleagues Dr. Chris Ramsey, a urologist, and Dr. Thomas Pollard, a cardiothoracic surgeon, both of whom use the robot frequently, to do some training in their specialties as well.

New 'standard of care'

Knoxville's first da Vinci robot was put into use at Fort Sanders Regional Medical Center in 2005 after staff urologist Dr. Jeff Flickinger saw one elsewhere and returned to tell his employer that he was sure a Knoxville hospital would get one soon, and he hoped it was Fort Sanders.

"I think people got pretty excited right away," said urologist Dr. Edward Tieng, who said Fort Sanders surgeons were already doing a lot of laparoscopic surgeries, but the robot "kind of takes it to a whole new level."

Tieng said Fort Sanders urologists use the robot for about 95 percent of prostectomies, and doctors there keep finding new uses for it.

Doctors at sister Covenant Health hospital Parkwest Medical Center also have access to the robot. Three years later, Methodist Medical Center at Oak Ridge had its own, the money partially raised in a hospital foundation campaign.

The robot, introduced in 2000 by Intuitive Surgical Inc., has become almost a standard of care in America, with the majority of large hospital systems boasting at least one. Three hospitals each in Chattanooga and Nashville have it. In 2007, University of Tennessee Medical Center bought a robot, which is used for heart, prostate and gynecological surgeries. The hospital recently recruited gynecologic oncologist Dr. Larry Kilgore, a Knoxville native who practiced at the University of Alabama-Birmingham for the past 20 years, in part because of his skill using the robot for gynecologic cancer surgeries.

And doctors at Baptist West succeeded late last year in convincing Mercy to invest in a robot for that hospital. Installed a few weeks ago, the robot will be used for urologic and gynecologic procedures beginning Jan. 27.

"My (robotic surgery) patients have seen great outcomes with less pain and discomfort in the recovery period," said urologist Dr. Christopher Harris, who has used the da Vinci robot at other hospitals and is scheduled to perform Baptist West's first robot-assisted procedure - removal of a prostate gland. "Now it is great to be able to offer them this service at Baptist Hospital West."

A monitor shows the robotic tools of the da Vinci surgical system operating on a patient in an operating room.

Mercy Hospital gynecologist Dr. Michael Fields has been a staunch advocate for robot surgery in the Knoxville area and has now been selected as a trainer for other surgeons.

Trickling down

Even smaller community hospitals, such as Johnson City Medical Center and Jackson-Madison County Hospital, are making the da Vinci investment - usually about $1.3 million for the robot and several hundred thousand dollars a year in maintenance fees. Blount Memorial Hospital in Maryville purchased a da Vinci SI surgical system late last year, which surgeons (some trained by Fields) began using for urological and gynecological procedures in early December.

On Dec. 21, bariatric surgeon Dr. Mark Colquitt of Maryville's Foothills Weight Loss Specialists performed the area's first robot-assisted gastric bypass weight-loss surgery, which he did laparoscopically, with several small incisions.

"The robotic technology makes hand-sewing much easier by allowing surgeons better access to some of the hard-to-reach abdominal and gastrointestinal areas," said Colquitt, adding that he thinks robot-assisted surgery will become the "preferred method" for bariatric surgery. "This allows us to perform the delicate and challenging bypass procedure with even greater precision. The most important advantage is the ability to make very precise incisions and sutures, resulting in the most effective surgical outcomes for our patients."

Sonya Newman, Blount Memorial's chief nursing officer and assistant administrator, said the hospital plans to offer robot-assisted thoracic procedures as well.

Cookeville Regional Medical Center also has a da Vinci robot, which has been used primarily for prostatectomies, although its use in other fields is growing, said hospital marketing director Melahn Finley.

"We've done a lot of marketing," Finley said.

Finley said she thinks patients are beginning to expect even smaller hospitals to have the robot, and that area patients, desiring smaller incisions and quicker recovery times, "are starting to request it" and are being referred from places that don't have da Vinci.

She said the hospital considers the robot a good investment.

"It elevates the perception of your medical center, that you can offer such state-of-the-art technology," Finley said.

Future applications

Fields said the robot also can make surgery easier on the surgeon by eliminating fatigue from standing during a long procedure and by keeping a physician's hands from shaking during delicate motions.

Using the console is like having one's hands inside the patient, but allows for more range of motion, making it easier to get up under tissue or do precise dissections, he said. In addition, the video screen provides the surgeon with a better, clearer view, he noted.

Fields said the robot is now gaining use for cardiothoracic, colon and ear-nose-and-throat surgeries.

"You can reach and access spaces in the throat areas without having to disarticulate the lower jaw," he said.

And he wonders if, someday, only a minority of surgeries will not be robot-assisted. After all, he's become amazed at all he can do better with the robot - and he's excited to pass that knowledge on.

"All of our hard work over the last three years has been to prepare us" to become a training center, Fields said. To "transfer our knowledge and our incredible patient outcomes that we have to these physicians, for their benefit and for their patients' benefit."

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After gastric bypass surgery, couple loses 249 pounds in a year

Chicago, IL

Their daily Starbucks drink of choice was once a Venti Java Chip Frappuccino -- a whopping 600 calories in a cup.

These days, Lorie and Todd Richmond splurge on coffees with Splenda and a dash of half-and-half. But they are more likely to be riding their bikes, shooting hoops with their three kids or shopping for new clothes.

The Chicago Sun-Times featured the Richmonds in a Dec. 22, 2008, story after the couple from northwest Indiana had weight-loss surgery at the University of Chicago Medical Center on the same day.

Before the surgery, Lorie weighed 402 pounds, Todd 305.

A year later, Todd is at his goal weight of 207 pounds. He's off cholesterol and blood-pressure medications. Lorie weighs 251 pounds and is confident she can lose another 60 pounds or more to reach her goal.

Together, the two have lost 249 pounds in one year.

"It makes you feel so good that people notice," Lorie said. "For the first time in my life, I don't mind telling people my weight."

The Richmonds' say their quality of life also skyrocketed as their weight decreased.

They vacationed in the Smoky Mountains, hiking and riding roller coasters -- things they couldn't do before.

They bought bikes, and Todd consistently rode about 10 miles every other day throughout the summer. When she started, Lorie could only ride a block before having to stop; by the end of the summer, she took an eight-mile ride.

And when she ran to pick up an errant basketball while shooting baskets with her 7-year-old son, he said words she had never heard before: "I just saw my mom run."

"I almost cried," she said. "I was so happy I could do that with him. It gives me even more drive to keep going."

Dr. Vivek Prachand, an assistant professor of surgery at the University of Chicago Medical Center, performed Lorie's duodenal switch and Todd's gastric bypass.

A duodenal switch involves removing part of the stomach and bypassing much of the small intestine to limit how many calories are absorbed. A gastric bypass shrinks the stomach.

