Bariatric surgery

Expanding choices lead to shrinking waistlines

Dr. Ninh Nguyen, chief of the Division of Gastrointestinal Surgery and vice chair of the Department of Surgery.

Surgeries to help people lose weight and become healthier are among the most frequently performed elective operations in America today. UCI Health is at the forefront in offering the newest and most effective bariatric procedures.

The program at the UCI Health H.H. Chao Comprehensive Digestive Disease Center is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and is led by Dr. Ninh T. Nguyen, chief of the Division of Gastrointestinal Surgery and vice chair of the Department of Surgery, UC Irvine School of Medicine. Live Well spoke with Nguyen about the latest advances in treating obesity and how patients benefit.

We hear that obesity is an epidemic in America. Is it true?

The obesity epidemic is rampant. Right now more than one-third of Americans are obese. Obesity is defined as a body mass index [BMI, based on height and weight] equal to or greater than 30.

The gastric balloon procedure was just approved by the food and drug administration. Who is this procedure for?

The gastric balloon procedure is particularly exciting since we haven’t had a procedure to offer to obese patients with BMIs less than 35—those who are just 50 pounds over their desired weights. With this procedure, either a single or dual balloon is inserted into the stomach through the mouth with an endoscope, then inflated with a saline solution and left in place for six months. The balloons take up a significant amount of space, and patients cannot eat as much and they feel full sooner. After the balloons are removed, patients follow up monthly with our team members, including work with a dietitian and social worker to maintain their weight losses.

The FDA also recently approved a procedure called VBLOC therapy. How does it work?

We insert a pacer lead—a device like a cardiac pacemaker—around the vagus nerve that periodically blocks signals between the brain and the stomach. Unlike with the gastric sleeve and gastric bypass, we don’t need to remove or reroute anything. Research has shown that people lost an average of 28 percent of their excess weight during the first year. We are offering VBLOC therapy to adults with BMIs between 35 and 45 who also have an obesity related condition such as type 2 diabetes.

What type of bariatric surgeries do you offer for severely obese patients?

For patients with BMIs of 35 with conditions such as diabetes or hypertension, or BMIs of 40 or more, we offer the Roux-en-Y gastric bypass and the vertical sleeve gastrectomy. With the bypass, we construct a small pouch to restrict the size of the stomach and bypass parts of the digestive tract to limit the calories absorbed as food passes through the intestines. Patients with diabetes or metabolic syndrome are more likely to be candidates for the bypass, as studies have shown that gastric bypass is more likely to improve or resolve these conditions. With the sleeve, we make the stomach smaller, reducing its capacity by 80 percent, so patients feel full sooner. We also remove a portion of the stomach that secretes the hunger hormone, so the hunger sensation is decreased. We perform these procedures laparoscopically—through incisions that are 2 centimeters or smaller.

Patients who have undergone bariatric surgery sometimes need a second procedure, either because of complications from the original surgery or problems after regaining weight. What can you do for them?

We perform revisional surgery for patients who have developed complications—such as chronic obstruction, reflux or leakage—from their original operations. Additionally, we perform revisional surgery for patients who have not lost sufficient weight or have regained weight. For example, a patient with poor weight loss after adjustable gastric band surgery may be a candidate to have the band removed and undergo a sleeve gastrectomy. In a patient who had a gastric bypass, endoscopic gastric revision may be an option. After the patient is sedated, a flexible scope is passed through the mouth into the stomach pouch. We then place sutures to reduce the size of the stomach and stomach outlet.

What's the cost of the obesity epidemic?

The problem with obesity is that it’s associated with a whole host of medical conditions, such as hypertension, diabetes, high cholesterol, obstructive sleep apnea and fatty liver, to name a few. Obese individuals with metabolic syndrome—high blood pressure, diabetes and high cholesterol—are at high risk for developing coronary artery disease and having heart attacks and strokes, even at a young age. The health risks associated with obesity are cumulative and costly: obesity-related disease drives more than 20 percent of all healthcare costs—that’s almost $200 billion a year.

Who are the best candidates for bariatric surgery?

People who qualify for bariatric surgery are adults with BMIs of 35 with at least one obesity-related condition, or those with BMIs of 40 or more. Individuals with conditions such as depression, eating disorders and substance abuse have to be treated before they can be candidates for surgery. Good candidates need to be willing to continue follow-up care in our multidisciplinary program after surgery.

How successful are these surgeries in helping patients lost weight and control their disease?

Overall, patients lose 65 to 75 percent of their excess weight over the first year, and 90 percent maintain that weight loss over the next five years. Studies show they also experience a 60 to 80 percent improvement in their obesity-related health problems. Many of the obesity-related conditions, particularly high blood pressure and type 2 diabetes, improve or resolve relatively quickly after the operation. We can see benefits within one month after surgery. Some patients reduce their diabetes medication, and some will eventually get off it altogether. Studies have shown a 40 percent reduction in the risk of death associated with cardiac disease.

How do you help patients decide what procedure to undergo?

We spend time listening to the patient, evaluating the patient’s health conditions and explaining the options and recommendations. It’s just one of the reasons we have been designated a Boeing Center of Excellence for bariatric surgery, one of only four in the country and the only one on the West Coast.

Learn more about weight-loss surgery at ucirvinehealth.org/bariatric.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Winter 2016