Friday, February 08, 2008

By Victoria O’Hara – Belfast Telegraph
An Ulster woman last night said she was left devastated after being told – on the very day of the life-changing surgery she had waited months for – that it was only performed in England.

The woman, who is from the Antrim area, had her bags packed ready to undergo bariatric surgery – an elaborate procedure designed to promote weight loss – in the Royal Victoria Hospital, Belfast on Wednesday.

She had been preparing for almost four months after receiving a date for the operation in October.

Within 10 minutes of the hospital confirming there was a bed available she was left “stunned” when they rang back informing her a decision to cease bariatric surgery in Northern Ireland had been taken by health chiefs.

The woman, who wishes to remain anonymous, said she was left in tears as she had been “mentally prepping herself” for the surgery for months.

“The night before I couldn’t sleep, I felt like a child on Christmas Eve I was so excited,” she said. “This was supposed to be my new life.”

She added: “My friend was here ready to take me to hospital, I had the house cleaned and sorted out legal affairs.

“I had gone off work, told my children, packed my suitcase and set aside 12 weeks to recover. “There was so much to arrange.”

The surgery will take place in Leeds within four to six weeks.

She said she is now worried about how she will cope having the procedure away from home.

“Now I’m going to have to fly to Leeds on my own. And my eldest child is worried about me being on my own.

“I have been gearing up to have this done over the last five years. I am just so disappointed and angry.

She added: “The surgeon has contacted me and said he was sorry about the situation.

“I am not sure if it is a budget issue or what, but this shouldn’t happen to people. If a decision had been taken earlier, why wasn’t I told? Psychologically, it has a big affect on a person.”

Belfast Health and Social Care Trust issued an apology.

“The hospital was directed, under guidelines issued by the National Institute for Health and Clinical Excellence, to discontinue the procedure,” a spokesman said.

“Unfortunately, this information was not communicated in time to the patient and we apologise for the inconvenience,” he added.

By DENISE GRADY New York Times
Published: January 23, 2008
Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. (Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.)

But the new results probably do not apply to all patients with Type 2 diabetes, because the people in the study had fairly mild cases with a recent onset; all had received the diagnosis within the previous two years. In people who have more severe and longstanding diabetes, the disease may no longer be reversible, no matter how much weight is lost.

The operation used in the study, adjustable gastric banding, is performed through small slits and loops a band around the top of the stomach to cinch it into a small pouch so that people eat less and yet feel full. Other weight-loss operations are more extreme and involve cutting or stapling the stomach and rearranging the small intestine. Of the 205,000 weight-loss operations performed in the United States last year, 25 percent to 30 percent used the gastric banding.

Remission of Type 2 diabetes after weight-loss surgery is not a new finding; doctors have known about it for years. But the new research is the first effort to find out scientifically how it measures up against medical treatment in similar groups of patients with the disease.

The study reflects a growing interest among researchers in using surgery specifically to treat Type 2 diabetes, even in people who are not as obese as those who typically undergo operations to lose weight. The new thrust is in some sense a measure of desperation, as the United States and the world face increasing rates of the disease and its devastating complications, which can include heart attacks, blindness, kidney failure and amputation. To many doctors, the time is ripe for studying surgery as a potential cure for diabetes, and also as way to understand the disease better and develop better drugs to treat it.

Medical societies in the United States and abroad that once called their specialty bariatric surgery, a term that refers to weight loss, have started adding the word “metabolic� to their titles to emphasize the new focus on diabetes.

“I think diabetes surgery will become common within the next few years,� said Dr. John Dixon, the lead author of the study and an obesity researcher at Monash University in Melbourne, Australia, where the research was conducted.

The study and an editorial about it are being published Wednesday in The Journal of the American Medical Association.

The editorial, by doctors not involved in the study, said, “The insights already beginning to be gained by studying surgical interventions for diabetes may be the most profound since the discovery of insulin.�

A researcher who is not a surgeon and was not part of the research, Dr. Rudolph L. Leibel, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center, said the study was important because it showed that a minimally invasive type of surgery could reverse diabetes.

