SURGEONS OFFER WEIGHT LOSS BREAKTHROUGH

February 1, 2003

Celebrities such as Al Roker from NBCâ??s â??Todayâ? show and singer Carnie Wilson are showing off their new physiques and crediting their sudden weight loss to gastric bypass surgery. But a newer surgery, called laparoscopic gastric banding, may be a better option for obese people considering surgery as a solution to their weight problems and related health issues.

Last winter, surgeons at UNT Health Science Center became the first in Tarrant County to perform laparoscopic gastric band surgery, the latest surgical advance in weight-loss surgery. Adam Smith, DO, and German Berbel, DO, surgeons with the Physicians & Surgeons Medical Group at the health science center, have performed more than 50 gastric band surgeries in the last year. They currently perform the surgery at Osteopathic Medical Center of Texas and Harris Hospital Northwest in Azle.

The operation is a minimally invasive surgery that involves placing an inflatable, adjustable prosthesis, the BioEnterics LAP-BAND System®, around the upper part of the stomach 1 1/2 to 2 inches below the esophagus to create a small pouch that restricts food intake to one to two ounces at a time.

By creating a smaller gastric pouch, the procedure limits the amount of food that the stomach will hold so that the patient will feel comfortably full with small amounts of food. The inflatable ring also controls the flow of food from the pouch to the rest of the digestive tract. The stomach empties more slowly, which allows the patient to continue to feel full for several hours, reducing the urge to eat between meals.

Laparoscopic gastric band surgery is an alternative to gastric bypass surgery, currently the most common surgical procedure used for severe obesity in America. In gastric bypass surgery, part of the stomach is stapled, and part of the intestine is rerouted.

Dr. Smith said the lap band method has several advantages over the traditional gastric bypass; no cutting or stapling of the stomach is required, it is adjustable, and it can be removed. In addition, laparoscopic surgery reduces surgical trauma and pain and is less invasive for both the abdominal wall and the stomach than traditional

surgery.

â??Laparoscopic surgery is much safer than a traditional gastric bypass on all levels,â? Dr. Smith said. â??Weâ??re not altering the physiology of the digestive system. Patients still have their whole stomach so thereâ??s no permanent alteration of the anatomy.â?

â??Since weâ??re not stapling the stomach or cutting it in any way, thereâ??s no chance for malabsorption or leakage, as there is with other gastric bypass methods,â? Dr. Smith said.

The band has the additional benefit of being adjustable. The amount of food that patients are able to digest at one time can be changed as needed by deflating the band or inflating the band with saline, which is inserted through a tube connected to a titanium port that is sewn into the abdomen, Dr. Berbel said.

â??What if a patient chooses to become pregnant? Her gastric band can be loosened for the duration of her pregnancy and then re-adjusted,â? said Susan Franks, PhD, one of three health psychologists who work with the surgeons. â??Or what if a patient needs surgery? The band can be adjusted to accommodate those needs,â? she said.

The band can also be removed if needed, completely reversing the surgery, Dr. Berbel said. To be considered for the surgery, prospective patients must meet the clinical definition of â??morbidly obese,â? generally weighing at least twice their ideal weight or at least 100 pounds more than their ideal weight. This degree of excess weight may considerably reduce life expectancy and is associated with numerous health conditions, including diabetes and heart disease, Dr. Berbel said.

Patients considering the surgery should understand that â??itâ??s not a magic wand that immediately produces dramatic results,â? Dr. Smith said. â??Lap-Band surgery is a tool that helps these patients lose weight. Itâ??s one component of a fundamental lifestyle change.â?

Patients who choose the health science center for gastric band surgery have the additional benefit of a collaborative on-site team of health professionals. In addition to the surgeon, potential patients meet with a health psychologist and a clinical dietician

.

â??Our patients donâ??t have to be referred to outside specialists and then have to make separate appointments and drive to different places,â? Dr. Smith said. â??Weâ??re a one-stop shop.â?

