Deaths Raise Fears Over Stomach Stapling

[doreen T]

Deaths Raise Fears Over Stomach Stapling

Wednesday, August 11, 2004


By LINDA A. JOHNSON, Associated Press Writer

An obese Massachusetts woman and her 8-month-old fetus died of complications 18 months after stomach-stapling surgery, an apparent first that is leading to warnings about the risks of pregancy soon after the surgery.

The deaths raise concerns because most of the 110,000 people who have gastric, or stomach, bypass surgery each year in this country are women in their child-bearing years, say doctors at Brigham and Women's Hospital in Boston who tried to save the mother and baby. They reported on the case in a letter in Thursday's New England Journal of Medicine.

Brigham surgeon Dr. Edward E. Whang cared for the 41-year-old woman nearly two years ago, when she was brought to their emergency department after two days at another hospital, where the cause of sudden pain in her upper stomach was misdiagnosed.

"She was nearly dead," said Whang, who noted the woman had the gastric bypass and prenatal care at other hospitals.

After tests and symptoms indicated a massive infection, Whang did emergency surgery. He found most of the woman's small intestine had slid through a hernia, or tear, in an adjacent membrane, a defect sometimes left after the intestines are rearranged in the bypass operation. The hole choked off blood to the stretch of intestines, and the tissue turned gangrenous.

By then the fetus had died. Whang repaired the intestine, but the woman died within a few hours. She still weighed 440 pounds; her original weight was not available.

"This is a tragic case, but you need to look at the overall risk-benefit of the surgery," said Dr. Harvey Sugerman, president of the American Society for Bariatric Surgery, an educational group for obesity surgeons.

Sugerman said three studies show extremely obese patients have death rates as much as four or five times lower if they undergo gastric bypass surgery, compared with those who don't, and other research shows lower rates of pregnancy complications after the weight-loss surgery.

Sugerman estimated more than 110,000 gastric bypasses will be done in the United States this year. Complications strike as many as 1 in 5 patients, and it is believed that for every 200 patients, 1 to 4 will die.

Sugerman and other doctors said they know of no other mother-baby deaths after the operation.

But Whang said about 85 percent gastric bypasses are performed on women, most of childbearing age. He advised any pregnant patients with sudden pain to see a bypass expert quickly.

"Most doctors recommend contraceptives for two years after the surgery" to avoid pregnancy until the woman's weight stabilizes, said Dr. Sattar Hadi, who runs the high-risk obesity clinic at Vanderbilt University's Center for Human Nutrition.

Hadi said it's unclear whether the Massachusetts woman's hernia was due solely to the surgery "or the fetus pushing onto the intestines."

Dr. Mark Tucker, director of bariatric surgery at the University of Medicine and Dentistry of New Jersey in Stratford, said such hernias are not uncommon and can happen up to five years after the surgery. Because fertility increases with major weight loss, he said, reports of pregnancies within a year of surgery are becoming more common.

In the standard type of gastric bypass surgery performed on this woman, a small pouch at the stomach's top is separated from the rest using staples. Moving down the small intestine a few feet, the surgeon then cuts it in two, pulls the bottom segment up and attaches it to the new pouch. The dangling upper segment, which carries digestive juices, is then reattached to the lower segment.

Patients then lose weight because the new pouch holds a few ounces of food at a time, and some calories and nutrients are not absorbed because the food bypasses much of the stomach and small intestine. Patients must take protein and vitamin supplements to avoid malnutrition.

Since the start of 2003, three other Massachusetts patients have died after gastric bypass, and the state is developing guidelines to increase safety.

The federal Medicare program has paid for stomach bypass surgeries for a few years, but only in people with related medical conditions such as diabetes. It covered 7,801 operations in 2003, about double the number in 2001.

Dr. Steve Phurrough of the Centers for Medicare and Medicaid Services said the agency recently ruled obesity can be considered an illness on its own, so an advisory panel this fall is to recommend whether Medicare should cover the surgery in people without related conditions. He expects the panel will urge waiting until there's more research on the surgery on the elderly.

"We have significant concerns about the risks," Phurrough said. "People die from this procedure."


http://story.news.yahoo.com/news?tmpl=story&cid=534&e=1&u=/ap/20040811/ap_on_he_me/fit_stomach_stapling

[potatofree]

<shudder>.....