“At this point,� Dr. Leibel said, “maybe we should be more accepting or responsive to the idea of surgical intervention for reducing or prevention of diabetes and its complications.�

But at the same time, he said, caution was in order, because the study lasted only two years and it would be essential to find out how these patients fared over time.

About 19 million people in the United States have Type 2 diabetes, and another 54 million are “prediabetic,� meaning they have abnormalities in their blood sugar that increase their risk for the disease, according to the American Diabetes Association. Diabetes is the fifth-leading cause of death by disease in this country, killing about 73,000 people a year. The number of cases in the United States is growing by about 8 percent a year, according to the association. Though treatable, the disease is not curable, and it is often poorly controlled.

The 60 people in the study had an average age of 47 and were assigned at random to have either surgery or medical care. All were obese, with a body mass index, or B.M.I., of 30 to 40. A B.M.I. over 25 is considered overweight, and over 30 is obese. (A person who is 5 feet 6 inches tall with a B.M.I. of 25 would weigh 155 pounds; with a B.M.I. of 30, 186 pounds; a B.M.I. of 35, 216 pounds; and a B.M.I. of 40, 247 pounds.)

Based on guidelines created by the National Institutes of Health in 1991, weight-loss surgery is generally only recommended for people whose B.M.I. is 40 or more, unless they also have Type 2 diabetes, in which case a B.M.I. of 35 is the cutoff. In this study, 13 people, or 22 percent, had a B.M.I. under 35.

Medicare covers weight-loss surgery according to the institutes’ rules, but many private insurers refuse to cover the surgery at all, said Dr. Philip Schauer, director of the bariatric and metabolic institute at the Cleveland Clinic. He said his center had to turn away three or four patients for every one accepted because insurers would not pay.

On average in the United States, banding costs $17,000 and the other bariatric operations $25,000.

Dr. Schauer said that the B.M.I. cutoffs did not make sense medically and that the study “blows away this arbitrary barrier.� He said that the cutoffs should be lowered, so that a patient with diabetes and a B.M.I. of 34.9 would not be considered ineligible, as is now the case.

Dr. Francesco Rubino, director of the metabolic surgery program at NewYork-Presbyterian/Weill Cornell Medical Center, also said that the criteria for the surgery should be changed so that it could be offered to diabetes patients early enough to reverse the disease.

Dr. Rubino and other researchers said that weight-loss operations that rearranged the small intestine had faster and more powerful effects on diabetes than did the banding, because the other operations changed the levels of certain gut hormones that greatly improve the body’s ability to control blood sugar, weight and lipid levels in the bloodstream. These operations, and the hormones responsible, have become the focus of intense research.

Dr. Dixon has received research grants and speakers’ fees from the company that makes the gastric bands, Allergan Health, and the company paid for the study through a grant to the university. But his report said the company had no influence on the design of the study, the data or their report.

The editorial writers said they had accepted travel grants from Allergan and other companies to attend a conference on diabetes surgery in Rome.

With thanks to Dr Milton Owens & Rancho Speciality hospital California

The procedure was originally conceived of in England and has been further developed and utilized in the U.S, Germany and Belgium. The technique is an improvement over earlier gastroplasty procedures which included placement of foreign bodies, and left the excess stomach intact. It was originally used for very high BMI patients (~ 500 lbs.) to try to reduce the overall risk of surgery. It was then followed by a second surgery when the patient had lost enough weight to safely go through a second procedure like the Gastric Bypass.
The new procedure was started in England about 5 years ago as a stand alone procedure for patients of BMI’s of 35-45. It proved to be quite safe and effective even at 5 years post op.

U.S. studies have been very impressive; in one study of almost 100 very high risk, very high BMI patients there were no deaths, and only 1 leak, and 1 pulmonary embolus.

