Bariatric Surgery San Antonio Doctors Offer Texas Options

By Author: Thackeray Scott
Total Articles: 50
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Texas obesity is reaching epidemic proportions in the U. S., and San Antonio regularly ranks as one of the fattest cities in the nation. Results published in a recent Center for Disease Control (CDC) report demonstrate that 34 percent of Americans over the age of 20 are considered obese. Bariatric surgery San Antonio options are one effort to fight this epidemic.

With obesity comes the staggering cost of providing healthcare goods and services to treat the co-morbidities that are often associated or exacerbated by obesity/morbid obes-ity. Texas bariatric solutions are intended to counter these co-morbidities:
* Type II Diabetes
* Coronary Heart Disease
* Cancer
* Hypertension
* Dyslipidemia
* Liver and Gallbladder diseases
* Obstructive Sleep Apnea
* Respiratory diseases
* Osteoarthritis
* Gynecologic problems (CDC, 2009).

The co-morbidities associated with obesity, more significantly morbid obesity, are already having an economic impact on the strained U.S. healthcare budget. Texas bariatric solutions could positively impact this strain. According ...
... to a study conducted by Finkelstein, Fiebelken, and Wang in 2004, medical expenditures to treat co-morbidities associated with morbid obesity "account for 9.1 percent of total U.S. medical expenditures." The good news is that there are proven ways to reduce this number.

There are numerous, highly publicized approaches to managing obesity. In addition to off-the-shelf diet programs, over-the-counter medications, and organized programs such as LA Weight Loss, NutriSystem, Weight Watchers, bariatric surgery San Antonio options are also becoming more and more common. Additionally, there are prescription medications, such as phentermine, available to patients attempting to lose weight. The issue with these programs and medications is that while they may produce short-term weight loss, most patients are not successful in keeping the weight off long-term, with some re-gaining more weight than they lost while dieting.

In Texas bariatric surgery is a tool that has proven successful in assisting patients with not only losing weight, but keeping the weight off on a long-term basis. It is imperative that referring physicians and patients recognize that bariatric surgery is not a "magic bullet", but rather a "tool" that, when combined with healthy lifestyle changes, allows patients to enjoy long-term weight loss success. The three most commonly performed weight loss surgery procedures are the Roux-en-Y Gastric Bypass, the Sleeve Gastrectomy and the Adjustable Gastric Band. Patients should learn about and discuss the various procedures thoroughly with their bariatric San Antonio surgeon to determine the most appropriate procedure to fit the patient's lifestyle needs and medical conditions.

Procedures

The Roux-en-Y Gastric Bypass (RNY) is currently considered the gold standard for all weight loss surgery procedures. The RNY procedure is considered restrictive and malabsorbtive in nature, creating an environment that is conducive to rapid and sustained weight loss. The procedure is performed laparoscopically using six tiny incisions. A portion of the stomach is used to create a pouch and the intestines are re-routed, which creates the malabsorbtive feature of the surgery. According to the National Institute of Diabetes and Digestive and Kidney Disease, RNY patients can expect to lose 65-70 percent of their excess body weight.

The Sleeve Gastrectomy, a fairly new procedure in the U.S., is also considered to be a restrictive procedure and can be performed laparoscopically. Using the upper portion of the stomach, the surgeon creates a pouch shaped much like a banana to create a new stomach for patients. Currently, there is minimal long-term data available on this procedure, but early results are promising for successful long-term weight loss that is similar to a gastric bypass.

The Adjustable Gastric Band (also known as the Lap-Bandâ„¢ or Realizeâ„¢ Band) procedure has been performed in the U.S. for approximately seven years. Like the gastric bypass and sleeve gastrectomy procedures, the adjustable gastric band proce-dure is performed laparoscopically and is considered a restrictive procedure. Surgeons perform the procedure by placing a band around the uppermost portion of the stomach -and it is generally performed on an outpatient basis. Patients begin to receive fills in the band approximately 2-4 weeks following the placement of the band. Band patients gen-erally lose 20 percent less weight than sleeve or bypass patients. In addition, the rate of weight loss is at a slower pace than their gastric bypass and sleeve gastrectomy counterparts.

Complications

Risks and the potential for complications are associated with any surgical procedure. The media has done a tremendous job highlighting and magnifying the complications associated with weight loss surgery. The reality is that the complication rate for surgeries performed by a well-trained, ASMBS Center of Excellence surgeon is minimal. Complications associated with weight loss surgery include anastomosis leaks, pulmonary embolisms, injury to the spleen or liver, infection, abdominal hematoma, and pneumonia.

