More turn to Lap Band surgery

By Mickey Tibbets, Special to The Free Press

BLUE EARTH — Desperate to lose weight, some obese people resort to surgeries that cut, staple or remove part of their stomachs.

For the last year, Dr. William Lee, a general surgeon at United Hospital in Blue Earth, has been doing Lap Band surgery. The advantage of this gastric operation, also known as laparoscopic adjustable gastric banding, is that it is less invasive than other gastric procedures and is reversible.

“Obesity is becoming a major problem in the United States,” Lee said. “We are treating the diseases rather than the problem. The problem is people are overweight. I think we are on the right track here.”

The only southern Minnesota surgeon doing the adjustable gastric band procedure, except for the Mayo Clinic, Lee draws patients from a wide area including northern Iowa. He gives educational seminars in Mankato and Albert Lea to perspective patients.

Lifestyle changes

Like all gastric surgeries, banding requires a motivated patient willing to make lifestyle changes.

“It’s not a gimme or a fail-safe thing,” said Dan Perrine, a Frost resident who had his surgery in September.

“You have to be careful with what you eat,” he said. “You chew everything really well. You chew and chew and chew. Sometimes I stop eating because my jaw gets tired.”

If he drinks liquids with his meal, the food acts like a sponge. Or if he doesn’t chew his food extremely well, Perrine gets an excruciating pain in his stomach. Perrine said he has learned to throw up to get rid of the pain.

“You can eat steak, but you have to chew it well,” the gastric band patient said. “You learn to eat more conscientiously.”

Perrine, 44, said he has been overweight all of his life. Weighing 375 pounds after trying Weight Watchers, the Atkins diet and other weight-loss methods, Perrine decided to undergo the procedure after he saw an ad on television.

Complications

The gastric band is safer than other gastric surgeries, Lee said, because it has a lower mortality rate and fewer major complications.

There can be complications, however. The major problems with gastric banding, Lee said, are erosion and slippage. The band can wear a hole in the stomach. Another problem is when the band slips and the lower part of the stomach falls over the band and causes an obstruction.

And like all surgery, there is a risk of infection.

So far Lee has performed 20 gastric band surgeries and is applying for certification from the American Society for Metabolic and Bariatric Surgery.

Patient selection

Lee’s patients weighed between 250 and 435 pounds before surgery. To be eligible for the operation the patient must have a body mass index of 35 with medical problems — such as diabetes, high blood pressure, sleep apnea or joint issues — or a BMI of 40 without medical problems.

Lee only accepts patients who are between 20 and 50 years old, weigh 450 pounds or less and are medically stable. “I’ve turned people down ... who need to be done in a larger hospital.”

He also will not operate on patients who are addicted to alcohol or drugs. “They need to get sobriety under their belt.”

And, unlike some Twin Cities clinics that do the procedure on an outpatient basis, Lee has his patients stay in the Blue Earth hospital overnight.

Lee’s patients are routinely seen before the surgery by a local psychologist who has had gastric surgery. There are also group meetings for gastric band patients after their surgery.

A burly man, Lee has a high BMI and hypertension. He has not had the gastric band surgery himself but is trying to lose weight by exercising. “I’ve thought about it,” he said. “I’m not ready to give up yet.”

Lee said that about 90 percent of his patients are female. Patients decide to have the procedure for a variety of reasons. “They are tired of being heavy, tired of how they look and feel. Other people are tired of medical problems. Or a combination of both.”

Some insurance companies pay for part or all of the operation, but people without insurance can pay $17,000 upfront or for an additional $8,000 get a “no interest” three- to four-year loan from United Hospital, Lee said.

Surgery success

The goal for his patients, Lee said, is to have them lose 1 to 3 pounds a week. “It is a little more controlled and healthier,” he said. Although gastric band patients initially do not lose as much weight as patients who have had other gastric surgeries, Lee said studies now show that after three of four years, the weight loss is the same.

Dr. Neil Hutcher, past president of the American Society for Metabolic and Bariatric Surgery pointed out, however, that this time lag is one of the disadvantages of gastric banding. Usually patients who have a gastric bypass will lose weight faster and see a reduction in their health problems in a matter of weeks versus a couple of years with gastric banding.

Although Hutcher was head of the organization that provides educational information on all types of gastric surgeries, as a private practice surgeon, he only performs gastric bypasses.

In European countries that are about five years ahead of the U.S in gastric procedures, Hutcher said, many patients are converting from bands to bypasses.

“Although the band works for a significant part of population, there are more side effects although they are of less magnitude,” Hutcher said. The band requires an average of four adjustments per year, he said.

Hutcher also said, “The band doesn’t always restrict the desire for food. Patients might feel full, but the desire for food is still there.”

Part of the problem, Lee said, is patients who have had any type of gastric surgery can “cheat,” drinking milkshakes and other high-calorie liquids.

Lee said his patients can be divided into two groups, those who shed 6 to 8 pounds a month and patients who lose 10 to 15 pounds a month. “The difference between these two groups,” he said, “is exercise.”

But, Lee said, success should not be measured in the amount of weight a patient loses, but eliminating their medical problems. Many of his patients, including Perrine, no longer have to take diabetes and high blood pressure medication.

“The operation is a success if the patient is happy with how they look and feel comfortable with themselves,” Lee said. “When they can chase their kids around — this is what my patients strive for.”

“It’s the best five grand I ever spent,” said Perrine, whose insurance company paid 80 percent of the operation’s cost.

Perrine now weighs 290 pounds. At 6 foot 2 inches tall, he hopes to get down to 225 pounds. “The operation has made a night-and-day difference in my life,” he said.

“It’s a good procedure,” Hutcher said. “It isn’t a magic procedure.”