Published April 2005

In battle against obesity,
Edmonds surgical clinic
offers latest technology

By Kimberly Hilden
SCBJ Staff

From dietary programs and exercise regimes to gastric bypass and stomach stapling surgeries, there is an ever-growing arsenal of tools to combat the national obesity epidemic. A new weight-loss weapon has been added to that arsenal in Snohomish County with the recent introduction of the LAP-BAND System.

Dr. Peter Billing, who joined the Puget Sound Surgical Clinic of Edmonds in July, began offering the laparoscopic procedure in October. Since then, four procedures have been performed and more than two dozen patients are now in the evaluation and preparation process for getting a LAP-BAND.

“This whole concept is just growing very rapidly across the country,” said Billing, who has been involved in some 200 laparoscopic weight-loss surgeries, including both the LAP-BAND and gastric bypass.

The procedure, in which an adjustable silicone band is placed around the upper stomach to form a small pouch, thus limiting how much food can be consumed at a time and creating a sense of fullness, was approved by the U.S. Food and Drug Administration in June 2001. Since then, more than 30,000 LAP-BAND procedures have been performed across the United States, Billing said.

Internationally, where the LAP-BAND has been in use since 1993, nearly 150,000 of the procedures have been performed, according to INAMED Health, the Santa Barbara, Calif.-based manufacturer of the device.

According to officials at INAMED, only eight surgical practices in Washington state offer the procedure, with the Puget Sound Surgical Clinic the only practice north of King County to offer it.

Billing said that many of the patients he now sees for treatment of morbid obesity are requesting the gastric-banding procedure over gastric bypass, a procedure that decreases the size of the stomach pouch and then reroutes the intestines so that they bypass the larger stomach area.

The reasons for that growing popularity are threefold, beginning with safety, he said.

“The LAP-BAND is 10 times safer than gastric bypass, with morbidity for gastric bypass at 1-in-200 and the morbidity for LAP-BAND at 1-in-2,000,” Billing said, noting that the stomach-banding procedure, which takes about an hour, is done on an outpatient basis in most instances.

The procedure first requires a “port” device to be attached just underneath the skin on the wall of the abdomen. It is at this port that the silicone band enters the body and is then adjusted around the upper stomach.

Tubing connects the band to the port, enabling the doctor to tighten or loosen the band over time by adding or removing saline from the band, Billing said. The band’s ability to adjust is another benefit that is leading to greater use of the device.

“With the LAP-BAND, if the patients are gaining weight, they can come in for an adjustment,” said Billing.

And the procedure is, under extreme circumstances, reversible, he said.

“But with the LAP-BAND, people don’t want it taken out. What can be done, is if a person has reached his or her ideal weight, the band can be loosened to see how that person does,” he said.

Like any surgical procedure, there are risks involved, including a 5 percent risk that a patient will have a problem with the port or tubing, where the port turns on its side or the tubing gets kinked, Billing said. There also is a 2 percent risk of band slippage, in which the stomach slips up above the band.

In all of these cases, the problem is treated laparoscopically.

“Erosion is another concern, which happens less frequently now, when the band erodes inside the stomach. It happens less than 1 percent of the time,” Billing said. “We believe this is caused by the band being too tight. This is treated by laparoscopically removing the band.”

And what about the rate of success? In the clinical trial performed for FDA approval, of those test subjects who were able to complete 36 months of follow-up, more than half lost more than 25 percent of their excess weight, and almost a quarter were able to lose more than 50 percent of their excess weight.

But the treatment is not for everybody, Billing said. Candidates for the procedure must have a body mass index of at least 40 or weigh at least 100 pounds more than their ideal weight. They also have to have been overweight for more than five years and have tried other measures to lose weight.

For those who do qualify, cost of care, which reaches into the thousands of dollars, includes the surgery itself as well as hospitalization, if needed. It also covers after-care, which includes dietary and physical therapy and LAP-BAND adjustments for one year, Billing said.

About 40 percent of patients having the LAP-BAND procedure done have insurance covering the cost, he said. The other 60 percent are self-pay.

For more information on the LAP-BAND, call the Puget Sound Surgical Clinic at 425-778-2220 or go online to www.wimis.com.

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