Innovations on the Agenda for Obesity Conference

by Geetha Parachuru

This week 4,500 physicians, surgeons and other health professionals who treat people with obesity converge on Atlanta’s World Congress Center for Obesity Week 2013. The conference opens during a time of unprecedented public concern about the fattening of America, and surgery aimed at helping people lose weight will be part of its agenda.  

When surgeons performed the first weight loss surgery in the 1950s, they opened a foot-long incision in the patient’s abdomen, reached inside, and mechanically limited how much food the stomach could hold. By the 1990s, they had switched to a less invasive, laparoscopic approach that required 5 or 6 “bandaid” incisions. 

The American Society for Metabolic and Bariatric Surgery (ASMBS) claims that 80 percent of people who undergo such procedures lose a significant amount of weight and keep it off, lowering their risk for diabetes and heart disease as well. Others regain the weight they lost, which is disappointing. But another group, about 20 percent of people who undergo this type of surgery, experience complications ranging from annoying to dangerous.

Complications After Surgery

Dallas Pass, a 30-year-old Atlanta native with fatty liver disease, underwent laparoscopic gastric bypass surgery at the beginning of February this year.  His wife, Beth Pass, 31, followed suit at the end of the month. 

“As a girl, mentally, you don’t want to be bigger than your guy,” said Beth Pass.  “I kind of jumped onto the bandwagon. He did it first and I waited so I could help him through it and he could help me through mine.”

After the procedure, Dallas Pass lost 2oo pounds and his wife shed 110.  Both developed complications.

“With my procedure,” said Beth Pass, “they blow up your stomach, filling it with gas.  The first week is just torture.  I had my surgery on a Monday, I woke him [Dallas] up at 3 a.m. that Thursday, begging him to go to Wal-Mart to get me Gas- X.  I thought I was in labor. “

Fortunately, the over-the-counter treatment worked and she soon felt better.  Her husband’s problems were more serious and took longer to develop and resolve. 

Months after his procedure, Dallas Pass developed stomach ulcers and kidney stones – neither uncommon in bariatric surgery patients. Surgery has reversed his fatty liver disease.

Surgery without incisions?

Some instrument designers look at complications associated with abdominal surgery and envision a better way: bariatric surgery that involves no incisions because surgeons introduce their tools through the patient’s mouth.

Surgeons already perform millions of upper endoscopies each year, primarily to diagnose problems with the esophagus, stomach, or upper small intestine.

One Georgia-based company is developing a bariatric surgery tool that can access a patient’s stomach through the mouth, according to Dave Bjerken, CEO of InTailor Surgical, based in Marietta, Georgia.  

Bjerken claims his device can help avoid some of the complications associated with operating on obese patients.

“You have added difficulties… like reaching the stomach when you have to get through 5 to 10 inches of fat,” said Bjerken. “The complication rates for these patients are magnified.” 

Bjerken’s innovation is a small, flexible device that allows the surgeon to both view and place an implant that restricts the size of the stomach and limits the amount of food it can hold.

These devices, which are still experimental, have yet to be approved by the FDA. 

Bjerken says his new tool, which makes abdominal incisions unnecessary, “has the potential to open the door for millions of people who are afraid of surgery.” 

In a 2012 report, the American Society for Metabolic and Bariatric Surgery claimed that endoscopic surgeries have the potential to offer “superior safety and cost profile” in comparison to current weight loss surgery. “Such benefits increase the appeal and acceptance of this therapy to patients.“

The push for safer weight-loss procedures is a high priority for surgery boards, doctors and patients alike.  “It changed my life,” said Dallas.  “I want to be alive to have kids.”   

NOTE: The original version of this story contained errors.  After reviewing her notes, student reporter Geetha Parachuru found that Mr. Pass lost 200 pounds, not 238, and the surgery did halt the progress of his fatty liver disease. She regrets the errors.