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Month: September 2010

Lecture at Glendale College

September 23, 2010 10:44 pm


“”Weight Loss Surgery: Benefits and Risks”” is a free lecture at Glendale
Community College to be presented on Tuesday, September 28 as part of
the monthly Science Lecture Series.

The lecture will be held at 12:20 p.m. in Santa Barbara Building room 243.

Admission is free and open to the public.

The speaker is a bariatric surgeon, Dr. Ara Keshishian. He is the medical
director of Bariatric and Metabolic surgery at Verdugo Hills Hospital and has
a private practice in Glendale, Ca. Dr. Keshishian will discuss the subject beyond the billboards, radio ads and TV commercials and explore the future of weight loss surgery and treatment of obesity.

Omega Fatty Acids

September 22, 2010 12:24 am

Fatty acids are a byproduct of fat metabolism. These are acids that are produced when fat is broken down in our body. Fatty acids are important in a number of metabolic functions in our body. They help move oxygen, keep skin healthy, prevent aging at a cellular level, promote weight loss by promoting cholesterol processing by the body, and prevent build up of plaques in blood vessels. Examples of different types of Omega fatty acids are Omega-3, Omega-6, and Omega-9.

Omega-3 and Omega-6 fatty acids are essential fatty acids (EFA) because unlike other fatty acids, our body is not able to make them. Omega-9 fatty acids can be produces in out body.

These EFA are involved more specifically in regulation of blood pressure, cardiovascular health and others.

I have looked and have not found any studies regarding any relationship (positive or negative) associating Duodenal Switch and Omega Fatty acids.

I would however make some educated guesses here: The fact is that the lipid profile improves significantly with the duodenal switch operation is known. The duodenal switch operation can be performed with limited or not gastrectomy to correct significant lipid disorders that are either non responsive to medical treatments, or in cases where the side effect of statin medications are debilitating.

With this known, I would guess that even if the Omega fatty acids are not absorbed as well at least some of the beneficial effects are not lost. I would recommend that a healthy diet be used to assure adequate absorption of EFA.

Ask Dr. K: Problems over the years

September 09, 2010 10:42 pm

There are numerous sources available on the internet for patients to search for information. The information that one can find ranges from scientific to anecdotal. Patients individually have asked me a number of questions and I will peridically address them in an “Ask Dr. K” newsletter. I would also like for my opatients to submit their questions by emailing it to me.

“Problems Over The Years”

Question:
“What are the main things we should be looking for “symptom wise” at 3, 5, 7, or 10, etc. years out.
I’d like to know how the duodenal switch effects teeth? On hydration as I think my body pulls water from my stool when I’m not drinking enough. Actually – it’s not “enough” it’s that my body passes it out my kidneys if I am not sipping constantly throughout the day. Is that normal? Omega Fatty Acids – are we screwed? What do those deficiencies look like?”

Answer:
I do not know of any particular study that looks at the health of the
teeth specifically, however, I would assume that if a patient is not
complaint with their Calcium, or even complaint, and they are deficient
in minerals such as Calcium, Vitamin D, Magnesium, and others, then
one can develop poor teeth. Hydration is a very important issue. Surgery or not, most of us tend to run around a little “dry”. Constipation may be a side effect of inadequate water intake.
For the Omega fatty acids, see the next newsletter dated 9/22.

Question:
I would love to know what types of problems are seen in post operative patients and what the distributions are by years post-op.

Answer:
In very broad terms, I can classify them in both time frame, and in term of causes of complication (mechanical vs. nutritional). See table 1.

Please note that this is by-no-means a complete list, only a brief, very brief, overview of some of the potential problems that may surface. This list is not meant to be all inclusive or complete.

