Gastric Bypass Surgery News

Weight-loss surgery may decrease the risk of cancer in women

2009-07-03T19:29:00.000-07:00

Researchers from Sweden have reported that weight-loss surgery (bariatric surgery) was associated with a reduced incidence of cancer in obese women but not in obese men. The details of this study appeared in an early online publication in Lancet Oncology on June 24, 2009.[1]

Previous studies have suggested that obesity increases the risk of developing cancers of colon, rectum, liver, gallbladder, pancreas, breast, uterus, cervical, ovary, and kidney as well as lymphoid tumors such as non-Hodgkin’s lymphoma and multiple myeloma. It has been estimated that obesity increases the cancer death rate in men and women by more than 50%. It has been suggested that obesity causes 14% of all cancer deaths in men and 20% of all cancer deaths in women in the United States.

Weight loss surgery is usually the last resort for morbidly obese individuals when diets fail. Weight loss surgery refers to various procedures that restrict nutrient intake such as bands or bypasses. (See Wikipedia [http://en.wikipedia.org/wiki/Bariatric_surgery] for descriptions of the various surgical procedures currently being used.)

The current study evaluated the risk of cancer in 2,010 obese patients with a body mass index greater than 34 kg/m2 in men and greater than 38 kg/m2 in women who underwent weight loss surgery. Outcomes were compared with 2,037 controls who were comparably obese but did not opt for weight loss surgery. The median follow-up of this study was over 10 years.

* Weight loss surgery was associated with a 20 kg weight loss over the 10 years of observation compared with a 1.3 kg gain in controls.
* There were 117 cancers in the surgery group and 169 in the control group.
* There were 79 cancers in women in the surgery group and 130 in the control group.
* There were 39 cancers in men in the surgery group and 39 in the control group.
* Similar results were obtained when cancers developing in the first three years from surgery were excluded.

These authors concluded: “Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men.”

Comments: This is the first study to document a decreased risk of cancer following significant weight loss. It is very interesting that this decreased risk was limited to women. This may suggest that cancers in women are more hormonally dependent than in men. It has been speculated that hormones produced by fat may be the cause of increased breast, uterine, and ovarian cancer risk in obese individuals.

References:

[1] Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncology [early online publication]. June 24, 2009.

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New study finds gastric bypass surgery not more risky for senior citizens than young

2009-06-29T05:24:00.000-07:00

Dallas, TX

About 26% of seniors 65 and older in U.S. are obese, nearly 40% are overweight, putting them at a higher risk for Type 2 diabetes, high blood pressure and heart disease

Morbidly obese seniors, age 65 and over, who had laparoscopic gastric bypass surgery lost nearly 76 percent of their excess weight after two years and had low complication rates and short hospital stays comparable to younger surgical patients, according to a new study presented today at the 26th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

“Bariatric surgery in the older population is underutilized because of a misperception that old age alone puts patients at higher risk for complications and mortality,” said Joseph Kuhn, MD, co-author and director of General Surgical Research at Baylor University Medical Center in Dallas, TX.

“We found seniors can benefit just as much as younger people from bariatric surgery without taking on additional risk.”

In one of the largest series of laparoscopic gastric bypass surgeries performed on elderly patients, researchers from Baylor University Medical Center analyzed a prospective database of 100 patients over age 65 and compared safety and outcomes to a younger population.

All patients had laparoscopic gastric bypass surgery between January 2005 and July 2008.

Prior to surgery, older patients demonstrated higher operative risk profiles compared to their younger counterparts in relation to -
● sleep apnea (45% vs. 34%),
● Type 2 diabetes (65% vs. 33%) and
● hypertension (81% vs. 57%).

Older patients ranged in age from 65 to 77 with an average BMI of 45, and younger patients ranged in age from 18 to 64 with an average BMI of 47.

Post-operative excess body weight loss (EWL) and complication rates were comparable in both groups.

At 12 and 24 months, both lost nearly the same amount of weight -- patients over age 65 showed 75.9 percent EWL after one year and 75.5 percent after two years; patients under 65 showed 77.8 percent EWL after one year and 79.2 percent after two years.

Neither group reported any deaths in the two-year follow-up period.

Post-operative complications were -
● low: bleeding (>65 1% v. < 65 1.3%),
● pulmonary infections (>65 3% v. <65 1.3%),
● cardiac (>65 2% vs. <65 0.36%) and
● wound infections (>65 1% v. <65 1.7%).

Due to the age and overall health status of the older group, researchers noted it was particularly interesting to also find length of hospital stays (1.9 vs.1.3 days) and 30 day readmissions rates (6% vs. 7.4%) to be so comparable.

About 26 percent of people 65 and older in the U.S. are obese and another nearly 40 percent are overweight, putting them at a higher risk for Type 2 diabetes, high blood pressure and heart disease. Since 1990, the prevalence of obesity has increased more than 50 percent in the elderly.

“The population is getting older and unfortunately more obese, so we will see a corresponding increase in the number of patients over 65 who are eligible for bariatric surgery and surgery needs to be an option for them,” said Christopher Willkomm, MD, study co-investigator from Baylor University Medical Center.

People who are morbidly obese are generally 100 or more pounds overweight, have a BMI of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea.

According to the ASMBS, more than 15 million Americans are considered morbidly obese and in 2008 an estimated 220,000 people had some form of bariatric surgery. The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB).

The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits.

It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information about the ASMBS, visit www.asmbs.org.

Gastric Bypass Malpractice Lawyers

Studies underway to determine why obesity surgery thins bones

2009-06-16T20:48:00.000-07:00

from Red Orbit

Experts say melting fat from obesity surgery somehow thins bones and even suggest that patients who undergo these procedures might have twice the average person's risk for a fracture, and are more likely to break a hand or foot, The Associated Press reported.

Further research is now under way to see if The Mayo Clinic's finding is significant. But specialists say uncovering long-term side effects from bariatric surgery and how to counter them takes on new urgency as more and more overweight people are electing to try it.

Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society that these procedures are now being sold as a panacea.

"It is of heightened importance to find the answers to these questions," he said.

And perhaps the only positive thing you'll ever hear a doctor say about too much fat is that obesity actually is considered protective against bone-weakening osteoporosis.

Mayo bone-metabolism expert Dr. Jackie Clowes said overweight people are starting out better than most of us when it comes to staving off osteoporosis.

Therefore, researchers are working towards answering whether those who undergo the procedures really end up with worse bones, or just go through a transition period as their bones adjust to their new body size.

In the United States, some 15 million people are classified as extremely obese (100 pounds or more overweight). With rampant diabetes and other health problems, surgery is fast becoming the preferred treatment.

Options include stomach stapling called gastric bypass to less invasive stomach banding procedures, where patients tend to lose between 15 percent and 25 percent of their original weight — dramatically improving diabetes symptoms.

The American Society for Metabolic and Bariatric Surgery shows that more than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone.

Now large National Institutes of Health studies on both adults and teens are underway to find more data on how patients fare many years after the surgeries.

However, doctors know that radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone.

A year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age, according to more recent studies.

And while almost half of peak bone mass develops during adolescence, more research is needed to determine if teen bones react similarly.

The Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't, to see if such changes translate into fractures.

Mayo's Dr. Elizabeth Haglind told the endocrinology meeting that a quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years. That group had twice the average risk six years after the surgery.

Interestingly, the surgery recipients had three times the risk of hand and foot fractures than their Minnesota neighbors.

