Category: Sleeve Gastrectomy
2015 ASMBS Summary
November 11, 2015 7:31 am
The 2015 ASMBS meeting was held November 2-6, 2015. It was combined with TOS (The Obesity Society) and had more than 5,600 attendees from all over the world in every aspect of obesity treatment. There were some interesting additions and deletions from this meeting compared to the past.
The one sentence that comes to my mind is “I told you so”.
One important addition was a DS course for Surgeons and Allied Health. This was very exciting, except the content and questions seemed to gravitate to SADI/SIPS/Loop rather than DS. Dr. Cottam was one of the moderators of the course. It seems that they have found the value in preserving the pyloric valve. It was clear that the discussion was driven by the need to come legitimize the single anastomosis procedures at this early stage with almost no data to prove long term outcome. With many of the Vertical Sleeve Gastrectomies having re-gain and the they are looking for a surgery that the “masses” can perform. This was actually the term used by one of the presenters, implying that the duodenal switch needed to be simplified so that all surgeons, those who have pushed all other procedures can not offer Duodenal Switch to their patients with less than desirable outcome. Several surgeons also voiced their concern and dissatisfaction with the issues and complication of the RNY and want an alternative. There was much discussion regarding SADI/SIPS/Loop being investigational and that it shouldn’t be as it is a Sleeve Gastrectomy with a Billroth II. Dr. Roslin and Dr. Cottam discussed their SIPS nomenclature saying they wanted to stay away from something that had Ileostomy, suggesting bowel issues, or the word “SAD”i due to negative connotations. The point to be made is that the SADI and SIPS and the loop are all the same. I have also noticed other surgeons using SADS (Single Anastomosis Duodenal Switch). There is a great deal of industry behind these procedures and many surgeons being trained in courses funded by industry. One surgeon stood up and informed the entire course that they need to be clear with their patients about the surgery they are performing, as he had been in Bariatric chat rooms and there is upset within the community about SADI/SIPS/Loop being toted as “the same or similar to Duodenal Switch”.
There was also presenter who said “We are doing something new about every five years.” No, “we” are not. Some of us have stood by the surgery and techniques with the best long term outcomes and not gone with every “new” thing out there. The process of Duodenal Switch may have changes, open Vs. Lap, drains, location of incisions, post operative care and stay, but the tested procedure with the best outcome has been the duodenal switch operation and not the shortcut versions. Although, those of us that are standing by long term results seems to be in the minority. Why do I stand by Duodenal Switch? Because it works, when done correctly by making the length of the bowel proportional to the patient total bowel length, and height, and not just cookie cutter length for all patients, with the right follow-up, patient education, vitamin and mineral regime and eating habits.
A new addition was the Gastric Balloon, which in the research presented had a 60-70% re-gain rate and a no more than 10-15% weight loss one year only. This data represents more than 70% weight regain when the balloon is taken out. The Gastric Balloons can be left in between 4-6 months depending on the brand or type of balloon. The Gastric Balloon is not new to the Bariatrics and was first introduced in 1985. After 20 years and 3,608 patients the results were and average of 17.6% excess weight loss. It seems that we are re-gurgiating old procedures. There are many new medications that were front and center in this meeting.
The Adjustable Gastric Bands were missing from the exhibit hall this year. It is my hope and feeling from the other attendees that we may be seeing the era of the Adjustable Gastric Band being placed in patients come to an end. Although there are some still holding out that there are some patients that can do well with the Band.
Attending the 2015 ASMBS meeting this year, as it has every year, only reemphasized the importance of avoiding what has become the norm of chasing a simple solution that is fashionable and easy now. We stay convinced that the duodenal switch operation with the common channel and the alimentary length measured as a percentage of the total length is by far the best procedure with the proven track record. The patient should avoid the temptation of settling for an unproven procedure or device, because if history holds true, there will be a need for revision surgeries in the future.
Staying on Track and Surviving Halloween
October 27, 2015 6:07 am
Halloween is the start of temptations during the holiday season and surviving Halloween is possible. It’s a time of high carbohydrate treats that can turn into a nasty trick of regain or slowed weight loss. Halloween is a fun holiday that you can participate in with some foresight and planning. Sugar and simple carbohydrates are easily absorbed and can decrease weight loss or regain. The following are some helpful tips to keep you on track.
- Stay steady with high protein, hydration, vitamins and minerals. Protein and hydration will keep you full and help curb the carb cravings.
- Make you own high protein treats. There are so many great recipes out there.
- If you give out candy don’t buy candy that you like. In fact, do the opposite and buy candy you dislike.
- Don’t give out candy at all. Instead opt to do a non-candy type item, stickers, pencils, rings, trinkets, easers, small coloring books, or other small items.
- Keep a list of your goals posted in a visible place.
- Make a picture collage of your goals, achievements you want, and non-scale victories you’d like to achieve posted in a high visibility location.