Dr. Owens has used this procedure for high risk, high BMI patients with good results. It can be considered by patients who are:

Concerned about bowel obstructions and leaks that may occur with Gastric Bypass due to the re-arrangement of the anatomy required.
Concerned about the dietary changes and vitamin supplements required by Gastric Bypass
Concerned about the foreign body introduced with the Lap Band placement
Concerned about the need for follow up, fills required with the Lap Band
It should also be considered for patients weighing over 500 lbs, patients with existing anemia, Crohn’s disease, or other conditions that make them too high risk for Bypass procedures.

Dr Owens is the first surgeon in Southern California to offer Sleeve Gastrectomy. His expertise in Sleeve Gastrectomy offers our patients another option to help them receive the best weight loss procedure for their individual needs. Vertical Sleeve Gastrectomy procedure also called Sleeve Gastrectomy, vertical gastroplasty, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and Sleeve Gastroplasty is performed by approximately 18 surgeons worldwide.

Choosing the Sleeve:

 • Those who are concerned about the potential long term side effects of an intestinal bypass such as bowel obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
• Those who are considering a LapBand but are concerned about a foreign body or the need for fills and more frequent follow up.
• Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, and other complex medical conditions.
• Those taking anti-inflammatory medications that may need to be avoided after gastric bypass due to increased risk of ulcers. Advantages of the Sleeve:
• Stomach holds less but tends to function normally so most food items can be consumed in small amounts
• Thought to eliminate the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
• No dumping syndrome
• Minimizes the chance of an ulcer occurring.
• Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
• Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2).

Extract from study paper published in Obesity Surgery. 2007 Jul
 Andrew A Gumbs , Michel Gagner , Gregory Dakin , Alfons Pomp 

The rising prevalence of morbid obesity and the increased incidence of super-obese patients (BMI >50 kg/m2) seeking surgical treatments has led to the search for surgical techniques that provide adequate EWL with the least possible morbidity. Sleeve gastrectomy (SG) was initially added as a modification to the biliopancreatic diversion (BPD) and then combined with a duodenal switch (DS) in 1988. It was first performed laparoscopically in 1999 as part of a DS and subsequently done alone as a staged procedure in 2000. With the revelation that patients experienced weight loss after SG, interest in using this procedure as a bridge to more definitive surgical treatment has risen. Benefits of SG include the low rate of complications, the avoidance of foreign material, the maintenance of normal gastro-intestinal continuity, the absence of malabsorption and the ability to convert to multiple other operations. Reduction of the ghrelin-producing stomach mass may account for its superiority to other gastric restrictive procedures. SG should be in the armamentarium of all bariatric surgeons. Nonetheless, long-term studies are necessary to see if it is a durable procedure in the treatment of morbid obesity. 

By LYNDSAY MOSS
HEALTH CORRESPONDENT Scotsman
A SURGEON opted to go under the knife himself for an operation that is becoming popular in the fight against obesity.

Chris Oliver lost more than seven stone after the procedure to limit his food intake. And now he is to donate his surgical robes, or “blues”, which he had to have specially made to cope with his 26-stone bulk, to a museum.

He is hoping his story will inspire others who have struggled with serious weight problems to consider the radical operation.

Mr Oliver, 47, a consultant orthopaedic surgeon at Edinburgh Royal Infirmary, decided on the operation – known as bariatric surgery – last year after visiting the Great Wall of China and being unable to walk it.

He had also developed type-2 diabetes linked to his obesity, which increases the risk of heart disease and stroke.

Although Mr Oliver never struggled with his weight early in life, the pressures of work and professional exams saw him pile on ten stone in 20 years.

“Making the choice to have surgery took me a while, and I guess for many people the choice is really hard.

It’s the individual who finally makes the choice,” Mr Oliver said.

After considering the complications, and writing a living will in case something went wrong, he had a gastric band fitted at the Nuffield Hospital, Glasgow, in February. The band is a belt that is tightened around the stomach, reducing the amount of food that can be consumed.