Dr. Scott Shikora, president of the bariatric surgeons group, said he was shocked at the numbers because he hasn't seen a significant fracture problem in his own practice.

Shikora estimates about half of surgery patients follow their doctor’s advice to take extra calcium and vitamin D, and other research suggests higher doses may be needed anyway as the obese tend to start out with vitamin D deficiency.

“Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies,” Clowes advised.

obesity surgery malpractice lawyers

No scars: New TOGA obesity surgery goes through mouth

2009-06-10T21:31:00.000-07:00

Chicago, IL

Doctors are testing a new kind of obesity surgery without any cuts through the abdomen, snaking a tube as thick as a garden hose down the throat to snap staples into the stomach. The experimental, scar-free procedure creates a narrow passage that slows the food as it moves from the upper stomach into the lower stomach, helping patients feel full more quickly and eat less.

Doctors say preliminary results from about 200 U.S. patients and 100 in Europe look promising.

After about 18 months, obese European patients have lost an average of about 45 percent of their body weight, said Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center in Los Angeles. He discussed the European and U.S. studies during a Chicago conference this week for digestive disease specialists.

The procedure is only being done in the studies, which recently ended enrollment. Makers of the device used in the operation plan to seek federal approval if the research continues to go as planned.

While the two studies are still under way and only brief details are being released, Nishi said results so far are slightly better than typical results from with conventional stomach stapling.

Risks include perforating the esophagus, as Nishi said happened to a patient at another center, but otherwise, he said, there have been no major complications.

Some study patients have lost weight after unknowingly undergoing fake procedures — sedation and the tube, but no stapling. Results comparing them with the real thing aren't yet available.

Liliana Gomez, an administrative coordinator at Cedars-Sinai, was among the first Americans to have the scarless obesity surgery last year, as a test case for the U.S. study. She had planned on more invasive conventional surgery until learning that doctors at her hospital were studying the scarless stapling technique.

"When I found out it was going to be oral, through your mouth, I was like, 'Wow, that's kind of different,'" she said.

Since her operation in August, Gomez has lost about 40 pounds and dropped from size 22 to size 16.

The 35-year-old mother of three has a long way to go — she's still obese according to body mass index standards. But Gomez says she has cut her meal portions by more than half and still feels full, and is optimistic she'll continue to lose weight.

The new method is part of a medical movement to perform surgery through body openings such as the nose, mouth and vagina instead of making cuts. The idea is to reduce chances of infection and pain, and speed recovery. With no scars, there are cosmetic advantages, too.

Gomez had considered a gastric bypass operation, a more complex kind of stomach stapling, but worried about risks from that surgery. It reduces the stomach to the size of a golf ball and reroutes the digestive tract.

Whether done through one large abdominal incision or several tiny ones, gastric bypass is far more invasive and increases chances for malnutrition because it repositions how the stomach attaches to the intestines to restrict calorie absorption.

Another popular weight-loss surgery option involves putting an adjustable band around the top part of the stomach to create a small pouch.

The experimental method Gomez had is the oral version of a different kind of stomach surgery, which reduces the size of the stomach with staples but doesn't reroute the digestive system.

Surgery is generally considered a last-resort treatment for obesity, which affects more than 15 million Americans. Still, demand is high. More than 200,000 Americans are expected to have conventional forms of obesity surgery this year, according to the American Society for Metabolic & Bariatric Surgery.

Dr. Scott Shikora, the society's president, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough."

Shikora said many U.S. obesity surgeons prefer the rerouting surgery or flexible bands, and that it remains to be seen whether the oral method has the same drawbacks as more outmoded stapling procedures.

The U.S. study is taking place at 10 centers. Patients will be followed for at least one year, with final results expected in 2010. They are randomly selected to undergo either the operation or a sham procedure.

Nishi said of 25 patients enrolled at his hospital, 17 got the real treatment, with no complications.

"I'm very impressed with it," Nishi said. So far, it looks like "a viable alternative," he said.

Satiety Inc., a California company that created the medical devices used in the technique, is paying for the research. Nishi said he has no financial ties to the company.

At Washington University School of Medicine in St. Louis, where the first U.S. procedure was done last summer, about 30 patients have undergone the treatment. Side effects have been minimal, including sore throats, nausea and some abdominal pain lasting less than a week, said Dr. J. Christopher Eagon. He said weight loss results from his center aren't yet available.

New procedure for obesity surgery - enter through mouth, no scars

2009-06-07T11:40:00.000-07:00

Denver, CO

A new kind of obesity surgery without any cuts in the abdomen is being tested in small experimental groups. In this surgery the stomach is stapled by means of a tube that has been put down the throat of the patient. Preliminary results from US and European studies look promising.

In the experimental procedure the stomach is stapled to create a narrow passage that slows the food down as it moves through the stomach. This helps the patients feel full after eating small amounts of food and as a result eat less. Stapling the stomach is not a new technique, but this procedure is unique as there are no scars.

About 300 patients have undergone this new procedure. If all goes well, the makers of the tube, which is as thick as a garden hose, plan to seek federal approval of the device. This procedure is part of a move by the medical community to perform surgeries through body openings instead of incisions. The goal is to reduce chances of infection, pain, and speed recovery as well. Obviously, with no scars there are cosmetic advantages as well.

Studies in the US and Europe are still underway, so only brief details are being released. According to Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center, results so far are slightly better than typical results from conventional stomach stapling. In the European study, over the course of 18 months the patients have lost an average of 45 percent of their body weight. Final results from the US study, which is taking place at ten centers, are expected in 2010.

Demand for obesity surgery is high in the US with more than 15 million obese Americans. According to the American Society for Metabolic & Bariatric Surgery more than 200,000 Americans are expected to undergo conventional forms of obesity surgery this year. Existing procedures are far more invasive. Gastric bypass changes how the stomach attaches to the intestine which increases the chances for malnutrition while restricting calorie absorption. Another popular procedure involves putting an adjustable band around the top part of the stomach.

Dr. Scott Shikora, president of American Society for Metabolic & Bariatric Surgery, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough."

Weight Loss Surgery Malpractice Lawsuits

Gastric Bypass surgery: Pros and Cons

2009-05-17T14:53:00.000-07:00

Tulsa, OK

Gastric bypass surgery is growing more popular every year as America's obesity epidemic tips the scales. Even the elderly, and people with health problems are turning to this surgical solution to obesity.

It is a surgery that saves lives. But some also warn there can be life-changing drawbacks.

"These were 26 - and I wear a size 8 now," said Leslie Blunt as she proudly showed off the pants she will never wear again thanks to gastric bypass surgery. She has lost 140 pounds. "It works. It does. You live a healthier life," she added.

Micah Anderson chose gastric bypass surgery when his weight ballooned to 500 pounds. "Lost little over 200 pounds - easy," he told 2News anchor Karen Larsen. "I'm happy with myself. More confidence."

While gastric bypass is known for bringing on drastic weight loss, what many do not realize are specific changes it may cause for an individual, along with health benefits.

"A lot of this junk food they were eating before - their taste has disappeared they don't want it anymore," according to Dr. Luis Gorospe, gastric bypass surgeon at Bailey Medical Center in Owasso. Both Anderson and Blunt went to Dr. Gorospe for surgery. His patients come from surrounding states, drawn by his surgery success rate, the promise of dramatic weight loss and the immediate health benefits of gastric bypass.

"If they have diabetes - 70 percent of these patients wake up with normal blood sugar and will not require medications - forever," Dr. Gorospe said.

