OH Article

So much progress has been made in the industry since we had our surgeries in 2004. Here's an article from OH Magazine; I will never cease my pursuit of successfully maintaining my health and weight loss. If this helps one other person, it was worth my effort to make this post. I sincerely hope you are all doing well in your worlds. Maureen

The field of bariatric surgery is constantly evolving and new procedures continue to develop. Bariatric surgery has evolved from open very invasive surgery like the “stomach stapling" or vertical banded gastroplasty to laparoscopic gastric bypass, laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic duodenal switch, all of which are performed through tiny incisions in the abdomen. The medical development industry is constantly trying to discover new technology that requires less or no incisions to make bariatric surgery even less invasive in the future. These new technologies will help increase the likelihood that patients will choose surgery and help to decrease the epidemic of obesity in the United States.

One of the newest technologies currently being used in the United States is Single Incision Laparoscopic Surgery (SILS™) adjustable gastric banding. The procedure is a laparoscopic adjustable gastric banding that is performed through a single incision hidden inside the belly button instead of the traditional five incisions. This procedure results in much less pain, improved cosmesis, and quicker recovery. Patients are extremely happy that no one can even see that they had surgery with the one tiny scar hidden in the belly button. Presently this procedure is limited to lower risk patients with BMI closer to 40. The instrumentation and technology related to SILS™ surgery is evolving fast and as this technology improves the availability of SILS™ adjustable gastric banding will become widespread.

Another field of bariatric surgery that industry is trying to develop new procedures is for revision of previous gastric bypass procedures. It has been shown over time that gastric bypass patients will stretch their pouch and stretch the stoma or connection between the stomach pouch and the small intestine allowing the patients to eat more because the stomach pouch empties faster. Approximately 20 to 30 % of gastric bypass patients will have some weight gain many years after their surgery. The newest procedure is Revision Obesity Surgery Endoscopically (ROSE) using the Endoscopic Operating System by USGI Medical. This procedure is done completely through the mouth with no incisions and no recovery. The device sutures the stomach and slows the emptying of the stomach pouch as well as decreases the volume of the stomach pouch. This device has better durability than the StomaphyX™ procedure, which I have been performing for the past two years. One advantage of the ROSE procedure is that you use sutures with variable length to make the plications or folds in the stomach instead of a fixed length fastener that is used with the Stomaphyx™ device. This allows for variability of the thickness of the stomach tissue.

Endogastric Solutions is about to release the new Stomaphyx Titan™ that will hopefully have better results by taking larger bits of the stomach than the traditional Stomaphyx™ device that had poor results. The goal of these procedures is to develop technology to eventually perform primary obesity procedures completely endoscopically or through the mouth.

The intragastric balloon made by Allergan called the BIB™ system is currently undergoing a multi-center clinical study to get FDA approval in the US. This device is placed endoscopically through the mouth. A balloon is then inflated in the stomach to help patients feel full or satisfied. This device will only be indicated for placement for six months at a time and is not a long-term solution for weight loss, but is good for high risk patients that need to loss some weight before undergoing some other type of surgery.

The Endobarrier™ by GI Dynamics is a liner of the gastrointestinal tract that acts as an impermeable barrier to prevent food from coming in contact with the wall of the intestine. This device is placed and removed endoscopically through the mouth. The hope is that this procedure will mimic the metabolic effects of the Roux-en-Y gastric bypass. The potential benefits include metabolic weight loss and control of type 2 diabetes, minimized potential for complications of traditional surgery, and is less invasive than surgical alternatives. An initial study of 12 patients demonstrated a 23.6% excess weight loss in 12 weeks and four diabetic patients had normal glucose levels for the entire 12 weeks of having the device in place. The big problem so far with this procedure is with the sleeve migrating too far down the gastrointestinal tract. If this problem can be resolved, this procedure shows lots of promise in the future of bariatric surgery. It is presently undergoing clinical studies in the US.

