Endoluminal Suturing Shows Promise in Overcoming Weight Gain/Insufficient Weight Loss Following Initial Bariatric Surgery
UCSF Department of Surgery, Bariatric Surgery Program - July 08, 2014
UCSF bariatric surgeons Matthew Y.C. Lin, M.D. and Stanley J. Rogers, M.D. are helping to pioneer a novel incisionless endoscopic approach called endoluminal suturing for patients who either gained or failed to lose sufficient weight following bariatric surgery, a phenomenon know as WR/IWL that occurs in 1 in 5 or 20% of patients. Over time, the initial gastric bypass anatomy may enlarge or dilate allowing food to empty faster, greatly reducing the efficacy of the initial surgery. Standard therapy has been to re-operate laparoscopically to restore the initial restrictive anatomy, but often times these surgeries must be converted to an open procedure, one that carries significant risk for the patient. Principal investigators in the UCSF Bariatric Surgery Program are now testing a novel and innovative approach that allows restoration of the restrictive anatomy necessary to reverse WR/IWL without a surgical incision. Initial clinical trials showed high patient satisfaction, with favorable preliminary safety and efficacy outcomes. The ongoing clinical study and related efforts of UCSF bariatric surgeons were highlighted in the December 2013 issue of San Francisco Medicine, Journal of the San Francisco Medical Society.
Excellence of UCSF Bariatric Surgery Highlighted in Moving Patient Story
UCSF News - May 16, 2013
The story of James Dials', a gregarious 62-year-old limousine driver who weighed 400 lbs. and was down on his luck is riveting. “My life was very uncomfortable,” Dials said. “I was a diabetic and I injected insulin. I had high blood pressure, sleep apnea, and high cholesterol. I was on all kinds of medications.” That’s when he discovered the UCSF Bariatric Surgery Program, a Level 1 accredited center for weight-loss surgery by the Bariatric Surgery Center Network of the American College of Surgeons. “James had relatively advanced obesity,” says Stanley Rogers. M.D., chief of Minimally Invasive Surgery and director of the Bariatric Surgery Center and Liver Tumor Ablation Program at UCSF Medical Center. “And we know that weight loss either with or without surgery can significantly impact those medical problems, and can make these medical problems called co-morbidities go away as weight loss occurs.” “I have all sorts of choices now,” he said. “It’s like a kid getting a new toy on Christmas. That’s how life is to me now. Everything is new in life now. I have more self-esteem and I care more about myself."
Are doctors "nicer to patients
who aren't fat"? The New York Times, reporting on
a study by Johns Hopkins researchers, says the answer is apparently
"The study suggests that they are - that
thin patients are treated with more warmth and empathy than those
who are overweight or obese."*
"For the most part, all of the patients were treated about the
same; there were no meaningful differences in the amount of time
doctors spent with them or the topics discussed."*
"But when researchers analyzed transcripts of the visits, there
was one striking difference. Doctors seemed just a bit nicer to
their normal-weight patients, showing more empathy and warmth in
their conversations. Although the study was relatively small, the
findings are statistically significant."*
* Excerpted from THE WELL COLUMN APRIL 29,
2013, Are Doctors Nicer to Thinner Patients?,by Tara
Rogers Urges Caution on New Medical Device to Treat GERD
U.S. News - February 22, 2013
study in the New England Journal of Medicine touts a new
medical device for the treatment of
Gastroesophageal Reflux Disease (GERD) as an alternative
to standard therapy, long-term proton-pump inhibitors or
Nissen Fundoplication. The
new treatment is a surgical procedure in which a small band of
magnetic beads is surgically implanted to augment the lower esophageal
sphincter, the valve
between the esophagus and stomach.
ButStanley J. Rogers, M.D.,Associate Professor of Surgery at
UCSF,Chief of Minimally
Invasive Surgery, and Chief of Bariatric Surgery, expressed concern
about its use, telling CBS/KCBS News Healthwatch that the
device was essentially
untested except for the small study cited above. He cautioned that
the beads were a foreign
object and where the device was placed could
potentially cause serious complications including infection,
perforation and abdominal sepsis, leading to ultimate removal. He
emphasized that long-term data was needed to demonstrate
its safety and effectiveness.
Bariatric Surgery May Improve Chances for Successful Organ Transplantation
American Society For Metabolic And Bariatric Surgery, ABC News - December 03, 2012
"Bariatric surgery has been widely accepted in the medical
field, but now we're trying to apply it to specific patient
Matthew Y.C. Lin, M.D., a gastrointestinal surgeon, a former
surgical fellow*, and now an Assistant Professor of Surgery at
UCSF. In a pilot study of 26 morbidly obese patients waiting
for a kidney or liver transplant, Dr. Lin and colleagues in the UCSF Bariatric
Surgery Program found laproscopic sleeve
gastrectomy, a procedure that removes most of the stomach and
reshapes it into a small tube or sleeve, significantly improved the
chances of undergoing successful organ transplantation. "The
reason why physicians are skittish about bariatric surgery for
organ transplant is that these patients have more medical
comorbities," said Lin, who is the lead author of the study. "But
our study shows that it is safe to proceed."