Stay strong and avoid the pitfalls of temptation.
Shared Success Story- Stephanie U.
September 22, 2015 7:38 am
When I think back as far into my childhood as I can remember my weight was always a problem. I grew up being made fun of and missed out on the simple things that normal kids do growing up because my weight caused limitations.
Even into early adulthood I was still made fun of, but I learned to deal with it. I tried different methods of trying to lose weight. I went to a gym, tried diet pills, followed diets, cut out foods, sodas, alcohol, etc. Sure these things worked (very slowly) for a period of time, but then I would plateau and became discouraged and gain whatever little weight I lost plus some. By the time I was 27yrs old I found myself at my heaviest at 245lbs and I was also pregnant with my first child. I was lucky enough to have a healthy pregnancy. However after I had my daughter, I went up to 265lbs and just couldn’t get it off. I felt the toll the weight was taking on my body. My hips would ache, go numb, my lower back would get stiff, I would become winded just walking upstairs, it was difficult to get up from sitting, my feet would be sore if I was standing too long. I began to realize this was just going to get worse as time went on and as my daughter got older parenting would become more difficult. It became an even bigger concern to be healthier now that I had a little one depending on me and looking up to me.
I decided to explore the option of surgery in late 2013. I knew it was something that my insurance would cover so long as I met the requirements so I set out to find a reputable surgeon in my area.
Surprisingly I reached out into a Facebook group and was overwhelmed with recommendations for Dr. Keshishian (I was originally interested in the DS surgery). I went for my consultation in December of 2013. Upon meeting with Dr. Keshishian I knew I wouldn’t have wanted anyone else to perform this surgery on me. He was very upfront, honest, and straightforward with information regarding what was to come and the effort that needed to be put forth in order for this to work. The Gastric Sleeve was brought up and I decided to go with the sleeve surgery. I pushed forth and the staff at Dr. K’s office began the process of approval which happened to move very swiftly and smoothly.
I ended up having my surgery on 4/11/14 and I weighed 265lbs on the day of. Today, as I write this I am, approaching my 30th birthday healthier than I think I have ever been and I currently weigh 152lbs. The adjustment post-op was not an easy one, but it was well worthwhile. I am much more active, able to keep up and play with my daughter. I feel like I am living a normal life for once. I was scared, nervous, and had so many worries running through my head prior to surgery but now that I have gone through it I would make the same decision all over again in a second’s time.
Shared Success: Kurtis R.
September 08, 2015 5:27 am
For most of my life I had always been on the heavier side of the scale. Since I was a kid I’ve been extremely active with sports and other activities that required me to be running around, but my diet wasn’t on the right track. Even with all the working out or running I did, my diet is what led me to having the body I didn’t want anymore.
I didn’t have the same troubles a lot of bigger or heavier kids had. I wasn’t picked on or depressed. I was liked by just about everyone and had a large group of friends. That part of my life has never changed. What did change was the way I looked at myself in the mirror. I never had confidence in myself when it came to most aspects of life. Sports, I had all the confidence in the world. Nobody could strike me out, or get passed me with a football. The day it really changed for me was about 3 years ago. I was sitting on my bed, about to go to the store and realized I couldn’t bend down far enough to put my socks on without sucking in, holding my breath and leaning my legs out to the side. I got on the scale and realized I had hit 410LBS. 410LBS with a BMI around 50% at 22 years old. A weight I had never thought about, but also a weight I never thought I would be. I was lazy and didn’t care about what I ate. I worked from 7-4 and then played video games until it was time to go to sleep. No exercise and a terrible diet only lead to one result, and that’s a very unhealthy body. I brought this all up to my mom (who had gastric bypass ~15 years ago) and she said if I wanted, we could look into the weight loss surgery options.
She did the work in the beginning, finding out where we needed to go and when I decided I wanted to do this, she was there with me at the group meeting where we first met Dr. Keshishian. I knew from the second I saw his bow tie that he would be a pleasure be around. He brought out pictures and described the differences, pros and cons of each different surgery, I knew Dr. Keshishian was the doctor I wanted. Originally I wanted to just have the Gastric Band, but after hearing Dr. Keshishian go through every option, I ultimately decided to have the Sleeve Gastrectomy done. This was one of the best decisions of my life.
I had the surgery done in March of 2013 (~2.5 years ago) with a starting weight of 410 LBS. Now, 2.5 years later I weigh 250LBS and have lowered my BMI to about 20%, a number that I’m focusing on now. I didn’t have the surgery to become a skinny man. I like being a bigger guy. I just want to be healthy and get my BMI to about 12-15%. With the help and motivation from my parents, friends, family and beautiful girlfriend Kori, there are no doubts in my mind that I’ll be able to reach my end goal and continue on this path of health and exercise for the rest of my life.
Revision of a Sleeve Gastrectomy or RNY
August 31, 2015 6:32 am
These are examples of two types of patients referred to us for revision surgery.
