Bariatric Surgery

An American Society of Bariatric Surgery Center of Excellence

Representing the best in their fields, UT bariatric surgeons bring special expertise to their patients to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption. For individuals who have been unable to achieve significant weight loss through diet modifications and exercise programs alone, bariatric surgery may help to attain a more healthy body weight. Our surgeons are respected pioneers in minimally-invasive procedures.  UT bariatric surgeons provide a comprehensive bariatric surgery program and perform more than 700 laparoscopic bariatric procedures each year.

The American Society for Bariatric Surgery (ASBS) has designated Memorial Hermann – Texas Medical Center’s Bariatric Program as a “Center of Excellence” in the United States.  The Memorial Hermann program is a partnership with The University of Texas Medical School at Houston.  Bariatric surgeons Erik B. Wilson, M.D. and Brad Snyder, M.D. are assistant professors of surgery at The University of Texas Medical School at Houston.

For more about Minimally Invasive and Bariatric Surgery, visit our web site: www.UTMIST.com.

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Obesity

Defining Morbid Obesity
Obesity is a serious disease with symptoms that build slowly over an extended period of time. The National Institutes of Health (NIH) define morbid obesity as:1

- Being 100 pounds or more above your ideal body weight

- Or, having a Body Mass Index (BMI) of 40 or greater

- Or, having a BMI of 35 or greater and one or more co-morbid condition

The disease of morbid obesity interferes with basic physical functions such as breathing or walking. Long-term implications of the disease include shorter life expectancy, serious health consequences in the form of weight-related conditions such as type 2 diabetes and heart disease, and a lower quality of life with fewer economic and social opportunities.

Obesity is a serious public health issue in the U.S.

- 24 million U.S. adults are living with morbid obesity and may qualify for bariatric surgery based on NIH guidelines.

- By 2010, it’s projected that there may be 31 million U.S. adults living with morbid obesity who may qualify for bariatric surgery based on NIH guidelines.

Co-morbid Conditions

The presence of obesity increases the risk of a number of medical conditions, including cancer. A co-morbid condition is a health condition related to a primary disease such as obesity.
There are many health conditions related to morbid obesity, but some of the most common are:

- Type 2 diabetes, which can lead to heart disease, kidney failure, blindness, amputation of the feet or legs, and nerve damage

- Heart disease, such as hardening of the arteries, heart attack, and angina

- High blood pressure, which can lead to heart disease, stroke, kidney failure, and vision loss

- High cholesterol, which can lead to heart disease, stroke, and kidney failure

- Obstructive sleep apnea has been associated with high blood pressure

- Acid reflux/GERD, which can lead to esophagitis, Barrett’s esophagus, and esophageal cancer (adenocarcinoma) 8

- Cancer

- Depression

- Osteoarthritis and joint pain, which can lead to loss of mobility

- Stress urinary incontinence

- Asthma

- Sleep Apnea

- Gallstones

- Osteoarthritis and gout

- Low back pain

- Immobility
- Skin infections

- Venous/stasis ulcers

- Intertrigo

- DVT and thromboembolism

- Female reproductive health disorder, which can lead to infertility,  sexual dysfunction and obstetric complications

- Mortality rates from many of these conditions are also higher among people with morbid obesity.

Body Mass Index  (BMI)

- Calculated as follows: Weight/Height2

- Lowest mortality = BMI less than 25 kg/m2

- Highest mortality = BMI greater than 40 kg/m2

- BMI greater than 40 = approximately 100 lbs. over ideal body weight

Procedures

Gastric Bypass Surgery
The most common form of gastric bypass surgery is Roux-en-Y gastric bypass surgery. Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption. During the procedure, the surgeon creates a smaller stomach pouch. The surgeon then attaches a Y-shaped section of the small intestine directly to the pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.