[wcollier]

I've just finished re-reading one of my books, "Mastering Leptin" which further implicates the dangers of gastric bypass.

Apparently the surgery reduces the amount of functional stomach, thereby dramatically lowering the levels of ghrelin. Although this initially seems like a good thing, ghrelin is the key signal in the body that enables the proper release of growth hormone. So without proper ghrelin function, aging worsens as the body cannot correctly repair itself.

Scarey stuff!

Wanda

[OtistheCat]

I can (try) to understand the reason for Stomach Stapling, but, I personally would try Atkins first. Although, these folks opting for Stomach Stapling must have tried just about everything. I know of no one that has had the procedure. Anyone here know anyone? How did they make out? I guess it is the "last resort". I can't imagine doctors doing this surgery if it wasn't necessary. What do you think? :wave:

[Angeline]

I can't imagine doctors doing this surgery if it wasn't necessary.

I hate to be so cynical but you got to be kidding right ? There are a lot of $$$$$ involved in this, and it has turned into an industry. They would probably turn down someone who was obviously unsuited, like an anorexic, but everyone with 100 lbs to loose is fair game.

[adkpam]

I think some doctors find it easy to justify because they DO consider it "the last resort." In the past I've seen it used for people with 400+ pounds to lose, but now you qualify if you need to lose 100?

What about the liquid fasts? They were for "emergency use only" and they wound up too dangerous. What about this?

[Angeline]

, but now you qualify if you need to lose 100?

That was off the top of my head, I 'm not exactly sure what the criteria is. Got to be careful, sometimes statements like this can take on a life of their own :)

What never cease to amaze me is how little the medical profession seems to be concerned with this operation yet you never cease to hear about how Atkins is "potentially" dangerous. What about the not so potential dangers of WLS? This is the sort of thing that leads me to be so cynical. I have to conclude that since the medical profession is in love with surgery in general and the $$$ it generates in particular, then WLS is ok. Since there is no money to be made for them with Atkins, then it's "potentially dangerous". The only potentially dangerous thing about Atkins is loss profits for the medical profession!

[adkpam]

I agree, Angeline, and I wanted you to know you are right...the 100 pounds is now the cutoff. And that's my point.

[Jinglz]

A woman I used to work with had this done to her. She was about 300 lbs. At first she seemed to be doing great, since she got down into a size 14-16. When I spoke with her though what she described to me as her now "normal" way of life was horrible. She eats and vomits.All kinds of foods make her sick. She never got the real problem fixed which was her compulsive eating. She says she still can't help herself when she sees sweets, breads, and chips. And after she gives in she gets sick. She told me that she used to be able (after the surgery)to only eat an amount of food the size of my thumb, but that she can eat more than a fist size now. Is she stretching out her pouch thing???
:(
I felt so bad and last time I saw her she had gained a good amount of weight back and all of it abdominal. She had skinny little stick legs and a round belly. She looked like the apple from the fruit of the loom commercials. I am glad I threw out the card for the doctor she gave me.

I cant imagine living that way. I know all this weight is just awful to have and I can empathise and even understand why people would do this. Being severely obese is horrible. So is the way she has to "live" now.

[BadgerGirl]

This post will probably generate some hate mail (and I apologize in advance if I offend anyone who has gone through WLS), but I think there is *almost* always an alternative to stomach stapling.

Despite the fact that many of us became "addicted" to refined foods and carbohydrates (making them very hard to give up)--thus, suffering years of bodily abuse at our own hands, there comes a point where we have to exert just a little discipline.

No way in hell was I ever going to let someone butcher my insides and never enjoy normal digestion again.

As much as I LOVED my foodies, no one but I lifts that fork or hand to my mouth.

[BadgerGirl]

And another thing: every woman has the right to bear children if that's what she wants. But I find it criminal that a 440 pound woman became pregnant and wasn't under constant supervision of her OB-GYN.

The article didn't say she wasn't, but one has to wonder. Her weight put her at extremely high risk for gestational diabetes (if she didn't have it already) and other life-threating illnesses.

