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No More Stapling Stomachs

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SAN DIEGO, Calif. (Ivanhoe Newswire) - It's being called the plague of the twenty-first century. Sixty million adults are now obese. It costs $147-billion to treat it annually. Now, a new less invasive procedure is helping people who have tried everything, to finally get control of their weight.

It doesn't take long for costume designer Courtney Gileo to help actors transform.

"I'm altering a vintage dress for a dance piece for west side story," Courtney told Ivanhoe.

Now, Courtney is working to transform herself. Yo-yoing from 120 to 330 pounds, Courtney tried a new procedure at UC San Diego called stomach plication—think of it as stomach origami.

"Instead of dividing the stomach, in gastric plication, we take the stomach and we fold it in upon itself," Garth r. Jacobsen, M.D., FACS, a bariatric surgeon at UC San Diego, explained.

Unlike gastric bypass, it's reversible. Surgeons don't use permanent staples to decrease the size of the stomach and they don't reroute the small intestine.

"What we are seeking to do is to minimize that risk," Dr. Jacobsen said.

It's the most minimally invasive procedure to reduce the stomach's size by as much as 70 percent. After stomach plication, Courtney lost 40 pounds in five weeks.

"I'm not hungry. I don't have the same hunger signals," Courtney said.

She's happy and so is her husband.

"He's just really happy for me, so it's amazing," Courtney Gileo

There are some downsides to the procedure, like gastric reflux, but the doctor says it decreases over time. Doctors said most patients can expect to lose two pounds per week with stomach plication.

RESEARCH SUMMARY

BACKGROUND: Obesity means having too much body fat and also that a person's weight is higher than what is considered to be healthy for their height. Biology plays a big role in why some people become obese, but not getting enough exercise, eating more food than the body can use, and drinking too much alcohol also contributes to people becoming obese. Obesity is a major health threat because excess weight puts more stress on every part of the body and puts people at risk of several health problems, such as diabetes, heart disease, and stroke. (Source: www.nih.gov)

SIGNS: How do you know if you are obese? The two common ways to determine your weight and the health risks associated with that weight are body mass index (aka BMI) and waist circumference. Both of these measurements can estimate how much body fat you have. BMI is calculated using height and weight, so different people will have different BMIs that are considered healthy. Waist circumference is the size of a person's waist (the area right about the hip bones) and extra weight around the waist and stomach has been linked to several health problems. A good rule of thumb for waist circumference is to maintain a waist size that is smaller than hip circumference. For people who naturally have body shapes where their hips are larger than their waist, they still have an increased risk for the diseases linked to extra weight around the waist.

TREATMENT: For some people, lifestyle changes like maintaining a healthy diet and exercising regularly can help them drop body fat and stop being obese. For others though, it can be extremely difficult to lose the body fat and keep it off. Medications for losing weight fast are all over the market, but some can have serious side effects and may not actually be effective. For obese people who can't lower their amount of body fat through lifestyle changes, surgery is an option. These are three common weight-loss surgeries:

Laparoscopic gastric banding – A band is placed around the upper part of the stomach to create a small pouch to hold food; limiting the amount of food a person can eat.

Gastric bypass surgery – The stomach is made smaller with staples and then a small part of the small intestine is connected to the stomach pouch left to hold food so the body will absorb fewer calories.

Sleeve gastrectomy – This surgery is less common and parts of the stomach are actually removed to make it smaller. (Source: www.nih.gov)

STOMACH PLICATION: Stomach plication is a minimally invasive surgery where the stomach is folded into a smaller size, and the doctors can even reduce the volume of the stomach by 70 percent. Stomach plication is possibly reversible and is performed laparoscopically, which means only one to five small incisions are made in the abdomen to reach the stomach. Another benefit of stomach plication is that the patient will not have any severe food restrictions. Currently, stomach plication is a clinical trial option at the University of California San Diego Health System. (Source: www.ucsd.edu)

INTERVIEW

Dr. Garth Jacobsen, Assistant Professor of Surgery, Bariatric Surgery at the University of California San Diego, talks about a new alternative to gastric bypass surgery that's helping patients lose weights.

How long have you been doing this type of surgery?

Dr. Jacobsen: I'm about four years out of my training and I've seen a lot of change over the last four years.

When you first started was gastric bypass the norm?

Dr. Jacobsen: Yes, throughout my residency and fellowship training gastric bypass was the standard of care for surgery in the United States and then came on the Intestinal gastric band, and more recently sleeve plication is one of the more investigational procedures that we have.

They tend to be less and less invasive right?

