Gastric bypass vs. large volume liposuction for bariatric surgery

Discussion in 'Health and medical' started by Dead Soon, Feb 19, 2004.

  1. Dead Soon

    Dead Soon Guest

    Why do bariatic surgeons only seem to offer gastric banding whilst plastic surgeons don't want to
    know about large volume liposuction?

    I have been doing some research to understand my options for the treatment of obesity (BMI >30, but
    not Morbit Obesity as my BMI <40 it is ~35).

    I am male, mid-forties and I have had a number of related treatments:

    - Olistat (which didn't work, it had nasty side effects and made me very hungry)
    - CPAP for sleep apnoea (after two sleep studies, this has solved the problem, but not lost weight)
    - exercise (I swim 20 lengths in 10 minutes 5 days a week)
    - consultation with diatician (I was already doing 99% of what she suggested, no sugar, no butter,
    no cream, no processed foods etc. etc. she recommended cutting down red meat consumption, that is
    now around 4 days a week)
    - Malaria - this worked well, but I was back to my normal weight in about a year I have looked at a
    number of articles on surgical treatment using Pubmed (Medline). These suggest that gastric
    binding and similar bariatric treatments have a result that can be predicted from the
    psychological makeup of the patient - so placebo treatements might work just as well in tractible
    cases. I also know that these have unpleasant side-effects.

    A number of studies (Plast Reconstr Surg. 2001 Aug;108(2):510-9; discussion 520-1. Improvements in
    cardiovascular risk profile with large-volume liposuction: a pilot study. Giese SY, Bulan EJ,
    Commons GW, Spear SL, Yanovski JA. - for example) suggest that large volume liposuction has fewer
    unpleasant side effects, and results in long term stable weight loss.

    Reading other articles on large volume liposuction suggest that it is a good solution.

    However, looking at plastic surgery web-sites, I find almost universal objection to this (sometimes
    whole sentences of objection in capital letters). When I wrote to one plastic surgeon (who shall
    remain nameless), he said 'You can find a paper to support any medical opinion that you hold.' this
    rather suggested a good old fashioned contempt for anything that happened after he had left medical
    school, or maybe he had plenty of experience hunting for papers to support his opinions. I certainly
    wouldn't want him as my doctor whatever the reason!

    So, before going through the expense of consultations with doctors with fixed opinions, I'd like to
    know more about this debate.

    Are there any rational reasons for the plastic surgeon's objections? Or are they just motivated by
    the documented antipathy to fat people (another article in medline)?

    Why is gastric band (or other gastric bypass) surgery so favoured when it seems to have so many
    unpleasant side effects?

    Since we seem to be having a worldwide (rich world anyway) epidemice of obesity, why is this debate
    not going on? [or should I be reading different magazines?]

    Papers:
    ==============================

    Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study.

    Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA.

    Georgetown University, Washington, DC, USA. www.drsharongiese.com

    In this study, the authors investigated the physiologic effects of the altered body composition
    that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen
    women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma
    insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA),
    resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-
    assisted liposuction.There were no significant intraoperative complications. Body weight had
    decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight
    loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of
    6.5 kg (p < .00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5
    kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat
    mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/-
    3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p
    < .0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml
    before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic
    blood pressure
    (4.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein
    cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly
    altered after liposuction.In conclusion, over a 4-month period, large-volume liposuction
    decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without
    detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles.
    Should these improvements be maintained over time, liposuction may prove to be a valuable tool
    for reducing the comorbid conditions associated with obesity.

    ======================================

    Large-volume liposuction: a review of 631 consecutive cases over 12 years.

    Commons GW, Halperin B, Chang CC.

    Department of Plastic Surgery, Stanford University Medical Center, Stanford, CA, USA.

    Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management
    techniques, increasingly larger and larger volumes of liposuction aspirations have been reported.
    Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of
    complications have also been reported, with the worst of these resulting in deaths. In a response to
    the increasing concerns over the safety of large-volume liposuction, a critical review of the senior
    author's own series has been performed to evaluate risks and benefits and to recommend guidelines
    for safe and effective large-volume liposuction. A retrospective chart review was performed on 631
    consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All
    procedures were performed by the same senior surgeon between January of 1986 and March of 1998.
    Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-
    assisted liposuction was performed. The superwet technique of fluid management was employed for all
    procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are
    reviewed in the article. Data collection included preoperative patient demographics, preoperative
    and postoperative weights and measurements, and preoperative and postoperative photographs. Total
    aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were
    tallied. Average follow-up was 1 year.Results showed the majority of patients to be women, aged 17
    to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart
    weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10
    liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end
    of the procedure, with none of these patients experiencing any significant fluid balance
    abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements,
    depending on the area treated. Ten percent of patients experienced minor skin contour
    irregularities, with most of these patients not requiring any additional surgical procedures. One
    year after surgery, 80 percent of patients maintained stable postoperative weights. No serious
    complications were experienced in this series. The majority of the complications consisted of minor
    skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious
    complications included four patients who developed mild pulmonary edema and one patient who
    developed pneumonia postoperatively. These patients were treated appropriately and went on to have
    uneventful recoveries. The results show that large-volume liposuction can be a safe and effective
    procedure when patients are carefully selected and when anesthetic and surgical techniques are
    properly performed. Meticulous fluid balance calculations are necessary to avoid volume
    abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic
    benefits are excellent, and overall complication rates are low.

    ===================================================

    Large-volume circumferential liposuction with
    tumescent technique: a sure and viable procedure.

    Cardenas-Camarena L, Tobar-Losada A, Lacouture AM.

    Jalisco Institute of Reconstructive Surgery, Guadalajara, Mexico. [email protected]

    During a 4-year period, 152 female and 9 male patients underwent large-volume liposuction, with ages
    ranging from 19 to 65 years (mean of 36 years), with a weight previous to surgery between 57 and 126
    kg (mean of 72 kg). Tumescent liposuction was done simultaneously by two surgeons in several
    corporal areas according to the necessities of each case. In 28 patients (17 percent), 500 ml of
    whole blood was required previous to the surgery by self donation. By means of liposuction, volumes
    between 5 and 22.3 liters (mean of 8.7 liters) were obtained with an average relation of 860 cc of
    fat for 140 cc of liquid. The reduction of hemoglobin and hematocrit at 1 week after surgery was of
    3.8 g and 12 percent, respectively. The weight after surgery during the patient's follow-up varied
    from 54 to 111 kg, with an average of 66 kg. Major complications were not presented. Minor
    complications consisted of two superficial cutaneous necroses (1.2 percent) and 18 seromas (11.2
    percent), which were drained without leaving sequelae; 24 patients (14.9 percent) presented
    postsurgical palpable irregularities, visible in only 8 patients (5 percent); 148 patients (92
    percent) expressed important satisfaction with the results of the surgery, with the remaining 13 (8
    percent) expressing some disagreement due to persistent irregularities. These complications had a
    direct relationship to some factors of the surgical technique and some characteristics of the
    patients. The amount of fat liposuctioned, the ideal height-weight relationship of the patient, the
    diameter of the cannulas used, and the experience acquired during the time were the most important
    factors that were associated with the complications. Based on these results, we concluded that large-
    volume circumferential liposuction with tumescent technique is a viable and sure alternative to
    achieve improvement of the body contour and weight loss.

    ========================================================
    Large-volume liposuction in 181 patients.

    Albin R, de Campo T.

    Liposuction is a commonly performed cosmetic surgery procedure that is associated with
    complications, including fatalities. Many of these have been associated with large-volume
    liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the
    Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily defined
    large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any more than
    this volume except in specific circumstances such as a hospital-type setting [1]. This study
    includes 181 patients who have had greater than this amount of total aspirate removed in a single
    procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only (31
    patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic liposuction
    using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150 patients). During
    the last part of the latter series we calculated the blood loss of 45 patients derived from preop
    and 5-day postop hematocrits. The results show that (1) there is no correlation between the aspirate
    volume and the calculated blood loss; (2) the majority of the calculated blood loss is not in the
    cannister; and (3) no deaths occurred, but one patient suffered a deep venous thrombosis and two
    patients suffered pulmonary emboli. As others have pointed out [2-6] large-volume liposuction can be
    performed relatively safely if this procedure is treated with the respect it deserves and the
    practitioner exercises sound surgical judgment, uses appropriate technique, and does not try to cut
    corners to save money for the patient by performing this surgery in minimal settings.
    =============================================

    __________________________________
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  2. Beachhouse

    Beachhouse Guest

    A few points in reply. One, we know nothing of your health history -- so unless you are diabetic,
    hypertensive, or have other chronic health problems (your sleep apnea is an issue, but it's being
    treated with the CPAP) and unless your BMI were in the morbidly obese category, you're not really a
    candidate for gastric bypass surgery at this time...

