Dr. Michael Simonson values patients’ experiences after weight loss surgery as they regain quality of life and regain control of their health.
Bariatrics is the branch of medicine involved in weight loss surgery. There are a number of options depending on the patient’s risk factors and co-morbidities — other conditions besides obesity.
“There’s multiple surgeries that have been around for 40 years and even longer in terms of weight loss,” said Simonson, a general surgeon at Great Plains Health in North Platte. “But obviously with the obesity epidemic, it’s really circled back to what is the most effective way for Americans and people in general to lose weight.”
He said, fortunately or unfortunately, the answer often involves a surgical aspect.
“The two (surgeries) that we’re seeing longevity from are the sleeve gastrectomy and the Roux-en-Y,” Simonson said.
According to the Mayo Clinic website, gastric bypass, also called Roux-en-Y gastric bypass, is a type of weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. In sleeve gastrectomy, also called a vertical sleeve gastrectomy, about 80 percent of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana. This procedure is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.
“The Roux-en-Y has actually been around since the 1960s, but it had a lot of complications when it was an open operation.”
Now that it can be done laparoscopically, Simonson said, it’s much better tolerated.
“The sleeve gastrectomy was initially thought to be a good first stage,” Simonson said. “If you have to do a Roux-en-Y on somebody and they’re high risk because of their weight and other co-morbidities because of obesity, their time in the operating room significantly increases the risk of morbidities or complications.”
The thought from the medical community was to do the sleeve first as an intermittent step.
“After people lose weight, (the thought was) we’ll complete the operation in a second stage so that it breaks up the time and the risk is smaller because of the two small operations,” Simonson said. “What we found was that the removal of that portion of the stomach actually allowed almost as good a weight loss as the other operation.”
He said most patients would never come back to have the second stage.
“Both of those operations have been around for enough time, based on risk, they provide very good results,” Simonson said. “The comparison between the two is really an individual comparison based on each patient, what co-morbidities they may have, their risk, their weight and what their expectations are.”
There are a lot of definitions of obesity, but Simonson said there is a common standard used by the medical community.
“There is actually an equation based on height and weight that defines obesity and comes up with something called a body mass index, or BMI,” Simonson said. “That’s the most widely accepted format for understanding how do you compare someone who’s 5-foot-2 versus somebody that’s 6-foot-5.”
He said both medical societies and insurance companies will use BMI to determine eligibility for bariatric surgery.
“The majority of my patients come to me when they feel they’ve tried other options, exhausted non-surgical options,” Simonson said. “They’ve done all the diets, they’ve tried all the fad exercises and haven’t had the success that they want.”
The patients get to the point where they are not able to do the things they enjoy and their weight is limiting their quality of life.
“A lot of it is genetic and a lot of it is environmental — a significant amount is psychological,” Simonson said.
He said the bariatric program offers a complete study of the options for surgery and follow-up.
“We’re not just set up around the surgery, we’re set up around the patient,” Simonson said. “We’ve got dietitians, psychologists, exercise therapists, coordinators, technicians, all these people working together to provide the best outcome for the patient.”
GPH is coming up on recertification of its bariatric program as a center of excellence, Simonson said.
“We want to have all possible elements to ensure success in the patients,” Simonson said. “I can do a great surgery every time and not have any complications and still not have good outcomes if we’re not providing these people with all of the tools that they need for success.”
Simonson said the program doesn’t just kick the patient out the door after surgery.
“That’s very important,” Simonson said. “Again, we emphasize that the surgery is not the ultimate goal.”
That’s not where the process stops, he said; it’s a lifestyle change.
“It takes many years to get unhealthy enough to be considered morbidly obese, so one day in the operating room won’t fix that,” Simonson said. “We really work to change the lifestyle habits that have caused the problem in the first place.”