But the surgery alone wouldn't help the Richmonds lose and keep off the weight. They altered their diet and exercise habits -- something they had tried repeatedly in the past but without success.

"You have to recognize the surgery is a tool, it's not a cure," Prachand said. "I only take half the credit for it. You accomplish the other half."

The Richmonds said they were stung by hostile online anonymous critics who said the surgery was "cheating'' and accused the couple of laziness.

Prachand said he has heard all the criticism before, but said they are unfair. He said the surgery is highly effective and corrects multiple medical issues with one procedure.

"What we're dealing with when we're talking about surgery for severe obesity, we're talking about people who are 10 to 15 times heavier than the 10 to 15 pounds all of us have struggled with at one point or another," Prachand said. "Sometimes it's hard to project the added difficulty of that much more."

Beyond the surgery and added exercise, the Richmonds dramatically changed what they ate.

Todd said a year ago, he could "put a buffet out of business."

Now, the couple eat off saucers to help control portions.

They eat small meals consistently throughout the day, including daily breakfast.

And while they haven't abandoned Starbucks completely, they cut out the oversize sweet drinks and other treats -- even though they say they are constantly celebrating.

"This year has been awesome for us," Lorie Richmond said. "There's so much, I want to shout at the rooftops. Life is opening up for us."

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Better gastric bypass surgery outcomes linke to preoperative weight loss

Trenton, NJ

Preoperative weight loss is associated with fewer complications after gastric bypass surgery, according to the results of a record review reported in the December issue of Archives of Surgery.

"Despite the improved ability to accurately predict an increase in surgical risk, the optimal preoperative preparation of such high-risk bariatric surgery candidates remains controversial," write Peter N. Benotti, MD, from Saint Francis Medical Center in Trenton, New Jersey, and colleagues.

"Proposed risk-reducing strategies supported by varying degrees of evidence include staged surgical procedures, preoperative gastric balloon placement for weight loss, and preoperative medical weight reduction....Because the major determinant of postoperative length of stay is operative morbidity, we hypothesized that preoperative weight loss will reduce the frequency of surgical complications in patients who undergo bariatric surgery."

At a comprehensive, multidisciplinary obesity treatment center at a tertiary referral center serving central Pennsylvania, the investigators reviewed records of 881 patients undergoing open or laparoscopic gastric bypass surgery from May 31, 2002, through February 24, 2006. Before surgery, all patients underwent a 6-month multidisciplinary program with the goal of achieving a 10% preoperative weight loss. The primary endpoints of the study were loss of excess body weight and rates of total and major complications.

Loss of 5% or more excess body weight was achieved by 592 (67.2%) of the 881 patients and loss of more than 10% excess body weight by 423 patients (48.0%). Compared with patients undergoing laparoscopic gastric bypass surgery (n = 415), those referred for open gastric bypass (n = 466) were generally older (P < .001), had a higher body mass index (P < .001), and were more often men (P < .001). In addition, they had higher total complication rates (P < .001) and major complication rates (P = .03) vs patients undergoing laparoscopic gastric bypass surgery. Increased preoperative weight loss was associated with decreased rates of total complications (P = .004) and, most likely, decreased rates of major complications (P = .06), based on univariate analysis. In a multiple logistic regression model controlling for age, sex, baseline body mass index, and type of surgery, increased preoperative weight loss predicted reduced rates of total complications (P = .004) and major complications (P = .03). "Preoperative weight loss is associated with fewer complications after gastric bypass surgery," the study authors write. "We hope that these findings will be confirmed by prospective, controlled trials and that bariatric surgeons will consider this modality for preoperative risk reduction in selected patients who are deemed high risk for complications after surgery." Limitations of this study include retrospective design, lack of a control group, referral bias, and possible unmeasured confounding variables. In an accompanying invited critique, Patricia L. Turner, MD, from the University of Maryland Medical Center in Baltimore, recommends emphasizing an aggressive preoperative weight loss regimen. "Overall, this article presents the largest study thus far, to our knowledge, which may demonstrate a significant advantage to preoperative weight loss," Dr. Turner writes. "Moreover, the authors did not experience the attrition feared by some surgeons should they require preoperative weight loss of their patients. These findings suggest that consideration be given to incorporating either a suggestion of or the requirement for modest weight loss prior to bariatric surgery as a means of decreasing postoperative complications."

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A prospective study of risk factors for nephrolithiasis after Roux-en-Y gastric bypass surgery (Abstract)

Roux-en-Y gastric bypass surgery has become an increasingly common form of weight management. Early retrospective reviews have suggested that new onset nephrolithiasis develops in some patients after undergoing Roux-en-Y gastric bypass. We present a prospective longitudinal study to assess risk factors for nephrolithiasis after Roux-en-Y gastric bypass.

A total of 45 morbidly obese patients scheduled to undergo Roux-en-Y gastric bypass surgery were enrolled in this prospective study between November 2006 and November 2007. Exclusion criteria included history of nephrolithiasis or inflammatory bowel disease. Serum uric acid, parathyroid hormone, calcium, albumin, and creatinine and 24-hour urine collections were obtained within 6 months before Roux-en-Y gastric bypass, and at 6 to 12 months postoperatively. A Wilcoxon signed-rank test was used to compare preoperative and postoperative serum laboratory values and 24-hour urine values. McNemar's test was used to determine if the percent of abnormal values underwent a statistically significant change after Roux-en-Y gastric bypass. For both statistical methods a p value was calculated for the change in each variable with p <0.05 considered statistically significant. Statistically significant changes included increased urinary oxalate and calcium oxalate supersaturation, and decreased urinary citrate and total urinary volume postoperatively. A statistically significant percentage of patients exhibited decreased urinary calcium, while a statistically significant percentage of patients experienced increased urinary oxalate and calcium oxalate supersaturation. Our prospective study demonstrated multiple factors that increase the relative risk of nephrolithiasis after Roux-en-Y gastric bypass. These changes may make stone formation after Roux-en-Y gastric bypass increasingly likely and pose an ongoing challenge in the realm of urology. Gastric Bypass Malpractice Lawsuit Attorneys

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3 Years after gastric bypas surgery, man loses 259 pounds and competes in triathalons

St. Petersburg, FL

Three years ago, Chad Soileau was sitting in a roller coaster seat at Six Flags amusement park near Washington, D.C., when he was overcome with panic. He had waited in line for more than an hour for the four-minute ride on the Wild One, but when it came time to buckle up, the seat belt wouldn't fit.

"The attendant walked up and told me I was too big for the ride," recalled Soileau. "She yelled back to her co-workers, 'Bring the tool, we've got a large rider.' "

Five minutes seemed like an eternity as the crew struggled to extend the roller coaster's seat belt.

