Patricia Kling's weight, a problem all her life, had reached 286 pounds. Her back hurt. Her hips and knees hurt. She decided to turn to surgery for help and chose adjustable gastric banding, known as Lap-Band. In July 2007, three days before her 49th birthday, she weighed 268 and underwent surgery. She now weighs 165.
Two years ago, Patricia Kling thought she might not live to see her grandchildren grow up.
Her weight, a problem all her life, had reached 286 pounds. Her back hurt. Her hips and knees hurt.
“My weight was definitely starting to take a toll on me,” the 50-year-old mother of three said. “I was starting to want to do less and less walking. I wasn’t sure if I was changing my lifestyle to accommodate my physical being or if my physical being was just taking over my lifestyle.”
She decided to turn to surgery for help and chose adjustable gastric banding, known as Lap-Band because of the minimally invasive technique called laparoscopy and the silicone band placed around the upper part of the stomach in the procedure.
“It was something that I definitely needed to do,” Kling said. “I’ve been on every diet there ever was. I’d lost lots of weight lots of different times but never could keep it off. That’s why this seemed like such a good procedure for me.”
She saw Dr. Vafa Shayani, who along with Dr. Karin Blumofe has begun performing the surgery at OSF Saint Anthony Hospital, for help in 2007. Shayani put Kling on a medically managed weight-loss program while he assessed her suitability for the procedure.
In July 2007, three days before her 49th birthday, she weighed 268 and underwent surgery. She now weighs 165. Her joints don’t hurt, she no longer has to consider taking medication for high cholesterol and she eats what she wants.
Shayani said the operation is performed by making five incisions about the size of a buttonhole on a man’s suit and using video equipment and surgical instruments to place the band around the upper portion of the stomach, buckle it in place, attach a catheterlike tube called the reservoir to the band and secure the reservoir and a small port that allows the doctor access to the band in the tissues of the abdominal wall.
The port, Blumofe said, is under one of the incisions and the doctor can tighten or loosen the band, according to the patient’s needs, by using a needle and syringe to inject a saline solution into the port. The saline solution goes through the reservoir to expandable pouches in the band to apply the right amount of pressure.
When in place, the band partitions the stomach into two compartments of about 10 percent and 90 percent of its size. The patient can then consume only enough food to fill the 10 percent partition before they get the feeling of being full, thus decreasing the amount of food they take in.
“The analogy I use for the amount of food consumption is that most of us adults, if we choose to, can probably consume the equivalent of about 20 chicken nuggets at any given meal,” said Shayani, a former director of minimally invasive surgery at Loyola University Medical Center in Maywood. “With this operation, and partitioning the stomach into 10 percent which becomes the new capacity for food, one would be able to consume the equivalent of about two chicken nuggets.
“If the band is appropriately tightened, it would take a substantial length of time for that food to travel from this small pouch to the remainder of the stomach. This is, basically, the basis for the operation and for its long-term success.”
Shayani, who started performing gastric banding surgery in 2001, said the operation typically takes an hour or less.
He said adjusting the band, which might be necessary if the patient experiences nausea or vomiting, can be done as an outpatient procedure in about five to 10 minutes, and patients need to visit the doctor about every four to six weeks in the first six to 12 months after surgery.
That later extends, he said, to every two to three months, and eventually, every year or so.
Blumofe, who has been practicing general surgery and advanced laparoscopy in Beloit for the past seven years, said candidates for Lap-Band surgery are considered severely or morbidly obese as determined by their body-mass index, a mathematical calculation based on a person’s height and weight.
“A person is considered morbidly obese when their body mass index is more than 40,” Blumofe said. “The other candidate we would look at is someone who has a body mass index of 35 to 40 but has another significant medical problem as well, such as diabetes, high blood pressure or sleep apnea.
“What we find is that, once they lose the weight, a lot of their symptoms get better and their quality of life improves significantly, so we’re not doing this for cosmetic reasons.”
She said patients typically lose one to two pounds a week “which doesn’t sound like a lot, but if you think about it over a two-year period, we hope that they will lose about 100 pounds in a really slow, healthy fashion.”
Even though the patient may eventually reach their ideal weight, Shayani said the band is intended to stay in place for life. “We might choose to loosen the band a bit to make it easier for patients to enjoy food,” he said, “but it will stay in the patient’s body unless there is a reason to remove it.”
Kling said she eats anything she wants, but that what she wants has changed since the surgery.
She said she doesn’t care for breads or pastas, which were among her favorite foods before the surgery, because they make her uncomfortable and make her feel too full too fast.
She said her eating after the surgery “was a lot more restricted than it had been, but I didn’t notice it as much because I had a continuous feeling of fullness. It took very little food to make me feel full, so I was satisfied and I could be around food and didn’t want food more than what my needs were.”
Shayani and Blumofe said they work with dietitians and counselors to help patients with eating behavior. Patients are on a liquid diet for a few weeks after the surgery, after which they recommend a diet high in protein. Once the patient is losing weight steadily, they can return to a more balanced diet.
He said they also recommend their patients use a daily multivitamin.
“Thinking to do a medical correction for my weight was very scary for me,” Kling said, “but after researching it, this seemed to be the best choice. It seemed to be the least invasive and it seemed to make sense that it would be long-term. I wanted it to be a permanent solution if I was going to go medically.”
Mike DeDoncker can be reached at (815) 987-1382 or firstname.lastname@example.org.
Adjustable gastric band surgeryWhat: Surgery in which an inflatable silicone band is placed around the upper portion of the stomach to restrict food intake. The band is adjustable by injecting or extracting a saline solution into or out of a port connected to the band.