Table 1
Post operative
Time Frame
Nutritional Mechanical
Days Dehydration Leaks, abscesses,
infection (urinary,
pulmonary) DVT, PE,
Wound dehiscence, Bowel
Obstruction
Weeks Dehydration, protein
calorie malnutrition-acute
Wound infections, DVT,
PE, Bowel Obstruction
Months Protein Calorie Malnutrition, mineral deficiency, Kidney stones Bowel obstruction,
Cholecystitis (if your
gallbladder not removed)
Years 1-3 Protein Calorie Malnutrition, mineral deficiency, Kidney stones Bowel obstruction,
Cholecystitis (if your
gallbladder not removed)
Years 3-5 Occasional mineral
deficiency, Kidney stones
Bowel obstruction, Skin
Rashes (if applicable)
Years over 5 Occasional mineral
deficiency, Kidney stones
Bowel obstruction, Skin
Rashes (if applicable)

Deep Vain Thrombosis (DVT) Where a blood clot is formed in the deep venous system of the lower legs and can travel and block the flow of the blood to the lungs. If large enough in it a common cause of death in post operative patients. DVT’s are not the same as varicose veins.

Pulmonary Embolism (PE) A clot or a tumor that is dislodged from one part of the venous circulatory system and blocks the flow of the blood to the lungs. The most common source for the PE is a DVT.

Wound Dehiscence Complete or partial breakdown of the suture line at the deep layers where the bowel may become unprotected. In some cases this needs re-operation on an urgent fashion.

Summary of Selected Presentations of ASMBS Meeting Part 5

September 03, 2010 10:46 am

Long-Term Outcomes and Consequences of Distal Gastric Bypass (D-GB) In Severe Clinical Obesity

Sugerman et.al.-Surgery, Virginia Commonwealth University, Richmond, VA

This study was conducted to measure longterm weight loss and metabolic results in Distal Gastric Bypass (D-GB) patients within a 24 year time span. Through a bariatric database and office visits statistics were inquired about a 3 year cliental list of 40 super – obese and 6 morbidly obese cases that had the D-GB done with the Roux-En-Y bypass. Preoperative BMI in patients was 59 kg/m2 (80% being women) and the average age was around 36 years old. In addition, approximately 40% of the patients required limb-lengthening revision as a result of protein-calorie malnutrition, and thirteen patients required another surgery. Unfortunately, six to nineteen years later after the D-GB surgery was performed, eight patients died. As a followup, patients who did not have revision surgery showed some weight loss, resulting in a BMI of 34 kg/m2 and an initial excess weight loss of 67%. Patients did have beneficial results in terms of weight loss; however, the protein-calorie malnutrition was too high and some patients’ levels of iron and vitamin D dropped. Distal-GB isn’t the best primary operation for morbid or super obese patients.

Editorial: There has been a resurgence of the distal gastric bypass as a salvage operation for failed proximal gastric bypass operation. The distal gastric bypass operation is a tested procedure, with is known complication rates. The number of distal procedures had gone down significantly, till recently when some centers and surgeons started offering is a revision to other restrictive procedures. It is my opinion that the distal gastric bypass has significant metabolic and nutritional sequel that do not justify its superior weight loss. It is also important to remember that distal gastric bypass is not the same as the duodenal switch or the BPD operation.
Ara Keshishian, MD


Short Term Outcomes Comparing Roux-En-Y Gastric Bypass vs. Sleeve Gastrectomy as Treatment for Failed or Complicated Gastric Banding

Lieb et.al. Cleveland Clinic Florida, Weston, FL

Laparoscopic adjustable gastric band (LAGB) is a commonly performed bariatric operation; however, when major problems take place or weight loss disappoints a revision surgery may take place; Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) are the most popular options. This study was conducted to compare the efficiency of LRYGB and LSG from 2003 until 2008 analyzing weight loss in terms of the body mass index (BMI). A total of 25 conversions were performed, 13 from LAGB to LRYGB (patients losing 10 BMI points) and 12 from LAGB to LSG (8 points lost in BMI). Hence, after a year the LAGB to LRYGB portrayed more weight loss in comparison to the LAGB to LSG.

Editorial: A common patient presented to our office is a gastric bypass or a lap band that has had less than desirable weight loss. More so, some patients are presenting with complications, such as dumping syndrome, weight regain, nutritional deficiencies, slipped band, dilation of the esophagus and other. There are solutions that are being offered, and most are nothing more than a band aid. I believe that the best reversional operation for failed gastric bypass and the adjustable gastric banding is the duodenal switch operation. This issue was discussed at length last in July 2009 newsletter.
Ara Keshishian, MD