The first example is a gastric bypass that we revise to the duodenal switch operation. The upper GI series after the revision, shows a “banana shaped” stomach, the pyloric valve and the duodo-ilesotomy anatomosis component of the duodenal switch.
The second example, images noted below, is that of a sleeve revised to the duodenal switch – both operations done at different institution. Note how the stomach is not a “banana shaped” and more like a funnel with a narrowing at the bottom of the stomach- a stricture.
Internal Hernia And Bowel Obstruction
August 21, 2015 7:49 pm
Whenever there is a bowel resection with anastomosis made there will be a defect in the mesentery (the tissue that holds the blood supply and the nerves etc going to and from the bowel) that needs to be closed. In this particular case, the stitches that were used to close the defect were intact and yet the tissue had separated from it. The result is an internal hernia. This can cause bowel obstruction, where by a loop of the bowel can go through the defect and kink the bowel causing the blockage. In some cases, the internal hernia may reduce itself with intermittent symptoms of the bowel obstruction and in other cases it may require immediate emergent surgery. A CAT scan with oral and IV contrast is needed after Duodenal Switch to visualize the alimentary and bioliopancreatic limbs.
Symptoms may include but are not limited to:
- nausea
- vomiting
- abdominal bloating
- abdominal tenderness
- cramping abdominal pain
- diarrhea, constipation
- feeling of inability to completely empty bowels
- fever
- severe abdominal pain.
Surgical Treatment of Gastric Fistula
August 05, 2015 7:45 pm
Alcohol and Weight Loss Surgery Webinar May 20, 2015
July 27, 2015 7:27 am
Band Removal Revision to Sleeve Gastrectomy
July 06, 2015 11:49 am
Shared Success Story- Kylie
June 08, 2015 6:29 pm
I never knew how big and unhealthy I was until I decided I wanted a change. My experience with Dr. Keshishian and his staff was nothing less than amazing. He was very informative and made me feel comfortable and safe when undergoing the procedure. Not only did he operate on me, but also my brother, dad, and uncle as well. We are all so grateful for him and his knowledge as a surgeon. My mom had gastric bypass in 2005 by a different doctor and has numerous problems. We are all hopeful that eventually Dr. Keshishian will be able to help her also. Having my whole family’s support and understanding made the experience much easier for me. I am now happier and healthier than I’ve ever thought I’d be.
Before surgery, I weighed 250lbs, and my pant size was a 22. I now weigh 160lbs with a pant size of 8-10. I decided to have surgery because I wanted to be the confident girl who was trapped inside a 250-pound body to be able to shine. I wanted to be active and live a long and healthy life. I also wanted to start this lifestyle now so that when I have children one day, I can be a good example to them on how to be active. Most importantly, I wanted to be comfortable in my own skin. I wanted to feel beautiful. I was always “bigger.” I was a cheerleader from toddlerhood until high school and a swimmer for 12 years. I always stayed very active. Once I graduated high school, I moved out of state to attend cosmetology school and my active lifestyle completely stopped. I ate unhealthy and became very lazy. I wasn’t proud of the person I was becoming and struggled to change my bad habits. My brother had his surgery while I was in Idaho, and when I saw how great he was doing, I was inspired. I decided to fly home and meet these people and then it was my turn.
My Life has changed dramatically since I first met Dr. Keshishian. Working out and eating healthy have become habit. I ran in my first 5k, 10k, and half marathon. I continue to run every day in hopes of running in a full marathon. I LOVE to run, and have made it a way to relieve stress. Running has become good therapy for me. I love cooking and experimenting with foods I didn’t even know existed before I had surgery. It’s been 2 years, and I still haven’t bought or had a soda. I eventually gained what I call my “gym family.” I am there so often, that eventually, most of my friends were from the gym and people who have similar goals.
This surgery affects everyone differently. For me, it was a game I had to play with my mind. Being big, I loved the satisfaction of feeling full after a meal. I would order food and try to decide if it was enough to make me full. After surgery, I would forget that I couldn’t eat that much. I would still want to order the item with the most food. It was almost like the “Old Kylie” was still sitting in the back of my mind telling me what I would have ordered before my surgery. I had to learn to be tough, and ignore her. That was (and sometimes still is) one of the hardest things I’ve had to do. I would look in the mirror and still see a 250 pound girl. I had to have a mental talk with myself, and look at old photos. It was a temporary issue I had with myself. I’ve learned so much about who I am since the surgery, and am so happy with the woman I have become. Having this surgery has made me feel like I can conquer anything I put my mind to. I had no idea how mentally strong I was until I made the choice to have this procedure. This will always be one of the best decisions I’ve ever made for myself, and I’ll always be supportive of others who are thinking of choosing the weight-loss surgery. I owe Dr. Keshishian so much for giving me my life back. Thank you!