Less-Invasive Weight-Loss Surgery Booming

Multiple, tiny incisions means less pain, scarring

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HealthDay Reporter

THURSDAY, June 17, 2004 (HealthDayNews) -- The popularity of a surgical technique that requires a handful of small incisions instead of one big one is driving a boom in weight-loss surgery that's slimming celebrities and non-celebrities alike.

The percentage of bariatric surgeries using the so-called laparoscopic technique increased eightfold from 1998 to 2001, according to a study released this week. The study's lead author estimated that the rate may now have reached 30 percent, and he predicts the technique could eventually account for more than two-thirds of all weight-loss procedures.

The study was presented this week at the annual scientific meeting of the American Society for Bariatric Surgery, in San Diego.

Patients "come in asking for the laparoscopic approach," said Dr. Ninh T. Nguyen, chief of the division of gastrointestinal surgery at the University of California at Irvine Medical Center. "The patients are very educated these days. They listen on the radio, they watch TV, and here is Al Roker and Carnie Wilson, saying they had this operation performed laparoscopically."

NBC's "Today Show" weatherman Roker, singer Wilson and other celebrities have greatly raised the profile of bariatric operations, which have been performed since the 1960s but only became well-known over the last five years. The operations contribute to weight loss in the extremely obese by shrinking the size of the stomach, literally forcing patients to eat less. In some cases, the surgeries rearrange the connection between the stomach and the intestines, creating a "bypass" past areas where food is absorbed.

Not everyone is a fan, however. Critics say the procedures are risky, and some insurance companies no longer cover them. Side effects include gallstones, hernias, and nutritional deficiencies. Even if they recover without severe side effects, some patients report they have trouble adjusting to eating tiny meals.

One thing is clear: Weight-loss operations themselves are changing. In their study, Nguyen's team analyzed statistics on two popular weight-loss surgeries -- Roux-en-Y gastric bypass and vertical banded gastroplasty -- performed at community hospitals across the U.S.

They report that the percentage of laparoscopic surgeries rose from 2 percent of all weight-loss operations in 1998 to 16 percent in 2001. During that time, the number of both traditional and laparoscopic bariatric surgeries rose from 12,775 in 1998 to 53,685 in 2001. An estimated 140,000 Americans will undergo gastric bypass surgeries and similar operations this year.

Traditionally, surgeons reached the stomach by cutting vertical incisions in the chest between the breastbone and belly button, said Dr. Alan Wittgrove, medical director at the Alvarado Center for Surgical Weight Control in San Diego. Then doctors would use one of several techniques to either shrink the size of the stomach or prevent it from fully absorbing food. In some cases, they use a band to make the working part of the stomach smaller.

Doctors using the laparoscopic technique cut several inch-long incisions into the abdomen, creating "ports," which they use to insert video-equipped instruments into the chest, Wittgrove said. They use TV monitors to monitor the operation, he said.

According to Wittgrove, the benefits of the technique include shorter recovery times, less pain, less risk of hernias, and less "dramatic" scarring.

But laparoscopic surgeries aren't for everyone. With costs ranging around $25,000, they're more expensive than the traditional approach, even though recovery time may be shorter. Also, some kinds of patients -- including the heaviest people and those who have already had stomach surgeries -- may not be eligible for the procedure.

So should doctors rush to adopt the laparoscopic technique? Not necessarily, Wittgrove said. "Quite honestly, if a surgeon does an open [traditional] gastric bypass well, and they have a whole program to support their patients and everything else, they should continue to do it open, rather than try to learn a whole new access technique," he said.

More information

Get more details about weight-loss operations from the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Ninh T. Nguyen, M.D., chief, division of gastrointestinal surgery, University of California, Irvine, Medical Center; Alan Wittgrove, M.D., medical director, Alvarado Center for Surgical Weight Control, San Diego; American Society for Bariatric Surgery annual scientific meeting, June 15, 2004

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