Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA.


BACKGROUND: The vertical gastrectomy http://www.alighterme.com/surgery_vg.html (VG) is the restrictive part of the technically difficult biliopancreatic diversion with duodenal switch operation (DS). The VG was originally conceived of as an independent operation-the first stage of a two-stage DS that would reduce mortality and morbidity in the high-risk superobese because of a shorter operating time and no anastomoses. This article presents two-year data after VG. METHODS: Laparoscopic VG was performed in a nonrandomized fashion in obese patients that met the NIH criteria for bariatric surgery. By using 5-7 firings of 45-60-mm linear 3.5-mm GI staplers along a 32-Fr bougie, a greater-curvature gastrectomy is performed and a 60-80-ml gastric tube is created. VG was compared to adjustable Lap-Band placement, Roux-en-Y gastric bypass (RGB), and DS. RESULTS: Between November 2002 and August 2005, 216 patients underwent VG. The mean age was 44.7 years (range = 16-64) and 173 (80%) were female. The mean preoperative weight and body mass index (BMI) was 302 +/- 77 lbs and 49 +/- 11 kg/m2, respectively. Of the 216 patients, 5 (2.3%) had a BMI > 80 kg/m2, 6 (2.8%) had a BMI of 70-80 kg/m(2), and 25 (11.6%) had a BMI of 60-70 kg/m2. The mean operative time was 66 +/- 11 min (range = 45-180) and the mean length of hospital stay was 1.9 +/- 1.2 days. Complications occurred in 20 (6.3%) patients (vs. 7.1% after Lap-Band). Leaks occurred in 3 (1.4%) VG patients, reoperations were performed in 6 (2.8%), and no conversions to open or deaths occurred. Weight loss on par with the DS and RGB was achieved with just the VG alone. CONCLUSION: The VG operation is able to achieve significant weight loss comparable to the RGB and DS operations but with the low morbidity profile similar to that of Lap-Band placement.

Assoc Press
Updated: 2:02 p.m. PT Aug 22, 2007


LOS ANGELES - The first long-term studies of stomach stapling and other radical obesity treatments show that they not only lead to lasting weight loss but also dramatically improve survival. The results are expected to lead to more such operations, possibly for less severely obese people, too.


Researchers in Sweden and the United States separately found that obese people who underwent drastic surgery had a 30 percent to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.


The research, published in Thursday’s New England Journal of Medicine, should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.


“It’s going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives,” said Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.


More obesity surgeries
Obesity surgeries have surged in recent years along with global waistlines. In the United States alone, 177,600 operations were performed last year, according to the American Society for Metabolic & Bariatric Surgery. The most common method was gastric bypass, or stomach-stapling surgery, which reduces the stomach to a small walnut-sized pouch and bypasses part of the small intestine where digestion occurs.


The Swedish study is the longest look yet at how obesity surgery affects mortality.


Researchers led by Dr. Lars Sjostrom of Goteborg University compared 4,047 people with a body-mass index over 34 who had one of three types of surgery or received standard diet advice. BMI is a standard measure of height and weight and a BMI over 30 is considered obese.


After a decade, those in the surgery group lost 14 percent to 25 percent of their original weight compared to 2 percent in the other group. Of the 2,010 surgery patients, 101 died. There were 129 deaths in the comparison group of 2,037 people.


In the U.S. study, Ted Adams of the University of Utah led a team that looked at 7,925 severely obese people in the state who had gastric bypass . They were matched with similar people who did not have the operation and who were selected through their driver’s license records listing height and weight.


After an average of seven years’ follow-up, 213 people who had surgery died compared to 321 who did not have the procedure. The study did not look at weight loss.


Deaths from disease drops
Deaths from diabetes in the surgery group were dramatically cut by 92 percent; from cancer by 60 percent and from heart disease by 56 percent. Surprisingly, the surgery group had a higher risk of death from accidents, suicides and other causes not related to disease. The researchers were puzzled by this.


Both studies were done before surgery advances that have led to smaller incisions and faster recovery time. Experts say future long-term survival rates from obesity surgery should be even better.


