Why are some patients choosing to have a Gastric Sleeve Procedure?

The Gastric Sleeve Procedure is an operation that has been around for about seven years and we have found it to be a very successful operation. At Fresh Start Bariatrics we have proformed over 100 Gastric Sleeve Procedures. Often patients would pefer not to be concerned with vitamin and mineral difficiencies after a Gastric Bypass Operation. Since the small intestine is not effected by a Gastric Sleeve operation, there is less concern regarding absorption of vitamins and minerals. Also, many patients choose to have a Gastric Sleeve operation because they would like to avoid any potential complications from the placement of an adjustable Gastric Band. In our practice, now approximately 20% of patients choose to have a gastric sleeve procedure. We have found that their weight loss is very similar to the results of the Gastric Bypass operation.

Weight loss in the first year from Gastric Sleeve

There is a “Magic Year” after a bariatric operation is your year to get your weight off.

Gastric bypass and gastric sleeve patients will lose nearly all of the excess weight that they will lose from their operation by the end of one year after the operation. (Gastric band patients also lose most of the weight they will lose in the first year but their weight loss is usually slower and it takes about 3 years to reach a stable lower weight.)

In our practice it is common that patients lose about 20 lbs a month for 2 or 3 months then 15 lbs for a couple of months then 12 lbs for a couple of months and so on slowly decreasing the amount of weight they lose over the first year until their weight is stable. Our patients lose about 80% of their excess weight at one year for both of these operations. The most frequent BMI I see from patients having these operations a BMI of 28.

After the one year time period the operation will help the patient to keep the weight off but is unlikely to cause very much more weight loss.

Do not miss your year of opportunity! This is your year to get your weight off.

The weight loss stops because after one year a patient is able to consume enough food to meet their caloric needs and weight loss will probably soon come to a halt.

This is why it is so important to do everything your bariatric surgeon ask of you especially during that all important first year after the operation.

In our practice we ask patients to start their exercise program at 3 to 4 weeks after the operation and avoid liquid calories whenever possible and keep the portion size of each meal at an appropriate level and follow the directions of the dietitian. Other suggestions to lose or maintain weight loss can be found on the June 4, 2010 posting on this blog: “8 Rules for Long Term Success after Bariatric Surgery”.

We want all bariatric surgery patients to obtain their best result so make sure you are determined to make the most of your “Magic Year” after bariatric surgery.

Remember, where your weight is at 1 year is probably where you can expect it to stay if you do what is asked thereafter.

Advice from Steve Myers, MD, bariatric surgeon in Columbus, Ohio

Aetna Changes It's Policy and Now Covers the Gastric Sleeve Operation!

Today I was informed of the following:


As of April 9, 2010, Aetna has changed its position on reimbursement for sleeve gastrectomy, and will now cover the procedure. This coverage will be the same as the other bariatric surgery procedures covered by Aetna.

Per the official Aetna coverage policy, “Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria are met.” (Selection Criteria detailed in the policy -0157).

This policy has the potential to impact over 18 million lives covered by Aetna.


This means Aetna now joins several other medical insurance companies in the Ohio area including Medical Mutual, United Health Care and Humana,(through OhioHealth),that cover the gastric sleeve procedure.

This is great news since the gastric sleeve procedure is increasingly the operation preferred by many people that come to Fresh Start Bariatrics at Riverside to have their bariatric operation.

I have performed over 100 gastric sleeve operations over the last two and a half years and have found that this operation is comparable to a gastric bypass operation in the amount of weight a person looses in the first year after their batiatric operation.

Although I believe a Roux en-Y gastric bypass is still the best option for most patients with type II diabetes and severe gastroesophageal reflux, other patients may do well to choose a gastric sleeve operation since there is less concern about mineral and vitamin deficiencies.

Hopefully in the near future all insurance companies will include coverage for the gastric sleeve procedure.

Please see the video posting I did on this blog to better understand how the gastric sleeve procedure works.
.

Thank you, Dr. Myers, For the broken finger!

Greetings Dr. Myers,
I just wanted to say, thanks for the broken finger. Sound odd? Silly, perhaps, but let me explain. (This is kind of long…sorry!)