Studies show gastric bypass may improve or even eliminate such health problems as:

Leslie Blunt says she is living proof, "I don't have high blood pressure. I don't have diabetes. I am pill free."

However, Micah Anderson tells a different story. "I'll vomit maybe not every week - but if something doesn't agree it does come right back up."

When surgeons create a tiny new stomach for patients, vomiting is a common problem when patients eat too much, too fast - until they get used to their new, smaller stomach. Micah says he expected that - but then he started fainting - once behind the wheel of his car.

Anderson's wife Katie said, "The passing out has happened four times. Spells where he could potentially pass out... weekly!"

Frightened by the potential danger such episodes represented, the Andersons began researching online and discovered other gastric bypass patients having such problems.

"Describing the same kind of drunk-like symptoms, incoherent, can't talk, slurring the speech. and people were experiencing the same things," Katie added.

The Andersons say they went to numerous doctors and nutritionists, trying to find a physician who was experienced with gastric surgery side effects. After trial and error, they say they have finally found the right doctor to care for Micah. As a result, Micah now follows a diet carefully crafted to meet his personal needs. He eats every two hours, consumes plenty of protein and takes vitamins.

"For me its lack of eating. I forget to eat and that's what causes my issues. It's partially my fault as much as it is the surgery," Micah said. "If I don't follow the rules like they tell you - you do have issues."

Doctor Gorospe agreed. He said healthy eating - the same issue obese patients struggle with before gastric bypass - is more important than ever after surgery. "If you follow the rules, this surgery will be successful," Dr. Gorospe said.

Because some patients do encounter issues following surgery, and with their new lifestyle, Doctor Gorospe offers monthly support groups. "I make it a point of being there," he said. "I want to be available to my patients." The meetings offer patients an opportunity to share their stories and talk with Dr. Gorospe.

Micah did attend the monthly meetings. However, some of his problems did not occur until several years following the procedure. As a result of his struggle, the Anderson's suggest to those considering gastric bypass surgery: do plenty of research, know the rules they will have to live by, and read up on potential side effects.

"There is a list and, by golly, one of those things on the list will affect you," Katie Anderson said. "They just need to tell you flat out - you are trading one set of issues for another set of issues."

However, when asked if he would have the surgery again, Micah's answer is, "Unfortunately, yes." He went on to say he is pleased with his more than 200 pound weight loss. His joints ache less when he gets out of bed in the morning, and it is easier to be active.

Leslie Blunt agrees. Now, this svelte hair stylist says work is easy. No more suffering from carrying too much weight while being on her feet each day. Plus, she loves buying clothes with her new look and the fact that she is setting a good example for her young children by living a healthier lifestyle.

In fact, Leslie says gastric bypass surgery is the best thing she ever did for herself. "Yes! I would do it over and over and over again! I never want to be that way again."

Gastric Bypass Malpractice Lawyers

Help now available after failed gastric bypass surgery

2009-05-12T06:21:00.000-07:00

San Diego, CA

A new procedure, called a ROSE procedure, is now available for patients who have had gastric bypass, lost weight and then slowly put weight back on again as their stomach pouch stretched. One of the problems with surgeries that reduce the size of the stomach for weight loss is that the pouch size may not be permanent. Over time, the pouch can enlarge to the point where meals of significant size can be eaten.

Rose, or Restorative Obesity Surgery, Endolumenal, is an outpatient procedure where the surgeon inserts a tiny camera and special tools into the stomach by introducing them into the mouth and down through the esophagus. Remarkably, no incisions are made to reduce the size of the stomach opening and the actual stomach. The surgeon essentially makes folds in the tissue of the stomach from the inside, similar to creating pleats, then uses stitches to hold the folds in place.

The procedure is currently available at the Center For The Treatment of Obesity at UC San Diego Medical Center.

Woman's decision to undergo gastric bypass changes her life

2009-05-06T05:53:00.000-07:00

Harrisburg, PA

Corinna Van Hine's moments of reckoning with her weight were mounting. At 30, she was out of breath when she walked with her husband, often avoiding hills. Shopping for women's clothes was a thing of the past, and she was buying from the racks in men's departments instead. She could barely squeeze into seats at movie theaters or amusement parks.

The worst setback was when her 320-pound frame kept her from horseback riding, a passion since she was 5 years old. "It really limited me because you have to have a big enough horse to handle your weight," Van Hine said. "My weight had gotten to a point where it wasn't safe for the horse for me to be riding it."

That's when the Steelton woman decided enough was enough. After years of shedding pounds through dieting and exercise only to regain the weight and sometimes more, she hit the books and Internet for any information on weight-loss surgeries.

It eventually led Van Hine to Penn State Milton S. Hershey Medical Center's Surgical Weight Loss Program, where patients go through an extensive evaluation before undergoing six months of medically supervised weight loss prior to approved surgery. In March 2006, she attended an informational session with surgeons who explained the types of surgery offered -- Roux-en-Y gastric bypass surgery and laparoscopic adjustable gastric banding -- the risks involved and what to expect afterward. Van Hine left the meeting feeling more confident than she had in a long time.
Vince CassaroSince gastric bypass surgery, Van Hine has lost 115 pounds. She also eats better and exercises, often for a 2-mile walk with Callie, her dog, in and around her Swatara Township home.

Although she had lost 60 to 70 pounds on her own in 2001, she was sidelined by a broken collarbone, and the weight became increasingly difficult to keep off. "I said to myself, 'This is probably my only answer out of it,'" Van Hine said. "I thought, at 30 years old, I can't be doing this my whole life -- losing it and gaining it back. It hurts too much to be yo-yoing back and forth again and again."

Ann M. Rogers, a physician and the director of Hershey's weight loss program, said Van Hine is one of hundreds who have turned to its surgeries to lead healthier lives. About 80 percent of the patients are women, all of whom are severely obese -- 100 pounds over their ideal weight or a body mass index greater than 40 -- with health issues linked to their weight, Rogers said.

Like Van Hine, most candidates also are well informed about the surgeries before they walk in the hospital's doors. "I'd say 99.9 percent of them are ready to go with surgery by the time they come to our informational sessions," Rogers said. "Most of them have already spent years trying to lose weight. No matter how much they are able to lose, they invariably gain it back and then some. They simply can't keep it off."

In December 2006, after months of preparation and restricted dieting, Van Hine was wheeled in for a laparoscopic Roux-en-Y gastric bypass, in which doctors create a small pouch and bypass a portion of a patient's intestines through several small incisions.

Weight loss occurs rapidly in the first six months following surgery and slowly tapers off 18 to 24 months afterward. Patients can expect to lose an average of 77 percent of their excess body weight within a year after surgery, according to experts. As with any surgery, however, the procedure carried its risks, and they weighed on Van Hine's mind.

Death can occur in about 1 percent of gastric bypass surgeries, and less severe complications can arise in 10 percent of cases. Surgical risks include intestinal leakage and internal bleeding, while all surgeries carry the risk of pneumonia, heart attack and blood clots.

Fortunately, Van Hine said, she escaped any serious complications and, to her surprise, didn't feel much pain when she awoke from her surgery." I was shocked that I didn't feel bad. It didn't hurt, but it felt like I had done some sit-ups," she said. "I didn't use any pain medication by the second day."

There were challenges ahead, Van Hine said, and she was mentally prepared for it. For weeks, she would have to live on a liquid-only, protein diet. Small amounts of foods would come in several months. "I've gotten sick a few times," Van Hine said, usually because she didn't chew her food long enough. "That's the tool of the surgery. It's your body saying, 'No, you can't eat that.'"