Dr. Jacobsen: Right. That's one of the pushes that we have here at the Center for Future of Surgery is to try to minimize the impact on the patient. So each of the surgeries we perform sequentially becomes less invasive as the progress continues.

Can you talk about the gastric plication?

Dr. Jacobsen: Essentially what that is, is stomach folding, or essentially folding the stomach upon itself to reduce the volume.

Why is that better than the lap band?

Dr. Jacobsen: One of the main risks in gastric bypass or sleeve gastrectomy is leak from the staple lines. Any time you divide the stomach or have to reattach intestines there's an increased risk of surgical mishaps or problems. So what we're seeking to do is to minimize those risks, and by not dividing the stomach and not having to reroute intestines, we're trying to minimize that risk.

You would think with folding there would be leakage?

Dr. Jacobsen: Well since we're not actually dividing the stomach we don't have to worry about a staple and that's usually where we worry about the leakage occurring. We're not saying the risk is zero percent, but it's certainly less than with a conventional gastric bypass.

A man was in here and he had gastric bypass years ago. I don't think people realize that your stomach can again grow and you would need it again if you started to gain weight. Is that true?

Dr. Jacobsen: Absolutely, a small portion of patients that undergo gastric bypass will experience weight gain and we're still trying to discover what the reasons for that are. We don't have it from my understanding, but one of the things that can lead to that is stretching of the gastric pouch or stretching of the attachment point between the gastric pouch and the valve. We've pioneered some techniques here at UCSD to shrink the stomach back down again. This, however, is an attempt to take that concept into the neighbor stomach and take a patient that hasn't had bariatric surgery and give them some restriction to their food intake.

Does that mean with the plication it won't stretch again?

Dr. Jacobsen: It's still investigational, we're not sure what the ten year outcomes of this procedure are going to be, but certainly earlier results have been encouraging.

What do you like better about this procedure?

Dr. Jacobsen: Well I'm not sure that this procedure is going to be a replacement for most standard procedures, but it could be. We're still early on in the investigation, but we like the option of leaving the patient's native anatomy intact. It's kind of just rearranging it to give them that restriction without having to take part of their intestines out or reroute the intestines.

What patients would this not be good for?

Dr. Jacobsen: Well I think, again, that's still a population we're trying to define, but we're using this procedure in any patient that would be a candidate for conventional gastric bypass. We're following those patients very carefully to see how they do, to see if they do succeed like patients with bypass and see what the long-term consequences are. Certainly we're seeing weight loss; that's very encouraging.

Are there any risks to this?

Dr. Jacobsen: Yes, as with any surgery. Especially with bariatric surgery there are risks. There are risks with just the general anesthesia from the procedure and, as you astutely pointed out earlier, there's a small risk of leak. Just from where we take the stomach sutures and do the folding the stomach can tear, though we haven't seen that in our practice.

Is it any riskier than gastric bypass?

Dr. Jacobsen: I don't think that it would be riskier than gastric bypass. Certainly gastric bypass is one of the standard operations in the United States and most of the morbidity comes from the rerouting of the intestines and the division of the stomach, neither of which are part of this operation.

So traditionally you would staple.

Dr. Jacobsen: So a traditional gastric bypass involves stomach stapling and stomach stapling is just that. We use this device that implants two rows of staples and cuts between it. This is a cutting staple that we use, an everyday tool in the OR. What it does, this is a model of our stomach, we put the stapler across the stomach and we clamp it down, then we essentially automatically deploy these rows of staples, and then a knife blade cuts in between. So what you can see is the end result; this is a vision of the stomach with the staples on the top and the bottom. Gastric plication follows approximately the same principles that we utilize in our bariatric surgery where ours is reduction in stomach volume. Instead of dividing the stomach, in gastric plication we take the stomach and fold it in upon itself. In that folding you can see that you dramatically reduce the volume of the stomach making it harder to eat large quantities of food. This is a reversible procedure which can be undone by undoing the sutures.

Do you like this is better because there's no outside object being put in and you're not changing forever?

Dr. Jacobsen: Sure. Some of the potential advantages of this surgery are the lack of implanting the device. So unlike the gastric band you don't have to implant a device the patient has to wear the rest of their life. Again, as was mentioned before, we don't have to divide the stomach and we don't have to reroute the intestines. The simplicity is the beauty and we're really excited about the potential of this surgery.

FOR MORE INFORMATION, PLEASE CONTACT:

Jacqueline Carr
Communications Director - Clinical
UC San Diego Health Sciences
jcarr@ucsd.edu

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