The gastric bypass is the most commonly performed operation for weight loss in the United States. Furthermore, since the gastric bypass has been performed for almost 50 years, surgeons have become very comfortable with the understanding of the risks and benefits of the procedure. By sheer volume of cases combined with the volume of scientific research, the gastric bypass has become the “gold standard” operation for weight loss in the U.S. An emerging factor in the success of gastric bypass surgery is following an established gastric bypass diet after surgery

Excess Weight Loss

Gastric bypass patients typically lost 61.6 percent of their excess weight.

Health Benefits

Studies found that gastric bypass:

- Resolved type 2 diabetes in 83.8% of patients and often resolved the disease within days of surgery

- Resolved high blood pressure in 75.4% of patients

- Improved high cholesterol in 95% of patients

Quality of Life

One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

- Overall quality of life improved greatly

- They experienced improved physical functioning and appearance

- They experienced improved social and economic opportunities

Recovery

One study found that gastric bypass patients were able to:

- Leave the hospital after two days

- Return to work after 21 days

Potential Concerns of Gastric Bypass

- A condition known as dumping syndrome can occur from eating high-fat, high-sugar foods. While it isn’t considered a health risk, the results can be very unpleasant and may include vomiting, nausea, weakness, sweating, faintness, and diarrhea.

- Patients must supplement their diet with a daily multivitamin and calcium. Some patients must take vitamin B12 and/or iron

- The stomach, duodenum, and parts of the small intestine cannot be seen easily using X -ray or endoscopy if there are problems after surgery such as ulcers, bleeding, or malignancy

Gastric Banding

Gastric banding is a restrictive surgical procedure. During this procedure, two medical devices are implanted in the patient: a silicone band and an inj ection port. The silicone band is placed around the upper part of the stomach and molds the stomach into two connected chambers. The injection port is attached to the abdominal wall, underneath the skin. The port is connected to the band with soft, thin tubing.  The band is adjustable. Adjustments are made by your healthcare professional using a needle to inject saline solution into your band through the port. Adding saline increases the amount of restriction provided by the band, helping patients feel fuller sooner and with less food.

Excess Weight Loss

- Gastric banding patients typically lost 47% of their excess weight.

- Health Benefits
- Studies found that gastric banding:

- Resolved type 2 diabetes in 47.8 percent of patients

- Resolved high blood pressure in 38.4% of patients

- Improved high cholesterol in 78.3% of patients

Quality of Life

- One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

- Overall quality of life improved greatly

- They experienced improved physical functioning and appearance

- They experienced improved social and economic opportunities

Recovery

- Your healthcare team will advise you when to return to work and when you are able to resume normal activities

Potential Concerns of Gastric Banding

- Gastric banding can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by your surgeon to achieve success

Gastric banding requires more intensive follow-up care than most other bariatric surgeries.This is mostly because the band is adjustable. Keep in mind that even after reaching and maintaining your success weight, you may still need to see your healthcare professional for further adjustments

Robotically-Assisted Minimally Invasive Surgery

The da Vinci® Surgical System is state-of-the-art robotic technology. The System allows your surgeon’s hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative site. The magnified, three-dimensional view the surgeon experiences enables him to perform precise surgery in complex procedures through small surgical incisions.

Open vs. Minimally Invasive Surgery

Minimally invasive surgery (MIS) allows physicians to perform many kinds of major surgery with less patient trauma and pain, minimal scarring, faster recovery and shorter hospital stays. Surgeries are performed through small incisions, which replace the large incisions needed for conventional open surgeries.

Robotically-Assisted MIS

The use of robotics takes minimally invasive techniques into a new era, further minimizing the physical and emotional impact of surgery on patients. Robotically-assisted MIS represents a third generation of surgery, one which builds upon the advances to open surgery introduced by MIS. Robotic technology takes surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with three-dimensional visualization of the operative site.

Benefits of MIS

The benefits of MIS are numerous. Traditional surgery often requires a lengthy hospital stay and weeks of recovery. With minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery. Many procedures require only several days in the hospital and promote reduced recovery time. Patients can often get back to their normal routines more quickly.