As of October, Van Hine has dropped nearly 115 pounds, taking her from a size 32 to 14 or 16 --in the women's departments. The real payoff though: She is finally feeling more like herself.

"Mentally, I never felt like a fat person. Finally, the person I was in my head and the person I am on the outside are ... becoming closer together. It feels like being let out of jail."

Before surgery, Corinna ate more than the average person -- when she wasn't dieting over the years, that is. It wasn't uncommon for her to go through fast-food drive-throughs for loaded hamburgers and greasy fries. She also didn't know "when to say when" during dinners. Today, her appetite is very satisfied with smaller amounts of food, and she can still enjoy her favorite prime rib -- she just has to chew it to death before swallowing.

She's not concerned about losing more weight because she's happy at her current level. If she loses more, great. If she doesn't, that's fine, too. She is well aware that she has to exercise and keep a healthy diet to maintain the surgery's results.
Vince CassaroJason Van Hine, Corinna's husband, has lost 40 pounds with his wife. He didn't undergo surgery; he's just exercising and eating better.

Van Hine's husband, Jason, didn't realize how overweight his wife was until he recently stumbled upon some old photographs. "She kind of looked miserable," he said. "I didn't see that when I took those pictures then."

The couple now exercises together at a local gym, enjoys walks and is working to restore their old home.

"A lot of people think this a quick and easy fix, and it's not at all," she said. "It's a massive lifestyle change. You need to be committed to it. You can build a house with a hammer, but the hammer is not going to do the work by itself. You've got to choose to use the tool."

Surgical treatments

There are three ways that bariatric surgery may promote weight loss in obese patients:

• Decreasing food intake (restriction).
• Causing some food to be poorly digested or absorbed (malabsorption).
• Combination of restriction and malabsorption.

The Roux-Y Gastric Bypass is the surgical procedure offered at Penn State Hershey Medical Center. It provides gastric restriction combined with some malabsorption. Both the open and laparoscopic surgical procedures are available.

Open gastric bypass surgery can now be performed through a 6- to 8-inch midline incision. This operation is restrictive in nature but also creates a "dumping physiology." A 30- to 60-cc gastric pouch is created using several staple lines. The gastric pouch is drained into a segment of jejunum (small intestine) and "bypasses" the distal stomach and duodenum.

The small gastric pouch is "restrictive" and consumption of excessive carbohydrate rich liquids causes "dumping" or abdominal discomfort. The result is sustained weight loss of 50 percent excess body weight in more than 80 percent of patients. Gastric bypass is associated with iron and vitamin B12 deficiency, therefore patients must take supplemental vitamins after surgery.

You're not eligible: If your body mass index is below 35, you are not eligible for this surgical procedure. To find your body mass index, type the term into any Internet search engine to come up with a calculator.

Gastric bypass: One man's journey

2009-04-24T20:39:00.000-07:00

Baltimore, MD

Obesity is a condition that can cause all sorts of serious health and social problems, and they're all too familiar for an 11 News photographer who decided to have gastric bypass surgery.

Obesity can affect many things in life, including fitting into a movie seat, traveling on an airplane or going to a baseball game. They were problems long-time photographer Howard Melnick has been familiar with his entire life. 11 News decided to follow him on his journey through gastric bypass surgery.

Howard Melnick's Interview
Dr. Thomas Magnuson interview

Melnick has struggled with his weight all his life. He said it's tough carrying around heavy equipment, especially when he weighs more than 400 pounds.

"I was the fat kid who was about 10 minutes behind everybody else on the track. I was the fat kid who couldn't do chin-ups," he said.
Howard Melnick
Photographer Howard Melnick chose to get gastric bypass surgery.

His obesity has led to hypertension, sleep apnea and serious knee problems.

"My knees are shot -- just shot, and I need my knees (for work)," he said.

Finally, Melnick and his wife, Debbie, decided he would have bariatric surgery, or gastric bypass.

"It's the curse of my life. With Debbie, we love our lives today ... except for the weight," Melnick said.

Melnick's wife said she was fully supportive of his decision, but still worried because it was a big surgery.

"I'm very nervous, probably more than he is," she said.

Dr. Thomas Magnuson, the chief of general surgery at Johns Hopkins Bayview Hospital, said the surgery would take about three hours to complete and told Melnick the procedure has come a long way since it was first developed.
"Twenty years ago, people would lose weight then gain it back in two years (after gastric bypass). Now, they're more durable," said Dr. Thomas Magnuson

"They're a lot safer and they work better and last long-term. Twenty years ago, people would lose weight then gain it back in two years. Now, they're more durable -- a lifetime," Magnuson said.

Melnick could eventually lose many of the medical conditions caused by his obesity, Magnuson said.

After extensive counseling on nutrition, lifestyle and exercise, Melnick had his surgery.

"It hurts when I sit up and lay back down, but when I'm walking, not so much. They had me up last night," Melnick told 11 News the day after his surgery.

One week later, doctors said the surgery went well, and Melnick said he had already lost about eight pounds and was feeling great.

Healthy Weight: Malabsorption makes vitamins necessary for gastric bypass

2009-04-21T05:14:00.000-07:00

Billings, MT

Dear Dr. Baskett: Is it true that you have to take vitamins after weight loss surgery and that you have to do this for the rest of your life?

Actually, yes, that is true. After you have had bariatric surgery, regardless of the procedure - adjustable gastric banding (AGB) or Roux-en-Y gastric bypass - you are able to take in fewer calories. You are eating smaller amounts of food at any one time and you should not be snacking between meals. Therefore, you are at risk for nutritional deficiencies.

For example, after you have gastric bypass surgery, you often are able to eat only about a 1/2 cup of food at mealtime.

If you have had AGB, your capacity is also restricted to 1/2 cup to a cup of food at mealtime. Certainly, the decrease in calories leads to weight loss. This is your desired outcome. However, you are not able to get in all of the various nutrients that you need - such as calcium, iron, vitamin B12, and folate. Remember, that if you have had gastric bypass surgery, there is also a component of malabsorption. This can lead to further lack of essential nutrients.
Fortunately, this problem is readily resolved by taking a vitamin and mineral supplement on a daily basis. What is of most importance, though, is that you use a high-quality bariatric vitamin and mineral supplement.

There are several different brands that can be used and your bariatric team can make a recommendation for one that is suitable for you. These supplements have been designed specifically for the person who has had bariatric surgery and they provide the needed vitamins and minerals.

More common vitamins such as Flintstones or Centrum do NOT provide the essential nutrients that a bariatric surgical patient will need.

In addition, these products are not well absorbed. Although the bariatric supplements may cost a bit more, they are well worth the investment.

If your supplement is inadequate, long term nutritional and metabolic problems can occur.

Again, because you are eating less food, you are taking in less of the healthier fats called essential fatty acids - the omega 3's and 6's. Therefore, it is also important to supplement with fish oil capsules, flaxseed oil, or essential fatty acids (EFA).

Daily supplementation with bariatric vitamins/minerals and EFAs will help you to stay healthy after bariatric surgery. Don't shortchange yourself in this area.

Dr. Kathleen T. Baskett is medical director of the St. Vincent Healthcare Weight Management Clinic and author of "Moving Forward: The Weigh to a Healthier Weight."

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

2009-04-14T14:53:00.000-07:00

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."

Family demand answers after gastric bypass death

2009-04-03T20:26:00.000-07:00

Macclesfield, UK

The family of a woman who died following a gastric bypass are demanding answers into her death.

