Sleeve gastrectomy becoming preferred surgical option



“Once you’re 100 pounds overweight, it’s not going to be as easy as being good one weekend. It’s hard, and you think, ‘Why bother? I can’t be good forever, or for a year.’ So basically, you fall off the wagon. I always felt like I had to starve myself to lose weight.” — Patty Sprague
Patty Sprague was 284 pounds at her heaviest before pursuing gastrectomy. HQ PHOTO COURTESY PATTY SPRAGUE

For Patty Sprague, losing weight was never as simple as it sounded. A 52-year-old hairdresser from the Midcoast town of Warren, Sprague weighed 284 pounds at her heaviest, despite having tried dieting and weight loss programs.

She has acid reflux, a medical condition that made her feel nauseous and hungry. She also has a slow metabolism, meaning her body takes a longer time to burn calories. That meant not thinking about her weight on a single vacation could lead to a weight gain of as much as 10 pounds.

“Once you’re 100 pounds overweight, it’s not going to be as easy as being good one weekend. It’s hard, and you think, ‘Why bother? I can’t be good forever, or for a year.’ So basically, you fall off the wagon,” she said. “I always felt like I had to starve myself to lose weight.”

Yet lose weight Sprague has.

Two years later, she’s 130 pounds lighter. Trips to the mailbox and standing at her job used to make her tired, but now, “I feel comfortable working. I have so much energy,” she said. “I don’t obsess every day because I hate the way I look.”

Dieting and exercise have helped her get to 155 pounds, but it was a surgery to reduce the size of Sprague’s stomach that turned the tide in early 2014.

Called a sleeve gastrectomy, the operation is a relatively new approach, but one that is catching on in the world of bariatric surgery. Just over half the weight loss surgeries in the United States in 2014 were sleeve gastrectomies, according to the American Society for Metabolic & Bariatric Surgery.

The surgical weight loss program at Eastern Maine Medical Center (EMMC), where Sprague had her surgery, has performed more than 500 sleeve gastrectomies in the last three years. The operation now accounts for 60 percent of the hospital’s bariatric surgeries.

The operation has a few advantages over more traditional weight loss surgeries such as the gastric bypass.

In a gastric bypass, a surgeon will use staples to separate a patient’s stomach into two pouches. Food only enters the upper pouch, which is walnut sized, and the small intestine is rerouted to connect to it. With so much less space for the food, the patient finds her appetite considerably reduced.

Dr. Michelle Toder performed Sprague's gastrectomy. PHOTO COURTESY MCMH
Dr. Michelle Toder performed Sprague’s gastrectomy. PHOTO COURTESY MCMH

The gastric bypass is the “gold standard” of bariatric surgeries, according to Michelle Toder, surgical director in EMMC’s weight loss program, and can lead to a 70 percent reduction in excess weight when combined with exercise and other measures.

Sprague’s operation, the sleeve gastrectomy, is like the first part of a gastric bypass. A portion of the stomach is removed, and “We turn the stomach from a football-shaped structure into a long, skinny pipe,” Toder explained.

That reduces the patient’s appetite, which can result in a 50 to 60 percent reduction in excess body weight, when combined with diet and exercise.

But while the projected weight loss isn’t as great with a sleeve gastrectomy, Toder adds, the operation does improve on gastric bypass surgery in a significant way: afterward, patients are better able to tolerate and absorb vitamins, aspirin, steroids, non-steroidal inflammatory drugs (NSAIDs) and other medications. The operation also leads to fewer complications down the road.

Doctors started performing sleeve gastrectomies around 2008, and by 2010 major health insurers were covering the operation, Toder said.

The surgery itself takes an hour and a half, but requires months of preparation. Patients must start losing weight, quit smoking and drinking and meet various psychological requirements. Afterward, they continue to work with nutritionists and weight loss experts to consume the right number of calories and vitamins and exercise appropriately. Depending on their fields, patients can be back to work in two to six weeks.

Two years after the procedure, Patty Sprague is a svelte 155 pounds. PHOTO COURTESY PATTY SPRAGUE
Two years after the procedure, Patty Sprague is a svelte 155 pounds. PHOTO COURTESY PATTY SPRAGUE

Sprague learned about the option of getting a sleeve gastrectomy from a friend who also had the operation. Given that no other approaches to weight loss had worked, she consulted with her primary care physician and went through with it.

“It wasn’t painful at all,” she said. “I left the hospital not taking any pain medicine… My contusions were just tiny little dots.”

Her appetite was diminished almost immediately, but it’s slowly risen to a manageable level. She avoids sugary and starchy foods and regularly goes to the gym.

“Before I could eat a whole pizza. Now, I can eat one slice,” she said. “Just after the surgery, I could get just two bites of food.”

The sleeve gastrectomy was particularly appealing to Sprague because she can still use ibuprofen.

The growth in weight loss surgery comes at a time when the state’s adult obesity rates seem to have crested. It steadily rose from 10.9 percent in 1990 to 28.9 percent in 2013, then dropped to 28.2 percent last year, according to data from the Trust for American’s Health and Robert Wood Johnson Foundation. Childhood obesity has been dropping, going from 16 percent in 2001 to 14.3 percent in 2010.

Diabetes, hypertension, heart disease, arthritis and types of cancer have all been associated with obesity. According to Toder, the EMMC surgeon, more people in their 40s and 50s who aren’t very obese, but like Sprague, maybe 100 to 150 pounds overweight (or with a body-mass index greater than 40), should think about weight loss surgery.

Studies have suggested that exercise and dieting only work for about 10 percent of people trying to lose significant amounts of weight, Toder said, so anyone who doesn’t succeed with them shouldn’t feel like they’re cheating.

“They’re not alone,” she said.

Correction: An earlier version of this article misquoted Michelle Toder as saying patients who have undergone a sleeve gastrectomy can better tolerate and absorb medical marijuana. Toder did not say that.

Charles Eichacker

Charles Eichacker

Reporter at The Ellsworth American
Charles Eichacker covers the towns of Bucksport, Orland, Castine, Verona Island, Penobscot, Brooksville and Dedham. When not working on stories, he likes books, beer and the outdoors. [email protected]

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