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gastric bypass

New Study Finds Weight Loss Surgery Extends Lives

03/02/2023 by DrCurry

anatomy of gastric sleeve procedure

by Dr. Trace Curry, Cincinnati, Ohio

I remember when I did my first laparoscopic gastric bypass in 2003 at Wayne Hospital in Greenville, Ohio.  I was a general surgeon then, and I wanted to branch out and challenge myself with more advanced procedures.  Those were the very early days of laparoscopic weight loss surgery, and we were still fighting the bad rap of years of high complication rates from the same exact procedure being done with a huge 12 inch incision.  Originally, I had planned on weight loss surgery being just a small part of my general surgery practice, but when I saw how these procedures totally transformed my patients’ health with just a few tiny incisions, I quickly decided to dedicate my entire practice to this exciting field.  I could see a patient’s life expectancy improve right before my very eyes – in fact I once had a patient who was so obese and had such severe sleep apnea that he had to have a tracheostomy done (this was long before Thousand Pound Sisters).  When he came in for his 1 year post op check after his gastric bypass procedure, he proudly rode his bike right into my office, his trach tube long removed!

As a weight loss surgeon, the fact that weight loss surgery increases life expectancy is something that has been plainly obvious to me for the last 20 years.  Now, however, we have new data from a study spanning 40 years and including nearly 22,000 people that confirms this as fact!

These results were just published last Wednesday in the journal Obesity. It was a retrospective study out of Utah, meaning the researchers looked back at data from patients over past years. They looked at patients with and without weight loss surgery and matched patients for things such as age, sex, and BMI so they were comparing apples to apples. There were 21,837 matched surgery and non-surgery pairs and the follow up was up to a very impressive 40 years.  This study is important not only because of the large number of patients including such a large time span, but also because it involves data on American patients which may be more applicable to patients in my practice than if the data were taken from, say patients in Sweden or Africa.

Four procedures were examined (listed from most common to least common):

  • gastric bypass
  • gastric sleeve
  • gastric band
  • duodenal switch

The researchers found that patients who underwent one of these procedures were 16% less likely to die from any cause, 29% less likely to die from cardiovascular disease, 43% less likely to die from various cancers, and incredibly–72% less likely to die from diabetes!

There have been other large studies that support the data seen here, so I feel like it’s about time to shout it from the rooftops!  In the U.S., it’s estimated that only 2% of patients who qualify actually end up having weight loss surgery.  Some of this is related to lack of insurance coverage, and some to patients’ reluctance to seek out weight loss surgery.  Many patients are not even aware that, when they choose an insurance plan, it may exclude access to a surgical weight loss procedure which they qualify for medically.  Not because they don’t need it, but because language is written into their policy that says it’s not going to be covered, no matter how badly they need it.

Regardless of the reason, considering modern techniques, the complication rate for bariatric surgery procedures such as gastric bypass, gastric sleeve, Lap Band, and duodenal switch are miniscule compared to what they used to be 30 years ago.  This, given with the data we see from this study and others, should compel more insurance companies to provide coverage for these life-saving procedures and more patients to consider taking this step to be rid of the disease of obesity.

Trace Curry M.D.

 

Dr. Trace Curry is the medical director of JourneyLite Physicians and JourneyLite Surgery Center in Cincinnati, Ohio.  JourneyLite is a multi-specialty center that focuses on advanced outpatient laparoscopic weight loss surgery and incisionless weight loss procedures.  He has done over 7000 weight loss procedures in his career and is a key opinion leader in the field of surgical and incisionless weight loss.

Gastric Sleeve

vertical sleeve gastrectomy

Gastric Bypass

gastric bypass anatomy

SIPS

loop duodenal switch

Lap Band

lap band photo

Filed Under: Education Tagged With: duodenal switch, gastric band, gastric bypass, gastric sleeve, lap band, SADI, SIPS, weight loss surgery

Gastric Bypass and Smoking

26/05/2021 by DrCurry Leave a Comment

STOP smokingSmoking and gastric bypass are a bad combination.  Beyond the general health risks of smoking, gastric bypass patients have the added risk of developing a marginal ulcer.  A marginal ulcer, also called an anastomotic ulcer, occurs at the connection (or “margin”) between the newly-created gastric pouch and the small intestine.  This connection has reduced perfusion after surgery, and the microvascular disease that can occur with smoking often leads to the development of this potentially serious complication.

Marginal ulcers usually present with pain in the upper abdominal region, which can occur after eating or can be constant.  Marginal ulcers can mimic the symptoms of gallbladder disease, so often times an ultrasound will be done first to rule this out.  Typically an endoscopy is then done to look at this connection and see if there is indeed an ulcer.

While there are some medical and endoscopic options for treating marginal ulcers, many do not respond to treatment. When they don’t resolve medically, it can require higher-risk revisional surgery to excise the ulcer and make a new pouch and connection.  If smoking continues, another ulcer could occur in the new connection.  Also sometimes, if left untreated for a long period of time, the ulcer can penetrate all the way through the wall of the GI tract, causing leakage of gastric contents into the abdominal cavity.

marginal ulcer-Due to the risk of marginal ulcers in smokers after gastric bypass, we require patients to stop smoking (and/or all nicotine products) prior to scheduling surgery.  Smokers will be tested for nicotine prior to scheduling their procedure, and again at the surgical consent visit.