Last week and this week here in Columbus is the annual Bike to Work Challenge. Never before would I even have considered such a thing – me, not just ride my bike approximately 13 miles downtown to work, but logically, home at the end of the day? So, I made the commitment this year to do it at least once. Children’s Hospital has a nice-sized group of cyclists that bike to work frequently, so there were experienced cyclists to buddy up with so that I wouldn’t have to make the trek alone.
Because I was hesitant to undertake such a thing with relative strangers, I tested the route on the Sunday before my scheduled Monday trek with coworkers, to make certain that I was up to the distance, etc. I made the trip downtown with no problems. I didn’t have a huge amount of time to give to this effort on a busy Sunday, so I immediately turned around and headed home to make certain that I was familiar with the route switches in the downtown area. George picked me up at Ohio Stadium so that we could get along with the rest of our day. So, I knew that the distance was totally doable and that I was comfortable with the sections when I would have to ride on the city streets.
Well…I overslept on Monday morning and woke up with only 30 minutes to shower, get my work clothes into a backpack and meet my fellow employees by the scheduled time…plus it was only 37 degrees at the time. It would have been SO easy to just make the phone call and say “Not going to make it, go ahead without me,” which is so in keeping with what I would expect of myself. Well, made it…hair blown dry and everything. Met everyone along the trail at the scheduled times and locations and was changed and at my desk in time to start the day.
Fast forward to the end of the day, and the small group of 4 that I had finished the ride with that morning had changed to include two men that I had never met and a coworker that I know slightly from our IS department (she would qualify as a runway model). So, our group of six, four of them very experienced riders, take off together. Approximately a mile from work, one of the veteran riders wipes out in front of me and I go head over heals over her. All I could think of was that I was going to break her in half, break every rib in her tiny body, or snap her leg (well, that and my dental work). After our four coworkers and a stranger who was also biking on the trail untangled us (literally, I had a handlebar caught totally up my pants leg) we were able to check for damage to self and bicycles. My coworker had quite the bloody gashes on her knee – but with her experience, had a first aid kit. There was much discussion by our coworkers about whether or not we should call for a ride, if they should ride to their end point and come back with their truck, etc. My preference was to get back up on my bike and go; which we did, after making certain that our bikes were road worthy.
I made it back to my starting point of Antrim Park, only a few minutes later than expected, knowing that I was sporting a broken pinkie finger on my right hand, but little else (which turned out to be incorrect – at home I discovered some decent scrapes and bruises across both thighs – I’m grateful that I don’t bruise much, it would have been a disgusting sight, otherwise).
So, at the end of the day:
• I didn’t roll back over in bed and say “to hell with it.”
• I rode my bike about 13 miles when it was only 37 degrees.
• I wasn’t mortified to be with relative strangers in stretchy work-out pants (NEVER bike shorts – puhleeze!)
• I got back “up on that horse” when it would have been easy (and perhaps better judgment) to call for a pick up.
• I did not shed a tear.
• I’m scheduled to do this twice again this week.

None of this is earth shattering, but all together, a big day for my psyche. Two years ago, I didn’t own a bike. I only bought a bike because I was getting one for George for his birthday and thought this would be fun to do together. Two years ago, I would NOT have dragged my rear end out of bed to ride a bike in 37 degree weather and if I had wiped out on said bike, you could have bet good money that I would have made a call for a pick up.

So, I’m thanking you for your part in all of this – broken pinkie and all. I’m extremely grateful for the wonderful care that you have provided and appreciate your calm…I think that I’ve learned a thing or two from you about patience, and much more.

Peace,
aph

Ann P. Holzapfel

Gastric Sleeve Operation

Recently we have noticed that more and more patients are choosing to have a laparoscopic gastric sleeve operation. I have now performed over 80 of these operations and patients seem to be generally very pleased with the results. Their weight loss is quite good having lost an average of 87 lbs in the first year which is 78% of their excess weight. The range of weight loss is between 41% and 102% of their excess weight.

The weight loss appears to occurring in a very similar fashion to the weight loss from a gastric bypass. nearly all of the weight is lost in the first year.

There is no rearranging of the small intestine and therefore vitamins and calcium are not medically necessary although still a good idea.

A gastric sleeve operation is likely to improve or resolve many obesity related medical problems such as sleep apnea, urinary stress incontinence and high cholesterol but it is not as good as a gastric bypass to resolve type II diabetes or severe gastroesophageal reflux.

The complication rates are low and the two most frequent problems have become even more infrequent in our practice over the last year. Fairly early in our series we had two people who had leaks along the staple line and two patients had narrowing of the sleeve which was treated with revision to a gastric bypass. Neither of these problems have occurred since we have gained more experience with the procedure but they are still a possibility.

All operations have been able to be performed laparoscopically with no conversion to open operation.

All commercial insurance companies in our area cover a gastric sleeve except Anthem/Blue Cross and Blue Shield companies.
I feel a gastric sleeve operation is an excellent option for patients who do not have severe type II diabetes or severe gastroesophageal reflux disease.