By Patricia Anstett, Detroit Free Press
Jun. 16–The Michigan Bariatric Surgery Collaborative will have more complete information within the next year about a promising new bariatric option, sleeve gastrectomy.
The operation, through which tiny surgical tools are inserted through keyhole-sized incisions, removes 85% of the stomach, creating a banana-shaped or sleeve-like organ.
To date, there is only one-year follow-up data on 10 patients in the registry who had the operation — too little to be statistically valid. But as the procedure grows — 14 surgeons at eight Michigan hospitals offer it — more people are asking about it because of the promise it holds for the most morbidly obese people.
It might cause fewer complications and may not create lifelong vitamin deficiency and food absorption problems associated with other gastric bypass operations, some doctors say.
Dr. John Birkmeyer, director of bariatric surgery at the University of Michigan Health System in Ann Arbor said it is too early to know whether people will sustain weight loss achieved in the first year after sleeve gastrectomy surgery.
“The durability of weight loss over time is still a very open question,” Birkmeyer said, who prefers minimally invasive gastric bypass surgery for now, at least.
Over time, the reconstructed, smaller stomach may stretch and lose its effectiveness, Birkmeyer said. He also wants more data to demonstrate the procedure is safer than others.
Dr. Abe Hawasli, a St. John Hospital and Medical Center bariatric surgeon who has offered sleeve gastrectomy since 2004, said his statistics show the operation is safe and lasting.
“The results are excellent,” Hawasli said. “There are virtually no side effects. There’s no foreign body, no band that will slip or erode in the future.”
The operation suppresses a hormone that generates hunger sensations and helps patients achieve more weight loss than with other procedures, he said.
Hawasli also offers a so-called reversal procedure to perform sleeve gastrectomy in people who had other bariatric procedures that failed to produce significant weight loss, he said.
“It works much better than Lap-Band and other procedures,” Hawasli said.
For now, reimbursement for the surgery, which costs $23,000 to $30,000, varies.
Blue Cross Blue Shield of Michigan pays for it only as part of a multistage procedure for morbidly obese people, high-risk patients with a body mass index of 50 of more.
Carey Bartosiewicz, 34, of Clinton Township, one of Hawasli’s patients, has been turned down twice by Aetna Inc. for a sleeve gastrectomy procedure.
Now she’s trying to make the case with Aetna to have a Lap-Band procedure. She’s joined a health club, tries to restrict herself to a modest 2,000-calories-a-day diet and goes to a doctor regularly, as Aetna requires, to monitor her weight-loss progress.
“At this point, I’ll do anything,” said Bartosiewicz, who weighs 405 pounds and has many health problems: high blood pressure, sleep apnea, edema, shortness of breath, arthritis and depression and anxiety, all common among severely overweight people.
Another of Hawasli’s patients, Robert Haas, 55, of Southfield, considers himself fortunate that Blue Cross paid for his sleeve procedure in June 2007. He now weighs 196 pounds, down from 360 pounds.
“I’ve never felt better,” said Haas, a teacher at the Michigan Department of Corrections.
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