"Hundreds of people were watching," Soileau said. "It was the most humbling, humiliating experience of my life."

Afterward, Soileau stumbled off the ride and ran to the nearest restroom. "My stomach was in knots," he said. "I vomited for 10 minutes."

On Nov. 14, a very different Soileau will again face an audience — but this one will be cheering his remarkable achievements.

The Louisiana man will be among the 1,500 or so elite athletes who will gather on Clearwater Beach to swim 1.2 miles, bike 56 miles and run 13.1 miles in the Ironman World Championship 70.3. (The name comes from the combined distance of the three events, which is half the distance of the world famous Ironman World Championship held each October in Kona, Hawaii.)

"It has been a long road to get here," said Soileau, 37. "And I still have a long way to go."

Team 464

Despite the trauma of the roller coaster incident, it wasn't until a few months later that Soileau realized the full extent of his obesity.

"I was on the scale at the doctor's office when he asked if I knew how much I weighed," he said. "I figured about 350. He said no, 464."

Soileau couldn't believe he was off by 114 pounds. He made up his mind, then and there, that he would do something about his weight.

On March 22, 2006, he underwent gastric bypass surgery. "I call it my re-birthday," he said.

The surgery came with complications. He developed several blood clots and had to undergo three additional surgeries, including one to have his gallbladder removed and another to repair a twisted bowel and an internal hernia. But Soileau persevered.

Soileau was 34 when he started his weight-loss journey. Overcoming his longtime addiction to food was his first obstacle.

"I used to order double of everything . . . two appetizers, two entrees, two desserts," he said. "When I would go to the drive-through I would pretend there was somebody else in the car because I was ordering so much food."

Weight-loss surgery is no sure bet; plenty of people regain weight after the procedure. But after his surgery, Soileau found it easier to control his urges. (See related story, Page 12.)

"Physically I couldn't eat as much," he said.

The physical changes soon were followed by emotional ones. "After a while I stopped wanting the food,'' he said.

The victories piled up. One day, he discovered he could bend over to tie his shoes. "It was a huge accomplishment for me when I could get in my truck without my stomach hitting the steering wheel," he said.

Soileau set weight goals, which he published on his Web site, www.Team464.com:

"Weigh less than 400 pounds — DONE!''

"Weigh less than 350 pounds — DONE!''

He also kept track of his progress by his pants size: He went from a size 64 to a size 34.

ONE STEP AT A TIME

As he recovered from the surgery and started to drop pounds, he began to exercise.

He started off small, walking back and forth to the stop sign a block from his house. Gradually, his walks got longer and longer. Eventually, he started running, then swimming, then biking.

"I came up with a list of goals for myself," he said. "One of them was to complete a triathlon."

To help him reach his goals, he kept a training log.

"At first it was just a mile, then 2 miles, then 3 miles," he said. "The whole time I dreamed about completing a marathon."

Soileau, who has a girlfriend, works as a Web site designer in New Orleans. He struggles to find time for the one to two hours of daily training a triathlon requires. As for his diet, he focuses on fruits, vegetables, whole grains and lean protein to help power his new physique.

The discipline paid off. In February 2008, Soileau finished the Mardis Gras Marathon in New Orleans with a time of 5 hours and 36 minutes.

IRONMAN

Soileau has completed dozens of road races and triathlons. He was invited by the World Triathlon Corporation to be its guest at this year's event in Clearwater. Officials hope Soileau's story will inspire others to try the sport.

"It is an honor to be here," he said. "What other sport lets you share the course with the pros?"

But despite his success, Soileau doesn't feel as if he has won his battle against obesity. He won't feel victorious, he said, until he completes a full-distance Ironman.

"I will know I won when I step over the finish line and I hear the announcer yell, 'Chad Soileau, you are an IRONMAN!' "

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Laparoscopic gastric bypass surgery helps man shed obesity

St. Louis, MO

Two years ago, Herb Simmons tipped the scales at 497 pounds.

"As the years snuck up on me I noticed it was getting harder to get around," he says. "I couldn't leave home in the morning without soaking my knees in Ben Gay."

He was suffering from sleep apnea, atrial fibrillation and hypertension. Getting from his car to his house was an exhausting, stop-and-go process because he'd rest every few feet to catch his breath. He needed an extra seat belt on airplanes and a chair without arms in restaurants.

Simmons says he didn't eat big meals, but admits to snacking on chips and slurping sugary colas every day. He says he's been on every diet known to man.


"I once lost 100 pounds on OPTIFAST and regained 200," he says. "I was a yo-yo dieter."

In 2007, he attended a bariatric seminar to learn more about Lap-Band surgery, a laparoscopic procedure to place a silicone band around the top of the stomach. The band reduces the amount of food the stomach can hold so patients eat less. Simmons made an appointment with one of the surgeons, Dr. Van L. Wagner, of Heart of America Bariatrics in Lemay. He was surprised when Wagner recommended gastric bypass instead.

Gastric bypass uses staples to make the stomach smaller, then reroutes food past part of the small intestine. Patients feel full sooner, and absorb fewer calories and nutrients.

With a Lap-Band, patients lose only between 50 and 70 pounds in the first year then often taper off on weight loss, Wagner says. With gastric bypass they almost always lose between 200 and 250 pounds in two years.

"Bypass is usually a better option for patients who are sicker, older and have higher weights," Wagner says. "And Herb was extreme on several of those things so banding would not have provided the weight loss he needed."

Wagner performed laparoscopic gastric bypass surgery on Simmons Sept. 19, 2007, at St. Alexius Hospital.

Gastric bypass comes with risks, including developing gallstones and nutritional deficiencies.

Simmons takes calcium and vitamin pills and drinks protein shakes to prevent malnutrition. Two weeks after surgery, he began walking, first up and down the sidewalk in front of his house, then on a quarter-mile track. At first he couldn't walk a lap without stopping to rest several times. Within a few months, he was walking two miles. Now, he walks three to five miles every afternoon and bicycles three to five miles every evening.

He also eats a lot less, especially high-fat, sugary foods.

"It can cause dumping syndrome, which makes you want to lock yourself in a room for hours," Simmons says. WebMD describes the syndrome as a shock-like state that lasts for 30 to 60 minutes after small, easily absorbed food particles are rapidly dumped into the digestive system. Symptoms include a clammy sweat, butterflies in the stomach, a pounding pulse, cramps and diarrhea.

Simmons says his triglyceride and cholesterol levels have plummeted, his sleep apnea has dissipated and his blood pressure medications are one-fourth the dose they were before surgery. His legs no longer swell and his knees feel fine.

He credits ongoing counseling by Wagner and St. Alexius' NewStart program for his success. Both offer emotional support, nutritional guidance and ongoing education.

