New weight-loss surgery available at Munson

TRAVERSE CITY – A new surgical option for patients who are morbidly obese is now available through Munson Medical Center's Bariatric Surgery Program.

"We believe LAP-BAND® is the right alternative for some of our patients," said Dr. Michael A. Nizzi, D.O., one of three bariatric surgeons in practice with Grand Traverse Surgery, P.C., including Roche J. Featherstone, M.D., Steven Slikkers, M.D. and program coordinator Mary Kay Williams, MSN, FNP-C.

"As a less invasive procedure, there is less potential for complications, a shorter hospital stay, and there is the potential in the long term to lose as many pounds as with the Roux-en-Y (stomach bypass surgery)," Nizzi said.

While the procedure generates slower initial weight loss than Roux-en-Y, typically one to two pounds per week, and requires regular adjustments to achieve optimal results, Nizzi said it's important for patients to have the option to choose a procedure that best matches their long-term weight loss goal.

During the laparoscopic banding procedure, small incisions are made in the abdomen, and a hollow silicone band is inserted and placed around the upper part of the stomach, creating a small pouch. The band is inflated with a salt solution which passes through a tube connecting the band to an access port under the patient's abdominal skin. Adjustments are made by inserting a needle at the port and removing or adding solution. The procedure restricts the amount of food that can be eaten in one sitting and increases the time needed to empty the stomach. Nizzi said most patients require three or four adjustments after surgery.

According to information on the LAP-BAND web site, the surgery costs anywhere from $12,000 to $30,000, depending on where the patient lives and their insurance coverage.

Approximately 500 bariatric surgeries have been performed since Munson's program began in August 2003. Ninety-five percent of those have been Roux-en-Y procedures, Nizzi said. With the addition of the banding procedure, he said he expects the ratio of LAP-BAND to Roux-en-Y procedures to be 50/50 or 60/40.

Patients requesting weight-loss surgeries are carefully screened. Those without other health issues must have a body mass index or BMI (a measure of body fat based on height and weight) of at least 40 to qualify. Adults experiencing other obesity-related health issues (called co-morbid illnesses or conditions) must have a BMI over 35.

"A majority of patients have at least one co-morbidity," Nizzi said. "It's a rare patient that is morbidly obese without other health issues."

Co-morbid conditions related to obesity include: type 2 diabetes, high cholesterol, high blood pressure, sleep apnea, stroke, cancer, osteoarthritis, respiratory or joint problems, according to the National Institutes of Health.

Deb Markiewicz, 45, of Houghton Lake, said she gained 10 pounds every year after she quit smoking in 1989. She tried a popular weight-loss program for five years without success. In time, she developed sleep apnea, indigestion problems and heartburn, and was prescribed acid-reflux medication for the latter. The treatment for her sleep apnea compelled her to consider surgical weight-loss options.

"My CPAP machine is a nightmare for me," Markiewicz said. "It prevents me from snoring by keeping air flowing through my passages, but it's noisy…and it would scare anyone who walked in my bedroom. It's not exactly great for your love life."

Markiewicz, a first-grade teacher, knew two people in her school district who had undergone bariatric surgery. Last Spring, she attended three seminars in Traverse City to learn about the Roux-en-Y and LAP-BAND procedures, and to meet the surgeons and discuss nutritional needs following surgery. Though her BMI wasn't quite 40, her other health conditions qualified her for the LAP-BAND procedure she preferred.

"My surgery was a breeze," Markiewicz said. "I never took pain medication from the time I left the hospital."

Her surgery was scheduled on a Wednesday at 12:30 p.m. She was up by 6 p.m. and walking by 8 p.m., she said, and she returned to work the following Tuesday.

"My biggest fear was not being able to do things with my 8-year-old son after the surgery, like eating pizza or a piece of cake. I know eventually I'll be able to," Markiewicz said.

LAP-BAND patients eat three meals a day, unlike those who undergo the Roux-en-Y procedure. All bariatric surgery patients must avoid excess carbohydrates, especially sweets.

Since her surgery in September, Markiewicz, one of four patients to undergo the LAP-BAND procedure thus far, has lost 16 pounds. She no longer takes her acid-reflux medication, her blood pressure is lower, and she walks at least one mile five times a week. But she said what really drives her to lose more weight is the thought of being rid of the breathing machine.

"I look in the mirror every day and ask myself, 'Am I thinner?' I do a little bit more of that now." BN