    Second, to lose weight generally it's a fairly straightforward equation -- you must take in less
    calories than what you burn. 10 minutes of exercise is probably not enough. Have you consulted a
    physical therapist or exercise physiologist? You're probably in need of at least 30 minutes of
    sustained activity 3 days a week or more in addition to caloric restriction.

    Third, if you are interested in your liposuction idea -- why not go to the centers that actually
    published results in this area? You did not provide the names of the journals that these research
    papers supposedly appeared in; so we don't know if these were peer-reviewed or just presented at
    meetings. But maybe you would want to invest in a plane ticket to Stanford or Georgetown and talk
    with the plastic surgery folks there.

    Fourth, the studies you presented had very short follow-up periods -- 4 months to 1 year. It is
    possible that, barring major lifestyle changes, patients gained back their weight over the long-
    term. This is the same problem that occurs with many gastric bypass patients.

    good luck. :)

    "Dead Soon" <[email protected]> wrote in message
    news:[email protected]...
    > Why do bariatic surgeons only seem to offer gastric banding whilst plastic surgeons don't want to
    > know about large volume liposuction?
    >
    > I have been doing some research to understand my options for the treatment of obesity (BMI >30,
    > but not Morbit Obesity as my BMI <40 it is ~35).
    >
    > I am male, mid-forties and I have had a number of related treatments:
    >
    > - Olistat (which didn't work, it had nasty side effects and made me very hungry)
    > - CPAP for sleep apnoea (after two sleep studies, this has solved the problem, but not lost
    > weight)
    > - exercise (I swim 20 lengths in 10 minutes 5 days a week)
    > - consultation with diatician (I was already doing 99% of what she suggested, no sugar, no butter,
    > no cream, no processed foods etc. etc. she recommended cutting down red meat consumption, that
    > is now around 4 days a week)
    > - Malaria - this worked well, but I was back to my normal weight in about a year I have looked at
    > a number of articles on surgical treatment using Pubmed (Medline). These suggest that gastric
    > binding and similar bariatric treatments have a result that can be predicted from the
    > psychological makeup of the patient - so placebo treatements might work just as well in
    > tractible cases. I also know that these have unpleasant side-effects.
    >
    > A number of studies (Plast Reconstr Surg. 2001 Aug;108(2):510-9; discussion 520-1. Improvements in
    > cardiovascular risk profile with large-volume liposuction: a pilot study. Giese SY, Bulan EJ,
    > Commons GW, Spear SL, Yanovski JA. - for example) suggest that large volume liposuction has fewer
    > unpleasant side effects, and results in long term stable weight loss.
    >
    > Reading other articles on large volume liposuction suggest that it is a good solution.
    >
    > However, looking at plastic surgery web-sites, I find almost universal objection to this
    > (sometimes whole sentences of objection in capital letters). When I wrote to one plastic surgeon
    > (who shall remain nameless), he said 'You can find a paper to support any medical opinion that you
    > hold.' this rather suggested a good old fashioned contempt for anything that happened after he had
    > left medical school, or maybe he had plenty of experience hunting for papers to support his
    > opinions. I certainly wouldn't want him as my doctor whatever the reason!
    >
    > So, before going through the expense of consultations with doctors with fixed opinions, I'd like
    > to know more about this debate.
    >
    > Are there any rational reasons for the plastic surgeon's objections? Or are they just motivated by
    > the documented antipathy to fat people (another article in medline)?
    >
    > Why is gastric band (or other gastric bypass) surgery so favoured when it seems to have so many
    > unpleasant side effects?
    >
    > Since we seem to be having a worldwide (rich world anyway) epidemice of obesity, why is this
    > debate not going on? [or should I be reading different magazines?]
    >
    > Papers:
    > ==============================
    >
    > Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study.
    >
    > Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA.
    >
    > Georgetown University, Washington, DC, USA. www.drsharongiese.com
    >
    > In this study, the authors investigated the physiologic effects of the altered body
    > composition that results from surgical removal of large amounts of subcutaneous adipose
    > tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent
    > measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-
    > energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and
    > after undergoing large-volume ultrasound-assisted liposuction.There were no significant
    > intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks
    > after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks
    > and 4 months after surgery, for a total weight loss of 6.5 kg (p < .00006). Body mass index
    > decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in
    > body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean
    > body mass did not change (43.8 +/- 3.1 kg to 43.4 +/-
    > 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg
    > (p < .0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5
    > mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and
    > systolic blood pressure
    > (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein
    > cholesterol, plasma triglycerides, and resting energy expenditure values were not
    > significantly altered after liposuction.In conclusion, over a 4-month period, large-volume
    > liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin
    > levels without detrimental effects on lean body mass, bone mass, resting energy expenditure,
    > or lipid profiles. Should these improvements be maintained over time, liposuction may prove
    > to be a valuable tool for reducing the comorbid conditions associated with obesity.
    >
    > ======================================
    >
    > Large-volume liposuction: a review of 631 consecutive cases over 12 years.
    >
    > Commons GW, Halperin B, Chang CC.
    >
    > Department of Plastic Surgery, Stanford University Medical Center, Stanford, CA, USA.
    >
    > Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management
    > techniques, increasingly larger and larger volumes of liposuction aspirations have been reported.
    > Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates
    > of complications have also been reported, with the worst of these resulting in deaths. In a
