Most Common Surgical Treatments for Clinically Severe Obesity

The obesity epidemic continues to grow in our country, and with obesity comes a whole host of additional health risks, like type 2 diabetes, heart disease, high blood pressure, osteoarthritis and stroke. Those looking to reduce these obesity-related health risks are turning to bariatric or medical weight-loss surgeries like gastric bypass.

With weight-loss surgery, your surgeon makes changes to your stomach or small intestine, or both. The procedure resolves diabetes 80 percent of the time, and patients lose an average of 70 percent of extra weight. However, gastric bypass isn’t the only choice. Learn about your options:

Laparoscopic Adjustable Gastric Band – The surgeon puts a small band around the top of your stomach. The band has a small balloon inside it that controls how tight or loose the band is. The band limits how much food can go into your stomach. This surgery is done using a laparoscope. Advantages include:

  • Minimally invasive with small incisions
  • Short hospital stay
  • Adjustable without additional surgery
  • Can support pregnancy
  • Removable at any time

Laparoscopic Gastric Sleeve – This surgery removes most of the stomach and leaves only a narrow section of the upper part of the stomach, called a gastric sleeve. The surgery may also curb the hunger hormone ghrelin, so you eat less. Advantages include:

  • No cutting, bypassing, or stapling of the intestine
  • Little concern about vitamin and calcium absorption
  • No adjustments or artificial devices put into place
  • Most foods are possible

Laparoscopic Roux-en-Y Gastric Bypass Surgery – The surgeon leaves only a very small part of the stomach (called the pouch). That pouch can’t hold a lot of food, so you eat less. The food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine. This surgery can often be done through several small incisions using a camera to see inside (laparoscope). Doctors can also perform a mini-gastric bypass, which is a similar procedure also done through a laparoscope. Advantages include:

  • Tiny incisions, resulting is less scarring and easier healing
  • Excellent cosmetic result
  • Little pain
  • Few wound complications
  • Fast recovery
  • Short hospital stay
  • Resuming physical activity soon
  • Little risk of hernia formation

Duodenal Switch- This is complicated surgery that removes most of the stomach and uses a gastric sleeve to bypass most of your small intestine. It limits how much you can eat. It also means your body doesn’t get as much of a chance to absorb nutrients from your food, which could mean you don’t get enough of the vitamins and minerals you need. Advantages include:

  • Results in greater weight loss than other methods, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  • Allows patients to eventually eat near normal meals
  • Reduces the absorption of fat by 70 percent or more
  • Causes favorable changes in gut hormones to reduce appetite and improve satiety
  • Is the most effective against diabetes compared to other methods

If you’re considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He can help you decide which, if any, of these treatments is right for your unique situation.Fat man running

 

Gastric Bypass for a Longer Life

According to research by the Geisinger Health System, one of the largest health service organizations in the U.S., patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48% up to 10 years after surgery, compared to similar patients who do not undergo the procedure. This is significant considering that the American Society for Metabolic and Bariatric Surgery estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.

Researchers from the Geisinger Health System followed nearly 2,700 patients who had gastric bypass at the system’s nationally accredited bariatric surgery center between 2004 and 2014. Mortality benefits began to emerge within two years after surgery and were significant within four years. The biggest reduction in risk occurred in patients 60 years or older at the time of surgery and in patients who had diabetes before surgery.

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” said Michelle R. Lent, Ph.D., a Geisinger Obesity Institute researcher. “While this study did not evaluate specific-cause mortality, as expected, we did find significant improvements or remission in diabetes and high blood pressure.”

In the study, more than 60 percent of patients with diabetes before surgery experienced diabetes remission about five years after surgery. Previous studies have shown death from heart disease and even certain cancers are lower in gastric bypass patients than patients with severe obesity who do not have the operation.

People with obesity and severe obesity have higher rates of heart disease, diabetes, some cancers, arthritis, sleep apnea, high blood pressure and dozens of other diseases and conditions. Studies have shown individuals with a BMI greater than 30 have a 50 to 100 percent greater risk of premature death compared to healthy weight individuals.Live Longer

If you live in the Las Vegas area and are interested in learning what bariatric surgery can do for you, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help you choose the best treatment for your unique situation.

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.

 

 

Get the Facts about Bariatric Surgery

Bariatric surgery is an option that many obesity medicine specialists say is too often ignored or dismissed. Yet it is the only option that almost always works to help very heavy people lose a lot of weight. Weight-loss surgery can also make some chronic conditions vanish entirely.

Here are some facts about bariatric surgery and what it does:

  • Twenty-four million, Americans are eligible for bariatric surgery according to the American Society for Metabolic and Bariatric Surgery. The criteria are a body mass index (BMI) above 40, or a BMI of at least 35 along with other medical conditions like diabetes, hypertension, sleep apnea, or acid reflux.
  • Fewer than 200,000 have the surgery each year.
  • There are four surgical types in use today. The two most popular procedures are the Roux-en-Y gastric bypass and the gastric sleeve. Both make the stomach smaller. The bypass also reroutes the small intestine. A simpler procedure, the gastric band, is less effective and has fallen out of favor. And a much more drastic operation, the biliopancreatic diversion with duodenal switch, which bypasses a large part of the small intestine, is rarely used because it has higher mortality and complication rates.
  • The average cost of a sleeve gastrectomy is $16,000 to $19,000, and the average cost of a gastric bypass is $20,000 to $25,000. Most insurance plans cover the cost for patients who qualify, though some plans require that patients try dieting for a certain amount of time first.
  • Bariatric surgery is not a magic bullet that will solve all of your weight-related problems. Leading a healthy lifestyle full of healthy foods and exercise post surgery is crucial.