Last month, Simmons celebrated the second anniversary of his surgery by walking 3.7 miles as part of the Walk From Obesity event in Creve Coeur.

"After my wedding anniversary, my surgery date is the second-most important anniversary for me," Simmons says.

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Gastric bypass surgery patients with seep apnea at higher risk, study says

Overland Park, KS

While short-term complications and death rates are low following bariatric surgery, according to the Longitudinal Assessment of Bariatric Surgery (LABS-1), patients with a preoperative history of sleep apnea remain at a greater risk of complications.

According to the study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, less than 1% (0.3%) of patients died within 30 days of surgery. The findings support the short-term safety of bariatric surgery as a treatment for patients with extreme obesity.

"Evaluating the 30-day safety outcomes of bariatric surgery in large populations is an essential step forward," said coauthor Myrlene Staten, MD, senior advisor for diabetes translation research at NIDDK in an announcement. "And LABS-1 data are from all patients who had their procedure performed by a surgeon participating in the study, not from just a select few patients."

The LABS-1 consortium followed 4,776 patients having bariatric surgery for the first time, and evaluated complications and death rates within the first 30 days after surgery. Patients were at least 18 years old and had an average body mass index (BMI) of 44. The majority of LABS-1 patients were white and female, which, according to the NIDDK, is the most common population to undergo bariatric surgery. The study took place over 2 years at 10 medical sites, with one additional center coordinating data collection and analyses.

Within 30 days of surgery, 4.1% of patients had at least one major adverse outcome, defined as death, development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries, or failure to be discharged from the hospital within 30 days of surgery.

Thirty-day mortality was low but varied depending on the type of bariatric surgery performed. This ranged from no deaths in the laparoscopic adjustable gastric band group, to six (0.2%) in the laparoscopic Roux-en-Y gastric bypass group, to nine (2.1%) in those undergoing open Roux-en-Y gastric bypass. After adjusting for patient and center characteristics, there were no significant differences in complication risk that could be attributed to the type of procedure. Patient factors such as a preoperative history of deep vein blood clots and sleep apnea increased the risk of postoperative complications. Patients with a very high BMI were also at an increased risk: A patient with a BMI of 75 had a 61% higher risk of complications than those with a BMI of 53.

LABS-1 is part of the Longitudinal Assessment of Bariatric Surgery consortium, an NIDDK-funded study launched in 2003 to examine the short- and long-term benefits and risks of bariatric surgery for adults with extreme obesity.

Results appear in the July 30 issue of the New England Journal of Medicine

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Gastric bypass surgery using robots reduce pain and speed recovery

Phoenix, AZ

Gastric bypass surgery has gone robotic at one Arizona hospital.

Using robots, doctors at Banner Gateway Medical Center can perform the surgery from inside the person's body, KPHO-TV reported.

"The robot allows you to perform the surgery (not only) in high definition, but also in three dimensions," said chief of surgery Dr. Rob Schuster.

Schuster said the procedure is less invasive and painful and it cuts the risk of infection.

Doctors use state-of-the-art technology with a three-dimensional image of the surgical area. The display controls the surgical instruments, working with the doctors' hands, wrists and eyes in real time.

"It really allows us to perform a more precise and perfect operation," Schuster said.

Schuster said the new procedure will result in shorter hospital stays and shorter recovery times, so patients are able to return more quickly to their normal routines.

Banner Gateway Medical Center is one of only a handful of hospitals in the country that use this technology.

KPHO's report did not address any additional costs or risks from the assisted surgery.

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Hospital criticized over death of 420-pound woman after gastric bypass surgery

Manchester, UK

A 420 pound woman who had a gastric bypass operation died at a hospital where staff hadn't been properly trained to care for obese patients.

Janice Barnardo, 46, was the first patient to undergo the weight-loss surgery at Tameside Hospital and was taken back in to repair problems with the surgery five days later.

A Stockport inquest heard staff were not trained to operate adapted beds for patients recovering from the surgery.

Miss Barnardo's bed - specially designed to provide support for overweight patients - had been left unplugged for two days. It was called a bariatric bed after the branch of medicine that deals with obesity.

Sections of the beds can be raised and lowered automatically to keep patients comfortable and prevent bed sores. Pathologist Andrew Yates said the cause of death was heart failure, gross obesity, high blood pressure, diabetes, asthma and pressure sores.

Jane Doyle, surgical ward manager, said staff had not been trained to operate bariatric beds. She said: "The hospital's bariatric policy was in draft form and had not been finalised."

Elaine Hughes said when her sister, Miss Barnardo, was put on a ward after leaving intensive care she felt unhappy.

Mrs Hughes said: "When she came back from the intensive care unit at Tameside, Janice was put in a bed at an angle at the end of a long ward.

"The first thing you saw coming on to the ward was Janice in a huge bed. She felt like she was in a freak show.

"We asked that she be moved to a side ward. That was so cramped we could not get around the bed." Miss Barnardo, from Mossley, had the operation in February 2007 and required surgery to repair a leak five days later. By the end of the following month, surgeon Abduljalil Benhamida discharged her to Shire Hill, Glossop, for rehabilitation.

But Miss Barnardo later developed deep bed sores and in May 2007 she returned to Tameside with septicaemia and later died.

Coroner John Pollard recorded a verdict of misadventure. He criticised nursing notes and said he would write to the chief executives of the local NHS trusts highlighting his concerns. After the inquest, Mrs Hughes said: "Janice's problems started on ward 15 at Tameside Hospital. Staff were not trained to care for bariatric patients."

A spokeswoman for Tameside Hospital Trust said: "This case highlights the complex medical and psychological rehabilitation needs of patients undergoing surgery of this nature and the need for careful assessment, planning and co-ordination of services to minimise the risk of similar problems in the future."

Jill Pinington, of Tameside and Glossop primary care trust, said: "Since Miss Barnardo's death an audit has shown a significant improvement in standards of documentation and note-keeping."

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Married couple has bariatric surgery together

Poughkeepsie, NY

Married couples do lots of things together.

Sometimes, that involves activities designed to get healthier, such as exercising and eating better.

Trish and Jeff Tryon decided to take that one step further: They had gastric bypass operations on the same day.

In Part Three of The Early Showseries "HeartScore" on Wednesday, correspondent Debbye Turner Bell introduced viewers to the couple from Poughkeepsie, in upstate New York, determined to lose large amounts of weight to improve their health and up their odds of living long lives.

It used to Jeff, a take volunteer firefighter, four minutes to get into his gear. Now, he can do in half that time.

Trish, an EMT instructor, also struggled. "I would walk down the hallway and I'd have to sit," she told Turner.

They were both morbidly obese, medically defined as more than 100 pounds overweight. Jeff was 440 pounds. Trish weighed in at 399.

