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International Physician Update
The Minimally Invasive Gastric Bypass
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| Surgeon Michael Schweitzer offers patients an easier gastric bypass. |
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Surgeon Michael Schweitzer recalls the case of Linda Brown, a 48-year-old patient who suffered constant pain in her back, hips and knees. But it wasn’t a disease like degenerative osteoarthritis that was causing her agony—it was her weight. At 1.5 m, she could barely carry her 115 kg body. She had tried dieting and exercise, but that didn’t help. Then she found her way to Schweitzer.
“Like many obese patients, her weight was causing her other serious medical problems,” Schweitzer says. “Diabetes, hypertension and sleep apnea are common among these patients, too.”
Schweitzer’s answer for Brown (not her real name) was gastric bypass surgery. The procedure had been shown to significantly reduce weight in the morbidly obese, and Brown had met the criteria—a body mass index of over 40 and an obesity-related condition. Schweitzer told her he would actually divide the stomach, leaving a small pouch the size of an egg. He would then cut the small intestine and connect it to the pouch.
“This smaller stomach makes you feel full with less food,” Schweitzer says. The surgeon adds that the procedure doesn’t affect levels of stomach-producing hormones that increase appetite. These hormone levels go up in people who diet until they return to their pre-diet weight. Also, gastric bypass produces nausea and diarrhea when high-calorie sweets are absorbed, discouraging their consumption.
“Some people call this a complication, but we see it as a good thing because it keeps patients away from bad foods,” Schweitzer says.
Brown was interested, but she was skittish about an open operation and a long scar on her abdomen. No problem, answered Schweitzer. He was among the very first surgeons to learn how to do the minimally invasive version of the procedure. Rather than make a large incision from the belly button to the breastbone, he would use six tiny “keyhole” incisions to gain access to the abdomen using special laparoscopic instruments and a miniature video camera. In this approach, her hospitalization would more likely be two days instead of four, and she’d experience much less postoperative pain.
Brown had the operation. Today she weighs around 54 kg. Also, her chronic joint pain has all but disappeared.
“It’s one of the most gratifying operations we perform because you prevent more than morbid obesity,” Schweitzer says. “About 85 percent of diabetics, 70 percent of hypertension patients, and 90 percent of sleep apnea patients who undergo this procedure go off their medications.”
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