Yesterday I heard that a dear patient died. Virginia was 65 years old, and had her Lap-Band placed in 2007. She took this task seriously, and she came to every support group we had. Over the course of her weight loss journey, she lost about 100 pounds, and kept it off.   Struggling sometimes, but always bouncing back, always coming to the office with a smile, and always making it to our monthly support group.

From a weight loss surgeon’s perspective you can’t ask more from a patient. Changing a lifestyle is difficult, especially difficult when you do it at 61 years old. But she set her mind that “I don’t know how long I have, but I am tired of carrying this weight.” Even when I told her that it is very difficult to change as you get older she said, “Dr. Simpson, I am going to prove to you that I will do this. I am going to be your model patient.” And she was.

Virginia Abner - Always smiling

We often see people come to the monthly support group pre surgery, and maybe a few visits after surgery- then they fall away. But there are those few who come on a regular basis- and funny thing- those are the ones that get to their goal and stay there. Virginia was a regular at our support group meeting- and people would ask her for advice, and she always said the same thing: “Never give up, measure your food, never be too full, and never be too hungry.”

From Virginia we have learned – never give up, never give in. There is always more to learn about weight loss – and she did everything she could – right up to the end.

We will miss Virginia. For those who were fortunate enough to call her a friend, a memorial service will be at the Heritage Funeral Chapel on 6830 W. Thunderbird, Peoria, AZ on December 18th at 1 pm.

It is a weight loss surgery that employs a restrictive technique. The advantage of this particular weight loss surgery is that it creates restriction in food intake without the use of any foreign implants and without removal of any stomach tissues. At this time, Gastric Plication has yet to be approved by the FDA (Food and Drug Administration) and therefore, is not currently offered in many surgical practices in the US.   (Our practice has seen positive results from gastric plication procedures, and we look forward to offering this surgery on a broader scale, in the near future).

Advantages of Gastric Sleeve Plication

One of the advantages of this kind of weight loss surgery is that it is completely reversible.  Sutures that bind the stomach together can be removed if necessary, and the original stomach capacity can be restored.

The Bariatric Times conducted a study on patients who had the gastric  plication procedure, and reports that these patients demonstrated satisfactory weight loss, and had the lowest complication rates among all weight loss surgery procedures. The study also concluded that the outcomes were more immediate in gastric  plication than in other weight loss surgeries.

Additionally, another advantage to gastric plication is that the nutrition absorbing capacity of the stomach remains intact. Patients don’t typically experience food intolerance, as they can in other weight loss procedures.

Compared to laparoscopic adjustable gastric banding, gastric plication does not require a medical implant, nor does it require periodic adjustments. Patients who undergo gastric plication will not experience common complications sometimes experienced with the Lap-Band (erosion, slippage, or leaking), port problems (displacement, leaking, or infection), or stoma blockage.

We’ll be providing more information on gastric plication and advances in weight loss surgery here and on our weight loss surgery blog.  Be sure to sign up for our e-newsletter to get the latest news and updates.

Careful review of the data reveals deficiencies in the RNY group’s reporting mechanisms. Comparing the two studies shows that having a LAP-BAND is not only safe, but is best done in high volume centers.

Operating Time: Average operating room time for the LAP-BAND in the Campos group was 145 minutes. Contrast that with the Low BMI study group average operating room time of 41 minutes. The Low BMI study group had surgeons who were highly experienced in performing LAP-BAND procedures, and this is reflected in the operating room time. The Campos group, spending over 100 additional minutes leads to the conclusion that they are not a high volume center. This conclusion is supported by the fact that it took Campos over three years to enroll enough patients.

Complications: No surgery is free of complications – but the complication rate from the Campos group is higher than normal (re operation rate of 13%). Contrast that with the Low BMI study group that had a re-operation rate of 4.7%. Again, the Low BMI study group consisted of surgeons with substantially more experience than the Campos group.

Weight Loss: The Campos group reported a 36% excess weight loss at one year for the LAP BAND and 64% for the RNY. This is in contrast to the Low BMI Study group who had 64.5% at the first year (which is equal to what the Campos group reported for the RNY gastric bypass). Two-year data was not available in the Campos group, but the Low BMI study group showed excess weight loss of 70.4%

Follow-Up Visits: The LAP-BAND works through appetite suppression. If there is no suppression of appetite the patient will not lose weight. This requires patients with the LAP-BAND undergo periodic adjustments to the band, particularly in the first year. The Campos protocol was to give two to three adjustments to the LAP-BAND in the year. The published standard is clear: patients who have a LAP-BAND need an average of six adjustments, not three. The Low BMI study group did an average of 6.2 adjustments in the first year – which no doubt accounts for the superior weight loss.

Quality of Life: The Campos Quality of Life indicators were not statistically significant. However, Quality of Life indicators for those receiving the LAP-BAND from our group are substantially higher than their group.

Conclusion: The LAP-BAND is not a simple operation, nor is the aftercare simple. However, high volume practices provide superior results with fewer complications than low volume centers, such as the Campos groups. Conclusions about the efficacy of the band should not be made based on small studies of surgical groups that do low volumes. The LAP-BAND procedure done in high volume centers provides superior outcomes in terms of less operating room time, fewer re operations, fewer complications, more adjustments, and more weight loss.