While neither study was the gold standard test, where patients are randomly given one treatment or another, surgery’s dramatic benefits make it ethically hard to deny patients the operation, said Dr. George Bray of the Pennington Biomedical Research Center at Louisiana State University.


Herb Olitsky, a 53-year-old business owner from New York City, credits his improved lifestyle to gastric bypass .


A diabetic, Olitsky was given months to live after developing a life-threatening bacterial infection near his heart muscles.


Olitsky, who stands 5 feet 8 inches, underwent stomach-stapling surgery in 1999 and went from 520 pounds to his current weight of 160. He no longer struggles to walk a quarter block and has managed to control his blood pressure and heart rate.


“I knew I had to get it and that’s what’s kept me alive,” Olitsky said. “I’m healthier now than I’ve ever been.”


More than 400 million people worldwide are obese and surgery is the only proven method to shed significant pounds in a short time. In the United States, it costs $17,000 to $35,000 and insurance coverage varies.


Weight-loss surgery is considered relatively safe with the risk of death from the surgery at less than 1 percent. Common complications include nutritional deficiency, gallstones and hernia.


U.S. guidelines recommend that surgery be considered only after traditional ways to slim down have failed. Candidates must be at least 100 pounds overweight and have a BMI over 40, or a BMI over 35 plus an obesity-related medical condition such as diabetes or high blood pressure.


This fall, a panel of experts from the National Institutes of Health will revisit the obesity surgery guidelines. It’s not yet known whether a BMI change would be considered, said spokeswoman Susan Dambrauskas.


Susan Pisano, a spokeswoman for America’s Health Insurance Plans, which represents 1,300 insurers, said the group will rely on any new recommendations from the federal government.


The Sweden study was paid for by the government-funded Swedish Medical Research Council, drug makers Hoffmann-La Roche Inc. and AstraZeneca PLC and Cederroth, which makes health care products. The U.S. study was supported by an NIH branch; one of the researchers has received a lecture fee from a company that makes equipment for obesity surgery .

It's the first time America is seeing one third of American Idol judge Randy Jackson! He's the latest famous name to go through the controversial weight loss procedure, gastric bypass surgery. Randy says he's been overweight his entire life, but it was his recent diagnosis of diabetes that forced him to take extreme measures. "Diabetes runs in my family, " he says. "I was afraid that if I didn't really get healthy and do something drastic that I may not be around that long. It's funny, diet and exercise really works, but when you're heavy, you don't want to workout. Now that I've lost this weight, I want to work out. If I don't do it, I'm mad, because I have all this energy!"


While Randy's career was climbing the charts, his weight was spiraling out of control. Before the surgery, he weighed 329 pounds. He's now lost 100 pounds and plans to lose another 20 pounds. One of his main motivations for weight-loss surgery was to be healthier for his wife and family. Says wife Erica, "I was very worried because we have children. He didn't take proper care of himself, and I wondered if we were going to have him around."


Now that Randy is more active and has to monitor what he eats, he feels healthier and like he's come out from behind a cloud. The cloud has lifted!


Gastric bypass surgery doesn't change eating habits, so many patients go through difficulties post-surgery as they learn how to eat with a new digestive system. Before surgery, Randy described himself as a "kid from the South" that naturally loves lots of sweets—cookies, cakes and pies. Now, he literally can't eat these foods because it can easily make him ill.


"I think, for me, as risky as this surgery is, it's a lifestyle-change decision. The word diet to me doesn't work, I really had to change my life. None of the behavioral things go away, but I get a jumpstart with this on my life. You go, 'If I'm going to go through a life-threatening surgery, so that I can try and live longer and help myself, I'm certainly not going to start back doing the things I know are wrong for me.'"

"I can shop at the Gap now."
Carnie Wilson


One year ago, Carnie Wilson went public with a drastic last attempt to lose weight. As the daughter of the legendary troubled musician Beach Boy Brian Wilson—her strained relationship with her father led her to a lifelong struggle with food.


Carnie began putting on excess weight at the age of four and dieting at twelve, but encountered her toughest struggles with weight when she started singing professionally with Wilson Phillips; the stress of being a performer led her to late-night eating binges. She says, "I started out about 180 pounds and then by the second album I was about 240 pounds... by May of '99 I was 300 pounds."


