Doctors May Have Developed a New No-Knife Surgery for Gastric Bypass

Gastric bypass is a group of surgical procedures that shrinks the stomach so that food "bypasses" most of the stomach as it goes to the small intestine. The bypass procedure drastically reduces the amount of food the stomach can digest at any one time, so that it is impossible to overeat. Weight loss after the surgery is both "easy," at least in the sense of controlling appetite, and inevitable, but the procedure is not without risk.

The Journal of Gastrointestinal Surgery published a study of 1,000 patients of the same, skilled gastric bypass surgeon, 854 women and 146 men. These patients all received a proximal Roux-en-Y gastric bypass procedure, in which the small intestine is divided into two parts, and one part is attached to the upper stomach, the lower part still attached to the lower stomach. After the graft heals, the patient feels full very quickly after eating. Protein foods are digested and flow quickly to the small intestine, but fats and starches settle in the stomach are sent to the other side of the "Y" made in the intestine. On their side of the Y, fats and starches ferment and produce noxious gases that may result in burping or flatulence. The procedure essential punishes the consumption of unhealthy foods with belches and farts.

As mutilating as the Roux-en-Y procedure may be, it works. But even a skilled surgeon like the one in the study has to deal with post-operative problems:

• 1.2% of the 1000 patients died within the first 30 days.
• 1.5% of the 1000 patients died of surgery-related complications after the first 30 days.
• 1.6% of the 1000 patients experienced intestinal "leaks" into surrounding tissue.
• 1.9% of the 1000 patients developed intestinal obstructions.
• 3.1% of the 1000 patients had to be operated on a second time within the first 30 days

To be fair to this excellent surgeon, over 90% of his bypass procedures produced no complications. But when traditional gastric bypass surgery goes wrong, it goes very wrong.

Newer Gastric Bypass Methods Are an Improvement, But Aren't Problem-Free

In the late 1990's, an American surgeon named Dr. Robert Rutledge developed a "mini-bypass" procedure in which a portion of the stomach is rolled into the shape of a long tube, and the small intestine is reconnected to this "tube" near the top of the new stomach. Some of the early results of the procedure were disastrous, especially when the stomach "tube" was attached to close to the esophagus. In recent years, however, the procedure has become much safer. When the records of 1000 patients of another skilled surgeon were examined in another study:

• None died in the first 30 days.
• 0.5% had to be treated for leakage from the stomach tube but none had to be treated for leakage from the intestine or the surgical connection site,
• 2.7% had some kind of complication during the first 30 days.

Those are better odds of recovery than can be obtained with Roux-en-Y surgery. But the newer lapband gastric bypass is even better. In yet another study of 1,186 lap band patients:

• 0.5% had to have the lapband removed.
• 0.6% had the lapband slip.
• 1.1% experienced "pouch dilation," that is, their available stomach size increased.
• 1.8% experienced other complications.

Read More: Gastric Bypass Success, But No Surgery

But wouldn't be a great thing if somehow it would be possible to get the benefits of gastric bypass with no surgery at all?

Left Gastric Artery Embolization To Bypass Gastric Bypass

That's exactly what Massachusetts General Hospital surgeon Dr. Rahmi Oklu believes he and his colleagues have discovered. A surgeon typically treating liver cancer, rather than weight loss, Oklu noticed that sometimes patients who receive treatment to stop gastrointestinal bleeding experience a welcome side effect, weight loss. This occurs even if the size of the stomach is not changed.

Stopping Blood Flow Stops Hunger

In this procedure, called left gastric artery embolization, an interventional cardiologist inserts a catheter into an artery in a leg or arm and threads a catheter to an artery on the left side of the stomach. The doctor introduces strings of tiny beads to reduce blood flow to the gastric fundus, the top part of the stomach. The vascular surgeon leaves enough blood flow that the stomach tissue survives, but blocks the flow of the hormones out of the stomach to the rest of the body.

It turns out that this part of the stomach produces the hormone ghrelin, which basically sends a signal to the brain telling it "Feed me! Feed me!" There is still some ghrellin production in the pancreas, so recipients of the procedure are not going to starve just because they forget to eat, but there are fewer hunger signals to the brain so appetite is greatly reduced. It is still possible to stuff the stomach. Surgery recipients just don't want to.

Effortless Weight Loss

In a presentation to the Radiological Society of North America, Dr. Oklu and colleagues compared the experiences of 15 patients who had the embolization procedure to the left gastric artery to the experiences of 18 patients who had this procedure to stop gastrointestinal bleeding elsewhere in the body. Oklu and associates found that blocking blood flow in the artery on the left side of the stomach results in an average weight loss of 7.9%, or about 15 pounds (7 kilos), without dieting. Patients who had the procedure in another artery in the digestive tract lost on average less than 2 pounds (1 kilo).

Read More: The Skinny on Life after Gastric Bypass Surgery

Almost No Risk of Complications

What's the major advantage of left gastric artery embolization? 

This endovascular procedure requires an incision just 3 mm (about 1/8 of an inch) wide. It only takes one day. Patients receive a sedative, but they usually do not have to be given anesthesia. There is little risk of bleeding, and there is very little pain. Patients do have to lie still for at least a couple of hours after the procedure, and they have to wash off a plastic packing over the tiny surgical incision a few days later, when they get home, but overall, embolization is vastly less complicated than gastric bypass or lapband surgery.

What Oklu and other doctors don't know yet is whether the decreases in ghrelin production that lead to reduction in appetite are permanent. They also do not know with certainty that the procedure is safe for healthy obese patients, or obese patients who have other medical problems. But a minimally invasive weight loss treatment may be just a few years from general use.