Is weight-loss surgery right for you? WMC now offers more options for bariatric patients

(Casper, Wyo.) – Free seminar: Wyoming Medical Center offers free monthly seminars to explain our surgical options for weight loss. The next one is on November 9th at 5:30 pm in the Wyoming Medical Center Support Services Building, 1200 E. Third St. Sign up and find more dates here.

Is weight-loss surgery for you?

Obesity is a disease. It affects more than 72 million Americans, including 28 percent of Wyoming adults. While it can be caused by a wide variety of lifestyle, genetic and metobolic factors, the associated health risks can be severe. These may include Type 2 diabetes, high blood pressure, sleep apnea, high cholesterol, non-alcoholic fatty liver disease, arthritis, acid reflux or other gastrointestinal disorders, heart disease, depression and low self-esteem.

Wyoming Medical Center’s Weight Managment Program offers a team approach to losing weight and keeping it off. But when non-surgical weight loss efforts have failed, consultation with a bariatric surgeon may be beneficial.  Multiple surgical options exist and no one single operation is perfect for everyone.  Your bariatric surgeon will discuss each option with you individually to find the best treatment.

Wyoming Medical Center now offers two new surgical options for those who need to lose a significant amount of weight.

Who qualifies for bariatric surgery?

The National Institutes of Health have established qualification criteria for weight-loss surgery.  The criteria are based on the Body Mass Index (BMI), which is a calculated ratio of weight to height.  To qualify for weight-loss surgery, you must have:

  • BMI of 40 or greater, or more than 100 pounds overweight, OR
  • BMI of 35 or greater and at least one obesity related health problem, AND
  • Inability to achieve sustained healthy weight loss despite prior weight-loss efforts.

What surgical weight-loss options are available at Wyoming Medical Center? 

Wyoming Medical Center offers three weight-loss operations as described below:

1. Laparoscopic Roux-en-Y gastric bypass (aka ‘gastric bypass’)

The Roux-en-Y gastric bypass is considered the gold standard weight-loss operation because it causes the greatest weight loss and the most rapid and significant resolution of weight-related illness.  Most patients typically lose about 70-80 percent of their excess body weight following gastric bypass.

The procedure consists of two parts.  First, a small bypassstomach pouch is created measuring about the size of an egg.  Second, the small intestine is divided and connected to the newly created small stomach pouch in a configuration that bypasses the majority of the stomach and the first portion of the small intestine as shown in the diagram.

Gastric bypass works to achieve weight loss and improve health conditions by a variety of mechanisms.  First, the small size of the stomach pouch accommodates only small amounts of food.  Second, the majority of the stomach and the initial segments of the small bowel are bypassed, preventing absorption of calories and nutrients in that portion of the intestine.  Following gastric bypass, hunger hormone levels are drastically diminished leading to decreased desire to eat.   Also, the hormones responsible for high blood sugar in diabetics are immediately altered, resulting in blood sugar normalization almost immediately following surgery.

Gastric bypass is the most effective weight-loss operation, but also carries the greatest risk of post-operative complications.   Patients who have gastric bypass are committed to taking vitamins on a daily basis for the rest of their lives.   Periodic blood tests are performed to check vitamin levels.  Because the intestine is “re-routed”, complications can occur including leak at the connection sites, bowel obstruction, and ulcer development.

2. Laparoscopic Sleeve Gastrectomy (aka ‘sleeve’)

Laparoscopic sleeve gastrectomy is a highly effective surgical option for treatment of morbid obesity.  This past year, the sleeve surpassed the gastric bypass as the most commonly performed weight loss operation in the world.  Sleeve gastrectomy involves the surgical removal of 80-90 percent of the stomach, leaving behind a small sleeve of stomach that resembles the sleeve of a shirt.

sleeveSleeve gastrectomy has two primary mechanisms that cause weight loss.  First, the small, thin stomach functions to limit the amount of food intake.  Second, and most importantly, the portion of the stomach that is removed is contains the majority of the cells that produce hunger hormones responsible for appetite stimulation.  Similar to the gastric bypass, without hunger hormones patients have a drastically decreased urge to eat.  Remission of diabetes also occurs rapidly following the sleeve gastrectomy by similar mechanisms.

One primary advantage of the sleeve over the bypass is that no re-routing of the GI tract is performed, which decreases the risk of post-operative complications.  Patients that have the sleeve gastrectomy typically lose about 60-70 percent of their excess body weight.

Complications can rarely occur following sleeve gastrectomy and include narrowing or stricture of the sleeve, leak, or acid reflux.

3. Adjustable gastric band (aka ‘Lap-Band’)

The adjustable gastric band was a popular weight-loss operation for many years, and has been offered at Wyoming Medical Center for awhile.  A plastic band is placed around the top of thelap bandstomach, creating a small pouch of stomach above the band.  This restriction causes a sensation of fullness after taking just a small amount of food.  Plastic tubing connects the band to a port that is placed under the skin.  The port is used to access and incrementally fill the band with fluid.   Larger fluid volume in the band results in greater restriction of the stomach and increased weight loss.

The Lap-Band causes weight loss by limiting food intake.  To be successful, patients must remain diligent with having frequent incremental filling of the band.  As weight is lost, health problems gradually improve.  The Lap-Band does not affect hunger hormones, leading to higher failure rates.  Patients who are successful with weight loss typically can lose around 50 percent of their excess body weight.

Complications of the Lap-Band are numerous and include band erosion into the stomach or esophagus, band slippage leading to stomach ischemia, cracked or dysfunctional plastic tubing, and port malfunction.  Up to 50 percent of patients with gastric band will require a subsequent operation in the future and for that reason placement of the lap band is falling out of favor in bariatric surgery programs throughout the country.

About Kevin Helling, M.D.
Dr. Kevin Helling was born in Laramie and grew up in Casper.  He is a board-certified general surgeon, completing training in general surgery at Stanford University and subspecialty training in advanced laparoscopic and weight loss surgery at Harvard University.  He has authored numerous publications, textbook chapters, and has presented his research at national and local scientific meetings. He practices at Wyoming Surgical Associates in Casper; call (307) 577-4220 for a referral. 

For more information about bariatric surgery at Wyoming Medical Center, to register for a free seminar, or to learn more about our Weight Management Program, call (307) 577-2592.