Posted on Sat, Sep. 09, 2006
Patients eating less but feeling full
DESONTA HOLDER
McClatchy Newspapers
"L ook at me a week after the surgery," Carmen Souza says. "I'm energetic. Physically, I feel great."
She's six pounds lighter, too, after undergoing a laparoscopic sleeve gastrectomy, a relatively new weight-loss procedure that removes up to 75 percent of the stomach, making it resemble a tube.
The so-called gastric sleeve also eliminates the portion of the stomach that produces hormones that stimulate hunger, and unlike the more common gastric bypass procedure, it does not alter the intestine. Therefore, patients don't have to worry about dumping syndrome, the forcing of undigested food into the intestine, which causes light-headedness, vomiting and diarrhea.
"People lose weight to the same degree as the bypass," up to 100 pounds in the first six months, says Dr. Moises Jacobs, who has been performing the procedure at Mercy Hospital in Coconut Grove, Fla., for about a year. "It's just a tremendously better operation."
With gastric bypass, surgeons create a pouch at the top of the stomach, using staples or a band. Then, the smaller stomach is connected to part of the small intestine, bypassing the rest of the stomach and the duodenum, the upper portion of the small intestine. Although this causes weight loss, "you can't absorb the vitamins that you need," Jacobs says. "You can get anemia."
With the gastric sleeve, "all we're doing is minimizing the size of the stomach," he says. "People are finding out instead of eating a 16-ounce steak, they can eat a three-ounce piece of steak and feel just as full."
Dr. Patricia Byers, director of bariatric surgery at the University of Miami Miller School of Medicine, considers the gastric sleeve "a good restrictive procedure. It has the usual risks of bariatric surgery, a staple line along the stomach, so that could have a problem with leaking, and the risk with bleeding, but it's safer and less invasive than the gastric bypass."
Still, whether patients undergo gastric bypass or a gastric sleeve, if they continue to eat when they're full, "the stomach stretches and gets bigger with time," Jacobs says.
That's why Lisa Schachter, a registered dietitian at Diet Design in Miami, is not a big fan of weight-loss surgery, although she considers the gastric sleeve to have the least damaging side effects compared with other procedures. "It doesn't bypass the intestines and cause malabsorption and vitamin and mineral deficiency," she says. "But you can eat high-calorie food and regain the weight."
Ana Pagan, 38, had the surgery last December, when she carried 267 pounds on her 5-foot 7-inch frame. She is now 101 pounds lighter, closer to her goal of 145, and very conscious of what she eats.
Before the operation, "I craved chocolate, the pasta and starches," she remembers. "Now, a lot of seafood, vegetables, grilled chicken. . . . The great thing . . . is that there's nothing I can't eat that I could eat before. I'll just have a very small portion and I'll be full. I can eat an Oreo cookie, just one and I'll be full."
The gastric sleeve has become popular as a laparoscopic procedure in the past year or so. Initially, it was considered Stage 1 of an operation for obese patients whose health was too fragile for gastric bypass. Once the patient lost enough weight and became healthy enough for a major operation, he or she would undergo Stage 2, a gastric bypass or similar procedure. But a Stage 2 isn't always necessary.
In a study published earlier this year, researchers at the Medical University of Vienna examined 23 obese patients for weight loss after a laparoscopic sleeve gastrectomy. At six and 12 months, patients lost 46 percent and 56 percent of their excess weight, respectively. Twenty months later, one patient's stomach had expanded, and three patients had regained weight. The conclusion: The gastric sleeve is highly effective as a sole bariatric operation, but weight regain could require a gastric bypass operation. Additional follow-up is required to evaluate long-term results, the study concluded.
Jacobs can recall only two complications in the year he has been doing the gastric sleeve. One person bled as a reaction to medication and another patient had an infection that was treated with antibiotics. "Neither required surgery," he says. "It's an easy, safe operation" that lasts 45 minutes to an hour.
As with all bariatric procedures, however, it does have disadvantages: It's not reversible, some insurance companies don't cover it because they consider it experimental, and there is the potential for inadequate weight loss or weight regain in some patients.
There's also a risk of blood clots, but the risk is lower than gastric bypass surgery, which can take up to four hours and requires a longer period of anesthesia. "Gastric sleeve is shorter than gastric bypass, but some people pick bypass for the benefits of the full procedure," which includes the restriction of many calories, Byers says. The risk of a hernia is also reduced, simply because the operation is done laparoscopically, rather than open.
Whether the surgery is for you depends on your age, body mass index (generally 40 or higher; 35 if you have weight-related health problems) and overall health. "There's never, ever one best procedure," Byers says. "Different people require different procedures."
http://www.bradenton.com/mld/bradent...printstory.jsp
Article: Patients Eating Less But Feeling Full 
