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

 

Gallstones and Gallbladder Disease

Some people think of their gallbladder as being “expendable”. Not that anybody wants any of their organs to be removed, but since many people live a seemingly normal life after getting their gallbladder removed, many people don’t think their gallbladder plays an important role in their overall health. After all, how important can your gallbladder be if you can do just fine after it’s surgically removed? The gallbladder actually plays a very important role in your body. It is an essential part of the digestive system.

In the United States, about a million new cases of gallstone disease are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making it the most common gastrointestinal disorder requiring hospitalization. Gallstones or gallbladder disease can quickly turn a great meal into a period of misery.

Gallstone disease is the most common disorder affecting the body’s biliary system, the network of organs and ducts that create, transport, store, and release bile. Bile is a thick fluid, made in the liver and stored in the gallbladder, which acts in the small intestine to digest fat. Bile contains cholesterol, water, proteins, bilirubin (a breakdown product from blood cells), bile salts (the chemicals necessary to digest fat), and small amounts of copper or other materials. If the chemical balance of bile contains too much of any of these components, particularly of cholesterol, crystals form and can harden into stones.

Bile is stored in the Gallbladder and is concentrated up to five times by the removal of water. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Bile contains water, cholesterol, bilirubin and other substances. Ideally these minerals remain in liquid form until they are passed out of the body. However, excessive amounts of these minerals in bile can cause them to crystallize.

These small crystals that form out of the saturated bile may begin to clump together. Any existing crystals makes it easier for other crystals to form. If they stay in the gallbladder too long, the crystals gradually grow larger until they become a gallstone so large that it cannot pass through the biliary ducts.

In terms of size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds! About 10 percent of the population has gallstones, but the vast majority experiences no symptoms and need no treatment. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.

Gallstone attack has some classic symptoms:

The most agonizing pain is experienced in the upper right part of the abdomen under the ribs. Usually it appears suddenly, sometimes an hour or two after eating a fatty meal. The pain may get worse quickly, and then last for several hours. Many times the pain may radiate to the back between the shoulder blades or under the right shoulder. Inhaling deeply, or moving, often makes the pain worse. The primary therapy for gallstones that are causing pain, inflammation, or infection is removal of the gallbladder.

A number of factors put people at higher risk of gallstones:

  • Gender: Women between the ages of 20 and 60 are 3 times more likely to develop gallstones than are men in the same age group. By age 60, 20 percent of American women have gallstones.
  • Age: The incidence of gallstone disease increases with age.
  • Genetics: Family history and ethnicity are critical risk factors in development of gallstones, though no gene responsible for gallstone formation has yet been discovered. African-Americans seem to have lower rates of gallstone disease than American Indians, whites, or Hispanics.
  • Obesity: Obesity is a significant risk factor, particularly for women. Obesity also slows down the emptying of the gallbladder.
  • Location of body fat: Belly fat, that spare tire around the middle, dramatically increases the chance of developing stones.
  • Diabetes: People with diabetes often have high levels of triglycerides in their blood, and these fatty acids tend to increase the risk of gallstones.

Even if you’re not at risk for gallstones, it is wise to maintain a healthy body weight, by among other things, sticking to a diet that is low in fat and cholesterol and high in fiber.

If you are in the Las Vegas area and suffering with gallstones or gallbladder disease, schedule a consultation with Dr. Shawn Tsuda.

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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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Robotic Gallbladder Surgery

A horrendous pain hits you in the upper right side or middle of the abdomen. You might think it’s a gas pain because your abdomen might feel especially full, or maybe it’s bad indigestion because you are also very nauseous and vomiting. These are all symptoms of a problem with the gallbladder. If the pain and/or nausea isn’t enough to send you to your doctor or the emergency room, symptoms such as fever, clay-colored stool, or yellowing of skin and whites of eyes (jaundice) should be assessed by a medical professional as soon as possible.

Gallbladder disease is very common, affecting about 10-15% of adults in Europe and the U.S. Treatment for gallbladder disease may include lifestyle changes and medication. However, if your symptoms worsen, your doctor may recommend surgery to remove your gallbladder.

Fortunately, your gallbladder is an organ that you can live without. The surgery to remove Gallbladderthe gallbladder is called a cholecystectomy. This surgery can be performed using open surgery through one large incision or through minimally invasive surgery (laparoscopy). Minimally invasive surgery can be done either through a few small incisions in your abdomen or one incision in your belly button. In laparoscopic procedures, surgeons use long-handled instruments to reach your gallbladder. One of the instruments is a tiny camera that takes images inside your body and sends them to a video monitor to guide surgeons as they operate.

Cholecystectomy through the belly button can be done using traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision.

It is important to discuss all treatment and surgical options with your doctor, as well as the risks and benefits of each. If your doctor believes you are a candidate for da Vinci Single-Site Surgery, your doctor removes your gallbladder using state-of-the-art precision instruments. With da Vinci, surgery is performed through one incision in the belly button, which dramatically limits visible scarring.

As a result of da Vinci technology, da Vinci Single-Site Cholecystectomy offers the following potential benefits compared to traditional laparoscopy:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

Though it is often called a “robot,” da Vinci cannot act on its own. Surgery is performed entirely by your doctor. This state-of-the-art technology must be operated by an experienced and specially trained surgeon like Dr. Tsuda.

If you need gallbladder surgery, contact Dr. Shawn Tsuda to see if you are a candidate for this type of procedure. Da Vinci surgery allows one to get back to normal life much more quickly than with traditional open and even laparoscopic surgeries.

Hernias and Surgery

Anyone who sews or does even simple crafts or carpentry knows that for a project to be well made, the seams have to be just right so that they don’t pull apart.

Our bodies are like that too. If our numerous “seams” aren’t made just right, they can pull AdobeStock_117491372 (3).jpgapart and let body parts slide into places they don’t belong. The abdomen is surrounded by muscles to keep the stomach, small intestine, and colon where they belong, but if one of these organs starts to slip though a weakness or a hole in the muscles, it’s called a hernia.

Other parts of the body can have organ herniation too. By definition, a hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained. However, when people talk about hernias, they are usually talking about the abdomen. While there are many types of abdominal hernias (hiatal, umbilical, or incisional), mentioning a hernia usually means they are talking about one in about the groin.

Risk factors for developing a hernia include:

  • family history
  • premature birth
  • chronic cough
  • constipation
  • lifting heavy weights
  • being overweight
  • smoking
  • Pregnancy

Surgery is often the only way to truly repair a hernia. Hernia repair can be done using traditional open surgery or minimally invasive surgery.

Open Surgery: With open surgery, a large incision is made in your abdomen that allows your surgeon’s hands to reach and touch your organs.

Minimally Invasive Surgery: Minimally invasive surgery is also known as laparoscopy. It is done through a few small incisions using long, thin surgical instruments and a tiny camera. The camera takes images inside your body and sends them to a video screen in the operating room to guide doctors during surgery.

da Vinci Surgery is another minimally invasive surgical option for adult patients facing abdominal hernia surgery. The da Vinci System features a magnified 3D HD vision system and special wristed instruments that bend and rotate far greater than the human hand. da Vinci technology enables your surgeon to operate with enhanced vision, precision, and control.

Early clinical data suggests: da Vinci Ventral Hernia Surgery offers the following potential benefits:

  • Low rate of pain
  • Low rate of the hernia returning
  • Low rate of surgeon switching to open surgery
  • Short hospital stay

Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, precise movements of tiny instruments inside your body. Dr. Shawn Tsuda is one of a growing number of surgeons worldwide offering da Vinci ® Surgery. Schedule an appointment to discuss the best treatment 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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