Dr. Franks and fellow health psychologists Jerry McGill, PhD, associate professor of manipulative medicine, and James Hall, PhD, associate professor of internal medicine, assess patientsâ?? readiness for the surgery. â??Patients eat for a reason, and some of those reasons have psychological basis,â? Dr. McGill said. â??We need to

deal with those issues first and get them under control before they go through surgery.�

â??We work with them before surgery so that we understand them enough to help them succeed post-operatively,â? Dr. Hall said.

In addition to meeting with a health psychologist, each potential patient also undergoes a one-hour assessment with Sharon Yurvati, MS, RD, LD, a clinical dietician. Yurvati and the patient discuss eating habits, medications, past attempts to lose weight, nutritional needs and other dietary issues related to the surgery.

â??Patients make a choice about the food they eat,â? Yurvati said. â??I work with them to make sure that they understand the limitations of the surgery and how it will affect the food choices they make.â?

Patients may need to consult with additional specialists before surgery. â??Many of these patients suffer from multiple health problems related to their weight,â? Dr. Smith said. â??They may also need to see a specialist to make sure their heart is healthy enough for anesthesia or to make sure that their medications can be tolerated by a smaller stomach.â?

The surgery takes about 90 to 120 minutes in the operating room, followed by an overnight stay in the hospital for observation. The patients then have the LAP-BAND filled with saline at their physicianâ??s office.After the procedure, patients slowly move from a protein-fortified liquid diet to soft foods. After about a month, they can usually resume eating some solid foods and participating in strenuous activities, Dr. Smith said. â??Some foods, such as bread or red meat, may be poorly tolerated,â? Yurvati said. â??A lot depends on how well they chew their food before swallowing.â?

The health science center coordinates an after-care therapy group that meets twice monthly. Group participants discuss their feelings about weight and the role of food in their lives, and they also address how others are reacting to their weight loss.

â??Food plays an important role in obese peopleâ??s lives and families,â? Dr. McGill said. â??As their weight

problems diminish, it may change the dynamic of communication within the family.�

â??We discuss their perceptions about food and help them adjust to a new lifestyle,â? Dr. Hall said. â??This is part of an overall behavior change that touches every aspect of their lives.â?

â??We encourage their progress and help them build the support network they need to reach their goal,â? Dr. Franks said.

Patients also continue to meet with Yurvati regularly for the first year after their surgery to evaluate their progress and address any dietetic concerns.

Before the surgery, these patients may have been suffering from diabetes, heart disease, degenerative joint pain, constant back pain, dermatitis, and a long list of other weight-related problems, Dr. Berbel said. â??Itâ??s heart-warming to hear patients talk about how their weight loss has affected their lives,â? he said.

Some patients have been able to return to work after being out on disability, some have reduced their need for medication for weight-related health problems, some no longer use canes, and others are tying shoes for the first time in years and no longer being bruised by the steering wheel.

These types of patient success stories are not the only by-products of the surgery. The team is now conducting research, funded by a health science center faculty research grant, into other effects of the surgery.

â??Weâ??re looking at their eating habits and comparing them before the surgery and post-operatively,â? Dr. Franks said. â??Weâ??re also studying the psychological impact of weight loss on their quality of life.â?

The team is also working with Joan Carroll, PhD, assistant professor of integrative physiology, to study how the laparoscopic banding affects levels of Ghrelin, a chemical thought to play a role in turning appetite on and off.â??Patients consistently tell us that their appetites change after surgery,â? Dr. Franks said. â??We are trying to find out what happens physiologically to explain that.â?

The LAP-BAND System® has been used extensively in Europe and Australia and was approved by the FDA for use in the United States in the fall of 2000. The surgery costs about $21,500 and will not be covered by insurance in most cases, Dr. Smith said.

For more information about gastric band surgery, contact the health science centerâ??s Department of Surgery at 817-735-5465.

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