Posted on 11/06/2003 12:53:25 PM PST by steppenwolffe
The death of a 37-year-old woman after stomach-reduction surgery has raised new concerns about the potential risks of this rapidly growing operation.
Officials at Brigham and Women's Hospital in Boston say they are investigating whether a faulty staple gun may have misfired during Ann Marie Simonelli's gastric bypass surgery and contributed to her death days later. They have suspended the popular surgery while the investigation continues.
Dr. Anthony Whittemore, chief medical officer at the hospital, said the ban on laproscopic bypass surgery was a safety precaution that would not necessarily be permanent.
"We temporarily halt this activity as a means of coping with this particular situation till we understand what actually occurred," Whittemore said.
Simonelli, of Lawrence, Mass., died Oct. 23, three days after undergoing the gastric bypass surgery in an attempt to fight obesity.
Gastric bypass surgery, more commonly known as stomach stapling, is a booming industry. The operation typically involves stapling off a large portion of the stomach so that the patient is left with a stomach the size of a golf ball. More than 100,000 stomach-reduction surgeries will be performed this year in the United States and membership in the American Society for Bariatric Surgery has more than doubled in the past few years.
Celebrities such as singer Carnie Wilson and TV weatherman Al Roker have helped popularize stomach surgery after undergoing successful procedures themselves.
Just How Dangerous Are the Staplers?
The Food and Drug Administration, which keeps statistics on deaths associated with medical devices, lists 14 deaths from 2001-2003 that occurred after abdominal surgery involving staplers. However, in most cases, the surgeons were able to correct the stapler mishap so it is not clear what role the stapler malfunction may have played in the patients' deaths.
Dr. Peter Pressman, who performs bariatric surgeries at the University of Southern California, said he has not had any serious problems with the staplers. "None of us [at USC] has had experience that would lead us to suspend the procedure," he said.
But Dr. Robert Kozol, chairman of the surgery department at the University of Connecticut, said he has experienced trouble with staplers. Once while he was performing a laproscopic colonectomy, the stapler jammed, and he couldn't remove it from the patient. Kozol said he had to convert to an open procedure, and everything proceeded smoothly after that.
"I expect there are misfires happening weekly," he said. "Maybe daily. But overall, the staplers are very reliable."
An open gastric bypass requires a large incision. In the laproscopic procedure, a small incision is made and the physician uses a scope to look inside.
Pressman said even if something were to go wrong with the stapler, the surgeon usually can correct any misfires. "What generally happens is that the suture lines are tested before you close the incision," he said.
"The problem [with mechanical devices] is never going to be totally eliminated," said Kozol. "The important thing is for the surgeons to be very aware of the different things that might go wrong so that they can be prepared."
Who Gets the Surgery?
The National Institutes of Health and the American Society of Bariatic Surgeons both agree that a person must be seriously overweight before gastric bypass surgery is recommended. Their guidelines say a person is eligible for gastric bypass surgery only if he or she has a body mass index of 40 or higher, or a BMI of 35-39 with co-morbid risk factors such as hypertension or diabetes. People seeking the surgery must also have made at least one serious attempt to lose weight without surgery.
American Surgery recently published a study of more than 16,000 patients who had received gastric bypass surgery. Overall, 10 percent of the patients experience complications. While 84 percent of the patients were women, the men had a 70 percent greater chance of complications.
Even when all the equipment works perfectly, gastric bypass carries significant risk. Mortality rates for the surgery have been calculated as high as 1 percent to 2 percent. Seams that seemed fine during surgery can develop leaks afterward. It was complications from a leak that killed Simonelli.
"It's a complicated operation," said Dr. Ed Felix, whose Fresno, Calif., group has performed more than 2,000 gastric bypass surgeries. "And if you do any operation on morbidly obese patients, even a simple appendix removal, the risk of mortality goes up. These are typically very sick patients."