-If either of these tests are positive for nicotine, the procedure will need to be delayed indefinitely until our team can be sure that smoking cessation has been successful.

-It’s important to note that nicotine tests can be positive in non-smokers who are exposed to a significant amount of second-hand smoke.

If you are a smoker and you are interested in gastric bypass, we recommend consulting with your primary care physician for smoking cessation options.  It’s important to let them know that medications like Chantix are ok, but nicotine-based products such as patches and/or gum are not.

In conclusion, smoking carries significant risks for gastric bypass patients. and it is imperative to stop all smoking (and any other form of nicotine use) and not to ever resume again.  Failing to do so can lead to serious long-term consequences!

Filed Under: Education Tagged With: gastric bypass, nicotine, rny, smoking

Gastric Bypass

Important: due to the higher risk of ulcers in patients who smoke (or are exposed nicotine through second-hand smoke or vaping) ALL patients undergoing gastric bypass will need AT LEAST ONE negative nicotine test prior to scheduling.

RNY gastric bypass
Gastric Bypass

For decades, Roux-en-Y gastric bypass surgery was the gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the small intestine, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. Many studies show that diabetes goes away in up to 80% of patients after surgery!

 

Advantages of Gastric Bypass:

  • The average excess weight loss after the Roux-en-Y procedure can be higher in a compliant patient than with purely restrictive procedures.
  • One year after surgery, weight loss can average 77% of excess body weight.
  • Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
  • A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Risks of Gastric Bypass:

  • Because some of the small intestine is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
  • Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  • A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
  • A condition known as “dumping syndrome ” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
  • In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
  • The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

If you are a self-pay patient and want info on pricing and financing for gastric bypass, click here!

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adipex

New 2023 Ohio Rules for Weight Loss Medications

On February 8th, 2023, the State Medical Board of Ohio adopted new rules regarding weight loss medications.  These new rules will significantly increase access to these critical medications for many Ohioans.  As the old rules have been in place for a long time, it may take a little while for pharmacists to become accustomed to [...]

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loop duodenal switch

SIPS/SADI/LDS Versus Sleeve–What’s the Difference

Gastric Sleeve SIPS/SADI/LDS The field of bariatric surgery, or weight loss surgery, is always changing.  New options seem to come around frequently (and sometimes go away just as quickly).  One of the most recent options that has come to the forefront, however, is based on a time-tested procedure that has been around for decades and [...]

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12 lead ekg

Pre-op EKG Requirements for JourneyLite Surgery Center

Prior to any surgery, all patients need some sort of pre-admission testing, or PAT’s.  All patients having surgery at JourneyLite will require at the very least a recent set of basic labs. Patients who meet certain criteria will also need an EKG.  If we also request for you to see your primary care physician or cardiologist […]

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New study compares sleeve gastrectomy to gastric bypass

26/11/2013 by DrCurry Leave a Comment

A new study entitled "Early Results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass" shows equivalent weight loss and resolution of weight related medical problems at 1 year between the two procedures!

Dr. Curry

Filed Under: Uncategorized Tagged With: gastric bypass, sleeve gastrectomy, Weight loss

Weight loss surgery cuts diabetes risk by 78%

03/09/2012 by DrCurry Leave a Comment

A new study study from Sweden shows that patients who had weight loss surgery reduced their risk of developing diabetes by 78%! 25 million + Americans have diabetes, don’t wait until you have it – do something about it now!

See ABC news story here.

Click here to register for an online seminar to find out more about your options!

Trace Curry MD

glucose meter
Don’t wait until you have to use one of these!

Filed Under: Uncategorized Tagged With: diabetes, gastric band, gastric bypass, lap band, realize band, sleeve gastrectomy, weight loss surgery

Diabetes: Is It Now a Surgical Disease?

01/08/2012 by DrCurry Leave a Comment

This is a great article that is narrated by the author that talks about a couple of great studies that were just published showing how effective surgical weight loss can be for curing diabetes.

Both of these studies were published in the New England Journal of Medicine, one from Cleveland (the STAMPEDE study) and one from Italy.

Both showed very impressive results for overweight or obese patients and their ability to come of their diabetes medications. Neither of the studies looked at adjustable gastric band (Lap Band / Realize Band). The STAMPEDE study looked at sleeve gastrectomy (VSG) and gastric bypass, while the Italian study looked at gastric bypass and a more aggressive small bowel bypass.

I believe that we will see more patients coming for surgery who are diabetics, and maybe we will start thinking of this as diabetes surgery instead of weight loss surgery!

See the full text article here.

Trace Curry MD
www.LoseWeightCincy.com

Filed Under: Uncategorized Tagged With: diabetes, gastric band, gastric bypass, sleeve gastrectomy, Weight loss

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