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Laparoscopic sleeve gastrectomy: One more option for the obese

Laparoscopic sleeve gastrectomy: One more option for the obese

Article and photo courtesy of the Sioux City Journal

Obese patients wanting to go under the knife to lose weight now have another option: laparoscopic sleeve gastrectomy.

Since it made its debut in Siouxland in May, the procedure, which decreases feelings of hunger and the capacity to eat more by removing a portion of the stomach and re-shaping the remaining stomach into a sleeve, has grown in popularity, according to William Rizk, a bariatric surgeon at Midlands Clinic in Dakota Dunes.

By late August, Rizk and his colleague, Keith Vollstedt, had performed 10 laparoscopic sleeve gastrectomies between the two of them in Sioux City. The procedure joins laparoscopic gastric banding and laparoscopic gastric bypass.

“This is the en vogue surgery right now,” Rizk said just minutes before stepping into the operating room at Mercy Medical Center to perform the procedure on a woman.

“We really started doing it to satisfy patient demand. People come in absolutely seeking to have a sleeve. It’s very popular.”

BYPASS, SLEEVE OR BAND?

Laparoscopic gastric bypass surgery is the most common weight loss sugery. It is also the most invasive and effective, according to Rizk. Laparoscopic gastric banding on the other end of the spectrum is the least invasive and the least effective. Laparoscopic sleeve gastrectomy, he said, falls somewhere in the middle.

“Why someone would choose the sleeve gastrectomy is it’s less invasive as far as intestinal rerouting,” Rizk said. “There would be less malabsorption of certain vitamins while still having the advantage of significant weight loss.”

During the procedure, special laparoscopic stapling devices are used to reduce the human stomach from the size of a football to the size of a banana, according to Rizk.

“We put a sizing device that goes through the mouth, down the esophagus, down through the stomach and we staple along this sizing device to help us determine the diameter of this little banana,” he said.

About 80 to 85 percent of the stomach is then removed through one of five little incisions in the patient’s abdomen. A smaller stomach, Rizk said, will hold less food.

Ghrelin, a hormone produced by cells in the stomach, causes the feeling of hunger. After removing part of the stomach, Rizk said hunger dramatically decreases.

“As a patient eats a smaller amount of food, the stomach stretches slightly and sends a signal to the brain,” he explained. “The brain interprets that as being satisfied and the patients are no longer hungry.”

LIFESTYLE CHANGE

Although the stomach will stretch some after surgery, Rizk said it won’t stretch enough to allow patients to eat normally again. Eating frequent small meals, he said, is how most people gain weight back after having weight loss surgery.

“Grazing is the Achilles heel to all weight loss surgery, whether it’s a band, bypass or a sleeve,” he said. “If you eat a small amount for many hours a day, there’s potential that weight will be regained.”

Patients can expect to lose half a pound to a pound a day for the first four to six weeks following laparoscopic sleeve gastrectomy, according to Rizk. He said someone who weighs 450 pounds will lose more total pounds than someone who weighs 250.

“Most of these patients are morbidly obese, so to lose 100 to 150 pounds is very common,” he said. “If someone is going to go through surgical weight loss, it’s usually for a significant amount of weight. Our goal is to get them not to ideal weight, but to a healthy weight.”

Rizk cautions that weight loss surgery is a significant behavioral and psychological undertaking for patients and requires extensive counseling before and after surgery.

“Someone might see me today and have a gall bladder surgery tomorrow, it doesn’t work that way with weight loss surgery,” he said.

Rizk said occasionally patients will decide not to go through weight loss surgery after beginning counseling. Some, he said, will come back a year later when they feel more prepared to make lifestyle changes.

“If you’re going to undergo a surgery that is dramatically going to change the way you eat, you have to be ready to change your lifestyle,” he said.

 

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