December 15, 2000

Surgical procedure combats obesity

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Surgical procedure
combats obesity

Vanderbilt University Medical Center is the first medical center in the region to offer a new laparoscopic surgical procedure to help patients with morbid obesity. The procedure, laparoscopic gastric bypass, offers a less invasive surgical treatment for long-term management of the disease.

Physicians from the Center for Human Nutrition and the Section of Surgical Sciences will partner to effectively evaluate potential candidates who would benefit from surgical intervention as a treatment for their obesity.

“In addition to our medical weight management program, we are going to have a collaborative medical-surgical program where state-of-the-art obesity surgery is going to be available for patients who meet the criteria,” said Dr. Gordon L. Jensen, associate professor of Medicine and director of the Center for Human Nutrition. “The exciting part of this program will be the continuum of care.”

Clinically severe obesity is defined as weight in excess of 100 pounds over ideal calculated body weight, or somewhat less than 100 pounds if there is a serious associated condition. Clinically severe obesity results in a mortality rate of about 10 times that of the general population in the same age group.

“Severely overweight patients can come to the Center for Human Nutrition to receive appropriate evaluation and intervention. Appropriate surgical candidates can receive screening and evaluation as to which procedure may be best for them,” said Jensen. “Patients will also receive appropriate nutrition and lifestyle tools to help them thrive and maintain long-term weight reduction after obesity surgery.”

Gastric bypass surgery has become the surgical intervention of choice for those severely overweight patients unable to manage their weight otherwise. Dietary regimens often fail to provide long-term weight control in the severely overweight.

“For selected patients, gastric bypass surgery offers a very legitimate option for long-term success at significant weight loss and management,” said Jensen.

With the addition of laparoscopic bypass surgery, patients treated at Vanderbilt may be candidates for the less invasive procedure if they meet the criteria.

“The laparoscopic gastric bypass offers the patient several significant advantages over the open procedure such as reduction in post operative incisional hernia, reduced postoperative hospitalization, reduced recovery time, and reduced pain,” said Dr. William O. Richards, professor of Surgery and director of Laparoscopic Surgery. “However, we can’t offer this procedure to all gastric bypass patients.”

Dr. J. Kelly Wright Jr., associate professor of Surgery, has offered open gastric bypass surgery at VUMC for several years and currently performs the procedure on about 200 patients a year.

“We are able to offer patients comprehensive service. With the addition of this procedure we now have two surgical approaches, as well as an intensive, carefully monitored medical regimen from the Center for Human Nutrition,” said Wright. “This new surgical option puts Vanderbilt at the forefront of weight management.”

The National Institutes of Health has set certain criteria for patients who would benefit from surgery as a treatment for their obesity. Potential surgical candidates need to be 100 percent above desirable weight; have a body mass index (BMI= weight in kg divided in height by meters squared) of greater than or equal to 40 kilograms per meter squared with no existing comorbidities or have a BMI of greater than or equal to 35 kilograms per meter squared with coexisting medical complications; have failed at non-surgical methods of weight reduction; have an absence of endocrine disorders that can cause massive obesity; and be psychologically stable.

Richards says the ideal patient for laparoscopic bypass surgery would have a body mass index of less than 55, a history of no previous abdominal operative procedures, and would also need to fit into the general criteria for those eligible for gastric bypass surgery.

“For the severely overweight, gastric bypass surgery offers the opportunity to achieve and maintain a level of weight loss that is unusual to achieve and much harder to maintain for non-surgical patients,” said Jensen. “In terms of successful weight loss for very big people this is state of the art treatment.”

Whether done laparoscopically, or through an open procedure, gastric bypass surgery involves stapling the stomach to create a pouch that reduces the functional size of the stomach to the point it will only hold about two ounces of food. This small gastric pouch is attached to the small intestine and bypasses the rest of the stomach.

“Other gastric restrictive procedures reduce the size of the stomach forcing patients to eat less, but the patients still feel hungry. They still have this tremendous drive to eat,” said Richards. “But the gastric bypass procedure also works by reducing appetite and caloric intake.”

Richards says that patients experience rapid weight loss over the first six months after the procedure and then weight loss generally plateaus over time. Longitudinal studies show that patients are able to maintain the appreciable weight loss over many years.

Patients who undergo the procedure are followed closely and are required to take supplemental vitamins for life because they can experience problems such as various vitamin deficiencies and anemia.

The Center for Human Nutrition will be able to provide its patients with the necessary continuum of care. “We are able to offer patients a very special collaborative medical-surgical program with resources that are not going to exist anywhere else in Tennessee,” said Jensen.