Selecting A Bariatric San Antonio Program

Making the decision to have weight loss surgery is a life-changing event. Patients are encouraged to attend an orientation seminar (conducted by a bariatric surgeon) that reviews in detail each of the procedures and the steps necessary to undergo surgery. Patients should carefully select their bariatric surgeon as he/she will be their provider for life. They need to feel comfortable talking with their surgeon, including sharing informa-tion if they are struggling on their journey. It is imperative that patients select a surgeon designated as an American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence surgeon who is utilizing surgical centers that have obtained the ASMBS Center of Excellence designation. The designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric surgery.

Important Questions for Prospective Patients to Ask:
1. Is the surgeon and surgical center a designated ASMBS Center of Excellence?
2. Does the surgeon offer multiple kinds of bariatric surgery procedures or do they do more of one procedure over others?
3. Does the surgeon operate by himself or with another surgeon?
4. Does the program offer a comprehensive, multi-disciplinary team? Does the program offer a dietician, support groups, exercise physiologists, insurance and financing specialists, and a psychologist?
5. Ask around-talk to your primary care physician and friends/family who have had surgery. Ask them about surgeons you may be considering for your surgery.
6. Keep it local. Patients may talk to you about going to Mexico for bariatric surgery. This is not a good idea-band patients need to have their bands filled/adjusted regularly, which is a challenge if their surgeon is in Mexico. Additionally, if com-plications arise it is harder for U.S. physicians to handle if they are unfamiliar with the hardware that's been placed in the patient. Finally, if something were to go wrong in another country, you would have no recourse.

Insurance Coverage

The Center for Medicare and Medicaid opened the door for opportunity when the decision was made to allow patients receiving Medicare and Medicaid benefits to have weight loss surgery to cure morbid obesity. Many other insurance companies and em-ployers have added this benefit as the long-term cost of providing care for the co-morbidities associated with morbid obesity far outweighs the cost of the surgery and subsequent follow-up care. Today, nearly 70 percent of insurance companies in Texas cover weight loss surgery, however if insurance does not cover the procedure, financing solutions are often available to cover the cost. In most cases, Medicare and other insur-ance companies require a medically supervised diet ranging from 1-12 months, with the average being six months. Additionally, patients are required to meet with behavior health specialists to determine if there are any underlying issues that should be resolved prior to surgery. The intent of this behavioral health evaluation is not to deter patients, it is to prepare patients and provide tools for long-term success.

What's Ahead for Weight Loss Surgery?

The benefits of surgically reversing the effects of obesity are well-documented. Most patients are able to reduce or eliminate obesity-related diseases such as diabetes and hypertension. While weight loss surgery is safe-and effective, between 15 and 20 percent of gastric bypass patients do not lose the weight they desired, or they might experience weight gain. When this happens, the first thing to do is to return to the basic fundamentals of discussing behavioral modification and 'following the rules' such as separating liquids from solids, exercise, going to a support group, and working with the dietician.

Oftentimes, when patients experience weight gain after weight loss surgery, it is com-mon for patients to inquire about having a 'revision' of their original surgery. In short, revision surgery is almost always complicated and occasionally quite risky. Many surgeons are hesitant to perform them because of the heightened risk involved. For example, to laparoscopically revise previous gastric bypass surgery is approximately ten times riskier than the original bypass procedure. There are some new advances with less risk that can even be done on an outpatient basis. These new advances are endoscopic procedures.

Endoscopy is a safe, non-surgical technique where the surgeon inserts a scope through the patient's mouth, down the esophagus, and into the stomach pouch. The following is an overview of several emerging endoscopic techniques.

Stomaphyx: In the U.S., the Stomaphyx device is an endoscopic device whereby a gastroscope is inserted into the patient's mouth down into an existing gastric pouch and 'sutures' are used to make the original gastric pouch smaller. Weight loss is about 20 additional pounds at 12 months follow up ( Mikami, Needlemen, Narula, Durant, & Melvin, 2009). What is appealing about this is that this is an outpatient procedure with the biggest complaint by patients being a sore throat for 24-48 hours. The procedure is generally performed as an outpatient procedure and takes approximately one hour to perform. Patients typically require no downtime for recovery.

ROSE: Revision Obesity Surgery Endoscopic-ROSE-is an emerging technique that is not yet available in the U.S. Like the Stomaphyx, ROSE reduces the size of the original existing gastric pouch for patients who have already had gastric bypass surgery. Additionally, this procedure narrows the connection between the pouch and small intestine, which slows the movement of food, giving a longer lasting sensation of fullness after eating. The idea is that if the outlet from the stomach to the small intestine is smaller, the transit of food is slower, and satiety or fullness is greater. Currently, the results are modest but encouraging. Excess weight loss of about 17-20 pounds is demonstrated at 6 months ( Mullady, Lautz, & Thompson, 2009). Similar to Stomaphyx, the procedure is done as outpatient with minimal risk of complication. Recovery time is minimal.