A clinical trial of the TOGA™ device by Satiety, Inc. has also begun in the US. This procedure is designed to perform a transoral gastroplasty or stomach stapling completely endoscopically through the mouth. In this new procedure, the surgeon introduces a set of flexible stapling devices through the mouth into the stomach, and uses them to create a restrictive pouch that is intended to catch food as it enters the stomach, giving patients a feeling of fullness after a small meal. A 2006-2007 pilot study in Mexico and Belgium found that patients receiving the TOGA™ procedure lost more than a third of their excess body weight. By 12 months, their excess weight loss averaged almost 40 percent. The potential problem with this procedure will be similar to the old stomach stapling or vertical banded gastroplasty because the staple lines may come apart over time. It will be interesting to see the long-term results of the durability of this procedure.

As you can see, industry is trying hard to find the ultimate minimally invasive or “non-invasive" weight loss surgery. As the epidemic of obesity in the US is growing fast, industry is trying to develop new procedures for this growing market of potential patients. The market for a patient with a body mass index between 30 and 35 is even larger. If a non-invasive or very minimally invasive effective procedure for obesity can be developed the potential will be endless.

Shawn Garber, MD FACS, FASMBS is the director of The New York Bariatric Group in New Hyde Park, NY and specializes in the newest treatments for weight loss surgery. You can visit his website www.stopobesityforlife.com for more information.

I love this THANK YOU!!!! Some of these are iffy to me. the last being the worst because its stomach stapling and like they mention...of course there would be similar issues that old stomach stapling had. The other I think is iffy is the block in the intestines. While it would prevent the fat absorbtion etcetera etcetera... it would also really block our vitamin intake even more so I would think. Maybe not... I have heard of the ROSE procedure. But not too much about it because I think it was fairly new when I had heard about it. Thats still in the back of my mind (i know you've had that done and didn't have such good results). But just to have that little tiny extra boost would help. But not if I have to pay out of pocket!!!  which im sure i would. so thats out the window for me. I'm struggling but I think I'm slloooowly getting there. I'm going out this weekend to get my work out clothes. Well... work out shirt at least. Then I'm PLANNING on starting back up at the gym on Monday. :)  if I can get my lazy butt in there!!! I started new hours so there is no excuse for me!!! I'm gonna start with 1/2 hour a day 5 days a week. Thank you for this info! Always love reading this kind of stuff! ((hugs!!))

I sent you a message to your profile page - hope to hear from you! Maureen

Interesting and amazing findings here.  I never realized the staple lines could come apart...this is something that was not told to us at first, but I guess they have seen it over time.

That drinking 8 ounces of water thing you talked about in your last post....I could NEVER do that.  I think I would explode.  Seven "gulps" of water at a time is the max I can do before burping! 

I think if the surgeon finds something wrong after the surgery, no matter how far out you are...it should be repaired.  If things are stretching and can be tightened, then they should be. This is why it is important to see your surgeon on a regular basis. People tend to blame themselves for the gain, when in actuality it can be an internal problem.  Again, I also wonder about the high rate of weight gain after surgery and how it actually takes place. 

The bottom line is lifestyle change.  If all tests are normal and the surgery has not been compromised in any way, then other things need to be looked at.  I feel that many people were not properly prepared for the lifestyle change that should come with the surgery.  I think eating disorders and the reasons for overeating were not examined as closely as they should have been.  I just feel that many people were not prepared the way they should have been.

I will now get off my soap box and go back to work.

Bye!
Joanie

I had this long response written and the stupid thing knocked me out of the page. I agree with you whole heartedly in regards to the surgeon fixing things. I always thought that, if something mechanically is wrong after surgery... strtetching...stoma enlargement, failed suture lines etc... I think the surgeon should fix it too and it be covered!!! (not in america thats for sure) maybe in another country. 'sigh' I also think that plastic surgery should be included to take care of the pani and other issues. I know there are ways to get insurance to cover, but its next to impossible to accomplish unless you have severe underlying issues involved with excess skin and a bmi of 35 and over with underlying issues in order to get a revision. I know I can consume alot and know that I have an enlarged stoma because I got sick once eating something...i went to throw up and NOTHING was there. I mean this was almost like 3 minutes after I ate. It just went right on through!!! No word was ever mentioned that this was a possibliity when I was researching with my wls about surgery. I also knew that i would have to make a lifestyle change and had at least 1-2 years to prepare and adjust to the new way of eating. My surgeon agreed with me. I had about 6-7 months ONLY to prepare. Because after 6 months I could eat alot more and tolerate sugar etc... I had a feeling that something was wrong then. i struggled hard to get the rest of my 100 off. Now its even worse. My metabolism is screwed up due to the rapid weight loss and also... which others must keep in mind ... the vitamin deficiency has a lot to do with our poor metabolisms. I recently talked to my doc about all this. She is helping me alot with the insane hunger and getting on an exercise program and in 6 months we will see where I am and then weigh my options...meds... and if the exercise hasn't done much for my metabolism. And to check my levels again for deficiency. Its good when the docs are so understanding. The levels of course being the most important... I mean how weak and tired are we being anemic and B-12 deficient. Thats why metabolically its soooo hard to loose weight! Our bodies are so starved for nutrients that it soaks up every calorie our bodies actually allow.   even though due to our surgery its supposed to not soak up as much (calories and fat and such) yeah ok... lol....  ok im off my soap box too! lol!! 