Suzanne Wrighton, aged 59, died on May 30, 2008, less than 36 hours after having three operations at The Regency Hospital in Macclesfield.

Mrs Wrighton, who lived in Moreton Road, Crewe, decided to go in for the surgery paid for by the NHS at the private hospital because she was overweight and suffered from back pain.

Her husband Brian, aged 64, yesterday told an inquest into her death at Macclesfield Town Hall that he and his wife had been to two consultations prior to the operation and had been told there was a one per cent chance of fatality.

He said: "Suzanne had suffered from back pain for a long time. It started after she had a car crash in 1987. She had two operations on her spine but she still suffered from pain and she put on weight because she couldn't exercise.

"She decided on a bypass rather than a band. We know there is a risk with any operation but the risks we were told about weren't enough to worry her."

The inquest heard that after the first operation on May 28 Mrs Wrighton was in severe pain.

The following day consultant surgeon William Brough decided to perform a second operation to find out what the problem was but it wasn't until May 30 after the third operation that he found Mrs Wrighton had suffered a bleed.

Mr Brough said: "This was a rare complication that could not have been seen beforehand.

"It is the first time I have heard of a bleed from the staple line."

Mr Brough said that since Mrs Wrighton's death the hospital has altered protocol to ensure that all patients no matter how ill they are will have blood tests the day after the operation.

Mrs Wrighton died from adult respiratory distress syndrome (ARDS), which is when the lungs become filled with fluid and can't function properly.

Deputy coroner for Cheshire Janet Napier recorded a verdict of death due to complications following an operation for weight loss.

After the inquest Mr Wrighton, said: "We will be speaking to our solicitor and launching a complaint against the hospital. We are not happy with how Suzanne was treated. She was screaming out in pain most of the time she was in the hospital."

Suzanne's daughter-in-law Tammy Buxton, from Burslem, said: "The inquest hasn't really answered our questions.

"We still don't know why they failed to find the bleed until after the third operation.

"We have got to the bottom of the reason why she died. We don't want other families to go through the same pain and trauma we've been through."

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

2009-03-21T13:57:00.000-07:00

Charlottesville, VA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Weight-Loss Surgery Done With Just A Tiny Scar

2009-03-21T13:48:00.000-07:00

Denver, CO

A bariatric surgeon in Denver is now performing weight loss surgery through just one small incision near the belly button. The technique is called SILS or single incision laparoscopic surgery. It's an innovative way of doing adjustable gastric band surgery -- it leaves just a tiny scar.

Dr. Michael Snyder is the first bariatric surgeon in the region to perform the SILS technique.

"I can make about a 3 centimeter incision and do all the work through just that 3 centimeter incision," said Snyder after performing his sixth SILS surgery at Rose Medical Center.

Patient Judy Lucas decided it was right for her. Sixteen years ago, the co-owner of Mutt Puddles Dog Grooming quit smoking and started gaining weight. At 5 feet 3 inches, she weighs 260 pounds.

"I've tried every diet in the book; I own every diet book," said Lucas. "Every day I get home from work, my legs are swollen, my back hurts. It's harder for me to do my job."

That pushed Lucas to weight-loss surgery. She chose to have an adjustable gastric band inserted to restrict her stomach and make her feel fuller. It's an operation normally done laparoscopically through about five small incisions. But using the SILS technique, Dr. Snyder operated through just one small cut near the belly button.

"It doesn't change the operation at all, it just changes the access points," said Snyder.

It was a 45-minute surgery. Lucas went home the same day.

"I think the healing process is going to be a lot easier, " she said.

She has already lost 14 pounds. Her goal is to lose at least 100.

The SILS technique was approved by the Food and Drug Administration in May 2008. It is also being used in removing gall bladders and appendixes.

Woman files gastric bypass malpractice lawsuit vs. MaineGeneral

2009-03-06T05:01:00.000-08:00

Augusta, ME

A northern Maine woman is seeking more than $3 million, alleging a laparoscopic gastric bypass surgery performed on her at MaineGeneral Medical Center in Augusta more than seven years ago was botched.

Opening statements began Wednesday in Kennebec County Superior Court in the case of Donna and Charles DeLong, whose mailing address is Westfield, vs. the hospital and Dr. Padiath A. Aslam.

The DeLongs claim Donna DeLong suffered numerous complications from the surgery and afterward was admitted multiple times to hospitals, including Aroostook Medical Center, for treatment.

The attorney for the DeLongs, Daniel Lilley, is seeking more than $3 million in compensation for the couple.

In one court document, the couple said they suffered an estimated economic loss of $816,452.

Aslam, represented by attorney Mark Lavoie, and the hospital, represented by Robert Newton, deny the allegations.

Lavoie told jurors that Aslam had done the surgery properly and that Donna DeLong suffered complications after straining herself playing with her son's dog within hours of being discharged.

Lavoie also said a medical practice screening panel -- set up to evaluate the merits of claims against physicians and surgeons -- found Aslam's actions met the standard of care.

In a ruling prior to the trial, Justice Nancy Mills ruled that Aslam was an independent contractor and not an employee of the hospital. "Defendant MaineGeneral Medical Center is not liable for any negligence on the part of Defendant Padiath A. Aslam, M.D.," she wrote.

Aslam was initially licensed as a medical doctor in Maine in 1970 and is currently working at Rumford Hospital with Rumford Hospital Surgical Associates. He is licensed to practice in Maine until Feb. 28, 2010.

He has not been subject to any disciplinary actions in Maine or in Vermont, where he also was licensed from 1970 to 2006.

Selecting the 11-member jury took all day Tuesday, and trial is expected to last three weeks. More than a dozen boxes full of files related to the case were stacked up against a railing in the back of the courtroom.

Married couple has bariatric surgery together

2009-03-03T20:36:00.000-08:00

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."

Bariatrics surgery increases fertility of women and men

2009-03-03T20:29:00.000-08:00

Pittsburgh, PA

Melody and Phillip McIntyre, both morbidly obese, tried unsuccessfully for three years after their 2003 marriage to have a child before Mrs. McIntyre decided to try a gastric bypass in hopes of increasing her fertility. Some obstetric nurse friends had told her they had seen "many success stories after the surgery."

And so Mrs. McIntyre, a nurse at UPMC-Horizon in Greenville who lives in West Middlesex, Mercer County, headed to Allegheny General Hospital for an appointment with surgeon Dr. Joseph Colella, director of the hospital's bariatric center.

"That was the first question I asked. I said, 'I want to have a baby. Can you help me?' " Mrs. McIntyre recalled.

The doctor answered "of course," talked to her and her husband about how obesity affects fertility, then suggested the same operation for Mr. McIntyre, a residential adviser for mental health patients. It was advice he followed after a cardiologist got his heart function working well enough to undergo surgery in April 2007, when he was 35 years old.

Mrs. McIntyre had her laparoscopic procedure in late October 2006 and then settled back to follow medical advice that female bariatrics patients wait a year to a year and a half -- or maybe even two years -- before trying to get pregnant in order to ensure there are no complications.

But it was Mr. McIntyre who had a complication during his 2007 procedure, hemorrhaging because his spleen had been traumatized. In going back in to find and stop the bleeding, doctors found a cancerous kidney tumor that they watched for a year before removing it all last April.

By that time, Mrs. McIntyre, now 34, was pregnant with little Trent, who was born Dec. 6. He was conceived just five months after she went off birth control.

