New surgery

Sleeve gastrectomy considered in-between procedure

A new weight loss surgery is being introduced at Blount Memorial Hospital and it’s kin to a middle child.

The sleeve gastrectomy is considered to be in between the Roux-en-Y gastric bypass and the lap band surgeries in the amount of weight patients normally lose, the costs, the time it takes to complete the surgery and in the time the patient stays in the hospital.

Dr. Mark Colquitt, bariatric surgery medical director at Blount Memorial Hospital, explained the surgery. “It is interesting how it all evolved. For years, we were doing the duodenal switch - removing a large portion of the stomach and also dividing the small bowel and bypassing a large portion of the small intestine. You get something very thin and long, and you have a part of the intestine bypassed,” he said.

One of the pioneers of the duodenal switch and the sleeve gastrectomy is Dr. Michel Gagner. Colquitt said Gagner began doing the procedure in two parts with patients who weighed 500 to 700 pounds because doing the entire procedure was often too dangerous for them. Gagner decided to do the stomach work first and come back in a year or two and do the duodenal bypass part.

“The stomach part was relatively safe,” Colquitt said. “What they realized when they did the stomach resection was that there was a lot of weight loss with that alone. Some said, ‘I’m happy where I am now’ and didn’t want the bypass portion of the surgery.”

Surgeons started applying the same procedure to patients who were 300 to 400 pounds. “Now the gastric resection (sleeve) is being promoted as the new, greatest thing available for weight loss surgery. You end up with a tube, a stomach that is the shape of a banana,” Colquitt said. “It’s also called an in-between surgery. If you compare it to lap band and gastric bypass, it’s a little more invasive as far as the surgery. You’re actually removing and cutting the stomach.”

Colquitt said the procedure is more invasive than lap band and not as risky as gastric bypass. “The amount of weight loss is in between -- more than what you would with lap band and not as much as with gastric bypass,” he said. “What is nice is your not having to have it adjusted. The drawback with lap band is having it adjusted to control eating. If you do sleeve gastric surgery, one size fits all.”

Blount Memorial Hospital weight management center director Angie Stewart said some weight loss patients just didn’t like the idea of having the actual band inside their bodies. “Some just don’t like having to go back for adjustments, although we have had patients who have had real good results,” she said of the lap band procedure.

Colquitt said a drawback to the procedure is that some insurance companies won’t pay for the relatively new procedure, and doctors aren’t as familiar with it as the other weight loss surgeries. “It’s really only been done a few years so we’re still learning about it,” he said. “Still, they’ve gotten great results.”

Colquitt said another benefit to the surgery is that it is halfway to a full gastric bypass. “You can add a bypass to that later on if you’re not satisfied with the weight loss. It still can be a staged procedure,” he said.

Colquitt said the procedure is also in between on cost as far as the lap band and the gastric bypass and is something a patient should discuss with their spouse or family. “It’s not an easy decision. The reality is, it’s a life-changing event that’s going to last them the rest of their life if they choose,” he said. “We offer a lot of ways to help them make the decision.”

The doctor said a good candidate for the sleeve gastrectomy would be an individual who doesn’t want the risk of bypass but doesn’t feel they would be able to make the commitment to come in every four to six weeks for adjustments to the lap band.

The new procedure has the possibility of becoming the most commonly used one, Colquitt said.

“Right now, gastric bypass is number one as far as volume of surgeries. Lap band is number two. If the sleeve surgery proves to be very successful, it may take over as being the most used,” he said.

Colquitt said that the entire procedure is done laparoscopic instead of opening the person up. “There are five incisions and the biggest one is an inch and a half long, which is the one to get the stomach,” he said. The surgery takes about 45 minutes to an hour and requires one night’s stay in the hospital. Gastric bypass typically takes 90 minutes in the operating room and two to three nights in the hospital.

Stewart said this procedure is like any weight loss surgery in that it is a tool to help the patient eat less and feel full by eating less food and reshaping habits. “They’ll be taught the basics - slow down and chew food, focus on proteins and focus on drinking water. It’s not a crazy diet, just a healthy, balanced diet,” she said.

Stewart said that initially after the surgery patients are on a liquid diet for a short time before they progress to soft foods. “Within a month or two they should be able to eat normal, healthy, small meals. That’s our goal with all types of surgeries. It’s getting them back to real, normal healthy food,” she said.

Colquitt said the bottom line is that weight loss happens. “Weight loss is the most effective thing for treating disease,” he said. “It helps prevent cancer, and it treats sleep apnea, heart disease, diabetes. There’s nothing else as powerful as weight loss.”

Colquitt said what patients must remember is the education and life change following the procedure are as important as the surgery. “It’s not the surgery you do that maintains the weight loss, it’s how you become involved with the whole program we have created,” he said.

The keys are the lifestyle changes and behavior changes. “Exercise and diet all have to happen. I don’t care what it is. You have to change behavior, then you can expect to have weight loss,” he said.

Colquitt said some patients want a quick fix and Stewart said some patients still think they can just do the surgery and not change their lifestyle. “We’ve been talking about this a long time, and people still think they don’t have to do anything,” she said. “Most patients come knowing it requires a lifestyle change. This is not a quick fix.”

In spite of the educational material around, Colquitt said it’s not unusual to have patients think the surgery is a magic bullet, an all-in-one fix. “A lady told (fitness coordinator) Chad Hodson she wanted lap band because she didn’t want to exercise. He told her that you still have to exercise and modify eating,” he said. “Surgeries are there to give you a kick start and make you realize you’ve bought into something and committed yourself to it. You’ve been put to sleep and operated on. That should be a momentum to continue with weight loss the rest of your life.”

Stewart said that nearly 700 patients have had weight loss surgery at Blount Memorial Hospital since 2002. Colquitt said almost 25 tons of weight has been lost.

“We’ve had over 50,000 pounds of weight loss,” he said. “We’ve got a lot of people passionate about making this program work. It’s working great.”

Stewart said Dr. Julie Janeway recently complimented the Blount Memorial Hospital bariatric surgery program from top to bottom. Janeway is the author of the book, “The Real Skinny on Weight Loss Surgery,” Stewart said.

“We’re a certified as a Bariatric Surgery Center of Excellence by the American Society of Metabolic and Bariatric Surgery,” she said.

For more information about weight loss surgery, on the web visit www.foothillsweightloss.com or go to blountmemorial.org and click on weight management.

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