It saddens me that two lives were lost, which may have been avoided had she and baby been monitored more closely. :(

[DebPenny]

It saddens me that two lives were lost, which may have been avoided had she and baby been monitored more closely. :(
I agree with you on both points, BadgerGirl. I know I have physical tendencies that make it harder for me to lose weight and easier to gain weight, but I am still the one who fed myself albeit poorly (not so much quantity, although that at times was a factor, but nutritionally). I do wish I had "known then what I know now" so I might have been able to avoid all this extra weight. It's also scary to me that I would have qualified for WLS at my starting weight. I'm glad I never even considered it.

[Angeline]

This post will probably generate some hate mail

That's unlikely Badger, everyone here is very much against WLS. I have yet to read a post here supportive of the procedure.

She never got the real problem fixed which was her compulsive eating.

That's the problem with this surgery. It never addresses the root cause of the problem. If you are a compulsive eater before the surgery, you are still going to be a compulsive eater after. The only difference is that now, it will make you sick. That's not much of an improvement.

Now if the compulsion was healed, the surgery would become moot, as the weight would probably come off on it's own.

That's why people say that WLS is the easy way out. It's not so much that it's easy, because as we all know, it's everything but, but it's considered a "magic bullet". People and the medical are positively infatuated with the magic bullet concept. Here take this pill, or there have this procedure.

[Kristine]

How sad. :(

Considering the frail state of the digestive tract after WLS, I gotta wonder how any post-WLS woman can support a developing fetus. :confused: I wonder if there have been any studies of pregnancy after WLS surgery.

[OtistheCat]

WOW! That's scary. Yesterday a friend of mine (near 50) had the surgery. Today, (8/20/), she is sitting up and eating a little jello. She seems to be OK but I worry about the future. Her husband didn't want her to have it done, but she was adamant because she said she just couldn't lose weight. The doctor told her husband that she would probably die if she didn't lose the weight. She made her mind up to have it done, thus, so be it! I pray that things work out for her. After reading all about the surgery here, I definitely would think things out thouroughly. I hope she did her research!
Say a prayer for OTC's friend. Thanks :wave:

[bigted]

When I started I had 100lbs to lose, so in theory I could had had it done, but while it addresses the weight it does not nor will it ever address how it got there in the first place. So from my perspective it is like doing Aktins (or any other program for that matter) getting to goal and going back to eating as before. Now initially my stomach would be smaller but it stretches and it wouldn't take long for the poundage to come back.
In an nutshell I see it as a dangerous procedure with limited prospects for longevity.

[Turtle2003]

Hey, WCOLLIER, you mentioned that you were reading the book "Mastering Leptin". I read a review of it somewhere and thought it sounded interesting.

What did you think of it?

[liz175]

I understand why people have this surgery. A little over two years ago I was close to deciding to have weight loss surgery because my quality of life was so awful at my then weight of over 350 pounds. I had tried lots of different diets -- all lowfat and low calorie -- and none of them worked because I couldn't stick to them. Doctors suggested surgery to me, but no doctor ever suggested low carbing. It was only by accident that I discovered low carbing and decided to give one last diet a try before deciding on surgery. Fortunately for me, it worked and while I still have a lot of weight to lose, I have regained my health and mobility and I no longer need to consider weight loss surgery as an option.

However, what I didn't realize two years ago when I almost decided to go ahead with the surgery, is that for many people it is only a short-term solution. I know a woman who had the surgery, lost over a hundred pounds, and has now gained most of the weight back. Every time I see her, she is snacking on some type of high carb food. I have also lost over a hundred pounds, but I know I won't gain it back because I have changed the way I eat. If you are insulin resistant -- as I am and as is the woman I know who had surgery and is now gaining the weight back (she is diabetic) -- the only thing that will keep the weight off is low carbing.

[potatofree]

Or at the very least making a change to your patterns of eating for LIFE and not as a temporary fix. Surgery is such a MAJOR step that it saddens me after all the pain and ordeal of the surgery, a lot of people still have a twisted relationship with food that they hoped to cure by surgical means.