Mr Oliver has since lost almost 100lb, taking him to 19st, and is hoping to shed a further 4st by Christmas. The father of two teenage daughters has also been taking regular exercise, including cycling. “I’ve had to cut links out of my watch strap and all my shoes are too big,” he said.

Mr Oliver has just handed over his surgical blues for public display. “I can now fit into normal surgical wear, so I donated them to the Royal College of Surgeons Museum – a bit of bariatric social surgical history,” he said.

The operation came to prominence when the former television presenter Anne Diamond admitted last year that she had had a similar procedure.

Choosing to pay for gastric band surgery – which costs between £7,500 and £8,000 – means patients can avoid long NHS waiting lists. But surgeons will still carry out the operation only as a last resort.

David Galloway, a consultant bariatric surgeon in Glasgow, said he had performed up to 500 gastric-band operations in the past seven years – 200 of these in the past year alone.

“My strong impression is that this type of surgery is increasing,” he said. “It can be difficult to access this surgery on the NHS, which rightly tries every other option for patients.”

Mr Galloway said weight-control surgery was not a “magic bullet” and was not the only option for patients. But he added:

“For the right patients, surgery can be a passport to a happier and more fulfilled life.”

Shona Robison, the public health minister, said: “Surgery for obesity is rare and should only be used when all appropriate and available non-surgical measures have failed.”

Centres for obesity surgery are run in Glasgow and Aberdeen, with plans for a further one in Dundee or Edinburgh.

THE PLASTIC BAND THAT STOPS YOU EATING
GASTRIC banding is the most commonly used weight-control surgery in the UK.

The plastic band acts like a belt, positioned around the top portion of the stomach.

This reduces the space in the stomach so patients feel full after eating only a small quantity of food – around three small meals a day.

• A more major procedure is a gastric bypass operation. This works by making the stomach smaller and removing part of the bowel to make the digestive system shorter. It means patients can only eat small meals and their body will take up fewer calories from what they eat.

• Any kind of weight-control surgery is a major procedure, with a small risk of complications. Doctors also warn surgery will not be successful unless patients exercise and eat properly.

• The risk of complications means some patients opt for quicker fixes such as liposuction. But the fat can easily return unless a healthy diet is followed.

• Doctors can also prescribe certain weight-control drugs.

Scotsman 5 Nov 2007
LEADING surgeon Chris Oliver, who has had gastric band surgery, says he is “delighted” at being re-elected on to the council for the Royal College of Surgeons.

The consultant trauma orthopaedic surgeon at Edinburgh Royal Infirmary had the “life-changing” operation after tipping the scales at 26 stone.

Dr Oliver, 47, said: “I am delighted I have been re-elected to RCSEd Council for five years. Congratulations also to Judy Evans who got the other place.

“It has been an amazing year for me. My life has changed completely since my lap band surgery as I have now lost 100 pounds in weight. My new-found fitness and energy will allow me to return to my previous sporting activities.”

Surgical videos on WeBSurg

You can watch a Sleeve Gastrectomy on the Web. This video demonstrates a routine case of laparoscopic sleeve gastrectomy for morbid obesity. This is usually the first stage of a two-stage procedure. The surgeon starts at the mid portion of crow’s foot about 7 cm from the pylorus and mobilizes all the greater curvature vessels and attachments using bipolar cautery. After full mobilization of the greater curvature up to the angle of His, the gastric sleeve is constructed using a linear stapler. A bougie is used to calibrate the diameter of the gastric sleeve. The specimen is removed from an enlarged trocar site. The surgeon in this case placed a drain.
To watch the procedure visit http://www.websurg.com/ref/Laparoscopic_sleeve_gastrectomy-vd01en1853.htm 

Here’s an extract of a press release we saw this week.  It’s good to know Stomach Balloons are being more widely offered in the UK, but the cost is, as one would expect, significantly higher than in the Czech Republic. 