I think the only way to determine stoma enlargement is through testing.  I have gotten the 'dry heaves' after eating as well, and I don't think my stoma is enlarged.  I do believe the plastic surgery should be covered.  I did not have a problem with excess skin, but I have a friend who did and it just isn't good.  My surgeon told me at the start to expect an increase in appetite after 6 months to a year when your system begins to 'settle' and get used to its new plumbing.  He also told me that I would experience a weight gain of 10 to 20 pounds after hitting my bottom weight....I gained 12 since my bottom weight.  I am not going to self diagnose whether my surgery is still intact.  I do believe what you are saying about your metabolism.  I think the surgery has an affect on that.

joanie i agree with you 200 percent about the plastic being included in the surgery! i also wonder how people made out who went and had all that extensive plastic done then gained weight back. does that effect the skin? i know it gts pulled pretty tight and have wondered what happens when its pulled tight then extra weight is regained? could that tear the skin? that might sound silly but i've always wondered.
i didn't have the money to do that extra surgery and while it would have been nice i was lucky in that i didnt' havee a tremondous amount of extra saggy skin. no more than someone who is in their 50's and has had 3 kids anyways.
granted the first couple of years i prayed that i'd be able to have it done and have a tight tummy which i'd nevr have had but then again i'm not in my 20's.

Elizabeth, you hit on something that is probably the most critical aspect of our post-surgery lives. The vitamin and nutrient deficiencies that are a consequence of the surgery are wreaking havoc on our entire body systems. I know I will never be able to consider myself normal because all my innards are abnormal to the natural set-up. So for me, my journey continues - but now it's much more about sustaining physiological health (and hopeful keeping the weight off will be a benefit to that), and much less about looking normal in clothes. That was a wonderful period of time after I lost the weight - shopping! Slipping into size 6 jeans, and staying there for nearly 3 years - no more! Although I haven't given up the hope that I will one day get into those size 6 jeans again (I'm even holding onto the one pair of size 4 that I wore for a time!) - now it's much more about feeling good. And I don't. That's the bottom line. I am way beyond tired all of the time. My skin doesn't look good; my hair doesn't look good. So I'm going to do what I can to help my body get the nutrients it needs and that means I have to look at the consequences of WLS right in the face, own the fact that as happy as I am to no longer weigh nearly 400 lbs., I still have much, much work to do to be healthy. I'm so happy you're posting again! You are such a light! Maureen

O Reenie its so good to see you posting about the hard work your doing to feel healthier. thats the key!
I'm so happy I went to my homeopothic doctor cause she has made a world of difference in how healthy i now feel.
did you get the telephone number I sent to you? i know you had asked for it a while ago.
good luck and god bless i hope your feeling better soon!

i agree with you joanie that makes sense.
mine still works as long as i behave myself.
i agree our metabloism is all messed up but mine and i don't think i'm alone with this was to begin with.
yes i ate alot and alot of the wrong things but even when i stuck to a diet and excerize program 20 years ago i'd still drop one pound in a month. everyone else around me would be dropping 10 and i'd lose one. no one believed me that i wasn't eating the right way. the surgry made it so that i am normal sized.
oh yea i wanna be thinner but i still can not complain about my size when i compare the before.
my metobalism is still nutty but its more like back to my normal.
maybe thats it for each of us in a little way.
we have our own individula normals.