If you live in the Las Vegas area, have a BMI above 40 or any of the other conditions mentioned above, schedule a consultation with Dr. Shawn Tsuda. He and his expert team can help you find the treatment that’s right for you.

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Heart Health after Bariatric Surgery

Obesity has become a global pandemic affecting virtually all ages and socioeconomic groups and is majorly contributing to the international burden of chronic illness, including diseases of the cardiovascular system. Traditional treatments to achieve weight loss such as diet, lifestyle, and behavioral therapy have proven relatively ineffective in treating obesity and associated cardiovascular risk factors in the long term. These treatments have been specifically ineffective on the morbidly obese subgroup of patients.

Weight-loss (bariatric) surgery can be a useful tool to help break the vicious weight gain cycle and achieve long term weight loss and improved overall quality of health and life.

  • Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more.
  • Bariatric surgery, such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding, works by changing the anatomy of the gastrointestinal tract or by causing different physiologic changes in the body that change energy balance and fat metabolism. It is important to remember, however, that bariatric surgery is a “tool.” Weight loss success also depends on many other important factors, such as nutrition, exercise, behavior modification, and more.
  • Bariatric surgery may improve a number of conditions and hormonal changes to reverse the progression of obesity. Studies find that more than 90 percent of bariatric patients are able to maintain a long-term weight loss of 50 percent excess body weight or more.

Most, if not all, of the cardiovascular risk factors associated with obesity are improved or even resolved after bariatric surgery. The amount of improvement in cardiac risk factors is generally proportional to the amount of weight lost. The degree of weight loss varies with different bariatric procedures.

If you live in the Las Vegas area and want to learn more about your bariatric surgery options, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help you find the right treatment for you.
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The Decision that will Change your Life

Weight-loss surgery is a major, permanent life change. Most people don’t even consider it if they haven’t exhausted all of their other options. As a matter of fact, many people research weight-loss surgery for years and never take action. Whether it is fear of a drastic life change or fear of failure, making this choice could be a matter of life and death.

The truth is, bariatric treatment could drastically improve the health, happiness, and lifespan for the over 18 million Americans who currently qualify. If you are one of them, and you’re hesitating to have the surgery, here are some things to consider:

Why are you considering bariatric surgery? Freeway Sign - Decision - Yes or No

  • Obesity-related health problems
  • Depression
  • Out of breath quickly
  • Obesity discrimination
  • Relationship problems
  • Poor self-image
  • Failed diet and exercise programs

If you and your bariatric doctors decide that surgery makes sense for you, be prepared to do a lot of work both before surgery and for the rest of your life. Bariatric surgery should be thought of as one of the most effective tools available, but in order to succeed you must be ready to completely change your life.

According to the National Institutes of Health guidelines, you could be a good candidate for bariatric treatment if one of the following applies…

  • You have a body mass index (BMI) of 40 or more (“morbidly obese” or “super obese”), or
  • Your BMI is between 35 and 39.9 (“severely obese”) and you have a serious obesity-related health problem.

As mentioned above, bariatric treatment may be the best tool to make you happier and healthier, but that’s all it is — a tool. You will be the key to making it successful.

If you would like to talk to a doctor to see if bariatric surgery is a good option for you. Schedule a consultation with Dr. Shawn Tsuda. He and his teams of experts can help you make the right decision for you.

Preparing for Bariatric Surgery

One of the most common questions patients ask when they begin their weight-loss journey is, “Why do I have to wait to get bariatric surgery?” The answer is more complicated than they think at first, but ultimately they understand how important laying the groundwork can be maximizing their chances for success.

The first part of the answer has to do with your insurance company. Most insurance plans mandate that patients spend anywhere from three to six months undergoing medically supervised weight loss before they will be approved for surgery. The rationale the insurance companies use is that they want to ensure the patients are dedicated to losing weight before the insurance company assumes the significant cost of weight loss surgery.

The second part of the answer has to do with what is best for the patient and what helps the patient’s chances of being successful long-term with weight loss surgery. It takes a while to get used to eating healthily. Eating small meals frequently helps patients get used to life after surgery because all of the operations involve limiting how much food patients can eat. Small, frequent meals mean you are eating before you get hungry and minimizes the risk of overeating. Overeating after surgery almost invariably leads to pain and/ or vomiting. Learning how to eat right takes practice.

The third part of the answer deals with physical conditioning. Many patients are not in good physical shape when they start. Improving physical conditioning before surgery helps patients recover more quickly and with fewer problems after the operation.

The final piece of the weight loss puzzle relates to the emotional issues related to overeating. A common misconception is that the operation will fix all of the problems obese patients have. Patients must prepare emotionally for their upcoming operation. It is a lifestyle change patients are undergoing, and making sure patients understand what changes will occur after surgery is vitally important. Building the foundation for a lifestyle change starts before the operation, and that foundation-building takes a little time.

If you live in the Las Vegas area and are considering bariatric surgery, schedule a consultation with Dr. Shawn Tsuda. He and his expert team can help you find the right treatment.

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