The excess weight began affecting her health—she was choking in her sleep and was terrified of having a heart attack. The whole time Carnie struggled, she dreamed of someday "wearing this little white T-shirt and 501 jeans at a good healthy weight and just feeling free."


After trying everything, Carnie decided the best thing for her was to have a lifesaving operation called gastric bypass surgery . This is a drastic operation which she describes as "essentially cutting your intestines and rerouting them." Her stomach is now the size of a lemon, limiting how much food she can consume at one time.


"I knew in my heart that that was the answer for me. It had to be done. I didn't have a choice." Carnie's surgery was successful and she has now lost over 150 pounds.


Carnie says that because surgery can't heal the emotional issues associated with being overweight, she knows weight "will always be a struggle for [her]," but she loves her new feeling of freedom and is satisfied... and happily reports that she has worn the white T-shirt with the 501 jeans. http://http://www.alighterme.com/success.html

By Associated PressLOS ANGELES (AP) -


Extremely obese people suffering from depression or anxiety tend to lose less weight after obesity surgery than mentally healthy people, researchers reported Thursday in a study that suggests such patients could benefit from treatment beforehand.


People diagnosed with mood or anxiety disorders on average lost 81 pounds six months after gastric bypass surgery compared to their counterparts who shed 86 pounds. Although both groups lost significant weight after surgery, people without mental health problems did slightly better.


"Patients with a lifetime history of mental health problems might benefit from closer surveillance," said lead author Melissa Kalarchian of the University of Pittsburgh Medical Center.


The federally funded research was presented at a meeting of bariatric surgeons in San Diego Thursday. Researchers plan to follow patients for up to two years to determine if there's a weight difference over time.


Many hospitals and insurers require surgery candidates to go through a psychological evaluation before obesity surgery to make sure they are mentally fit for the operation and the lifestyle change afterward. Depressed people aren't automatically disqualified for surgery, but those who are suicidal or abusing drugs and alcohol are usually ruled out.


How depression and other mental health disorders are handled before obesity surgery vary widely by medical center.


For example, surgery candidates at the University of California, San Diego, go through a rigorous mental health evaluation first.


Those with serious problems are usually treated before surgery. That could include antidepressants, psychotherapy or more family involvement, said the center's director William Perry.


"The success of surgery is only as good as the willingness of a patient to make a life change," Perry said.


In the new study, Pittsburgh researchers interviewed 207 surgery candidates and found two-thirds had a history of depression, bipolar disorder, post-traumatic stress syndrome or panic attacks. The vast majority were women with an average body-mass index of 51. A person with a BMI of over 40 is considered morbidly obese.


After adjusting for age, gender and race, researchers compared weight loss six months after surgery. Patients with a history of depression on average weighed 322 pounds before surgery and 241 afterward. Those with no mental health problems weighed 303 pounds before the operation and 217 pounds afterward.


Having a history of mental health problems should not prevent people from getting obesity surgery, even though they may not lose quite as much weight as mentally healthy people, said Dr. Philip Schauer, president of the American Society for Bariatric Surgery.


Gastric bypass, or stomach-stapling surgery, is the most common obesity operation performed in the United States with about 177,600 people undergoing the procedure last year. Federal guidelines say a person should be at least 100 pounds overweight and should have tried traditional weight-loss means before choosing surgery.


Gastric bypass involves reducing the size of the stomach and bypassing part of the small intestine, where digestion occurs. People eat less and absorb fewer calories as a result.


Meg Phelps, a 48-year-old social worker from Pennsylvania, struggled with major depression and low self-esteem for a decade. Often, she wouldn't go out or even make eye contact with people.


Four years ago, Phelps had obesity surgery at the Geisinger Medical Center in Danville, Pa. Beforehand, she had a medical evaluation and attended several months of counseling for depression.


Phelps, who weighed 335 pounds, shed 120 pounds after the surgery and no longer has to see a therapist. She even went back to college and got a degree in social work last year.


"It helped me to take charge of my life," Phelps said of the operation.

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