For her, it was a life threatening situation. She suffered from high blood pressure, high cholesterol, and heart problems.

After several failed diets, they explored weight loss surgery and decided to have gastric bypass procedures together.

"Without this operation," says Dr. Laura Choi, a surgeon at Danbury Hospital, in Connecticut, "it was very difficult for them to change their lifestyle."

An emotional Jeff recalled that Choi said, "You have a choice. Sign a contract to have the surgery and add 25 years to your life. Or sign a contract with a funeral home."

The Tryons had their operations in November. A small pouch was created in their stomachs, and their small intestines re-routed to the new, smaller stomachs. It's "worked out beautifully" for them, Choi says, because they have instant support with each other, and they both they recovered very quickly. "You can see it in their faces," she adds. "You can see how excited they are about shedding the pounds, being able to do those everyday things they love to do."

Since the surgery, they eat very small portions. No more sweets or fried foods.

In just three months, Trish has a hundred pounds and Jeff, 81.

His legs don't hurt anymore and now, when he drives the firehouse ambulance, he no longer worries about his belly getting in the way. And she can walk much better.

They've lost weight and gained a whole new life. "It made our love bond very close," Jeff says.

"I know now that I am going to be around to see my son get married and have kids," Trish said, beginning to cry, "and I didn't think I was going to do that before."

Before the surgery, she was taking 14 pills every day for the long list of health issues her weight was causing. She's now off all her medications.

"Contrary to what a lot of people believe about gastric bypass surgery and other types of surgery, it's not the easy way out," Choi observes. "The long-term success essentially depends on how well a person is able to change their lifestyle, and their outlook and relationship with food."

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Woman has gastric bypass surgery, changes lifestyle and loses 125 pounds

Mt. Vernon, IL

A couple of years ago, Brittny Knight decided once and for all that she wanted to lose weight. Now that she has lost 125 pounds, Knight said she continues to work toward her goal in order to live life to the fullest.

Knight said that when she was younger a childhood disease caused her to gain weight. Although she received leg surgeries, Knight continued to play sports in middle school and high school. About 10 years ago Knight said she lost a substantial amount of weight, but later in her career, it was harder to remain active with her traveling job.

“With the job I wasn’t really able to exercise and I grabbed fast food a lot so I put the weight back on pretty rapidly,” Knight said. “I was tired of being unhappy, depressed and not as outgoing as I once was. I just wanted to get this weight off and be more active in live again – live life again.”

At this point, Knight decided to have gastric bypass surgery at St. Alexius Hospital in St. Louis. Although she said this surgery is not a “cure-all,” it did serve as “a little boost to get me in the right direction.”

“I kind of thought, ‘If I have this surgery it’s going to end it all,’ but that’s not necessarily true,” Knight said. “There are stipulations you have to go by. Exercise, eating right and changing my whole mental outlook on making myself healthy is what got me where I am.

“It’s a complete mental overhaul with yourself and you have to make it work. If you’re not in the right state of mind, you’re not going to be successful.”

To help reach her goal, Knight joined Curves and said she continues to work out four to five times each week. Knight also exercises by walking on weekends and throughout the summer.

Knight also eats healthier now and keeps a mental note of what she eats each week. If she’s having a craving for something like chocolate, Knight said she buys a Reese's candy bar but will only eat half. Knight noted she has also incorporated more protein into her diet, and is careful about dishes covered in cheese or sauces, and salad toppings such as croutons and dressing.

Sometimes when she goes to restaurants, Knight laughingly said she is reminded of Meg Ryan in “When Harry Met Sally” when she is ordering food and takes awhile because she’s very particular about what she wants.

“Everybody says that keeping a journal of what you eat and how much you exercise during the week is a good way to keep track and it helps you in losing weight,” Knight said. “I’ve tried keeping journals and diaries but I get kind of busy and lose track. I do keep a mental thought in my head as to what I’ve eaten and where my calories are for the day.”

Knight said that observing what she eats and how often she exercises each week also helps her when she is having a hard time losing weight. If she skipped a workout or ate something not as healthy, Knight knows how to change the next week in order to stay closer to her plan.

Throughout her journey, Knight has found it’s important to put yourself first at times in order to maintain a healthy lifestyle.

“Losing weight is something that someone must be really serious about,” Knight said. “Sometimes you have to let certain things go and say “no” once in a while to take care of yourself. If you’re not healthy, you’re not going to be able to take care of people around you.”

Eventually Knight would like to participate in a 5K or 10K walk, and she is also aiming to lose 50 more pounds. Along with support from her family, friends and coworkers, Knight said watching TV shows including “The Biggest Loser” has motivated her to reach her goals.

“It’s been an inspiration to see that they were where I was and had some of the same emotions I had about myself,” Knight said. “Watching them get to their goal weight and succeed makes me want to do even more for myself, too. Even though I’m not going to win $250,000, it’s just all about the self-esteem and the energy. I already feel like I’ve won some type of lottery anyway because I feel so much better about myself, and doing this has made me much stronger.”

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Three Illinois sisters lose over 300 pounds after gastric bypss surgery

Joliet, IL

One sister bikes, one walks the trails and one works out on the treadmill.

All of them now living healthier and happier lives after undergoing bariatric weight loss surgery at Silver Cross Hospital last July. Together, the three sisters have already lost more than 300 pounds.

“One of the reasons we decided to have the surgery was because our mom was overweight and died at age 68 of congestive heart failure,” Sandra Schmidt said. “Our dad was thrilled when we told him and is so proud of all of us that we have stayed committed to losing weight.”

Inspired by a co-worker who had weight-loss surgery, Sandra told her sisters, Andrea Russell and Pamela Bricker, about it. They decided to attend a free informational seminar held at Silver Cross.

“This was a great way to learn about the entire process,” Andrea said. “Once I learned what my options were, my apprehensions were alleviated and I became more determined to live a healthier life. Plus it has been a great support having my sisters to talk to during the entire process.”
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Their surgeon Dr. Christopher Joyce and his partner, Dr. Brian Lahmann, have performed over 1,000 weight loss procedures, including laparoscopic gastric bypass, Lap-Band and the new REALIZE gastric band system.

A Bariatric Center of Excellence, as well as a Blue Cross Blue Shield of Illinois Blue Distinction Center for Bariatric Surgery, the Silver Cross Hospital's program has a 0 percent operative mortality (death) rate and an extremely low complication rate. And patients lose an average of 86 percent of their excess body weight within four years after gastric bypass surgery.

“Our patients benefit from a multidisciplinary approach," Dr. Joyce said. "We screen them very carefully to ensure their success and safety."

Pamela says you have to be determined to stick to the program, but the support is there to help you succeed.

