The December Deseret News/Intermountain Healthcare Hotline focused on surgery to help severely overweight people shed pounds. In addition to answering phoned-in questions, several readers submitted questions by e-mail.
Dr. Sherman Smith, director of bariatric surgery at LDS Hospital, and his colleague, Dr. Rod McKinlay, a general and bariatric surgeon at LDS and St. Mark's Hospital, tackled the main themes that were submitted.
The hotline is held the second Saturday of each month and addresses a different health issue each time.
Question: I had bariatric surgery and lost a lot of weight, which I kept off for 18 years. Then, around 2000, I quit smoking and have been gaining weight ever since. What can I do? Is a redo even possible after all this time?
Answer: First, congratulations on quitting smoking. That's a great step toward better health, even though it seems to have been met by an increase in weight.
A surgical revision of your gastric bypass, or "redo" is possible. Of course, most people gain weight because their diet has changed, and if you revert to the type of diet you followed immediately following the gastric bypass, you may lose a lot of weight again.
But for people who feel they need surgical help again, there are options available. Simply put, the gastric bypass can be redone, or a band can be placed around the gastric pouch. To find out more about these options, you can come to an informational seminar that we have at our office on Tuesday night or Saturday morning, without cost or obligation. You can call our office at 801-268-3800 to find out more. Our office staff will probably put you in touch with one of our medical assistants who may ask you some questions about your bypass, your current weight, etc., to make sure that you would be a good candidate for a revision.
In brief, a revision does carry a higher risk than the original surgery, and results are not as predictable for your weight loss. (McKinlay)
Question: Since gastric bypass has now been around for a very long time, is it routine enough that it's safe to go somewhere like Mexico to have it done? I did some looking and it's much less expensive there. I don't think my insurance will cover it here, there or anywhere, so cost is important.
Answer: I would not recommend going to a foreign country for gastric bypass or lapband. The reason is simply that, if complications happen, you are in much safer hands here in the United States than you would be elsewhere. It is true that gastric bypass is more routine now than several years ago, but complications can still happen. Although rare, some complications can be dangerous, and it is wise to have access to the highest level of medical care. It is unfortunate that more insurance companies do not cover weight-loss surgery. We continue to lobby the Legislature to make this kind of insurance coverage mandatory. Financing plans are available. (McKinlay)
Question: What are the complications of gastric bypass compared to lapband? And how common are they? Are certain types of patients more prone to them?
Answer: Both surgeries carry risks common to any surgery, such as bleeding, infection, blood clot, or anesthesia-related complications.
Gastric bypass has the possibility of a leak from the stomach or intestine (risk about 1 percent), which is exceeding rare in lapband surgery (0.1 percent). There is also a higher risk of gastric pouch ulcer in gastric bypass compared to lapband, but this is still rare in bypass surgery (0.3 percent) and nearly unheard of in band surgery. The most common complication of bypass surgery (about 5 percent to 10 percent) that doesn't happen in band surgery is a stricture or narrowing of the gastric pouch, which can require an endoscopy to balloon open.
There are, of course, some complications unique to band surgery, such as a band slip, which is about a 5 percent risk over two years. This requires an additional surgery to fix or revise the band. Or a more rare complication such as a band erosion (less than 1 percent), which requires the surgical removal of the band and may lead to an extended stay in the hospital.
Patients who smoke, are exceedingly overweight (more than 200 pounds overweight), have a history of major abdominal surgery with scar tissue, or have poor heart or lung health are at higher risk of surgical or anesthetic complications.
Generally speaking, the risks of surgery are acceptable when compared with the benefits of significant weight loss, but that is a decision only an individual patient can make. We have free information seminars on the benefits and risks of weight-loss surgery. Call 801-268-3800 for more information. There's no obligation or cost. (McKinlay)
Question: My wife needs a bypass or something. We have explored a bypass, mini bypass and lapband surgery. What are your opinions as to the advantages? She weighs close to 400 pounds and needs this, she has a pulmonologist and has weight-related asthma. What are her best options, I know our insurance is now covering partially bypass of some sort.
Answer: Gastric bypass and mini bypass are essentially the same operation in terms of success with weight loss; 60 percent to 70 percent excess body weight would be lost within the first year or two after surgery.
Most surgeons do not perform mini bypass because of problems with bile reflux gastritis leading to a need for revisional surgery. Otherwise, the risk of serious complication is similar.
The adjustable gastric band surgery is a little less risky in the early phase, but it more often requires repeat surgery to replace, adjust or remove the band. Excess body weight loss is about 40 percent at two years. Patients with a BMI greater than 50 don't do as well with significant weight loss after lapbands than those with BMI less than 50.
Your wife is a good candidate for a gastric bypass at her weight. After she and you consider the risks and benefits of either procedure, it will be up to you to make a decision regarding which procedure will be best in her circumstances. Please refer to www.asbs.org to gather more information on this topic. (Smith)
Question: What are the particular risks associated with lapband surgery and is there a weight cut off at which it's not safe or effective?
Answer: Laparoscopic adjustable gastric banding can result in band slippage (also called gastric prolapse), band erosion, and leakage from the access port or tubing, all of which require repeat surgery. In the case of the erosion problem, the band must be removed. In the other cases the band may have to be replaced. These problems will occur up to 30 percent of the time within the first year with ongoing risk thereafter. However, many other patients do enjoy trouble- free success with weight loss without these problems.
Those patients with BMI greater than 50 may not be the best candidates for this kind of surgery as their weight loss may not be in the range they had hoped for. Patients with Type II diabetes will see their problem resolved over 80 percent of the time with gastric bypass but only 50 percent of the time with the band procedures. Please come to a free informational class to help you choose what is best for you. (Smith)
Question: If my insurance doesn't pay for gastric bypass, about how much would it cost me, assuming there were no complications? Is lapband about the same? I weigh about 380 pounds and am 5-foot-6. I've been going to the gym and paying attention to what I eat. But I don't seem to lose weight.
Answer: The total cost including hospital, surgeon, anesthesiologist, surgeon assistant and educational fee is $18,475 for gastric bypass and $15,150 for the lapband. Weight loss is about 40 percent excess body weight on average for the lapband and about 60 percent to 70 percent with the gastric bypass. Your BMI is 61 and the banding procedure may not provide the success with weight loss you would be hoping for. I would recommend a gastric bypass, but the ultimate decision is up to you. You would definitely be a candidate for bariatric surgery in either case. To attend an informative and introductory class without charge, please call 801-268-3800 to schedule a time. (Smith).