References: http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/Gastroenterology-UrologyDevicesPanel/ucm234224.htm

Campos, Rabl, et. Al. Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding. Arch Surg. Feb 2011

Terry Simpson, MD FACS – is a bariatric surgeon in Phoenix Arizona, and a member of the Low BMI Study Group.

On December 3, an FDA advisory panel recommended the expansion of the use of Allergan’s Lap-Band™ system for weight reduction in patients with a BMI of at least 35 kg/m2 or a BMI of at least 30 kg/m2 with one or more comorbid conditions. The panel voted 8 to 2 that the benefits of Lap-Band™ surgery were greater than the risks in patients in the new, lower weight range. While the FDA must still make the final decision, the agency usually agrees with its advisory committees.

Dr. Simpson was one of 30 weight loss surgeons involved in the study. In fact, Dr. Simpson was the only Phoenix weight loss surgeon selected to participate. Read more about this exciting new development regarding FDA approval of lower BMI guidelines for the Allergan Lap-Band.™

For patients who have undergone weight loss surgery, this can be a fun time of year, because it represents one of the few times that weight loss goals have been met.  But this is not the time to sit back—in fact, this is the time, more than ever, to focus on behaviors and routines that will promote progress moving forward. Here are a few things to keep in mind:

1. Do not get too dependent on your weight loss surgery.  The surgery is just a tool  – and while early on it appears that weight falls off magically, as time goes on, the weight loss will taper.
2. Remember there is NO surgery that will allow you to “eat anything you want” and lose weight. While it may seem so in the early stages – this is not an ongoing process.
3. You have control over two important things – -what you eat, and how much you eat. Focus on these two things that are within your control.

What you eat is critical.  If you had the surgery, do you remember how following your surgery you drank a lot of fluids, tried hard to get protein in, and lost weight? As time goes on, things change and it becomes a lot easier to get a lot of food in. So – go back to basics. First, healthy food – -the junk food never helped you.  When eating out—forget those places that don’t offer good nutrition.

Second, and just as important- focus on the amount of food that you eat. Early on this was never a problem- you almost needed more protein than your stomach would let you have. Portion control is still a key to weight loss- do not let your stomach (whether it be stapled, banded, or bypassed) decide when to stop eating.  Twice a week plan on measuring out a portion of food- and eating that and no more. Learn to eat less and once you find out you are satisfied, keep up with those portions.

Weight loss surgery is a gift, but it is just the start of a journey.  The surgery is not meant to be a collar that keeps you from doing things—the surgery is meant to be a tool that will enable you to lose weight and experience greater overall health.

Don’t forget to join me in the Weight Loss Challenge!
Visit www.azlapband.com to find out more.

In this study there were two groups of individuals: one group had “conventional diabetes therapy with a focus on weight loss by lifestyle change.”  This group did not do as well as the patients who underwent laparoscopic adjustable laparoscopic banding (LAP-BAND).

Below is the “abstract” of this landmark article in the Journal of the American Medical Association. Diabetes is associated with an increased rate of heart disease, stroke, renal failure, amputations, erectile dysfunction, and peripheral vascular disease.

Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes

A Randomized Controlled Trial

John B. Dixon, MBBS, PhD; Paul E. O’Brien, MD; Julie Playfair, RN; Leon Chapman, MBBS; Linda M. Schachter, MBBS, PhD; Stewart Skinner, MBBS, PhD; Joseph Proietto, MBBS, PhD; Michael Bailey, PhD, MSc(stats); Margaret Anderson, BHealthMan

JAMA. 2008;299(3):316-323.

ABSTRACT

Context Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.

Objective To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.

Design, Setting, and Participants Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.

Interventions Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.

Main Outcome Measures Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.

Results Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.

Conclusions Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss.

“Sexual dysfunction should be considered one of the numerous potential reversible complications of obesity,” the study concluded.

The study estimated that a morbidly obese male had the same sexual function as someone who was 20 years older.  By reduction of weight, this function was able to return in a number of men. The study, published in the Journal of The American College of Surgeons, showed that men who lost 2/3 of their excess weight had a significant improvement in their sexual function.

This is not surprising given the other co-morbidities that are associated with obesity.  Excess weight has been linked to diabetes, which is the leading cause of sexual dysfunction in males.

Far better than waiting to develop sexual dysfunction, it is better to prevent it, by considering weight loss surgery before this becomes an issue. Instead of waiting to be 100 pounds overweight, consider the LAP-BAND at 50 pounds overweight, allowing you to lose the 50 pounds, and avoid the pounding your body takes with the excess weight.

Weight loss is the best investment a person can make. It is the only investment that allows you to improve the quality of life as well as the quantity of life.

Eat Less, Lose Weight

This allows your body to do what it cannot do now– eating less, so you lose weight – but lose weight without being hungry. The second part is even better — you use your fat stores for fuel.

Ever notice on a diet how you lose weight initially, then the weight loss slows down? No matter how hard you try, after the first few weeks, weight loss becomes less and less.  Then, when you go off the “diet” the weight comes back, usually with more weight.  That is because your body is holding on to fat – trying to save your life. With the band the opposite occurs, because your brain is fooled, it unlocks the fat stores, making it easy for your body to burn fuel. So instead of feeling tired, lethargic, and hungover — you feel energized, and you continue to lose weight at a steady pace.

The LAP-BAND  allows you to do two things: you choose what you eat, and you choose how much you eat. What the band does, and what we help you with, is getting the excess weight off with the use of the band. Imagine – you can eat less, feel just as satisfied – and continue to lose weight to the level you want.