"We couldn't have found a better program. Dr. Joyce, his staff and the nurses at Silver Cross were all so kind, supportive and down-to-earth. We wouldn't have been so successful in our weight loss if it were not for them," Pamela said.

"Obesity is a medical condition, just like heart disease or diabetes,” Dr. Joyce stresses. “Unfortunately, there is a lot of prejudice against obese people, but this surgery can help them lose weight, and most importantly, keep it off."

“Prior to my surgery, I suffered from high blood pressure and cholesterol, diabetes and painful joints. Now I'm not taking any of those medications,” Pamela said.

“I've lost weight that I never could lose,” added her sister Andrea.

“I should have done the surgery years ago because I wasted my 40s being overweight,” Sandra said. “My life has changed dramatically. I used to have foot problems and now I don't, and my stamina is so much stronger, enabling me to play with my 7-month-old grandson.”

“The sisters are a wonderful example of how life-changing bariatric surgery can be,” Dr. Joyce. said. “Their new passion for life truly shows when you talk with them.”

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Surgical weight loss offers potential health gains

Maryville, TN

While bariatric, or surgical weight loss, procedures can help morbidly obese people lose significant weight, the potential health gains from the surgery are even more impressive. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), recent studies have shown that, in some patients, bariatric surgery can completely reverse type 2 diabetes and can reduce the risk of certain cancers.

Bariatric surgeon Dr. Mark Colquitt, who practices at the Blount Memorial Weight Management Center where 84 percent of surgical patients are female, says that resolving or improving obesity-related health conditions is the primary goal of bariatric surgery. "The reason we do this surgery is to treat co-morbidities, which are medical conditions that exist in addition to obesity and often are a result of being overweight. A lot of people, including some physicians, look at weight loss surgery as a cosmetic procedure, but that is not true. Bariatric surgery is a tool we can use to help save lives and improve the quality of those lives."

The National Institutes of Health has identified obesity as the second leading cause of preventable death in the United States, and recognizes bariatric surgery as an effective alternative for morbidly obese people who have tried, yet failed to lose significant weight. The weight loss achieved through bariatric surgery can help resolve a wide variety of serious medical issues ranging from high blood pressure to joint pain.

Colquitt explains that additional health benefits can be realized from the metabolic changes, which occur when the digestive process is surgically altered. For example, a 2008 study reported in the September issue of the journal Cell Metabolism found that obese diabetes patients who have gastric bypass weight loss surgery often show dramatic improvement in blood sugar control within days, long before significant weight loss occurs.

"A single bariatric procedure has the potential to cure at least five diseases. Following surgery, the cure and improvement rates for adult-onset diabetes, hypertension, sleep apnea, gastroesophageal reflux disease and hypercholesterolemia are remarkable."

Weight loss surgery typically takes one of two approaches -- a restrictive procedure that decreases food intake or a malabsorptive procedure that alters digestion. Some procedures combine both approaches. The Blount Memorial Weight Management Center, which is designated as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery, currently offers three bariatric and weight loss options: gastric banding, gastric bypass and gastric sleeve. Each has proven effective, Colquitt says, in resolving a wide range of conditions ranging from diabetes to depression.

"If you can lose the weight and keep it off, then the illnesses will get better. For people who have repeatedly tried and failed to lose weight, bariatric surgery offers the opportunity to live a full, active and long life. It really is a life saver."

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Laparoscopic gastric bypass provides better results

New York, NY

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

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

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

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

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

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

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

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

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

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

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Gastric bypass surgery: Lifestyle change & lifetime commitment

McAllen, TX

I have been working at my hospital since 1986, and I was obese most of my life.

In 2004, my hospital began offering weight-loss surgery. I had health problems such as hypertension and metabolic syndrome. I was never able to lose enough weight to make a difference in my hypertension.

I made the decision to have a Roux-en-y Gastric Bypass.

Within 3 months postop, I was able to stop taking of my glucophage, as well as medication for my hypertension, which I had taken for 17 years.

I am now the Bariatric Program Manager as well as a Certified Bariatric Nurse and we have achieved ASMBS Center of Excellence for Bariatric Surgery.

I enjoy being a resource person for our patients undergoing weight loss surgery and for those considering weight loss surgery. I want everyone to be as successful and as happy as I am with this life changing procedure.

Weight-loss surgery is not without risks, but neither is being obese. I tell everyone this is a personal decision that only they can make. It is a lifestyle change and a lifetime commitment. Make sure you do your research and put yourself in the most experienced hands possible.

Medicare and some insurance companies are only reimbursing procedures done at facilities that have achieved ASMBS Center of Excellence by the Surgical Review Corporation or American College of Surgeons Level I Certification.

Weight-loss surgery is a treatment for obesity and is done for health reasons. It is not a cosmetic procedure.

To qualify for weight-loss surgery you should have a BMI of 40 or greater, or 35-39 with comorbid conditions such as diabetes, depression, hypertension, urinary stress incontinence or sleep apnea, just to name a few.

Remember, surgery is a tool that should not be taken for granted.

By Paula Kilgore, RN, CBN
McAllen, TX

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60 Minutes segment on gastric bypass surgery effect on diabetes, cancer

60 Minutes reports: Gastric bypass surgery can send diabetes into remission and may reduce risk of other cancers.

It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Surgeons have been performing bariatric, or weight loshttp://www.blogger.com/img/gl.link.gifs operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation. More >>

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Philadelphia woman found it took more than a gastric bypass procedure to maintain her weight loss

Philadelphia, PA

IN THE PAST few years, bariatric surgery, otherwise known as gastric bypass or gastric banding, has become all the rage.

With 65 percent of Americans either overweight or obese, according to the federal Centers for Disease Control, it's not surprising that many people are electing to have this procedure done.

After all, post-procedure weight losses range from 60 to 80 percent of excess body weight in patients with a body mass index of 35 to 60, over the first two years. That could roughly equal a loss of 80 to 150 pounds, depending on your original weight.

Undoubtedly, weight-loss surgery guarantees permanent weight loss, right?

Well, perhaps . . .

Melissa Blanco, 32, once carried a whopping 274 pounds on her 5-foot-4-inch frame. But the Philly native shed 130 pounds after having the gastric bypass procedure.

"I did Weight Watchers, Jenny Craig, and the weight-loss program at the University of Pennsylvania, and had some success to some degree, but could not maintain it. I started feeling tired and wobbly. I knew something had to change," Blanco said.

So, in the winter of 2005, after doing some research, she decided to have gastric bypass surgery that reduced her stomach to the size of an egg. More >>

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After years battling weight, Trib writer turns to bariatric surgery - gastric bypass

Waco, TX

Waco Tribune staff writer Terri Jo Ryan has battled weight problems most of her life. After a frightening diagnosis, she weighed pros and cons and opted for bariatric surgery. She shares her story with others who might be fighting obesity and studying their options.

