OBESITY, DIABETES, & WEIGHT LOSS SURGERY

Obesity is the modern epidemic of the 21st century. Since the mid-1980s, the collective weight of American society has continued to increase. Obesity is now the second leading cause of death in our country. In addition, conditions associated with obesity such as diabetes, heart disease, NASH, and sleep apnea are becoming increasingly prevalent. Today, 8% of all adults suffer from Adult Onset Diabetes or Type II Diabetes. It is projected that by the year 2030, more than 25% of all adults will have diabetes. There is a direct relationship between the development of diabetes and obesity as 90% of patients with diabetes have at least Class I obesity (>50 lbs overweight). To date, the only truly successful strategy to address this problem for individuals is Bariatric Surgery.

chiasson

Dr. Chiasson started the Weight Loss Surgery Program at Northwest Medical Center in 2003. Since then the program has flourished and was the first in Southern Arizona to receive Center of Excellence accreditation status by the American Society of Metabolic and Bariatric Surgery (ASMBS). The program represents the oldest and most successful weight loss program in Tucson.

PRIMARY OBESITY SURGERY OPTIONS

Minimally Invasive Bariatric surgery continues to evolve with the development of new techniques and new technologies. The primary obesity surgery options have developed with the concept of limiting food intake (restriction), limiting food absorption (malabsorption), and affecting the hormonal environment in the body to enhance weight loss. The majority of primary weight loss surgery procedures performed using laparoscopic surgery techniques. There is a growing interest in less invasive endoscopic procedures which might play a larger role in the future.

  • Oberra Intra-Gastric Balloon
  • POSE 2 (pending FDA Approval)
    • Primary Obesity Surgery Endoluminal, or POSE procedure, is an endoscopic incisionless weight loss procedure that reduces the size of the stomach and helps to diminish hunger cravings. The POSE procedure is performed using endoscopic “through the mouth” techniques on an outpatient basis under general anesthesia. The POSE procedure is primarily designed for patients with a BMI of 30 to 40; who have less than 100 pounds of excess weight to lose; who have made serious non-surgical weight loss attempts that have proved unsuccessful; and who are motivated and willing to make significant lifestyle changes in diet and exercise.   I have been trained to perform this procedure.  However, I am not able to offer the procedure at this time as it is in the FDA approval process.  I look forward to being able to offer this procedure to my patients once this process is completed.
  • Sleeve Gastrectomy
  • Gastric Bypass
  • Single Anastomosis Duodenal Switch with Sleeve

REVISION OBESITY SURGERY OPTIONS

In the past 25 years, there has been a steady increase in the number of obesity surgery operations performed in the United States. Obesity surgery remains the best tool for patients with obesity to achieve significant and sustained weight loss. Unfortunately, long-term weight loss success is not 100 % certain. In recent years, there has been a growing recognition that there need to be treatment options for those individuals who either do not lose an adequate amount of weight after their primary obesity surgery procedure or those individuals who are initially successful in reaching their goals but experience weight regains over time. I am very interested in providing services to this sub-group of obesity surgery patients. I have obtained additional training in order to provide this group of patients with the most advanced and up-to-date techniques available.

ENDOSCOPIC

The “Revision of Obesity Surgery Endoluminal” (ROSE) procedure options are best geared to those individuals who have been successful in achieving their weight loss goals and then experience modest weight regain. These procedures are intended to re-create or augment the “restrictive” component of the primary weight loss procedure. These procedures are ideally suited for the patient in the BMI 25-35 range. They offer the advantage of being incisionless with minimal pain and minimal risk.

Some patients who have undergone Sleeve Gastrectomy surgery may experience inadequate weight loss or some weight regain over time. This may be due to gradual stretching of the gastric sleeve. It is felt that this results in a loss of the feeling of fullness. Patients can eat larger meals and weight regain occurs.

This is an endoscopic incision-less technique using new advanced tools to reduce the size of the gastric sleeve portion of the stomach through the patient’s mouth without making any external cuts to the body.  This procedure is performed using a small flexible endoscope and an EndoSurgical Operating System (EOS). The scope and the EOS instruments are inserted through the mouth into the gastric sleeve the same way as a standard endoscope. Tissue anchors are used to create multiple tissue folds along the sleeve portion of the stomach to reduce the diameter of the sleeve tube. After the procedure, the patient will enter our standard bariatric surgery follow-up program of nutritional counseling and exercise.

Patients who have undergone Gastric Bypass surgery may experience inadequate weight loss or some weight regain over time. This may be due to gradual stretching of the gastric pouch (the new small stomach pouch) and/or the stoma (the connection between the gastric pouch and the small intestine). This stretching may result in a loss of the feeling of fullness. Patients can eat larger meals and weight regain occurs.

This is an endoscopic incision-less technique using new advanced tools to reduce the size of the gastric pouch and stoma through the patient’s mouth without making any external cuts to the body. This procedure is performed using a small flexible endoscope and an EndoSurgical Operating System (EOS). The scope and the EOS instruments are inserted through the mouth into the gastric pouch the same way as a standard endoscope. Tissue anchors are used to create multiple, circumferential tissue folds around the stoma to reduce the diameter, typically to about 10mm. Using the same technique, additional anchors are placed in the gastric pouch to reduce its volume capacity. After the procedure, the patient will enter our standard bariatric surgery follow-up program of nutritional counseling and exercise.

