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BY ERIKA ROSE
Times Correspondent | Monday, September 04, 2006 | (No comments posted.)
For decades, severely obese individuals desperate to lose weight have turned to gastric bypass surgery, considered the "gold standard" in bariatric procedures in the United States.
All that is changing in favor of a less-invasive, safer procedure that is gaining ground here, says Dr. Paul Stanish, general surgeon and medical director of the Center for Weight Loss Surgery at the Methodist Hospitals.
Approved by the Federal Drug Administration (FDA) five years ago, the Lap-Band System is a relative newcomer in the United States, he says, although it's been the preferred method of bariatric surgery in other countries.
"If you were to see the surgeries back-to-back, what we do in a bypass and what we do with a band, and I told you that in 18 months, the weight loss will be the same, which one would you choose?"
The answer, he says, should be a no-brainer.
Weighing the options
Lap-Band system a simpler, safer surgical option for severely obese
On the morning of Aug. 8, a 307-pound woman arrives at the Methodist Hospitals Southlake Campus in Merrillville nervous, scared and anxious for her surgery to be over.
She's feeling a bit excited as well. She knows from watching 160 pounds drop off her husband in the last eight months that, with proper lifestyle changes, weight-loss surgery can help previously unsuccessful weight-loss attempts become a permanent reality.
Refusing to disclose her last name or where she lives for fear of others passing judgment, 44-year-old Angie is considered "super morbidly obese," with a dangerously high body mass index (BMI) of 54.
But rather than have her stomach stapled to reduce it to a small pouch and her intestine rerouted to prevent the absorption of much of her food, as is the case for gastric bypass patients like her husband, she opted for a safer, less invasive, reversible procedure performed by Dr. Paul Stanish, general surgeon and medical director for The Center for Weight Loss at Methodist Hospitals.
In the Lap-Band procedure, the preferred weight loss surgery in other countries but FDA-approved in the U.S. only five years ago according to Dr. Stanish, a silicone band is inserted laparoscopically and secured around the upper part of the stomach, creating a smaller opening for food to pass. The band, attached by tubing to a port implanted just under the skin, can then be filled with saline solution allowing the opening to be periodically adjusted.
When Angie awoke from the surgery, her midsection was sore, with five 1/2- to 1-inch incisions instead of the long open incision her husband had, but nothing too painful to prevent her from walking on her own to the restroom and being able to leave the hospital by later that afternoon.
One week later she was back at work, her weight unknown but her pants already noticeably roomier. Her stomach now the size of a walnut, the band allows only scant amounts of food through at a time while still providing a feeling of satiety (fullness).
Calling it "10 times safer" than the more well-known gastric bypass, Dr. Stanish predicts the Lap-Band procedure is on its way to becoming the preferred method for weight-loss surgery.
"In four or five years, I think we'll be doing mostly bands and fewer bypasses," he says.
The ideal candidate for the Lap-Band procedure is typically 100 or more pounds overweight, has a body mass index (BMI) of at least 40 or a BMI of 35 accompanied by one or more serious medical problem. Though each candidate is considered individually by Dr. Stanish, he says a good candidate is preferably younger than 65 and able to exercise and comply with the advice to avoid high-calorie foods.
Dr. Stanish says that with hard work, discipline and exercise, the weight will disappear at a much slower rate for Lap-Band patients than with gastric bypass but that, over time, the success rate will be the same. This option also requires more follow-up, with four to five adjustments typically needed in the first year.
Like all bariatric surgery patients, individuals with the Lap-Band must be careful to chew their food thoroughly, ingest enough protein, often in the form of supplements, as well as a multivitamin, calcium supplement and plenty of water, though they shouldn't drink with meals to avoid flushing food from the reduced stomach too quickly.
Though he overwhelmingly prefers the Lap-Band System because of the lower risk of complications and shorter recovery, Dr. Stanish says some patients are still better suited for gastric bypass, particularly those who are at risk for dying because of related medical conditions and need to lose the weight as quickly as possible.
Before being considered for weight-loss surgery, individuals must undergo a psychiatric evaluation and attend a serious of educational sessions because of the commitment and drastic lifestyle changes required for success.
Seeing her husband's experience, Angie knows the importance of this firsthand and she is prepared to do her part to ensure success.
"It's not the easy way out ... . If you think this is easy, don't have the surgery," she says.
"It's a fantastic tool if you use it the way you are supposed to."
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