[cheryle]

You guys are so right about this just becoming so common place. I know a woman who had this surgery last January 04 and lost 85 lbs in less than 5 months. She has lost much more since then. Now her hair is falling out in clumps, she vomits many times a day, and just looks awful.
Unless someone is morbidly obese and this is what is going to save their life, this should have stricter regulations. This is on the same level as plastic surgery in my opinion...too much of it is being performed.
On another note...the lady I referred to having the gastric bypass now makes fun of overweight people everyday. :nono: What's up with that!!!

[Mossling]

Two of the women at work had this surgery, about a year apart. The first one lost 150 pounds in about 6 months...and appears to have gained it all back (and is very apple shaped now). She complained that it wasn't fair that I could lose weight and keep it off!

The other had surgery last April. She's sticking to the liquid diet that was given to her early on--she drinks (very slowly...like an ounce every half hour!) two different protein drinks every day to make sure she gets 75 grams of protein; since the day of surgery I have NEVER seen her eat anything solid. Sorry--I couldn't live like that. Even to lose about 100 pounds in 5 months. She looks drawn, and is still losing.

Jude

[MsBatt]

Wow---the very first thread I read here, and I HAVE to reply!

I had a form of weight-loss surgery called the Duodenal Switch in Dec. of '03. I sincerely think it has saved my life.

At the time I was 45 years old, and weighed 395 pounds. At 5'1" tall, that gave me a BMI of 75. I have been overweight since the age of four, and over the years I've tried every diet plan, and some of the diet drugs. (No phen-fen, no Xenical, no Meridia.) The Atkins' diet worked better than anything else did, but nothing was working well ENOUGH. Between the arthritis in my feet and legs and my weight, I was almost in a wheelchair. Certainly I couldn't shop any place that didn't have handicapped carts.

I did a LOT of research, and yes, any form of WLS (weight loss surgery) is dangerous---but so is weighing 400 pounds.While I didn't have any weight-related health problems other than joint ones, relatives on both sides of my family are diabetic. My father and brothers all have BP problems.

I too read all the horror stories about people who've had WLS and vomit daily, even months afterwards, who can no longer tolerate foods that they loved before, who lose to little, or who regain. And I agreed that this didn't sound like something I wanted to live with. Then I was lucky enough to learn about the Duodenal Switch.

The more I learned about it, the better it sounded. I'd still have a fully-functional stomach, just a smaller one. I wouldn't have the 'dumping syndrome' common with other forms of WLS. I'd be able to eat small-but-normal-sized portions, and the post-op 'diet' is a liberal form of Atkins. And with this form of gastric bypass, the odds of my ever developing diabetes are vanishingly small. (Surgeons in Europe are doing the DS on normal-weight patients with out of control diabetes, and having remarkable success.)

Since surgery, I have lost 115 pounds. Other than the couple of weeks it took me to recover from the surgery itself, I've not had a moment's sickness. I've not vomited once, I have not lost any hair, the depression that I struggled with for many, many years is GONE, I feel younger and healthier than I have in over 15 years, and today I shopped for over FOUR HOURS, on my feet the whole time.

I am living a completely 'normal' lifestyle. Sure, I watch what I eat, but for the first time EVER I am full and satisfied with small portions, and I actually find that my tastes have changed. I no longer crave much of anything, but when I do it's meat, cheese, salads, or fruits, rather than sweets and breads.

I agree that there are a lot of people having WLS that probably shouldn't, but for people like me it's truly a life-saver. Generally, one must be at least 100 pounds overweight to qualify, and some insurance companies require co-morbidities worsened by obesity, such as diabetes, hypertension, arthritis, sleep apnea (which is usually cured by WLS), asthma, GERD, PCOS (Polycystic Ovarian Syndrome), or others.

Please, please, anyone who reads this and is or has considered having WLS---do your own research. Read the good things and the bad, and weigh them for YOURSELF. Don't believe all the bad things you hear, or all the good things, either. (Be like Riki-Tiki-Tavi---go and find out. (*grin*)

[DebPenny]

Congratulations, MsBat, on your success with WLS. Will you tell us more about the duodenal switch. By your inference it seems to be a less drastick form of the surgery. But having it done on normal-weight people, to me, is very scarey.