Some patients who have undergone Duodenal Switch with Sleeve Gastrectomy surgery may experience inadequate weight loss or some weight regain over time. This may be due to gradual stretching of the gastric sleeve. It is felt that this results in a loss of the feeling of fullness. Patients can eat larger meals and weight regain occurs.

This is an endoscopic incision-less technique using new advanced tools to reduce the size of the gastric sleeve portion of the stomach through the patient’s mouth without making any external cuts to the body. This procedure is performed using a small flexible endoscope and an EndoSurgical Operating System (EOS). The scope and the EOS instruments are inserted through the mouth into the gastric sleeve the same way as a standard endoscope. Tissue anchors are used to create multiple tissue folds along the sleeve portion of the stomach to reduce the diameter of the sleeve tube. After the procedure, the patient will enter our standard bariatric surgery follow-up program of nutritional counseling and exercise. [See video in Revision of Sleeve Gastrectomy]

LAPAROSCOPIC

The Laparoscopic Obesity Surgery Revision procedure options are best suited to those individuals who achieve their initial weight loss goals and then experience significant weight regain or those individuals who have been not been successful in achieving their initial weight loss goals. These procedures are intended to create or augment the “malabsorption” component of the primary weight loss procedure. These procedures are ideally suited for the patient with a BMI > 30 range. In my practice, they offer the advantage of being performed as outpatient procedures with minimal pain and significant weight loss.

The Sleeve Gastrectomy procedure is the most common procedure performed today. It works primarily by restriction and hormonal changes. The number of patients who experience inadequate weight loss or weight regain is about 30%. The laparoscopic procedures offered to these patients provide significant malabsorption. They include conversion to:

    • Distal Gastric Bypass (Severe GERD)
      • (150 cm afferent limb + 150 cm Roux limb)
  • Single Anastomosis Gastric Bypass
    • (200 cm afferent limb)
  • Single Anastomosis Duodenal Switch
    • (300 cm length from Ilio-Cecal Valve)

Patients who have undergone Gastric Bypass surgery may experience inadequate weight loss or weight regain over time.  This laparoscopic procedure is intended for patients who require significant additional weight loss.  In this case, a malabsorptive component is provided.   During the surgical procedure, the Roux limb emptying the gastric pouch is divided just before it reaches the jejuno-jejunostomy anastomosis.  From there an intestinal anastomosis is created to the ileum which is measured 250-300 cms from the junction of the colon and the small bowel.  The malabsorptive aspect of the procedure is due to a larger portion of the small intestines being bypassed.  This changes the normal way that bile and digestive juices break down food which cuts back on how many calories you absorb and contributes to more weight loss. After the procedure, the patient will enter our standard bariatric surgery follow-up program of nutritional counseling and exercise.

Patients who have undergone Single Anastomosis Duodenal Switch with Sleeve surgery may experience inadequate weight loss or weight regain over time. This laparoscopic procedure is intended for patients who require significant additional weight loss following prior Single Anastomosis Duodenal Switch with Sleeve surgery. In this case, an additional malabsorptive component is provided. During the surgical procedure, the small bowel is divided proximal to the prior duodenal-intestinal anastomosis. It is then re-connected 150 cm distal to the duodenal-intestinal anastomosis to create Roux-en-y anatomy consistent with the traditional Duodenal Switch. This results in creating a common channel where nutrients are absorbed to 150 cms from the junction of the colon and small bowel. The malabsorptive aspect of the procedure is therefore enhanced due to additional small intestine being bypassed. This further changes the normal way that bile and digestive juices break down food which reduces the calories one absorbs and contributes to more weight loss. After the procedure, the patient will enter our standard bariatric surgery follow-up program of nutritional counseling and exercise.

The Laparoscopic Adjustable Gastric Band operation has been an abysmal failure for long-term successful weight loss with > 70% of patients having their band removed for either complications or failure to achieve sufficient weight loss. Fortunately, this operation is easily modified and “Band” patients can be revised to any of the primary laparoscopic obesity surgery options.

REVISION SURGERY FOR COMPLICATIONS

Finally, Dr. Chiasson performs revision surgery to manage complications related to all of the primary weight loss procedures. These include: Linx procedure for severe GERD in Sleeve Gastrectomy, Revision Gastro-Jejunostomy for Ulcers, Gastric Bypass reversal, and surgical complications related to Duodenal Switch.

REAL PATIENT SUCCESSES

I would highly recommend Dr. Patrick Chiasson. He is very kind, caring, and listens to you. Dr. Chiasson will spend as much time as necessary explaining everything and answering all questions. After my gastric bypass 10 years ago, I gained the weight back. Dr. Chiasson explained all of my options very thoroughly, and we agreed on the Enteroenterostomy Anastomosis to revise my Gastric Bypass procedure. It was laparoscopic and performed as an outpatient procedure. Dr. Chiasson spent time talking with me prior to the procedure in pre-op, and again offered support, reassurance, and answered my questions. I was home within a few hours after surgery. Recovery was fast and went very well. As A Registered Nurse, I see the great care Dr. Chiasson gives to his patients. As a patient, I received the same wonderful care.

F.M.

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In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. You are not alone and you do not need to feel any less of a person if you are overweight or obese. Take action now and increase your quality of life.