Rolling the Dice
For obese patients who have exhausted all other options, gastric bypass surgery may literally be a lifesaver. It allows people to shed 100 pounds or more quickly, and this loss typically brings relief from diabetes and hypertension.
ABCNEWS affiliate KGTV in San Diego followed a young woman through the surgery last year. Amy Suter lost 58 pounds in 2 ½ months, and she is thrilled. "[The surgery] is the best hour and a half of your life," she said.
For others, the outcome is not as fortunate. ABCNEWS affiliate WBMA in Birmingham, Ala., reported last December on a woman who lost her daughter after gastric bypass surgery.
Doris Gracia said her daughter, Donna, wanted to lose weight to help control her diabetes, but something went wrong and Donna ended up with a hole in her small intestine. She was placed on life support and later died.
"I don't think it's wonderful 'cause I don't have my daughter," Gracia said "I didn't bring her in this world to be mutilated and for me to go through my old age without her."
Because of the risks, people need to be aware that this surgery is used only in cases where other weight-loss methods have failed. It is not an easy "get-thin-quick" scheme. Even patients for whom the operation is most successful face a lifetime of chronic diarrhea and vitamin deficiency.
Still, with 97 million Americans overweight, bariatric surgeons feel that this is not a treatment we can afford to lose.
While acknowledging that they did not have all the details of the Simonelli case, many surgeons found the Brigham and Women's decision to halt all laproscopic gastric surgery extreme.
"Any death is tragic and should be investigated," said Felix. "But you don't stop flying planes because of one crash."
Felix said he had a patient, a 500-pound man, who died because he did not get the surgery in time. "That's equally tragic," Felix said.
Patients Should Do Their Homework
The American Surgery study found that hospitals that had a lot of experience with gastric bypass procedures were far less likely to experience complications than smaller, less-experienced hospitals. If your doctor thinks you are a candidate for gastric bypass, ask him what his complication and mortality rates are for bariatric cases.
"The skill of the surgeon is key," said Pressman.
But make sure the complication rate is in context. If your doctor tends to accept the heaviest, sickest, patients, he may be an excellent surgeon who just takes on cases that are likely to have complications.
Patients can also look up their doctors on the American Society for Bariatric Surgery's Web site (asbs.org). If the doctor is listed as a regular member, he or she is broadly certified by the American Board of Surgery (there's no special certification for bariatric surgeons). If listed as an "affiliate" member, the doctor is not yet board-certified.
Laproscopic surgeries are generally preferable to open procedures because they are less invasive and leave less scarring, but not everyone will be a candidate for the laproscopic procedure. Patients who are relatively thinner, younger and healthier do best with the laproscopy.
Brigham and Women's hospital will continue to perform open gastric bypasses.
They want IMMEDIATE RESULTS. No one wants to work for ANYTHING.
Now she has to eat VERY slowly, and can only drink liquids MUCH later after dining. I guess the food & water together will expand in the new, tiny stomach. Not to mention the many suplements she needs to take for THE REST OF HER LIFE.
Doesn't sound worth it to me, & I AM overweight.
From what I understand, that's no so easy once one is morbidly obese. And for someone to become morbidly obese, I'd guess there are some extreme emotional and or mental issues in place.
Yes, but...you say you are overweight, so you should know it's just not that simple.
I've considered (and rejected) the surgery for lots of reasons. I've now lost enough on a diet plan that I probably would no longer be considered a candidate. But the problem most morbidly obese people has is the sheer slowness of dieting it off.
It's a pattern. Diet for a week or so, feel like you're starving and lose a pound. For a fat person the easiest way to deal with that disappointment is to eat.
Trouble with most diets is that they work too slowly and you get hungry. Diets like Atkins and the 6-Week-Body-Makeover (program I've used) are better because they allow you to eat and not get hungry.
It's really a matter of eliminating salt, sugar and white flour, then eating sensibly.
But it's not as easy as saying "eat less, move more."