'Banding' of the bypass: Another potentially safer option for patients who have already had gastric bypass surgery is to add an adjustable gastric band around the patient's existing pouch. The concept-placing a restrictive device around an existing restrictive element to increase weight loss-is sound in theory, but technically challenging from a surgical standpoint because of the amount of scar tissue usually created at the original operation.

Complexity aside, this option is gaining respect as a viable technique with decent results. One of the key reasons this procedure is so appealing is that it does not com-promise the existing pouch. In other words, there is no significant alteration of the gastro-jejunal anastomosis [top connection] and it is also a strong option for patients that have undergone 'open' gastric bypass where no other laparoscopic alternatives are present. This operation can be done as an outpatient or as an inpatient, depending on how difficult the operation is. The operation is done laparoscopically [even if the original operation was open], patients are back to work within a week and there are no physical restrictions after surgery. A recent article from a group in New York demonstrated that this surgery is not only a viable, but safe, alternative with good weight loss results. Patients that had this procedure demonstrated that that they could achieve greater than 40 percent excess weight loss at three, four, and five years (Bessler et al., 2009).

Intra-gastric balloon: Currently there are several intra-gastric balloons available, but only outside the U.S. As its name implies, this procedure uses a balloon inserted through the endoscope and the balloon is inflated once inside the patient's stomach. There is no stapling or banding required like other surgeries; the space occupied by the balloon creates the sensation of being "full" and thus patients theoretically eat less-thus lose weight. Although these balloon sound like a perfect option, the results have been surprisingly modest. For example, when the balloons were removed after six months of being inside the stomach, the weight loss averaged only 11kg +/- 9 kg [25 pounds +/- 20 pounds] (Trande, et al., 2008). As stated earlier, these balloons are currently only available outside the U.S. and the results are somewhat disappointing. This outpatient procedure can be performed on patients who have not previously undergone weight loss surgery and the balloon can be removed at any time.

Conclusion

Research has shown that people who are more than 100 pounds overweight have very little chance of losing the weight and keeping it off long-term. Many of our bariatric patients have told us that they lost and re-gained the same 100 pounds repeatedly before making the decision to have weight loss surgery. Weight loss surgery has been available for many years and is considered very safe. If one of your patients is considering weight loss surgery-or is experiencing any of the co-morbidities mentioned in this article as a result of their obesity-encourage them to attend a free, educational seminar to learn more about the various kinds of bariatric procedures available today-so that they can enjoy a healthier tomorrow..today!

About the author
Terive Duperier, MD is a bariatric surgeon in San Antonio, Texas. Dr. Duperier and his partner, Michael V. Seger, are co-founders of the Bariatric Medical Institute of Texas (www.bmioftexas.com). Dr. Duperier can be reached at drduperier@bmioftexas.com.

References:
Bessler, M., Daud, A., Digiorgi, M. Inabnet, W., Shrope, B., Olivero-Rivera, L., & Davis, D., (2009). Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass - intermediate results. Surg Obes Relat Dis. 2009 Oct 9. [Epub ahead of print]PMID: 19914147 [PubMed - as supplied by publisher].
Finkelstein E., Fiebelken, I., & Wang, G. (2004). State-level estimates of annual medical expenditures attributable to obesity. Obesity Research, 12(1). 18-24.

Mikami, D., Needleman, B., Naurla, V., Durant, J., & Melvin, W.S, (2009). Natural orifice surgery: Initial US experience utilizing the StomaphyXâ„¢ device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endo. DOI 10.1007/s00464-0640-y.

Mullady, D.K., Lautz, D.B., & Thompson, C.C., (2009). Treatment of weight regain after gastric bypass surgery when using new endoscopic platform initial experience and early outcomes (with video). 2009 Sep;70(3):440-4. Epub 2009 Jun 24. 1999-2000.
Trande, P., Mussetto A, Mirante VG, De Martinis E, Olivetti G, Conigliaro RL, & De Micheli EA. (2008). Efficacy, tolerance and safety of new intragastric air-filled balloon (hekiosphere bag) for obesity: The experience of 17 cases., [Epub ahead of print]PMID: 19082675 [PubMed - as supplied by publisher]..

Melinda Sampson writes for many medical periodicals and speaks at bariatric conventions. Recently, her interests have centered around bariatric surgery San Antonio options and other Texas based surgical weight loss solutions. Visit us: http://www.bmioftexas.com/ .