How important is body image and weight loss in western society? Canadians spend an estimated $3-$5 billion a year on diet products, health club memberships and exercise equipment just to lose that extra 5-10 kgs nagging them at the belt line.
For most, that extra ballast will be a life-long partner, coming and going. For a few others – the 3 per cent of Canadians considered morbidly obese – no amount of low-cal shakes or high-tech treadmills will make much of a difference in what is, for them, a life-threatening condition.
“They have tried all the products, and spent hundreds, if not thousands of dollars, on diet plans, and they never win,” says general laparoscopic and bariatric surgeon Dr. Patrick Yau. “For most of them, surgery is their best hope for weight loss of over 45 kgs, “he says.
Yau and Dr. Jacob Joffe, both of whom perform gastric by-pass and stomach stapling surgery at The Scarborough Hospital, Grace Division, have performed a relatively new third option since Oct., 2000: gastric banding. Developed in 1993 by a Belgian surgeon, the gastric band – also known as the lap band – is both less invasive and carries a lower risk than either the gastric by-pass (known as the Roux-en-Y) or stomach stapling (VBG) surgery.
“There are many advantages to the lap band,” says Dr. Joffe. “The procedure can be performed relatively quickly (in about an hour) and because it is done laparoscopically, it is less invasive than either the Roux-en-Y or VBG, and therefore recovery time is shortened,” he said.
The lap band is a silicone ring, approximately 7.5 cm in diameter, which is wrapped around the upper stomach, effectively dividing it into two sacs, with the smaller portion nearer the esophageal opening. This smaller portion fills with food first, giving the person the feeling of being full after eating much less food, therefore cutting down on their intake. The band carries a further advantage over the Roux-en-Y and VBG: the band has an expandable bladder into which saline solution can be injected or withdrawn (through a port inserted into the patient just below the skin) to adjust the band’s opening allowing more or less food to pass to the lower stomach.
When combined with a nutritional and exercise regimen (which it must be to be successful for weight loss), the lap band has a success rate of 80 per cent in terms of weight lost in Europe where over 50,000 people have undergone the procedure. This compares to about 60-70 per cent for stomach stapling (VBG) and 90 per cent for a gastric by-pass (Roux-en-y).
The VBG and Roux-en-y procedures carry their own risks.When a stomach is stapled, therefore making it smaller with the same effect as the la-band, there is a one in 100 risk of food leaking through tiny tears in the stomach walls and may lead to peritonitis and death.
In a gastric by-pass, the stomach is permanently divided as a portion of the intestine bypassed. While the procedure has the highest success for weight loss, there is less time for the food to be digested, therefore decreasing the body’s ability to absorb the nutrients. Patients must remain forever vigilant in their food intake to avoid malnutrition.
For all its benefits, however, the lap band is not for everyone, Joffe warns.”We’re not offering the bands to patients over 160 kgs (about 350 pounds) and who have to lose over 70 kgs (about 150 pounds) because they are not as effective as the patients’ situation demands,” he says. Those patients are advised to undergo the Roux-en-y. “The band is not a magic pill either,” says Yau. “This is not for people who want to lose a few pounds. And we want to make sure the people are determined to make it work and will combine the band with proper food intake and exercise,” he says.
When they began performing the procedure a year-and-a-half ago, Drs. Joffe and Yau were the only surgeons in Canada offering the gastric lap band surgery. (A surgeon is currently performing the operation in the Vancouver area. They have performed just over 70 operations to date, and expect to reach the 100 mark this summer, which will qualify The Scarborough Hospital as a teaching centre for the procedure. When they began, the procedure was covered by the Ontario Health Insurance Program, save and except for the cost of the band, which patients had to purchase at a cost of about $4,500. That, however, has now changed in the wake of debate over two-tiered health care.
“The province came to us and said that under the terms of The Canada Health Act, you cannot install a prosthesis paid for by a patient,” Joffe says. As a result, the procedure now costs $10,000, inclusive of everything, including counseling, follow-up assessments and even taxes.
“A few patients have backed out of the stomach band and chosen one of the other procedures” because of the increased cost, Joffe says. Still, the new fees to the patients haven’t dried up the demand – there is still a three-to-four month waiting period for the operation once the patients have qualified as candidates, he says.