Today I was thinking...

This morning I gave another Fresh Start seminar to prospective patients. I do this about 3-4 times a month and there are always interesting questions from the audience at the end. Today I met a delightful young woman who said, "I had a 'Gastric Stapling Procedure' back in the 1980s and I have gained my weight back. Am I was still a candidate for a Laparoscopic Gasstric Bypass?"

The procedure that is popularly known as "gastric stapling" is technically a vertical banded gastroplasty. This was an early attempt of Dr. Ed Mason in at the University of Iowa to help persons of size resolve their obesity and was used by many surgeons for a great many patients. The operation helped patients loose about 35% of their excess weight but the frequency of recurrence of obesity was very high. The operation created a small pouch of stomach below the junction of the esophagus and stomach with staples but left a small opening between the pouch and stomach open. A non-adjustable "band" was placed around this opening in an attempt to keep the opening from getting bigger. Unfortunately the band often failed to keep the restriction needed and would allow too much dilation over time. Also, since the pouch was in continuity with the rest of the stomach, any food that passed through the opening had no restriction and was absorbed normally. Of course, high calorie liquids would run right through the opening and would thwart the weight loss process and the patient could gain weight again. Also since the part of the stomach that produced the hormone, ghrelin, that makes us hungry for breakfast, lunch and dinner as not excluded from the flow of nutrients patients experienced no decrease in hunger. Also, since there was no opportunity to adjust the outlet of the pouch many patients did not feel restricted or their sense of restriction eventually went away and their obesity returned.

I told her, "Please do not 'beat up' on herself for gaining back her weight after the 'gastric stapling' because it was not a very successful operation and has been abandoned by nearly all bariatric surgeons since we have better techniques today." This was not a long term solution for most patients that had this procedure and as far as I am concerned I feel "failure" is nearly inevitable because it is the operation that failed the patients.

I further explained, "You can be converted to a Roux en-Y Gastric Bypass and usually I can do the operation laparoscopically even though your first operation was done open through a large incision." I have found this revision to be nearly as successful as the usual gastric bypass operation and have been very fortunate to have few complication after doing this revision but the risk of complications such as a staple line leak are reported as higher than if this was the first operation on the stomach.

She was excited about this possibility and is looking forward to starting the process. I feel she has every right to feel this revision could help her find a better long term solution for her obesity and I would be honored to be part of her transformation.