“PRIVATE SECTOR LEADS WAY WITH FAT BALLOON IMPLANTS – POSSIBLE CURE FOR OBESITY
The Hospital Group are one of the first medical organisations to provide what are referred to as “balloon implantsâ€� – a new revolutionary weight loss treatment, ignored by the NHS, which could save thousands suffering from the effects of obesity and its associated diseases.

The Hospital Group, the UK’s leading provider of weight loss surgery, are set to insert silicone balloons into the stomachs of people who are over weight with a BMI of 30+ – making them eat less, feel full and re-learn eating habits over a period of six months.

The procedure is already popular in the States and experts are predicting it could provide the answer the Britain’s obesity crisis. Recent research shows that almost one in four adults are now regarded as obese and two thirds as being overweight.

As demand for weight loss solutions grow, The Hospital Group predict that the gastric/silicone balloon could be the long awaited answer for short term weight loss. It is not, however, recommended for the morbidly obese – which Government watchdogs point as the reason why the NHS is turning a blind eye to such an effective weight loss treatment.

A new study from Brazil showed that patients who had this revolutionary treatment lost almost half their excess weight and with the gastric balloon suffered no side effects.

The gastric/silicone balloon is a non-invasive way of reducing the size of the stomach. A balloon is put in under sedation and the patient suffers only mild discomfort. Most patients say they don’t even feel that it is there. The objective of the balloon is to re-educate the patient about food and their relationship with it.

If patient starts to gain weight again they may require a gastric band or bypass. The gastric/silicone balloon is designed to act as a form of portion control allowing patients to lose weight whilst maintaining a healthy balanced diet.

Silicone balloon prices start at £3,950. For more information contact The Hospital Group, website: wwwthehospitalgroup.org or call: 0800 135 3055

Press Note: we do not have case studies yet as this proceedure is only being introduced through The Hospital Group this week. “

The Border Mail – Australia 30 August 2007
SEVERELY obese Australians should have access to cheap lap-band surgery to lengthen life and reduce the weight burden on the health system, obesity experts say.

Specialists are urging the Federal Government to make Medicare rebates available for the controversial stomach surgery, after international studies confirmed it could cut death rates.

Research from the US and Sweden released this week showed obese people who underwent the procedure had a mortality rate up to 40 per cent lower than their bandless counterparts.

Public health specialists say mounting evidence supports making lap-band surgery more widely and cheaply available for Australians with an extreme weight problem.

Access in the public health system is very limited.

Almost all of the 8000 people who get the adjustable band fitted each year pay up to $10,000 to have it done privately.

Professor John Dixon, from the Centre for Obesity Research at Monash University in Melbourne, said it was time to act now to make lap-band surgery publicly funded and widely available.

While it was expensive, the surgery had been proven beyond a doubt to be cost-effective, he said.

“It extends life, improves quality of life and severely limits the risk of developing diabetes, heart problems and other disease, but we have been slow to act on that knowledge,� he said.

Professor Dixon said about 8 per cent of adult Australians were obese, with a body mass index over 35, making them eligible for lap-band surgery.

“We’ve got to be realistic. That is what health is about,� he said.

Banbury Guardian 29 August 2007

A MOTHER who is sporting a whole new look after undergoing major plastic surgery will be baring all on national television.

Salena Newport, 40, of Adderbury is appearing on Channel 4 makeover programme 10 Years Younger on Thursday, August 30, where viewers will see the results of her extensive operations.

Mrs Newport – who used to weigh 231/2 stone and wore size 32 clothes – lost 121/2 stone in 2005 after paying £5,000 to have a gastric band fitted.

But the dramatic weight loss left her with baggy, excess skin.
As part of the popular TV show, which aims to make participants look ten years younger, Mrs Newport had loose skin cut from her arms and thighs, a complete lower body lift, breast uplift and implants, a nose job and new teeth.