Treating the whole person: ACMC/Rice bariatric surgery program goes the extra step
By Anne Polta Staff Writer Weight-loss surgery has been refined significantly since it was first introduced more than three decades ago. Over the last 10 years, surgeons have gained a much better handle on which procedures are the most effective,...
By Anne Polta
Weight-loss surgery has been refined significantly since it was first introduced more than three decades ago.
Over the last 10 years, surgeons have gained a much better handle on which procedures are the most effective, the safest and longest-lasting, said Dr. Steven Bell, one of three surgeons at Affiliated Community Medical Centers who's trained to perform gastric bypass surgery.
"That's part of what changed the whole business with more and more bariatric surgeries being done," he said. "These surgeries have been refined and some of them have floated to the top."
The procedure offered locally is the roux-en-y. It is considered the gold standard in gastric bypass surgery, and has been found to be the most successful, at least so far, in helping patients manage their weight over the long term, said Dr. Thomas Lange of Affiliated and Rice Memorial Hospital's joint bariatric surgery program.
"I think the weight loss initially for the roux-en-y is better and faster," he said.
The procedure involves creating a small pouch on top of the stomach, Lange explained.
"The pouch size is restrictive. People get a sense of fullness. You literally can't eat large amounts," he said.
A loop of the small intestine also is brought up to reduce the absorption of calories.
The procedure takes two to three hours and generally requires a four- or five-day stay in the hospital.
The local program currently requires patients to be between the ages of 18 and 60 before they can be considered a candidate for gastric bypass surgery. Eligible patients also must be morbidly obese -- defined as at least 100 pounds over their ideal body weight -- and must have previously tried non-surgical, medically supervised weight loss.
They're screened as well for health issues that might hinder their recovery, such as tobacco or alcohol use.
Because a gastric bypass can't be reversed, patients who undergo the surgery must be prepared for the lifelong effects. Not only does it mean a permanent change in how much they're able to eat at any given time, but it also requires them to change what they eat to ensure they're getting adequate nutrition.
They must exercise regularly as well, so they can maintain their muscle mass.
This makes it especially important for patients to be educated and counseled ahead of time and to receive followup care and emotional support afterwards, said Kathy Schmoll, nurse case manager for bariatric surgery at Affiliated's Weight Control Center.
"We use a total multidisciplinary approach," she said. "It includes the surgeon. It includes the psychologist. It includes the respiratory therapist and the dietitian. We always look at the whole person."
Support group meetings once a month give patients a chance to connect with their peers, share their stories and swap tips and advice.
The surgery is "not a quick fix," Schmoll said. "They're on a diet for the rest of their life. To have surgery is not for everybody. It's only for selected people who cannot lose weight any other way."
For the staff, working with these patients has been highly satisfying.
"By the time they get to me, they are so motivated and so educated," Bell said. "Of any surgery I have the privilege of doing, these patients are the most educated as far as what they're getting into. It's really a joy to work with them because they're right there. They're asking all the right questions and they really want to make it work."
"As a nurse it is so rewarding working with this clientele," Schmoll agreed. "You get results, and oh my gosh, the rewards are so huge."
Providers predict the local demand for gastric bypass surgery will continue to grow. Increasingly, patients are entering Affiliated's medical weight loss program to seek weight-loss surgery.
Data being collected on patients and their outcomes will help local providers continue to refine and improve the program.
"We have a very good working relationship. The team has really been great," Schmoll said. "We're just very proud of this program."