Leslie Gore's story is even more amazing. The 24-year-old Penn Hills woman was told when she was 16 that she probably never would get pregnant because she had polycystic ovarian syndrome, a problem in which a woman's hormones are out of balance. Treated with hormones to induce periods, she steadily packed on the weight until she reached 285 pounds on a 5-foot-3 frame for a body mass index in the high 40s to low 50s.

Mrs. Gore, who is a pregnancy caseworker for Unison Health Plan, went to Dr. Dan Gagne (pronounced ga-NYAY), director of West Penn Hospital's Bariatric Surgery Center, for two reasons: in hopes of having a child and of getting healthy enough to live to raise him.

The surgery on Jan. 8, 2008 worked beyond her and husband Tyrone's wildest dreams: She got pregnant in October while still taking birth control pills. The baby is due July 4.

"We were both floored. We were completely caught off-guard," Mrs. Gore said.

She called Dr. Gagne to pass on the news and, she remembered, got this response: "I'm not surprised. Congratulations."

No wonder.

Since West Penn's bariatrics center opened in July 1999, Dr. Gagne said, "we've had at least 39 women get pregnant after bariatric surgery." Those are women who delivered full-term babies, he said, adding that at least five in the practice are pregnant now.

"Some of them had had previous pregnancies; a lot did not. A lot had diagnoses of polycystic ovary disease ... We had several who had had problems getting pregnant that did get pregnant."

Dr. Colella has had similar experience at Allegheny General and so has Dr. Anita Courcoulas at UPMC, where she is director of minimally invasive bariatric and general surgery.

"It's over 30 and that would be in six years," Dr. Colella said, "and those are the ones I know about who had infertility problems who moved on to successful conception and delivery."

One couple was so grateful that they named their son Joseph.

Dr. Courcoulas said the number of women who have become pregnant after weight loss surgery at UPMC's center in Magee-Womens Hospital is "definitely in the hundreds" but noted that the big number is due in large part to the size of the UPMC practice. "Just at Magee we do 1,100 weight-loss operations a year."

Though one recent medical bulletin from the Practice Committee of the American Society for Reproductive Medicine declared that "most obese women are not infertile," it also goes on to say, "Conversely, ovulatory function and pregnancy rates frequently improve significantly after weight loss in obese anovulatory women."

Certainly, the experiences of the Pittsburgh bariatrics doctors are that many presurgical patients are at least less fertile than normal.

"The take-home message is that fertility is certainly improved." said Dr. Ronald Thomas, director of maternal fetal medicine at AGH, whose department collaborated with Dr. Colella's on two published studies about pregnancy outcomes after the laparoscopic gastric bypass known as Roux-en-Y.

"In one article we talked about the fact that the typical advice is wait two years and stabilize before getting pregnant and the problem is many get pregnant after six, seven or eight months. ...

"[What happens is] patients begin to ovulate and get pregnant without trying to. The fertility comes back roaring into place. These patients don't realize their fertility markedly improves."

Hormones involved

Why does this happen? Doctors interviewed all cited changes in hormonal activity post-weight loss.

"A lot of times it seems to be the interplay of female hormones and fat," Dr. Gagne said. "Just as we see improvement in other health problems, this too happens in weight loss."

"I agree with that," Dr. Courcoulas said, "but we don't know exactly how."

"There's a dramatic change in the way hormones in the body are regulated after they lose all the fat cells," Dr. Colella said. "It's called the hypothalamic-pituitary axis, and its interaction with the ovaries gets reset to normal function so women begin to experience the normal circulation of hormones that trigger ovulation that occurs each month. ...

"The way we understand it in our world is the fat cells are an estrogen-producing engine and it overwhelms the axis and stops it from producing two hormones, follicle stimulating hormone and luteinizing hormone, and those two hormones are the ones responsible for triggering ovulation. So if they're not made in the appropriate amount in the appropriate time you don't get a normal ovulation event.

"And there also may be some changes in the lining of the uterus that make it less likely to allow implantation if an egg gets fertilized, but most commonly it's that they don't ovulate."

Dr. Scott Kauma, reproductive endocrinologist and director of the Jones Institute for Reproductive Medicine at the West Penn Allegheny Health System, theorized that resumed ovulation "might have to do with decreasing insulin resistance. It may be decreased circulating testosterone levels as they're losing weight or some unknown metabolic changes that stimulate the body to ovulate better. None of this is certain."

He said there's a similar uncertainty about why heavier women respond differently to other treatments, such as in vitro fertilization: "... the amount of medicine you need to use to get women to respond appropriately is much higher and pregnancy rates are lower. When I see the the pregnancy rates [of IVF] ... you're not guaranteed a pregnancy, but if you're obese the likelihood of getting pregnant compared to normal weight women is less."

Obese men are much less likely to undergo bariatric surgery because of fertility issues, but only because they are less likely to have the surgery at all. "There's an 8-2 ratio, women to men," Dr. Colella said, "but that's not because obesity is contained to women but because men are reluctant to seek help in specialty practices. The prevalance of obesity is roughly the same between men and women."

Helping men

And, Dr. Kauma said, men's fertility also is affected by their overweight.

"The heavier you are, the more of a problem you have with a lower sperm count," he said. "It may be that men who are heavy may have more estrogen floating around their bodies. The fat will convert testosterone to estrogen, and the estrogen tends to decrease the signals to the testes, which increase the sperm."

The other problem is that fat enveloping the scrotum elevates the temperature, affecting manufacturing of sperm. "The testes are in the scrotum because it's cooler there, which works better for sperm production," Dr. Kauma explained.

Though he was most interested in getting healthy and living long enough to raise a child, Phillip McIntyre said he had been told by two doctors that his fertility would be improved "and it was in the back of my mind that it would help."

Dr. Courcoulas also said she has "a couple [male patients] in the works right now [with improved fertility] as one of the reasons they're pursuing surgery."

Weight loss achieved through diet or a preferred combination of diet and exercise also would improve fertility, but, Dr. Kauma said, "90 percent of people who diet have trouble keeping it off. ...

"The most successful way to lose weight and keep it off for good is gastric bypass or banding."

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

2009-03-03T20:22:00.000-08:00

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.”

Three Illinois sisters lose over 300 pounds after gastric bypss surgery

2009-03-03T20:17:00.000-08:00

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.”

Medicare Announces Final Coverage Policy for Bariatric Surgery as a Diabetes Treatment

2009-02-18T19:20:00.000-08:00

Washington, D.C.

The Centers for Medicare & Medicaid Services (CMS) announced today a clarification in its policy for Medicare coverage of bariatric surgery as a treatment for certain beneficiaries with type 2 (or non-insulin-dependent) diabetes.

The decision specifies type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese, as long as the surgery is furnished at a CMS-approved facility. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. Normal body-mass index is considered to be between 18.5 and 25.

“Medicare beneficiaries who are morbidly obese may face tremendous health complications,” said CMS Acting Administrator Charlene Frizzera. “Today’s coverage decision assures that beneficiaries who are morbidly obese can access safe, effective weight loss options to help prevent these complications.”

As part of today’s decision, CMS announced bariatric surgery will not be covered by Medicare when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for these non-morbidly obese individuals.

“Limiting coverage of bariatric surgery in type 2 diabetic patients who are not considered clinically obese is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, M.D., CMS Chief Medical Officer and Director of the agency’s Office of Clinical Standards & Quality.

In 2006, CMS expanded coverage of bariatric surgery for Medicare beneficiaries who received surgery in high-volume centers from highly qualified surgeons (as certified by the American College of Surgeons or the American Society for Bariatric Surgery, and as reported on the Medicare Coverage Web site).

