Newswise — Although surgery designed to reduce the size of the stomach and bring about significant weight loss became available about four decades ago, improved techniques, miniaturized instruments and precision optics have made the procedures more streamlined and less disruptive to patients' lives. Today, the life-changing procedure is even available on an outpatient basis to patients who meet certain criteria, and Cedars-Sinai is one of the first facilities in Southern California to offer it.
Camarillo resident April Robledo, 33, is the first patient to undergo outpatient laparoscopic gastric bypass surgery at Cedars-Sinai. Her operation was performed on Dec. 1, 2004 by Ted Khalili, M.D., director of the Bariatric Surgery Program and director of research at the Center for Minimally Invasive Surgery.
"I needed this procedure for medical reasons," says Robledo. Because of my health and the history of my family, a good thing was going to end real quick (without the operation). The doctors kept saying, 'You're lucky you're not diabetic " yet."
According to Khalili, the procedure takes about 90 minutes. "We place instruments, including a camera lens, through five or six very, very small incisions. Then we make a pouch. If you imagine the stomach being the size of a football, the new pouch, or the new stomach, is going to be the size of an egg. We also bypass about 100 centimeters of the small bowel so that the food the patient eats is not absorbed as well. Many patients will usually lose about 60 or 70 percent of their excess weight in about one year."
Not only does the minimally invasive approach offer reduced pain and risk of complications, it is more cost-effective because patients go home quickly and are able to resume their normal activities in a short time. Although Cedars-Sinai offers the procedure on an outpatient (23-hour hold) basis, patients who need to stay longer have that option, too.
Robledo went into surgery at about 8:30 a.m. As soon as she got out of recovery, she was able to walk to the bathroom with help. That night. . . I went for a little stroll around the hall," she remembers. She stayed overnight as a precaution, going home the next morning.
Khalili cautioned that the outpatient procedure is not appropriate for every case. "We look at each patient's other medical conditions and living situations to make an individualized assessment as to whether they are appropriate candidates. We don't want to send a patient home who has a chance of developing a complication. We make sure they are mobile, that they have appropriate support at home, that they don't live too far from the hospital, and that they are willing and able to do this. There are very strict criteria."
Any gastric bypass surgery " outpatient or inpatient " needs to be carefully considered, according to Khalili. The patient's eating habits and other lifestyle factors will change quickly and permanently.
"Patients usually have tried 10 or 12 other approaches to weight loss, and they may have been overweight for 20 or 30 years. We look at body mass index, but a rough guide is that candidates are at least 100 pounds overweight. These are not people who are overweight by 10 or 20 pounds," Khalili said, adding that the benefits of surgical intervention are dramatic. "Eighty to 90 percent of our diabetic patients are cured of their diabetes after surgery and weight loss. In most cases, blood pressure will come under control and cholesterol will come down to normal levels. There are many conditions related to obesity that are cured or that greatly benefit from the weight loss."
Diabetes, high blood pressure and weight problems run in Robledo's family. She remembers always being a little bigger than the other kids, starting at about sixth grade. Having a baby in her early 20s did not help. She tried the fen-phen diet drug when it was popular, the highly advertised weight loss plans, special diets, and the gym. "That was a waste of money," she said.
As an adult, Robledo developed asthma and says she was always "running out of breath," making it impossible for her to keep up with her surfer-swimmer daughter, who is now 12. Instead of being able to actively participate in her daughter's life, she felt that she was missing out on the fun while watching other children's parents have fun with her. "I was always having to puff on the inhaler," she says.
Two of Robledo's relatives underwent gastric bypass surgery before she did. Their results encouraged her to consider it, too. By the time of her surgery, she was carrying 257 pounds on a 5-foot-2-inch frame. Since the operation, her entire lifestyle has changed.
"I've dropped 35 pounds. I already feel different . . . I'm already starting to feel lighter than I did and I'm not having problems with asthma, which was the big thing," she says.
One of only four hospitals in California whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 17 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and was recently fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu.
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