A Complete Metabolic Surgery Solution in West Virginia

By: Valerie Lauer
Wednesday, March 11, 2015

As the state’s only university-based Level 1 Bariatric Center accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), WVU Healthcare Bariatrics is uniquely equipped to provide innovative surgical intervention complemented by medical support across the care continuum for patients with obesity. The WVU program offers the most advanced techniques in endoscopic, laparoscopic and robotic technology to treat morbid obesity and related metabolic disorders.

Morbid obesity is a major health concern in the state of West Virginia, which is ranked second in the country by the CDC for obesity prevalence, with adult obesity rates over 35 percent. Obesity has been found to reduce a person’s life span by five to 20 years in most major studies. Morbid obesity is a leading cause of diabetes, heart disease, hypertension, dyslipidemia, sleep apnea, infertility and increased cancer prevalence. WVU Healthcare Bariatrics provides safe, sophisticated, evidence-based solutions to those who struggle with weight management, and providers in WVU’s multidisciplinary program help resolve potentially dangerous comorbidities — health conditions that often appear concurrently with obesity.

“I came to West Virginia knowing that the state was greatly in need of advanced treatments for obesity and related comorbidities,” says Lawrence Tabone, MD, bariatric surgeon at WVU Healthcare Bariatrics and Assistant Professor of Surgery at the WVU School of Medicine. “The state of West Virginia currently has eight surgeons registered with the American Society for Metabolic and Bariatric Surgery, which is the lowest number of surgeons per disease occurrence in the nation. Effective treatments for morbid obesity are greatly needed in West Virginia.”

Meeting the Need

WVU Healthcare Bariatrics has established a comprehensive program that complements innovative surgical approaches with support from a team of providers that includes dieticians, psychologists and a cadre of specialists.

“The key to optimal outcomes is having a multidisciplinary team that provides care and support across the continuum of needed services,” Dr. Tabone says. “The operation is one component of an array of services that are provided at WVU to obtain the highest level of lifelong weight loss treatment. In every major study, diet and exercise alone have a long-term failure rate of 98 percent. At the same time, surgery alone is not the answer for long-term weight loss and improvement in health, either. It is the combination of an operation with a lifelong commitment to diet and exercise that is the most effective treatment for obesity and related co-morbidities.

“The success of the WVU program is in the multidisciplinary approach that delivers services and care to address all aspects of obesity. Most patients spend six months in our program preparing for weight loss surgery to ensure they have the tools and knowledge to have lifelong success after the operation. Surgery gives our patients a very effective tool for weight loss, and our program gives the patient all the knowledge needed to use the tool effectively for lifelong results. The program at WVU is able to offer lifelong services to patients after surgery, which has been shown in studies to significantly improve long-term results and success.”

In the months leading up to surgery, patients meet with the program’s dietitians, Shelley Talpas, MS, and Sara Bias, RD, who craft curricula that establish dietary changes necessary before undergoing surgery and nutrition strategies that ensure successful weight loss. Program Coordinator Robyn Toner, RN, and physician assistants Kristen Rosati, PA-C, and Kiley Iams, PA-C, ensure that patients receive the support and information necessary for success.

Patients also meet with the program’s psychologist, Stephanie Cox, PhD, to ensure they are mentally prepared for surgery and to make a commitment to a healthy lifestyle. The support of a patient coordinator and physician assistant, as well as access to WVU medical specialists, such as cardiologists, pulmonologists and internal medicine physicians, help ensure patient safety at each step of the process and successful outcomes.

Offering Advanced Solutions

WVU Healthcare Bariatrics offers a full range of minimally invasive weight-loss surgeries, including Roux-en-Y gastric bypass surgery, vertical sleeve gastrectomy and adjustable gastric banding. Minimally invasive techniques and robotic surgical platforms allow surgeons to make the greatest impact while using small incisions and safe, proven techniques that allow patients to recover rapidly.

WVU-Bariatric Surgery 750

“Bariatric surgery is unlike any other surgical discipline,” says Alan Brader, MD, FACS, Director of WVU Healthcare Bariatrics and Assistant Professor of Surgery at the WVU School of Medicine. “Some of our patients have multiple comorbid illnesses that require pharmaceutical management. Following bariatric surgery, these illnesses resolve and many prescriptions are no longer necessary. It’s not quite the fountain of youth, but it’s the next best thing.”