Under the 2006 decision, to be considered for coverage, Medicare beneficiaries were required to have a BMI of 35 or higher, and to have exhibited a serious health condition in addition to morbid obesity, such as hypertension, coronary artery disease, or osteoarthritis.

In that same decision, CMS covered four types of bariatric surgery procedures: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. No other bariatric surgery procedure is currently covered.

Today’s decision memorandum is available on CMS’ Coverage Web site at:
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=219

Gastric bypass surgery’s complications can be devastating for some patients

2009-02-15T07:26:00.000-08:00

Modesto, CA

Sandi Krueger of Turlock, Calif., dropped 120 pounds with weight-loss surgery, but she is hardly a success story.

The 2002 surgery led to chronic malnutrition and anemia. As the pounds melted away, so did her life.

With a sunken face and protruding collar bones, she is too weak to work and spends most afternoons on the couch wrapped in a blanket.

She has thoughts of giving up, but wants to be there for 12-year-old daughter Megan and 19-year-old son Dustin.

“It’s not acceptable leaving me like this,” said the 103-pound Krueger, who at 38 looks closer to 50. “I’ve gone to doctor after doctor and basically they don’t help me.”

According to studies on bariatric surgery, patients with long-term complications are in the minority and disastrous outcomes such as Krueger’s are rare. But with 200,000 weight-loss surgeries being performed each year, she and other patients believe the long-term complications deserve more attention.

Looking for hope

Krueger’s options appear to be running out. Her anemic blood hasn’t been responding to iron shots and she was told last month that she can’t have the gastric bypass reversed.

“This isn’t a life,” said Robert De Kasha, her brother. “If she doesn’t find an answer, she is just going to fade away.”

Spurred by a national epidemic of obesity, bariatric surgery has become a standard of care for people with weight-related health issues. It has improved the lives of people who suffered from diabetes, high blood pressure, sleep apnea and other issues, experts say. No one is sure why some bariatric patients fare better than others.

The stomach-shrinking surgery has risks, such as leaks that can cause life-threatening infections, hernias and bowel obstructions. After the surgery, patients are expected to follow nutritional and lifestyle guidelines to achieve weight loss and avoid trouble with their altered digestive tracts.

Most patients will have “dumping syndrome” at some point, when food passes too quickly from the tiny stomach pouch into the small intestine. Because the stomach hasn’t broken down the food, the person gets a rush of blood sugar, rapid heartbeat, sweating and nausea.

Other patients may have iron and vitamin B-12 deficiencies years after surgery. All bariatric patients need to take vitamin supplements for life.

A nationwide study released in 2006 concluded that bariatric surgery complications are common. By examining insurance claims for 2,522 surgeries, researchers with the federal Agency for Healthcare Research and Quality found that 40 percent of patients had complications in the six months after surgery, about double the rate in previous studies.

The complications ranged from the minor to the severe, including dumping syndrome, problems with the bariatric connections, hernias, infections and pneumonia. Post-surgery problems sent 18 percent of patients back to the hospital, some for costly readmissions or corrective surgery.

The agency contends that surgical advances recently have lowered the complication rate to 30 percent, still high for an elective procedure, said William Encinosa, lead author of the study.

“Anytime you can cut into the intestine, you have a risk of complications,” he said. “Clearly there are benefits for people who are morbidly obese, but these patients need to know what they are getting into.”

Live longer

Less is known about complications years after the surgery, although a 10-year Swedish study found many patients kept the weight off and had increased longevity.

Krueger, who once worked two jobs as a nursing assistant, sought treatment for an injured back in 2002. A specialist suggested that the 5-foot, 250-pound woman lose weight through bariatric surgery to deal with the back problem, she said.

She had what’s called a Roux-en-Y gastric bypass at Doctors Hospital of Manteca, Calif. To perform the common procedure, surgeons create a small pouch from the stomach and make a connection between the bottom of the pouch and a section of small intestine.

Most of the stomach and part of the intestine are bypassed, so the person feels full after a few bites of food and the intestine absorbs fewer nutrients.

Krueger, weighing 219 by the time of surgery, lost weight quickly as dumping syndrome made her sick for months. When she went to the doctor with complaints, he urged her to stick with the dietary instructions and take supplements, she said.

Bariatric surgeries were discontinued at Doctors Hospital of Manteca, so Krueger sought help from specialists at University of California at San Francisco Medical Center. In 2004, surgeons there corrected a problem from the initial surgery and, as her strength returned, she got up on water skis for the first time.

She gained 22 pounds, then her troubles returned and she bottomed out at 98 pounds.

With her body starved of nutrients, her blood sugar dropped so low she was admitted to Emanuel Medical Center for a week of monitoring, she said.

Tests have shown that her pouch no longer holds food but dumps it directly into the small intestine. Even if she eats five times a day, she doesn’t get the protein and other nutrients she needs.

She’s tried protein bars and countless other foods and even finds that fish is hard on her digestive tract. Daughter Megan brings her toast and crackers because she knows those are easy on her stomach.

Krueger said it’s heartbreaking for her daughter to see her tired and faint all the time. She has lost hair, her teeth are decaying, and she’s often out of breath.

To treat her anemia, she’s had a blood transfusion and three rounds of iron infusions. A reaction to the last infusion caused her blood pressure to plummet and nurses to come to her aid.

Second thoughts

Last year, she was considered for having the gastric bypass reversed at UCSF, but doctors told her in December that it was too dangerous. They were concerned that her remaining stomach would have inadequate blood flow and would rot, she said.

“That day was hard for me,” she said. “I don’t know what is ahead. I feel my life has been taken from me.”

Dr. Guilherme Campos, director of bariatric surgery at UCSF, said about 1 percent to 4 percent of the center’s patients suffer from nutritional deficiencies over the long term. The UCSF center has dieticians and other staff to work with patients with malnutrition. Reversal operations are major procedures and are done as a last resort, he said.

The surgeon contended that bariatric surgery is an effective way to treat morbid and superobesity, the main reason university hospitals have adopted the treatment in recent years.

“The benefits by far outweigh the risks that are associated with the procedure,” he said.

While many patients sing the praises of weight-loss surgery, including television personalities Al Roker and Star Jones, some patients say they’ve had a tough time.

Donna Sellers, 61, of Modesto, said four members of her family had weight-loss surgery with mixed results. Her husband and younger daughter lost weight with no complications. But Donna shed weight too fast and suffered from dumping, malnutrition and dehydration the first year after her 2004 surgery at Memorial Medical Center.

Attempts to eat made her feel sick and sweat profusely, even though she followed the guidelines to eat pureed food and take small bites, she said. She went from 246 pounds to 123 in six months and landed in the emergency room, where she was treated for dehydration for several hours, she said.

She finally discovered she could eat chicken and Swiss cheese, and force-fed herself. To deal with the hot flashes of dumping syndrome, she laid on the cold floor tiles of her kitchen to eat meals, she said.

Five years after the surgery, she still is forcing herself to eat and is relying on her nursing training to maintain her weight in the 130s.

“I eat three or four bites and then wait 10 minutes and eat some more,” she said. “I eat a scrambled egg for breakfast, and tomorrow a scrambled egg makes me sick.”

She said one of her daughters had the same post-surgery troubles, as well as a calcium deficiency resulting in dental problems.

A 2001 surgery in Southern California saved Alycsha Bostic of Merced, Calif., from sleep apnea and asthma attacks. But she developed hernias requiring two operations and iron deficiencies that cause headaches and dizziness.