In the final years of her life, my mother had three killers stalking her — chronic obstructive pulmonary disease, chronic heart disease and diabetes. On March 18, 2007, diabetes won.

So I was alarmed when my doctor told me that my mother’s killer had me in its sights, too. In June, I found out I had type 2 diabetes.

After the diagnosis, I was depressed and frightened. I am one of eight siblings, nearly all of us overweight, and I did not want to be the first one to die of obesity.

I spent a weekend re-evaluating my life and made a resolution: I would not continue to commit slow-motion suicide by eating whatever the heck I wanted. I rejoined the YMCA, where I do water aerobics three or four days a week. I gave up sugar, sodas, white potatoes, white bread and ice cream. I cut my portions in half.

Weight-loss surgery had been an option rolling around in my mind for more than a year. I’d been reading up on various procedures, side effects and mandatory lifestyle changes that come from having your innards rerouted for life.

A decade earlier, I would have sneered at the suggestion that I have surgery to correct the consequences of irresponsible consumption. But as someone who had tried numerous diets only to gain it all back and then some, I have come to appreciate the powerful tool that weight-loss surgery can offer in the perpetual battle against the bulge.

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Laparoscopic gastric bypass and sleeve gastrectomy to be broadcast at OR-Live.com

Ft. Lauderdale, FL

On January 15, 2008, at 6 pm, www.ORLive.com will broadcast two (2) bariatric procedures; a laparoscopic gastric bypass and a laparoscopic sleeve gastrectomy, both performed in Ft Lauderdale, FL and recorded ive to tape. The gastric bypass procedure will be performed by Robert Marema, MD, FACS. More >>

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Woman on death bed warns of gastric bypass surgery dangers

December 2, 2007

As she lay dying, Jan Malcolm made her husband promise.

"Tommy, we've got to tell people," she said. "If I live through this, we need to warn everyone so that no one else has to suffer like this. If I die, you must warn everyone so they will be aware of what to do to avoid this."

The last words T.F. "Tom" Malcolm heard from his wife of 47 years were, "You were right." more >>

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Gastric bypass surgery gives 38-year-old new opportunities

December 1, 2007

Four years ago, Wendy Juliano struggled with health problems and could barely walk up a flight of stairs or bend over to tie her shoes, all because of her weight.

The Gilbert 38-year-old wanted her life back. So in March 2004, she underwent gastric bypass surgery, which created a small stomach pouch to restrict her food intake.

At 5 foot, 4 1/2 inches tall, she went from 290 pounds to her lowest at 123 pounds.

She was able to stop taking her heart and asthma medicine, stopped her breathing treatments and has a renewed sense of energy and self-worth.

“I’m a full-time wife, full-time student, full-time employee, full-time mom and full-time grandma,” said Juliano, who is due in March with her third child. more >>

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Another Complication For Gastric Bypass Patients

November 27, 2007

Obese patients who suffer complications after gastric bypass surgery may face further health risks because their weight exceeds the limits of diagnostic imaging equipment, according to a study presented November 27 at the annual meeting of the Radiological Society of North America. In the study, approximately 27 percent of patients weighing more than 450 pounds needed imaging to diagnose a problem after surgery and could not be accommodated because of their size.

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"When patients weigh more than 450 pounds, standard diagnostic imaging often cannot be used," said Raul N. Uppot, M.D., an assistant radiologist at Massachusetts General Hospital (MGH) and instructor of radiology at Harvard Medical School in Boston. "In these cases, physicians must resort to other means of diagnosis such as exploratory surgery or using less accurate or more invasive techniques."

According to the Centers for Disease Control and Prevention, obesity has grown dramatically in the last 20 years. Today, nearly one-third of the American population is obese. Along with the rise in obesity among American adults has come an increase in the number of gastric bypass procedures performed.

The American Society for Bariatric Surgery estimated approximately 140,000 gastric bypass procedures were performed in the United States in 2005. In a gastric bypass procedure, the stomach is surgically reduced, and part of the small intestine is bypassed. Like any surgical procedure, gastric bypass is not without risks. Most common complications include suture tears and leaks, pulmonary embolism, pneumonia and infection. Serious complications tend to be more prevalent among the severely overweight.

Dr. Uppot and colleagues conducted an eight-year retrospective study of all patients weighing more than 450 pounds who underwent a gastric bypass procedure at MGH between June 1999 and April 2007. Patient imaging usage and clinical course were tracked using electronic health records and evaluated to determine the outcomes of those who, based on their weight, were denied their physicians' first choice of imaging. The maximum weight limit for a computed tomography (CT) table is 450 pounds.

The researchers found that 12 (27 percent) of the 44 patients who weighed more than 450 pounds required postsurgical imaging because of a clinical condition, but were denied because they were above the weight restriction for the equipment. Four patients who could not be evaluated with imaging for suspected leaks were required to return for surgery.

Two additional patients with suspected lung blood clots could not undergo a chest CT. Of two patients who came in with nonspecific abdominal pain, one was evaluated with ultrasound and the other one had a barium swallow test. Because imaging was not an option, one patient who suffered trauma underwent exploratory surgery in lieu of noninvasive imaging. Another patient was denied a chest CT and received no further imaging evaluation.

"When obese patients cannot be diagnosed using standard-of-care imaging techniques, then other diagnostic measures have to be instituted," Dr. Uppot said. "Patient care may be ultimately affected due to a compromised diagnosis."

Dr. Uppot noted that the obesity trend cannot be ignored. "Unless major changes are made to the American diet or exercise habits, this is a problem that we will have to address," he said. "When an obese person is contemplating gastric bypass surgery, he or she should consider that they will need follow-up imaging but may not be able to get the appropriate tests."

Co-authors of the paper presented by Dr. Uppot are D.V. Sahani, M.D., D.A. Gervais, M.D., P.R. Mueller, M.D., P.F. Hahn, M.D., Ph.D., and S.I. Lee, M.D., Ph.D.

Adapted from materials provided by Radiological Society of North America.

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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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LAP-BAND(R) System Weight-Loss Surgery Associated With More Than 70 Percent Reduced Risk of Death in People With Severe Obesity

November 21, 2007

About Obesity

In the United States, obesity is considered the second leading cause of preventable death (7). Further, research has shown that individuals with a BMI of 35 or more have a reduced life expectancy of nine to 13 years (8). A BMI of 35 or more translates to a weight of 200 pounds or more for a woman of average height (5' 4") when ideal weight at this height is considered to be 140 pounds, and to a weight of 250 pounds or more for man who is six feet tall when ideal weight for this height is considered to be 177 pounds.