[mio1996]

The problem is that if a smaller stomach makes someone lose weight, then a weight-loss diet would have worked just as well. That has always been my aversion to WLS. I too am a severe food addict (especially sugar), but there comes a point in someone's life when they must take charge and eat in a healthier way. Every day, I am confronted with intense longings for things like cake, cookies, and ice cream. I must simply choose better health over the sweet heat of the moment when those luscious, sugary edibles are on my tongue. I must remember that after I swallow them, they are no longer desirable. They are, in fact, deadly poison to me. No surgery could ever fix that. I am an addict, as most WLS patients are.
Does anyone think that if we were to reduce an alcoholic's mouth to prevent drinking except through a straw, they would be cured of alcoholism? What about simply giving heroin users smaller syringes? Sewing a cocaine addict's nostrils partway up? "No," you say, "that would not fix their problem!"

Does this sound obsurd? Of course it does! Then why would anyone think that WLS would fix an overeater?

[carrottop]

The government has approved this surgery for some folks on Medicaid. The rationale is that they will improve their health and cost the government less Medicaid money. What the govenment approves they often later mandate. I know a woman who was required to have to reduce her chest in order to keep Medicaid and Supplemental Security. She went through the surgery and emerged with significant scars. The purpose of the surgery was to reduce pressure on her spine. She still has the pain in her spinal disks.

[wcollier]

Hey, WCOLLIER, you mentioned that you were reading the book "Mastering Leptin". I read a review of it somewhere and thought it sounded interesting.

What did you think of it?Sorry, Turtle2003, I missed your post.

Other than the CKD, bodybuilding program, it's the only other book out there that addresses leptin which has recently become known as a master hormone of all other hormones. Pretty amazing since it was only discovered in the mid 1990s. So yes, I'd recommend that anyone read it b/c of its current research. Having said that, there's also another book coming out at the end of this month called "The Rosedale Diet" that's also fashioned around leptin management. I'm anxious to compare the two. I think we'll be reading a lot more about leptin when everyone "catches up".

Mastering Leptin isn't so much a diet as a set of 5 rules that keep leptin rhythms in sync and balanced. If you want to know more, come to my journal and I'll direct you to some notes I wrote about it for more info.

Wanda

[Turtle2003]

Does anyone think that if we were to reduce an alcoholic's mouth to prevent drinking except through a straw, they would be cured of alcoholism? What about simply giving heroin users smaller syringes? Sewing a cocaine addict's nostrils partway up? "No," you say, "that would not fix their problem!"


Wow! MIO1996, is this ever a stunning way to sum up your attitude. Great statement.

Now, let's hope the powers that be never think of doing things like this to people. :lol:

[OtistheCat]

Good analysis Mio....I'd like to learn more of the Duodenal Switch. Does anyone know what that entails? :wave:

[mio1996]

Does anyone think that if we were to reduce an alcoholic's mouth to prevent drinking except through a straw, they would be cured of alcoholism? What about simply giving heroin users smaller syringes? Sewing a cocaine addict's nostrils partway up? "No," you say, "that would not fix their problem!"


Wow! MIO1996, is this ever a stunning way to sum up your attitude. Great statement.

Now, let's hope the powers that be never think of doing things like this to people. :lol:

Yeah, I got so worked up I gave them some bad ideas. They'll probably start lab animal trials of those methods soon. Those poor monkeys...

[Angeline]

The BPD/DS combines restrictive and malabsorptive elements to achieve and maintain the best reported long-term percentage of excess weight loss among modern weight-loss surgery procedures.

The Restrictive Component
The BPD/DS procedure includes a partial gastrectomy, which reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining its normal functionality.

Unlike the unmodified BPD and RNY, which both employ a gastric “pouch” and bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures.

In addition, unlike the unmodified BPD and RNY procedures, the DS procedure keeps a portion of the duodenum in the food stream. The preservation of the pylorus/duodenum pathway means that food is digested normally (to an optimally absorbable consistency) in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables more-normal absorption of many nutrients (including protein, calcium, iron and vitamin B12) than is seen after other gastric bypass procedures.

The Malabsorptive Component
The malabsorptive component of the BPD/DS procedure rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined; food and digestive juices begin to mix, and limited fat absorption occurs in the common tract as the food continues on its path toward the large intestine.

For more detailed procedure information, see Dr. Hess’ patient brochure. For other detailed descriptions and illustrations, see the More Information page for links to surgeon’s websites and more.