Losing 160 pounds boosted her fertility and she got pregnant twice despite being on birth control, she said. Doctors put a port in her chest to feed iron into her blood during pregnancy. Her ferrous levels are a third of normal since her second child was born in 2007.

Bostic, 34, hopes doctors can figure how to get more iron into her system — and she needs another hernia operation.

“I am so tired of having surgery,” said Bostic, who talks with other bariatric patients with complications. “We’ve all had hair loss. I still get dumping syndrome. If I don’t chew my food 50 times, it collects at the bottom on my esophagus and I throw up.”

More than 3,000 weight-loss surgeries have been performed at Memorial Medical Center in Modesto since 2003.

Deana Chiarchianis, health center manager, said the post-surgery complications at the hospital are far lower than the numbers in the AHRQ report. The study considered data before widespread use of laparoscopic techniques, which have reduced problems such as surgical wound infections and hernias, she said.

The hospital tries to ensure good outcomes by evaluating and educating surgical candidates, including a psychological assessment of their ability to cope with the surgery. It also stresses post-surgery guidelines such as teaching patients to prevent dumping through the proper choice of foods.

“They need to understand that the surgery is a tool and the patient is responsible for complying with the recommendations for follow-up, nutrition, exercise and behavior change,” she said.

Dr. Kelvin Higa, a Fresno, Calif., surgeon and past president of the American Society for Metabolic and Bariatric Surgery, said it’s important for patients to have lifelong follow-up with their surgeons. Usually, there are surgical options for patients with severe complications such as Krueger’s.

“Any patient that has those problems should not be sitting there. They should seek help,” he said. “Almost invariably we can take these patients and adjust their anatomy to take care of their nutritional issues.”

Krueger said her poor health has taken a toll on family life. No longer does she take Megan to cheerleading and dance classes. She and her husband have postponed their dream of building a home.

Krueger worked as long as she could at Emanuel Medical Center last year to keep her health benefits, but ran out of strength. Her primary care doctor is trying to line her up with a nutritionist or hematologist who accepts Medi-Cal.

A feeding tube could be next if she loses more weight, which reminds her of a 32-year-old bariatric patient at a care facility where she worked.

“She had a feeding tube and it really bothered me,” Krueger said. “If I don’t get better, I know my organs will take a toll. If they would put me on the operating table to take me back to 250 pounds, I would do it.”

Surgical weight loss offers potential health gains

2009-01-28T18:43:00.000-08:00

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."

"Father of obesity surgery" presents talk in Iowa on Jan. 27

2009-01-28T18:39:00.000-08:00

Iowa City, IA

Dr. Edward E. Mason, known as the "father of obesity surgery," will present "The History of Gastric Bypass Surgery" from 5:30 to 6:30 p.m. Jan. 27 at the Information Commons West on the second floor of the UI Hardin Library for the Health Sciences. The talk, which is hosted by the UI History of Medicine Society, is free and open to the public.

Mason, UI professor emeritus of surgery, will provide an update on recent research in gastric bypass surgery, along with his firsthand historical account.

For more information, contact Donna Sabin at 319-335-6706 or donna-sabin@uiowa.edu.

StomphyX: Gastric bypass surgery without a scalpel

2009-01-28T18:26:00.000-08:00

East Brunswick, NJ

Imagine having surgery without being cut. No knife piercing through your skin — even if you can't feel it. No ugly, deformative scars. No side effects. It is possible, and Maria McDonald is living proof.

A new type of abdominal surgery — natural orifice translumenal endoscopic surgery — eliminates the need for a scalpel and reduces recovery time, as well as patient pain and infection.

For the 20 percent of Americans who need secondary gastric bypass surgery, this procedure — which uses a device called StomaphyX — is noteworthy because the transoral incisionless insertion has surgeons entering the body through the mouth, not anywhere in the abdomen.

THEN AND NOW:

McDonald thought she was on her way to having the body she always wanted when she underwent Roux-en-Y gastric bypass surgery in 2002. At the time, she weighed 300 pounds and had tried every fad diet.

"I tried the grapefruit diet, the cabbage soup diet, Weight Watchers and Jenny Craig," said McDonald, a social worker from the Somerset section of Franklin. "I just never really was successful at keeping it off."

Gastric bypass helped her lose about 150 pounds, but there were complications — including nausea and indigestion. So when McDonald, 36, found out she needed a second gastric bypass, she was relieved to find out her doctor at Overlook Hospital in Summit was going to use the Stomaphyx technique.

The procedure was much different from her first surgery, which involved a large incision and made her tired for about six months.

"Even though its surgery, it's all through the mouth," Dr. Muhammad Feteiha, director of minimally invasive surgery at Overlook said before the surgery. "So when Maria wakes up, she won't have any incisions. She'll have very minimal pain, and she'll be able to go home."

MYRIAD BENEFITS:

Lack of pain and quick recovery time are not the only benefits of the Stomaphyx procedure. Others include:

# Less risk of infection.

# Shorter surgery time (it takes about 45 minutes).

# Patients can return to work in as little as one day.

If McDonald were to have traditional gastric bypass surgery again, it would involve reopening her incision, removing part of the pouch and small intestine, and then reattaching it, Feteiha said. And she would have to stay in the hospital for seven to 10 days.

LIGHTLY USED:

Only about 150 doctors are using the Stomaphyx technique around the country. It was approved in March 2007 by the U.S. Food and Drug Administration, and physicians starting training with the Stomaphyx device that fall.

To date, about 500 patients have had the surgery, which allows doctors to reshrink the stomach without even using a scalpel. Research is being done to see if Stomaphyx can become a primary surgery in the future, Feteiha said.

BARIATRIC SURGERY:

For patients who are undergoing bariatric surgery for the first time and choosing to have a gastric band, Dr. Ajay Goyal, medical director of the Center for Advanced Bariatric Surgery at Overlook, performs a new technique that requires only two incisions.

Traditionally, the banding procedure requires four or five incisions around the abdomen. When it comes to severe obesity, traditional weight-loss methods — diets, weight-loss pills, exercise programs — do not work for most people.

Bariatric surgery is recognized by the American Heart Association and the American College of Surgeons and endorsed by the National Institutes of Health as a safe way to help people lose weight and minimize or even eliminate diabetes and hypertension, sometimes within months.

The Center for Advanced Bariatric Surgery at Overlook Hospital is available to individuals who are more than 100 pounds overweight and have tried and failed to lose weight, or who suffer from obesity-related health problems such as heart disease, diabetes or sleep apnea, joint disease or infertility.

3 sisters net triple-digit weight loss after gastric bypass surgery

2009-01-16T06:03:00.000-08:00

Joliet, IL

One sister bikes, one walks on trails and one works out on a treadmill. All of them are now living healthier lives after undergoing bariatric weight-loss surgery at Silver Cross Hospital in 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," said Sandra Schmidt. "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 at Silver Cross.

"This was a great way to learn about the entire process," said Andrea. "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."

Their surgeon, Dr. Christopher Joyce, and his partner, Dr. Brian Lahmann, have performed more than 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 program has a 0 percent operative death rate and a low complication rate. And patients lose an average of 86 percent of their excess body weight 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," said Pamela.

"Obesity is a medical condition, just like heart disease or diabetes," Joyce said. "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," said Pamela.

"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 forties being overweight," said Sandra. "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," said Joyce. "Their new passion for life truly shows when you talk with them."