Jonathan Carter, M.D. Discusses Obesity in America and Treatment Options on UCTV
UCSF Department of Surgery - November 20, 2012
In a recent UCTV presentation,
Jonathan Carter, M.D., an Assistant Professor of
Surgeryand bariatric and gastrointestinal surgeon, discussed in a
video why Americans are increasingly obese and medical and surgical
approaches to treatment.
Stanley J. Rogers, M.D. Named to U.S. News “Top Doctors” List
U.S. News - March 01, 2012
In its most recent survey, U.S. News named
Stanley J. Rogers, M.D. to its list of U.S. News
"Top Doctors". Rogers was also named to the
prestigious America's Top Doctors (ATD) list, a
distinction reserved for the top 1% of physicians
in the nation for that specialty.
The listings are published online at U.S. News.
"Even operations considered fairly routine in younger patients, like appendectomies, become high-risk for nursing home residents. “Something about undergoing anesthesia, the surgery’s physiological assault on the body, impacts older people much more than we think,” said Dr. Emily Finlayson, a colorectal surgeon at the University of California, San Francisco, and lead author of a recent study published in The Annals of Surgery.
In fact, the study, which compared mortality risks and subsequent interventions for four types of major abdominal surgery, found that even compared with adults of similar age who had the same number of chronic illnesses — but who weren’t in institutions — nursing home residents fared sharply worse.
Bluntly put, surgery is much more likely to kill them.
Dr. Finlayson and her colleagues used national Medicare claims and nursing home surveys to identify nearly 71,000 nursing home residents who had surgery from 1999 through 2006. They compared them with more than a million elders who underwent the same four procedures but did not live in a nursing home. The researchers chose operations frequently performed on older adults: removal of an infected appendix (appendectomy), removal of an infected gallbladder (cholecystectomy), surgery for a bleeding ulcer in the upper part of the intestine, or surgery for noncancerous colon diseases like diverticulitis or colitis. These are painful conditions requiring immediate decisions, as opposed to diagnoses like breast or prostate cancer, in which a patient and his or her family can take a few days to figure out the best course."
UCSF Accredited by the American College of Surgeons as Level 1 Accredited Bariatric Center (ACS BSCN)
UCSF Department of Surgery - September 27, 2011
UCSF has been accredited by the American
College of Surgeons (ACS) as a Level 1
Accredited Bariatric Center (ACS BSCN). The American College of
Surgeons Bariatric Surgery Center Network Accreditation Program
(ACS BSCN) accredits facilities in the United States that have
undergone an independent, voluntary and rigorous peer evaluation in
accordance with nationally recognized bariatric surgical
standards. This adds to the prestige of the program which
previously also earned the Blue Distinction for
Bariatric Surgery from Blue Shield of California
and was designated a Blue Cross "Center of Expertise
Hospital for bariatric
Teen girls’ obesity surgery may raise birth defect risk
UCSF News - October 03, 2010
A report by Diana Farmer, MD*, (former) chief of pediatric
surgery at UCSF Benioff Children's Hospital, has highlighted a
possible link between gastric bypass surgery in adolescent girls
and an increased risk for neural tube defects in their future
Dr. Stanley Rogers Named Surgical Director of Bariatric Surgery Program and Chief of Minimally Invasive Surgery
UCSF Division of General Surgery - September 14, 2009
Stanley J. Rogers, M.D.,
an Associate Clinical Professor of Surgery at UCSF, has been
named Surgical Director of the Bariatric Surgery Program and Chief
of Minimally Invasive Surgery in the Division of General Surgery.
Dr. Rogers received his M.D. from the University of Utah
School of Medicine and did his post-doctoral surgical training
at UCSF including his residency, and a fellowship in
laparoscopic surgery, surgical sonography and GI endoscopy.
Clinical Trial of Incision-Free Obesity Treatment Underway
UCSF News Office - March 05, 2009
Stanley Rogers, MD, FACS, Associate Clinical Professor of
Surgery and Co-Director of the UCSF Bariatric Surgery Center, and
John Cello, MD, Professor of Medicine and Surgery, and Medical
Director of Bariatric Surgery Center, recently led a
multidisciplinary team in performing the first two of
thirty procedures scheduled at the UCSF Medical Center.
The investigational procedure, transoral
gastroplasty, or "TOGA" for short, is being tested in a
clinical trial. UCSF is one of nine U.S. trial
sites. Drs. Rogers and Cello are principal investigators on
UCSF Named a Blue Shield Bariatric Quality Initiative Designated Program
UCSF Department of Surgery - July 01, 2008
"Blue Shield's Bariatric Quality Initiative has recognized
California surgeons and hospitals for meeting high-quality
standards in bariatric surgery. To qualify for this distinction,
bariatric surgeons and hospitals had to demonstrate a commitment to
quality by meeting a comprehensive set of volume, outcomes,
process, and program criteria."
"Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.............."The study and an editorial about it (were published) in The Journal of the American Medical Association. The editorial, by doctors not involved in the study, said, ''The insights already beginning to be gained by studying surgical interventions for diabetes may be the most profound since the discovery of insulin.''