Published: April 12, 2009 02:01 am      

‘Gastric bypass’ affects more than stomach size

FAIRMONT — Although surgeries with the name “gastric bypass” have been around since the 1960s, said Dr. Ehab Akkary of West Virginia University Hospitals, the procedure as done today only has been performed since the mid-1990s.

And, contrary to popular belief, the surgery does more than just make gastric bypass patients’ stomachs smaller so they cannot eat as much. It also affects something called the ghrelin hormone to make the surgery recipients want to eat less and energizes the metabolism so that it works at a higher rate.

“After the surgery, their hormone levels are low so they can go on a 500-calorie diet and not be hungry,” said Akkary, an assistant professor of minimally-invasive surgery and director of bariatric surgery at WVU Hospitals. “They are not as hungry and they are burning fat and their metabolism is high.”

Plus, the patients also receive counseling from a nutrition to learn how to change their diets as well as advice on exercise.

“We look at this like a tripod,” Akkary said. “In addition to the surgery we make sure the patients are following the diet they should follow and make sure they are exercising they like should.”

Gastric bypass is a laproscopic surgery in which the upper part of the patients stomach is made into a pouch the size of an egg or a golf ball.

“That’s the new stomach,” Akkary said. “The rest of the stomach is bypassed and food doesn’t go there.”

However, other bariatric surgeries exist, including the adjustable (and reversable) band procedure as well as the newer sleeve surgery, which removes part of the stomach, permanently reducing its size.

“There was a statement by the American Society of Metabolic and Bariatric Surgery (http://www.asbs.org) that just came out two weeks ago that said the organization considered the sleeve procedure another bariatric operation like the band and the bypass,” Akkary said.

However, “Insurance companies are still looking at the sleeve,” he said.

Which procedure should be performed on which patients is determined by various factors, including whether or not the patient has overall fat distribution or central fat distribution.

“The patient who is at high risk for gastric bypass, that’s how they started the sleeve,” Akkary said.

Still, in spite of risks, Akkary considers weight-loss surgery very safe, especially compared to remaining obese.

“The mortality rate for weight-loss surgery is 0.6 percent,” he said. “That’s considered safe surgery compared to a hysterectomy or knee replacement. The mortality from being morbidly obese is 6 percent. That’s 10 times higher than weight-loss surgery. Weight come with all these problems: diabetes, hypertension, sleep disturbance, heart disease, lung disease. When we do weight-loss surgery, we don’t do it just to lose the weight but also to treat the medical problem.”

Akkary, who has been at WVU Hospitals since last July, performs about 100 procedures a year.

“People are getting more aware of the weight problem and the obesity epidemic,” he said. “Once someone’s BMI (body mass index) is higher than 35 percent or they are 100 pounds overweight, diet and exercise most of the time will not work. We see more people asking for weight-loss surgery.”

Candidates for weight-loss surgery generally have a BMI of 40 percent or more, or 35 percent and additional health problems brought on by obesity, such as diabetes, hypertension, sleep apnea, knee problems, etc.

Akkary has seen patients receive near-instant lessening of these side effects from obesity after they have had weight loss surgery, including the elimination of diabetes and even improved vision.

“I’ve had patients who have had gastric bypass surgery not have diabetes anymore,” he said. “A lot of patients say their vision improves because their diabetes is controlled or gone. Often the diabetes disappears within a day or week of the surgery. That’s the great achievement we have with gastric bypass.”

After the surgery, patients go on a liquid diet for two weeks before graduating to pureed and then soft foods.

“After that, they can eat anything,” Akkary said.

Of course, they have to eat less of it because of the reduced size of the stomach. In addition to eating greatly reduced portions of food, patients also have to make sure they get enough nutrients so they do not become malnourished.

Physicians in WVU’s Department of Neurosurgery have performed deep brain stimulation (DBS), a procedure typically done on patients with essential tremors or Parkinson’s disease, in an effort to see if they can change the way people think about food. In essence, the surgery, which has been performed on two patients so far for this purpose, approaches weight loss through the brain instead of the stomach.

So far, patients receiving the treatment must have already had a gastric weight-loss procedure that failed, although if approved by the Food and Drug Administration (FDA), that eventually might not be the case.

“I think it’s an innovative idea, a great idea, and I think it will have an application in select patients,” Akkary said.

E-mail Mary Wade Burnside at mwburnside@timeswv.com.