I started a meal replacement program that was tested at John Hopkins and lost over 100 pounds in the same time frame. I feel great and look a lot younger than I did before.
First, not everyone has the same metabolism. I grew up eating an entire box of cupcakes a day an never gained weight. I still eat cupcakes and other junk food in my mid-thirties and still weigh under 200 pounds -- less than most of my friends. A friend who had gastric bypass surgery, on the other hand, was tested to see how many calories he would need to limit his diet to to lose weight. The answer was that he could maintain his weight at 900 calories. There are some fairly common metabolic and hormonal disorders that can cause problems like this. It is very easy to say "eat less" when you can maintain your weight on a more normal 2,000 to 3,000 calorie diet but I challenge any normal person here to try to live the rest of their lives on a 900 calorie a day diet.
Second, the human body feels hunger which is designed to compel you to eat. For some people, those feelings can malfunction into a problem. You will notice that the solution to smoking or drinking addictions is to 100% stop smoking or drinking. I've never heard anyone tell an alcoholic to simply moderate their drinking and I doubt that a program designed to moderate an alcoholic's intake of liquor rather than stopping it entirely would work. Yet this is exactly what a person who uses dieting must do to keep their weight under control. They cannot stop eating entirely and must constantly be in the presence of food. See how many alcoholics, drug addicts, or smokers could moderate their use in an environment like that.
Yes, there are people who simply eat way too much. Yes there are people who are simply too lazy to moderate their food intake. I have friends like that, too. But it seems to me that at least some of the people who are undergoing gastric bypass surgery know that they have a problem, may have tried more conventional ways of solving their problem, and seem to be pursuing a solution that will help them overcome their problem. I think that people should be rewarded for facing and solving their problems rather than being given a "holier than thou" lecture by people who don't share the problem. To me, one of the main attractions of the conservative world view is that it is about facing reality and solving problems rather than acting morally superior and resorting to emotions, jealousy, and anger. These people are trying to solve their problem. There is nothing wrong with that. And having seen how someone who has had gastric bypass surgery has to be careful about what they eat, this solution really isn't all that easy.
Actually, they have a "window" in which they can lose weight, after which their body will often simply get used to the lower food intake and maintain weight.
If they return to their old eating habits, I guess their stomach stretches back out?
No. They throw up. It is very unpleasant, which makes it a good incentive not to do it. In extreme cases, they can damage the staples and need additional surgery but a person needs to willfully disregard discomfort in order to do that.
Anyway, seems like most of them end up gaining it all back.
That's not what I've seen. In a way, it forces a lower food consumption diet by making the person feel "full" with much less food.
The ONLY real way to reduce is diet and exercise.
That's not even entirely true. There are plenty of women out there with PCOS who diet -- and don't lose weight. Why? Because they are on the wrong diet. People with PCOS often respond pretty well to low-carbohydrate diets but pretty badly to low-fat high-carbohydrate diets. Why? It is a hormonal disorder that responds to blood sugar levels. So you can give a woman with PCOS the snappy, "Eat less and excercise more!" line all day and if she picks a low-fat high-carb diet, she isn't going to lose weight and may gain it. Trust me. There are a lot of very unhappy women with PCOS out there and I wouldn't call them "lazy". So diets and excercise can help but you need the right diet and excercise and even doctors can get this wrong.
As for perpetual diets as a solution, as I said in an earlier post, self-help plans that rely on perpetual moderation rarely work. That's why you won't find people who treal alcoholics telling them to simply "Drink less!".
As for excercise, excercise takes time. Time that few people have. I can't really fault someone who works for 10 hours a day and spends another 2 hours commuting for not spending another hour or two excercising. A doctor once told me I was mildly depressed. He asked me why that might be. I told him that I didn't feel that I had enough time to do everything I wanted to do in a day. He told me to excercise to releave the depression. Which part of "not having enough time" didn't he hear?
