Gastric bypass alternative available

Gastric bypass surgery has been the most popular surgical method of losing weight in Cayman, but now a Canadian surgeon is offering an alternative.

Dr. Chris Cobourn

Dr. Chris Cobourn demonstrates how lap-band surgery works. Photo: Norma Connolly

Dr. Chris Cobourn spoke to members of the Cayman Islands Medical and Dental Society on Monday night, introducing to them the lap-band alternative.

Using keyhole surgery, the upper part of the stomach is encircled by a band to create a little pouch which can hold 15 to 30 cc.

The interior of the circular band can be inflated by adding saline, which is injected into a tiny reservoir port placed beneath the skin. This can reduce the size of the opening through which food can pass from the small upper stomach pouch into the main part of the stomach.

Patients feel full once the small pouch is filled.

Medical professionals estimate that about 30 people in Cayman have undergone gastric bypass surgery, a procedure that removes a large part of the stomach and by which food bypasses the small intestine.

‘Lap-band surgery does not involve any cutting or stapling,’ Mr. Cobourn said, showing doctors at the meeting on Monday a video of a stomach undergoing lap-band surgery.

Mr. Cobourn said lap band surgery is suitable for anyone with a body mass index of 35 or above. His average patient is a 45-year-old, 5ft 4in woman, weighing 275lbs and with a BMI of 45.

In his four years of practice carrying out lap-band surgeries, the biggest weight loss he has seen in a patient was in a 575lib man, who now weighs 275lbs.

Mr. Cobourn said 95 per cent of patients who have undergone the surgery at his Surgical Weight Loss Centre in Mississauga, Ontario, lose at least 25 per cent of their body weight over two years.

If doctors begin referring patients to his clinic in Canada, he will need to train medical staff in Cayman to adjust the lap-bands.

This is done by injecting saline into a port attached by a tube to the band, all of which are put in place during the operation.

Mr. Cobourn admitted that lap-band surgery is not for everyone and gastric bypass surgery may better suit patients who do not fully commit to losing weight and who do not have the commitment or ability to follow up the surgery by calling or visiting the weight-loss clinic and getting the band adjusted, if necessary.

If the opening is too big, the smaller pouch at the top of the stomach will not fill up and the food will go straight through the band and the patient would not feel full and would continue to eat. If the opening is too small, it can also cause the patient to gain weight when he or she turns to high calorie items like milkshakes or ice-cream to fill up.

The operation costs approximately $10,000. Gastric bypass surgery can be paid for by insurance companies in Cayman, so medical practitioners here believe they may also cover lap band surgeries.

Mr. Cobourn said that the lap-band procedure works better than gastric bypass because there is no chance of mal-absorption of nutrients.

He said the procedure was also more suitable for women who went on to become pregnant as the band could be adjusted to allow for more food to be digested, meaning their babies were born at normal weight, unlike babies of gastric bypass mothers who can be born malnourished and underweight because vitamins and minerals are not readily absorbed into the body.

‘In gastric bypass surgery, there is also the issue of the pouch stretching over time,’ he said.

Comparing the two types of surgeries, Mr. Cobourn said: ‘Lap-band is more like the tortoise compared to the hare. The weight loss is much more sustained,’ he said, adding that patients who have undergone lap-band surgery lose about one to two pounds a week, compared to far more dramatic weight loss with gastric bypass patients.

‘Also, there are more complications and much more serious complications in bypass patients,’ he said.

Gastric by-pass surgery is far more popular than lap-band in the United States, although this is not the case in most of the rest of the developed world where both surgeries are available. Some 200,000 gastric by-pass operations are carried out in the US every year.

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