    > response to the increasing concerns over the safety of large-volume liposuction, a critical review
    > of the senior author's own series has been performed to evaluate risks and benefits and to
    > recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review
    > was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc
    > total aspirate. All procedures were performed by the same senior surgeon between January of 1986
    > and March of 1998. Before September of 1996, traditional liposuction techniques were used. After
    > September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid
    > management was employed for all procedures performed after 1991. The particulars of the surgical
    > and anesthetic techniques used are reviewed in the article. Data collection included preoperative
    > patient demographics, preoperative and postoperative weights and measurements, and preoperative
    > and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were
    > measured, and all complications were tallied. Average follow-up was 1 year.Results showed the
    > majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7
    > percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17
    > liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average
    > of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients
    > experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to
    > 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients
    > experienced minor skin contour irregularities, with most of these patients not requiring any
    > additional surgical procedures. One year after surgery, 80 percent of patients maintained stable
    > postoperative weights. No serious complications were experienced in this series. The majority of
    > the complications consisted of minor skin injuries and burns, allergic reactions to garments, and
    > postoperative seromas. The more serious complications included four patients who developed mild
    > pulmonary edema and one patient who developed pneumonia postoperatively. These patients were
    > treated appropriately and went on to have uneventful recoveries. The results show that large-
    > volume liposuction can be a safe and effective procedure when patients are carefully selected and
    > when anesthetic and surgical techniques are properly performed. Meticulous fluid balance
    > calculations are necessary to avoid volume abnormalities, and experience is mandatory when
    > performing the largest aspirations. Cosmetic benefits are excellent, and overall complication
    > rates are low.
    >
    > ===================================================
    >
    > Large-volume circumferential liposuction with
    > tumescent technique: a sure and viable procedure.
    >
    > Cardenas-Camarena L, Tobar-Losada A, Lacouture AM.
    >
    > Jalisco Institute of Reconstructive Surgery, Guadalajara, Mexico. [email protected]
    >
    > During a 4-year period, 152 female and 9 male patients underwent large-volume liposuction, with
    > ages ranging from 19 to 65 years (mean of 36 years), with a weight previous to surgery between 57
    > and 126 kg (mean of 72 kg). Tumescent liposuction was done simultaneously by two surgeons in
    > several corporal areas according to the necessities of each case. In 28 patients (17 percent), 500
    > ml of whole blood was required previous to the surgery by self donation. By means of liposuction,
    > volumes between 5 and 22.3 liters (mean of 8.7 liters) were obtained with an average relation of
    > 860 cc of fat for 140 cc of liquid. The reduction of hemoglobin and hematocrit at 1 week after
    > surgery was of 3.8 g and 12 percent, respectively. The weight after surgery during the patient's
    > follow-up varied from 54 to 111 kg, with an average of 66 kg. Major complications were not
    > presented. Minor complications consisted of two superficial cutaneous necroses (1.2 percent) and
    > 18 seromas (11.2 percent), which were drained without leaving sequelae; 24 patients (14.9 percent)
    > presented postsurgical palpable irregularities, visible in only 8 patients (5 percent); 148
    > patients (92 percent) expressed important satisfaction with the results of the surgery, with the
    > remaining 13 (8 percent) expressing some disagreement due to persistent irregularities. These
    > complications had a direct relationship to some factors of the surgical technique and some
    > characteristics of the patients. The amount of fat liposuctioned, the ideal height-weight
    > relationship of the patient, the diameter of the cannulas used, and the experience acquired during
    > the time were the most important factors that were associated with the complications. Based on
    > these results, we concluded that large-volume circumferential liposuction with tumescent technique
    > is a viable and sure alternative to achieve improvement of the body contour and weight loss.
    >
    > ========================================================
    > Large-volume liposuction in 181 patients.
    >
    > Albin R, de Campo T.
    >
    > Liposuction is a commonly performed cosmetic surgery procedure that is associated with
    > complications, including fatalities. Many of these have been associated with large-volume
    > liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the
    > Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily
    > defined large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any
    > more than this volume except in specific circumstances such as a hospital-type setting [1]. This
    > study includes 181 patients who have had greater than this amount of total aspirate removed in a
    > single procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only
    > (31 patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic
    > liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150
    > patients). During the last part of the latter series we calculated the blood loss of 45 patients
    > derived from preop and 5-day postop hematocrits. The results show that (1) there is no correlation
    > between the aspirate volume and the calculated blood loss; (2) the majority of the calculated
    > blood loss is not in the cannister; and (3) no deaths occurred, but one patient suffered a deep
    > venous thrombosis and two patients suffered pulmonary emboli. As others have pointed out [2-6] large-
    > volume liposuction can be performed relatively safely if this procedure is treated with the
    > respect it deserves and the practitioner exercises sound surgical judgment, uses appropriate
    > technique, and does not try to cut corners to save money for the patient by performing this
    > surgery in minimal settings.
    > =============================================
    >
    >
    > __________________________________
    > Do you Yahoo!? Yahoo! Mail SpamGuard - Read only the mail you want.
    > http://antispam.yahoo.com/tools
     
