Bariatric experts examine benefits of sleeve gastrectomy at Fresno Heart & Surgical
More than 40 bariatric surgeons from around the world came to Fresno Heart & Surgical Hospital this month to examine gastric sleeve or sleeve gastrectomy benefits. Sleeve gastrectomy is a weight-loss surgery that has become a mainstream tool in the fight against obesity and diabetes. Developed initially as part of a two-step duodenal switch procedure, a form of gastric bypass surgery, the gastric sleeve procedure has become a stand-alone operation.
Sleeve gastrectomy differs from the gastric bypass in that 85% of the stomach is permanently removed and there is no alteration of the intestines. Unlike the gastric band, which also reduces the stomach, there is no foreign body or need for adjustments.
“This procedure is another tool that we can offer our patients. Each patient presents with different challenges, it is important to take into account many factors before advising treatment options. One size doesn’t fit all,” said Dr. Kelvin Higa, medical director of Fresno Heart & Surgical’s metabolic/bariatric and minimally invasive surgery program. The hospital’s program has been designated by the American Society for Metabolic and Bariatric Surgery as Center of Excellence and has been 5-star rated two years in a row by HealthGrades®.
“More and more patients are becoming aware of sleeve gastrectomy benefits and more and more surgeons are attempting to perform the procedure,” said Dr. Kelvin Higa during the Nov. 20 education conference. “However, this procedure is an easy one to perform incorrectly and has its own set of unique complications. It was important to bring together the world’s foremost experts for this educational experience.”
During the day-long event looking at sleeve gastrectomy benefits, Dr. Higa was joined by Dr. Michel Gagner, inventor of the sleeve gastrectomy, and Dr. Jacques Himpens from Belgium, who performed the first robotic surgery in the world. Other faculty members included Prof. Raul Rosenthal from the BMI Institute at the Cleveland Clinics in Florida and Dr. Almino Cardos Ramos from Sao Paulo, Brazil. Dr. Higa, a UCSF Clinical Professor of Surgery who also lectures and demonstrates surgery internationally, moderated the symposium.
Dr. Gagner, while at Cornell University, first proposed the gastric sleeve in 1999 as a way to reduce problems in high-risk patients. “We split the operation in two and did the sleeve first to reduce the stomach,” he explained. “We found all patients had the same weight loss and not everyone went in for the second stage” to remove part of the small intestine.
Dr. Gagner discovered that sleeve gastrectomy benefits were especially high for smaller patients (higher percentage of weight lost), and patients with Crohn’s disease or inflammatory bowel disease. “Also transplant patients do better and elderly patients do better with this operation where you don’t disrupt calcium absorption,” Dr. Gagner said. “I’ve operated on up to 80-year-olds, especially those who may need a hip or knee operation. In the elderly, if they just get the weight off they do better and may not need [the other operation].”
Dr. Himpens said when the gastric sleeve procedure doesn’t meet weight-loss expectations it leaves more room to do a second procedure. The second procedure will be to remove a portion of the small intestine or redo the sleeve to again reduce the stomach. Dr. Himpens also explained that with the sleeve gastrectomy weight can creep back on patients if they are not careful. His studies found patients generally had good success for three years but some began regaining weight. “It’s how many times they eat not what they eat,” he explained.
Dr. Keith Boone, Fellowship Director for UCSF / ALSA Minimally Invasive Surgery Fellowship and medical director at Fresno Heart & Surgical Hospital, said that some surgeons only offer one procedure. “A lot of patients don’t get properly educated about their therapeutic options,” he said. “Then there’s the ethics of a few insurance companies that simply don’t offer this procedure as a choice. There is enough clinical evidence that it should be a part of our clinical armamentarium.”
Dr. Boone and Dr. Gagner also said that one of several benefits of gastric sleeve is that patients might not suffer the malabsorption or malnutrition issues that can be seen with bypass patients. Among sleeve gastrectomy benefits is a reduced risk of ulcers. Some of the disadvantages of sleeve gastrectomy is the irreversibility of removing most of the stomach, the unknown long-term risks (greater than 5 years) and the potential to make GERD, or gastroesophageal reflux disease worse over time.
Dr. Saber Ghiassi, who has just completed a fellowship in minimally invasive surgery at Stanford University, said, “The sleeve gastrectomy is somewhere between the gastric bypass and the adjustable gastric band based on its safety and efficacy.” Dr. Ghiassi has joined Drs. Higa and Boone as the newest member of their practice.
“I’m very happy with the level of participation of this conference,” remarked Dr. Higa. “Initially, I wanted to limit the number of participants to 25 or less, but the course filled within minutes and we still had a long waiting list even after I agreed to expand the number to 40.” Many people learned about the benefits of gastric sleeve during the conference.
During breaks in the lectures, Ethicon Endo-Surgery representatives demonstrated some of the company’s newest equipment for minimally invasive surgeries with laparoscopic instruments. Company representatives remarked that it was a testament to Fresno Heart & Surgical Hospital’s program and the reputation of its surgeons that so many pioneers and world-renowned experts had come to teach and to participate in a conference on sleeve gastrectomy benefits.
This story was reported by Erin Kennedy. She can be reached at email@example.com.
For more information about sleeve gastrectomy benefits please call Fresno Bariatrics at 866.433.8558 or visit our sleeve gastrectomy surgery page.