About the LAP-BAND(R) System

The LAP-BAND(R) System was approved by the FDA in June 2001 for severely obese adults with a Body Mass Index (BMI) of 40 or more or for adults with a BMI of at least 35 plus at least one severe obesity-related health condition, such as Type 2 diabetes, hypertension and asthma. Used in more than 300,000 procedures worldwide, this simple reversible surgically implanted device has safely helped severely obese adults successfully achieve and maintain long- term weight loss.

The LAP-BAND(R) System was developed to facilitate long-term weight loss and reduce the health risks associated with severe and morbid obesity. Unlike gastric bypass, it does not involve stomach cutting, stapling or intestinal re-routing (9,10). Using laparoscopic surgical techniques, the device is placed around the top portion of the patient's stomach, creating a small pouch. By reducing stomach capacity, the LAP-BAND(R) System can help achieve long-term weight loss by creating an earlier feeling of satiety. The LAP-BAND(R) System is adjustable, which means that the inflatable band can be tightened or loosened to help the patient achieve a level of satiety while maintaining a healthy diet. It is also reversible and can be removed at any time.

Severely obese people who received the LAP-BAND(R) Adjustable Gastric Banding System to lose weight had a 72 percent reduction in their risk of dying compared to obese people who were not offered any specific weight-loss treatment, according to findings published in the December issue of the Annals of Surgery (1). The LAP-BAND(R) System was approved in June 2001 by the U.S. Food & Drug Administration for weight reduction in severely obese adults.

"This research is critical because it shows that people with severe obesity, who are known to be at a much higher risk than the general population for dying prematurely, may be able to significantly decrease their risk with laparoscopic adjustable gastric banding," explains Dr. Paul O'Brien, FRACS a study author from the Monash University Centre for Obesity Research and Education (CORE) in Melbourne, Australia, head of the Centre for Bariatric Surgery in Melbourne and the National Medical Director for the American Institute of Gastric Banding in Dallas, Texas. "What is also particularly compelling is that this study shows it is possible to gain a significant survival benefit without the risks associated with more invasive bariatric surgical procedures, such as gastric bypass." http://www.earthtimes.org/articles/show/news_press_release,228703.shtml

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The Bariatric Surgery Conundrum

November 18, 2007 - New York Times

This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese.

Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.”

Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ’70s and early ’80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.”

Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some circumstances — one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on — the overall mortality rate is now in the neighborhood of 1 percent.

But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications — physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000.

But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut — in fact, Bessler does consult for companies in the industry — the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced “complete resolution” of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea. From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions. That’s why some insurance companies cover bariatric surgery — as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about?

On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.” More >>

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Learning about Bariatric Surgery: Gastric Bypass

Learning about Bariatric Surgery: Gastric Bypass

An estimated 66 percent of adults in the United States are overweight or obese, according to the Centers for Disease Control and Prevention. Although doctors recommend that those who wish to lose weight first try to do so through dieting, exercise, behavior therapy and anti-obesity drugs, an increasing number of people are turning to surgery when these steps fail.

In 2006, for example, about 150,000 patients in the United States underwent what is known as bariatric surgery, says Michael Schweitzer, director of minimally invasive bariatric surgery at Johns Hopkins Bayview Medical Center. That number is up from about 14,000 patients in 2003.

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Health Risks Remain After Gastric Bypass Surgery

Surgeons Urge More Post-Surgical Follow-Up of Patients

While gastric bypass surgery may help obese people improve their health by shedding weight, the procedure may have a darker flipside when it comes to patients' risk of death from suicide and a continued risk of heart disease.

According to a study published in the current issue of the journal Archives of Surgery, this increased risk may indicate that bariatric surgery patients may require more intense follow-up in the months and years after their procedures. More >>

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Obese Couple has Gastric Bypass Surgery Together

They're happy newlyweds that once looked like different people.

Dawn Marie holds up an old pair of jeans. "These are a size 30, and now I'm a size 8!" Her now-husband, Frankie does the same, telling INSIDE EDITION, "These are a size 78, and now I'm a size 36."

Dawn Marie and Frankie Hveen can now share a pair of his old jeans! His old shirts look like bed sheets, and his belt, amazingly was almost seven feet-long.
About four years ago, the Long Island, New York couple vowed to go from obese to fit...together. He was a massive 550 lbs! She tipped the scales at 400! But Dawn Marie says, "I saw myself in a box, and I didn't want to die." They were inspired to lose weight after the death of Frankie's 27-year-old sister Margaret, who weighed as much as 700 lbs.

After undergoing gastric bypass surgery, they began a diet of healthy food and regular exercise.

The weight loss from before to after is dramatic. Combined, they've lost an amazing 550 pounds. Dawn Marie is now a trim 160, and Frankie's a shadow of his former self at 235!

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Mother of 6 Dies Days after Gastric Bypass Surgery

(London, UK)

A dedicated mum-of-six who was desperate to lose weight died just days after a gastric bypass operation.

Annette High, 42, had already lost seven stones after having a gastric band fitted in 2000. But as her weight crept up from 14 stone she decided she needed more drastic action. Despite her family's pleas, Annette decided to have the NHS funded operation, which reduced her stomach and removed part of her bowel.

She was found collapsed by her husband Gavin just four days later at their home in Hull, East Yorks. She died in hospital on May 12th and a post mortem revealed she had a previously undetected heart defect. She died as a result of heart disease.

Speaking after the inquest on Wednesday at Hull Coroners Court, Gavin said: "I begged her not to have it. I loved her whatever she was like. It didn't matter about her weight. More >>

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Gastric Bypass Surgery Patient Exercises, and Diets Right to Keep the Weight off

LAS CRUCES — Russell Clark is less than half the man he used to be, and he and his friends and family couldn't be happier about it.

On June 7, 2006, Clark weighed 445 pounds. This month, he weighed in at 195 pounds.

Clark isn't sure what his total weight loss is.

"I fasted for two weeks before I had gastric bypass surgery, so I'm not sure now much I weighed before that," Clark said.

He estimates his all-time high was about 470, which puts his loss to date at something between 250 and 275 pounds.

During gastric bypass surgery, a small stomach pouch is created and a "bypass" for food is constructed which allows food to skip parts of the small intestine, so the body can't absorb as many nutrients and calories.

There are risks and problems associated with the procedure, which range from dizziness, nausea, diarrhea and digestive difficulties, to problems associated with malnutrition, such as anemia. More >>

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Gastric Bypass Surgery: Are You a Proper Candidate

(MayoClinic.com)
It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option. Gastric bypass surgery — one type of bariatric surgery — changes the anatomy of your digestive system to limit the amount of food you can eat and digest. Weight loss is achieved by restricting the amount of food that your stomach can hold and by reducing the amount of calories that are absorbed. Gastric bypass surgery isn't for everyone, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. An extensive and careful screening process determines whether you're a candidate for this surgery.

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