  3. Anon

    Anon Guest

    On 2004-02-19 16:31:22 -0500, Dead Soon <[email protected]> said:

    > Why do bariatic surgeons only seem to offer gastric banding whilst plastic surgeons don't want to
    > know about large volume liposuction?

    Liposuction isn't really weight loss, at least not from a health standpoint. Without dietary habit
    and lifestyle changes, it's almost guaranteed to be temporary, with no proven health benefits and
    some pretty well-established risks.

    > I have been doing some research to understand my options for the treatment of obesity (BMI >30,
    > but not Morbit Obesity as my BMI <40 it is ~35).

    Then you really shouldn't even be considering gastric bypass surgery.

    > - Olistat (which didn't work, it had nasty side effects and made me very hungry)

    The "nasty side effects" can be limited simply by cutting back drastically on your dietary fat
    intake, which for most obese persons, is a lot higher than it should be. Saying "it didn't work"
    implies that you took it as directed for an appropriate period of time (at least 30-60 days) in
    combination with appropriate dietary and lifestyle modifications but experienced no weight loss.
    Short of having done that, you can't accurately state that it didn't work.

    > - CPAP for sleep apnoea (after two sleep studies, this has solved the problem, but not lost
    > weight)

    Sleep apnea is one of the sequelae of obesity, not a cause. Treating sleep apnea can do many things
    (lower blood pressure, improve restorative sleep, etc.), but it won't help you lose weight.

    > - exercise (I swim 20 lengths in 10 minutes 5 days a week)

    That's not very much. You should make a concerted effort to increase this to at least 30 minutes of
    sustained cardiovascular exercise 5 days per week, in combination with appropriate dietary
    modifications (not a "diet" - I'm talking about eating the way you should've been eating your entire
    life...correctly).

    > - consultation with diatician (I was already doing 99% of what she suggested

    I doubt it. Be honest with yourself. Either you're fooling yourself, or you had a lousy dietician.

    > she recommended cutting down red meat consumption, that is now around 4 days a week)

    That's still three days too many. Cut your red meat back to no more than once per week, and keep the
    portion size small.

    > Since we seem to be having a worldwide (rich world anyway) epidemice of obesity, why is this
    > debate not going on? [or should I be reading different magazines?]

    I'm not sure what debate you're referring to. The "epidemic" is caused by too little exercise and
    too much food with a high glycemic index and concentrated calories. Getting fat in today's society
    is easy; being healthy takes effort. However, it's up to every individual to take responsibility for
    their own health, and start making the tough choices. Looking for easy solutions and quick fixes
    isn't the answer.
     