All during this past summer, as my weight slid off, people would come to me and ask me how I was doing it. As soon as I mentioned walking at least two hours a day or cutting out all junk food, their eyes glazed over and they said "No thanks, not for me."
Now my BMI was close to 40 and I was reaching the minimum threshold for this stomach stapling surgery. I am so glad that I decided to go a different route because I know people who have had this surgery, including a cousin of mine, and it just doesn't seem to work over the long term. Not to mention the considerable expense and risk that goes with that kind of treatment.
I feel bad for those who are fat. I was fat and believe me, it sucks being fat. Being fat is no fun at all. I mean, it never affected me emotionally (like it does with women). I could joke around about it and was very self-deprecating about it. Being called fat didn't hurt my self-esteem one bit. But it did take it's toll physically. I had trouble climbing flights of stairs. I couldn't keep up with my kids anymore. Any extended walking or exercise made me sore for days. In fact, my thighs would rub together on long walks so my pants would get soaked with blood. This is something many people who say "move more" don't realize. It HURTS to move when you're fat!
It also took it's toll economically. I had to buy all my pants at the fat man shop because even Wal-Mart didn't have my size. Shirts were XXXL and XXXXL. And when you are as big as I was (I had a size 52 waist), nothing fits you good. Your shirttails are always hanging out because you can't get your pants up where they need to be. Your gut is always hanging over your belt, forcing your pants down, which is why you always see fat people pulling their pants up all the time.
So being fat is no way to live. I urge all those who are fat to do what I did. Go on a normal-carb diet and exercise twice a day. Don't give me the excuse you can't find time. I get up at 5AM so that I can walk an hour before going to work. I then take my lunch hour at work to walk an hour around my place of business. So I am doing six miles right there. Add another 1-2 miles during the course of the day (by parking far away from places and taking the long way to get there) and you have your exercise covered. On weekends, I try to walk even more, only I go on the road to places like the beach or state parks or whatever. A change of scenery really breaks up the monotony. MP3 players are good too or books on tape (Walkman).
Yes, it can be done. But it takes real commitment, as I said before. This "3 times a week" exercise crap isn't going to cut it. Not when you were over 100 pounds overweight like I was. It wasn't easy. I went through a lot of pain in the beginning. My feet blistered and my sneakers were full of blood after some walks. My thighs bled, like I mentioned before. I had shin splints that were excruciating. But I ploughed ahead anyway and worked through the pain. Eventually, I started feeling really good and now when I take my walks, I have to stop myself from running, that's how much energy I have. And I could literally walk all day long now. Only time is a limiting factor. It is not unusual for me to walk 20 miles nonstop when I have the time (such as a Saturday). A few weeks ago, I hiked 20 miles in a state forest and then spent the rest of the day doing yard work at home. I was sore as hell the next morning but I got up at 5 and did my first walk anyhow.
I must say that even though I am on a strict carb-controlled diet, food has never been an issue for me. Not since April have I had any kind of cookie, candy, pie, cake or anything else processed or sugary. Only meat, fish, vegetables, nuts, yogurt, berries, olive oil, cheese and eggs. Anything that is natural. Nothing out of a tin can, nothing out of a package on the supermarket shelf and nothing out of the frozen section either. Nothing but fresh and natural foods. Sort of like our grandparents used to eat before there was a Piggly-Wiggly.
My father grew up in Alabama on a farm and was thin as a rail. He'd have to walk three miles (each way) just to go to the general store. He was always walking. But he ate whatever and whenever he wanted. Of course, the only food available was the kind of food that is real and not processed to have a shelf life of six months or more.
That is the key right there. Obesity is a huge problem in the modern world because food is so processed, cheap and plentiful and virtually nobody does manual labor or walks around much anymore. Getting back to processed food, if it was processed to have a shelf life of six months, how long do you think it can sit in your stomach? Something to think about.
Anyway, I cannot say enough how different I feel after having lost all this weight. Click on my profile to see what I looked like a month ago. (I've lost another 12 pounds since then.)
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.