History
The standalone Duodenal Switch procedure (without the accompanying gastric bypass as used in weight-loss surgery) was originally devised by Tom R. DeMeester, M.D. to treat bile gastritis, a condition in which the stomach and esophagus are burned by bile. In 1988, Dr. Douglas Hess of Bowling Green, Ohio, was the first surgeon to combine the DS with the Biliopancreatic Diversion (BPD) form of obesity surgery. This hybrid procedure, known as the Biliopancreatic Diversion with Duodenal Switch (or the Distal Gastric Bypass with Duodenal Switch), solves many nutritional problems associated with other forms of WLS, and allows a magnificent eating quality when compared to other WLS procedures.

http://www.duodenalswitch.com/Procedure/procedure.html

[Angeline]

Welcome to the forum Msbatt. Don't worry about negative replies, as any form of WLS is highly controversial on this board. We might not approve of WLS but that doesn't extend to you personally !

Anyway, I'm curious to why, in your estimation, Atkins wasn't all that successful for you, but the procedure was. Was it a question of malabsorption or some other factor that made one more efficient than the other. It was always my impression that WLS basically forced you to low-carb and made it very difficult to cheat.

[MsBatt]

Well, Angeline's already posted a very clear review of the technical aspects of the DS, so I won't go into that. However, I will address the question of why it DOES work even when a good diet program doesn't.

I know that for me, the DS has actually changed my physiology to the point where I no longer HAVE the sorts of cravings I did, pre-op---which makes sticking to a diet plan SOOO much easier! I'm no longer constantly thinking about food with some part of my mind, and the things I do crave tend to be healthy foods. I can't explain WHY this is, just that it IS. (And boy, is that NICE!)

For one thing, the removal of 80% of my stomach drastically reduced the production of ghrelin, the so-called 'hunger hormone'. I just don't get hungry like I used to. Atkins' was very successful for me---for as long as I could stick to it. The problem was, I just couldn't stick to the routine, pre-op---and now I can. Certainly the malabsorption helps, and the fact that I experience the 'full feeling' much sooner. To compare it to an alcoholic, if you could perform surgery on an alcoholic and somehow reduce their 'craving' for alcohol---yes, I'm sure that would really help them stop drinking. (My mom says that if there was a surgery that would curb her craving for nicotine, she'd have it in a heartbeat.)

AS to whether the DS is a 'less drastic' form of WLS than the so-called 'gold standard', the RNY---that's a matter of opinion. Surgically speaking, it's a more complex procedure to perform, but many surgeons believe it has correspondingly greater benefits. (I agree!) As far as its' effects on the patient's post-op lifestyle---yes, I'd definitely say it's 'less drastic'.

In my humble opinion (*grin*), the RNY is much more punishment-oriented. Many RNY patients experience 'dumping syndrome' if they eat more than a few (5 or so) grams of sugar, and some have a similar reaction to fats. ('Dumping syndrome' is an insulin-based reaction to sugar entering the small intestine rapidly.) Also, many RNYers vomit if they eat ONE BITE more than their 1-2 ounce pouches can hold.

The DS, on the other hand, is more forgiving, but not without it's own consequences. DSers who over-do the carbs, especially simple ones, frequently experience excess gas and/or BMs, and everyone has to learn their own, personal limits as to how many are 'too many'.

One word about the 'normal weight people' having this procedure---I don't think I was quite clear on that. What's actually being done is just the intestinal part of the DS, when it's being done on those with a 'normal' BMI, and it's being done for the treatment of out-of-control Type II diabetes. There's a woman I've talked with who had the DS for weight loss. A couple of years later, her normal-weight husband was in severe trouble with his diabetes---almost blind, his kidneys were failing, and he was looking at being in a wheelchair within weeks or months. He went to Spain and had this new procedure about 6 months ago. His vision is now 20/20, his kidneys are functioning normally, and the nerve damage in his legs seems to be reversing itself.

[OtistheCat]

Thanks Angeline for posting the website on the DS. It provides a great deal of information.... of course a lot of it, I didn't quite understand. However, there is no question that one should definitely do some research and read read read to obtain as much information as possible before having any of this done.... at least, that's what I would do. Just my opinion! :wave: