Re: post on the pregnant women and fetus.

[Guest guest]

That is good to know. And by the way, Dr. Hadi, who is quoted in the article,

is the doctor I will do all of my follow-up visits with. He is not doing my

surgery but does all the follow-up.

Dora in Tennessee

Lap/Open RNY 9/20/2004

Vanderbilt Hospital

[Guest guest]

In regards to pregnancy soon after having the surgery.. Was I the

only one who was told to wait AT LEAST 2 YEARS, if not more, to have

children after the surgery???

Alana

> this is the story on that.

>

>

> An obese Massachusetts woman and her 8-month-old fetus died of

> complications 18 months after stomach-stapling surgery, an

apparent

> first that is leading to warnings about the risks of pregancy soon

> after the surgery.

>

> The deaths raise concerns because most of the 110,000 people who

> have gastric, or stomach, bypass surgery each year in this country

> are women in their child-bearing years, say doctors at Brigham and

> Women's Hospital in Boston who tried to save the mother and baby.

> They reported on the case in a letter in Thursday's New England

> Journal of Medicine.

>

> Brigham surgeon Dr. E. Whang cared for the 41-year-old

woman

> nearly two years ago, when she was brought to their emergency

> department after two days at another hospital, where the cause of

> sudden pain in her upper stomach was misdiagnosed.

>

> " She was nearly dead, " said Whang, who noted the woman had the

> gastric bypass and prenatal care at other hospitals.

>

> After tests and symptoms indicated a massive infection, Whang did

> emergency surgery. He found most of the woman's small intestine

had

> slid through a hernia, or tear, in an adjacent membrane, a defect

> sometimes left after the intestines are rearranged in the bypass

> operation. The hole choked off blood to the stretch of intestines,

> and the tissue turned gangrenous.

>

> By then the fetus had died. Whang repaired the intestine, but the

> woman died within a few hours. She still weighed 440 pounds; her

> original weight was not available.

>

> " This is a tragic case, but you need to look at the overall risk-

> benefit of the surgery, " said Dr. Harvey Sugerman, president of

the

> American Society for Bariatric Surgery, an educational group for

> obesity surgeons.

>

> Sugerman said three studies show extremely obese patients have

death

> rates as much as four or five times lower if they undergo gastric

> bypass surgery, compared with those who don't, and other research

> shows lower rates of pregnancy complications after the weight-loss

> surgery.

>

> Sugerman estimated more than 110,000 gastric bypasses will be done

> in the United States this year. Complications strike as many as 1

in

> 5 patients, and it is believed that for every 200 patients, 1 to 4

> will die.

>

> Sugerman and other doctors said they know of no other mother-baby

> deaths after the operation.

>

> But Whang said about 85 percent gastric bypasses are performed on

> women, most of childbearing age. He advised any pregnant patients

> with sudden pain to see a bypass expert quickly.

>

> " Most doctors recommend contraceptives for two years after the

> surgery " to avoid pregnancy until the woman's weight stabilizes,

> said Dr. Sattar Hadi, who runs the high-risk obesity clinic at

> Vanderbilt University's Center for Human Nutrition.

>

>

> Hadi said it's unclear whether the Massachusetts woman's hernia

was

> due solely to the surgery " or the fetus pushing onto the

intestines. "

>

> Dr. Mark Tucker, director of bariatric surgery at the University

of

> Medicine and Dentistry of New Jersey in Stratford, said such

hernias

> are not uncommon and can happen up to five years after the

surgery.

> Because fertility increases with major weight loss, he said,

reports

> of pregnancies within a year of surgery are becoming more common.

>

> In the standard type of gastric bypass surgery performed on this

> woman, a small pouch at the stomach's top is separated from the

rest

> using staples. Moving down the small intestine a few feet, the

> surgeon then cuts it in two, pulls the bottom segment up and

> attaches it to the new pouch. The dangling upper segment, which

> carries digestive juices, is then reattached to the lower segment.

>

> Patients then lose weight because the new pouch holds a few ounces

> of food at a time, and some calories and nutrients are not

absorbed

> because the food bypasses much of the stomach and small intestine.

> Patients must take protein and vitamin supplements to avoid

> malnutrition.

>

> Since the start of 2003, three other Massachusetts patients have

> died after gastric bypass, and the state is developing guidelines

to

> increase safety.

>

> The federal Medicare program has paid for stomach bypass surgeries

> for a few years, but only in people with related medical

conditions

> such as diabetes. It covered 7,801 operations in 2003, about

double

> the number in 2001.

>

> Dr. Steve Phurrough of the Centers for Medicare and Medicaid

> Services said the agency recently ruled obesity can be considered

an

> illness on its own, so an advisory panel this fall is to recommend

> whether Medicare should cover the surgery in people without

related

> conditions. He expects the panel will urge waiting until there's

> more research on the surgery on the elderly.

>

> " We have significant concerns about the risks, " Phurrough

> said. " People die from this procedure. "

[Guest guest]

I was told 18 months to 2 years.

Dora in Tennessee

Lap/Open RNY 9/20/2004

Vanderbilt Hospital