“Weight loss surgery is not the easy way out. Obesity is an illness, and as with other severe illnesses, surgery can be a frontline treatment option. For severely weight-challenged individuals, surgical weight loss is an effective and safe option.”
—Alan Brader, MD, FACS, Director of WVU Healthcare Bariatrics and Assistant Professor of Surgery at the WVU School of Medicine

Many patients with morbid obesity suffer from acid reflux, and although bariatric surgery often resolves the condition, for some patients, symptoms may persist after the operation. Traditional surgical techniques for correcting reflux carry risks, but WVU Healthcare Bariatrics providers offer a leading-edge solution. Using the innovative Stretta system, Dr. Tabone performs an outpatient endoscopic procedure in which he uses radiofrequency ablation to improve muscle tissue between the stomach and esophagus, which enhances barrier function and is effective at treating reflux disease after bariatric surgery.

Revisional Support

The clinical expertise of WVU Healthcare Bariatrics’ surgical staff and the availability of subspecialty experts permits the department to perform complex revision procedures and continued medical care other facilities may not provide.

“Bariatric surgery by itself is not a curative solution. Surgery provides the physical sense of satiety, which is something no diet can offer, but successful weight loss depends upon maintaining healthy dietary and exercise behaviors after surgery. To ensure optimal outcomes, we’ve established a multispecialty support system that leverages the expertise of WVU Healthcare providers to complement our surgery program.”
—Alan Brader, MD, FACS, Director of WVU Healthcare Bariatrics and Assistant Professor of Surgery at the WVU School of Medicine

Alan Brader 150“In a university setting, you have every resource available for every type of situation,” Dr. Brader says. “A smaller, community-based program might not.”

Because revision operations are more challenging than initial surgeries, Drs. Brader and Tabone carefully evaluate each candidate and use detailed imaging studies and, if necessary, endoscopic discovery procedures to review the previous operation and construct a revised surgical plan. Metabolic surgery revision may be necessary for patients who received a procedure that is no longer supported by bariatric programs, such as vertical banded gastroplasty, or one who has not succeeded in losing weight after surgery due to a failed procedure.

Patients who did not lose weight after a metabolic intervention because they failed to follow through with healthy lifestyle changes aren’t indicated for revision surgery; however, WVU Healthcare Bariatrics offers nutritional counseling, band adjustments, support groups and mental health services to help all patients — even those who are struggling — become successful in their efforts.

Looking Ahead

Head Gut Illustration 175As an academic institution, WVU Healthcare Bariatrics focuses on enhancing the understanding of weight-loss surgery through outcomes-based research and by embracing the latest advances in care. To this end, the WVU Healthcare Bariatrics collaborates with WVU Clinical and Translational Sciences Institute to develop a tracking model for coronary artery disease after metabolic surgery.

“Establishing relationships with national metabolic disease and bariatric surgery societies enables WVU Healthcare Bariatrics to increase the awareness of morbid obesity in the state and across the country,” Dr. Tabone says.

Drs. Brader and Tabone, along with their multidisciplinary team at WVU, look forward to increasing the awareness and treatment of obesity in the state of West Virginia and surrounding areas.

Three Unique Options

Selecting a surgical weight-loss option is a collaborative process between patients and WVU Healthcare Bariatrics surgeons to identify the most effective operation.

WVU Healthcare Bariatrics offers the full spectrum of weight-loss surgery options. Some of the most commonly performed procedures at WVU include the following:

Roux-en-Y Gastric Bypass Surgery

Considered the gold standard for weight-loss surgery, Roux-en-Y gastric bypass reduces the stomach volume and redirects the food away from the first part of the intestine, which is responsible for changing the body’s metabolism and regulating appetite. During the operation, bariatric surgeons use staples to reduce the size of the stomach to help patients reach satiety sooner and reroute a portion of the small intestine to change the body’s metabolism and significantly improve glucose control. This is responsible for significantly improving or curing diabetes after the operation.

Vertical Sleeve Gastrectomy

Bariatric surgeons resect approximately two-thirds of the stomach, which results in a banana-shaped organ that not only takes less food to fill but also helps patients feel less hungry thanks to the removal of most of the cells that produce ghrelin, the hormone that triggers hunger.

Adjustable Gastric Banding

Surgeons implant a band around a small piece of the stomach, limiting the amount of food that can pass and be digested at one time. Patients who receive this surgery feel fuller faster, which helps them lose weight. The band can be adjusted as needed.

For more information about the WVU Bariatric program, visit wvuobesity.com.