  4. Luv2pump

    Luv2pump Guest

    Liposuction is definitely NOT something to be taken lightly (and is very invasive). It IS a
    dangerous procedure, especially if considering large volumes being removed (a reputable surgeon will
    remain within certain guidelines in order to reduce surgical risk). If you understand physiology,
    lipo injects fluid, removes fluid & removes fat, which can result in life-threatening fluid shifts
    during and after surgery.

    After liposuction, weight gain will again get you back to your original condition. So in the end,
    you need to watch what you eat, and exercise. Calories in vs. calories out. Period.

    Gastric bypass can be done through a large abdominal incision, or through a scope. Depends on the
    surgeon. But even after the original weight is lost, it can be put on again. I have a friend who had
    it done 3 years ago, lost 80 lbs, and has gained back 30. She's now dieting to keep from gaining
    more. Her attitude about food has not changed, and she rarely exercises. The surgery just won't do
    it--it takes much more than that. There are no quick fixes.

    Dead Soon wrote:

    > Why do bariatic surgeons only seem to offer gastric banding whilst plastic surgeons don't want to
    > know about large volume liposuction?
    >
    > I have been doing some research to understand my options for the treatment of obesity (BMI >30,
    > but not Morbit Obesity as my BMI <40 it is ~35).
    >
    > I am male, mid-forties and I have had a number of related treatments:
    >
    > - Olistat (which didn't work, it had nasty side effects and made me very hungry)
    > - CPAP for sleep apnoea (after two sleep studies, this has solved the problem, but not lost
    > weight)
    > - exercise (I swim 20 lengths in 10 minutes 5 days a week)
    > - consultation with diatician (I was already doing 99% of what she suggested, no sugar, no butter,
    > no cream, no processed foods etc. etc. she recommended cutting down red meat consumption, that
    > is now around 4 days a week)
    > - Malaria - this worked well, but I was back to my normal weight in about a year I have looked at
    > a number of articles on surgical treatment using Pubmed (Medline). These suggest that gastric
    > binding and similar bariatric treatments have a result that can be predicted from the
    > psychological makeup of the patient - so placebo treatements might work just as well in
    > tractible cases. I also know that these have unpleasant side-effects.
    >
    > A number of studies (Plast Reconstr Surg. 2001 Aug;108(2):510-9; discussion 520-1. Improvements in
    > cardiovascular risk profile with large-volume liposuction: a pilot study. Giese SY, Bulan EJ,
    > Commons GW, Spear SL, Yanovski JA. - for example) suggest that large volume liposuction has fewer
    > unpleasant side effects, and results in long term stable weight loss.
    >
    > Reading other articles on large volume liposuction suggest that it is a good solution.
    >
    > However, looking at plastic surgery web-sites, I find almost universal objection to this
    > (sometimes whole sentences of objection in capital letters). When I wrote to one plastic surgeon
    > (who shall remain nameless), he said 'You can find a paper to support any medical opinion that you
    > hold.' this rather suggested a good old fashioned contempt for anything that happened after he had
    > left medical school, or maybe he had plenty of experience hunting for papers to support his
    > opinions. I certainly wouldn't want him as my doctor whatever the reason!
    >
    > So, before going through the expense of consultations with doctors with fixed opinions, I'd like
    > to know more about this debate.
    >
    > Are there any rational reasons for the plastic surgeon's objections? Or are they just motivated by
    > the documented antipathy to fat people (another article in medline)?
    >
    > Why is gastric band (or other gastric bypass) surgery so favoured when it seems to have so many
    > unpleasant side effects?
    >
    > Since we seem to be having a worldwide (rich world anyway) epidemice of obesity, why is this
    > debate not going on? [or should I be reading different magazines?]
    >
    > Papers:
    > ==============================
    >
    > Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study.
    >
    > Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA.
    >
    > Georgetown University, Washington, DC, USA. www.drsharongiese.com
    >
    > In this study, the authors investigated the physiologic effects of the altered body
    > composition that results from surgical removal of large amounts of subcutaneous adipose
    > tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent
    > measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-
    > energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and
    > after undergoing large-volume ultrasound-assisted liposuction.There were no significant
    > intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks
    > after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks
    > and 4 months after surgery, for a total weight loss of 6.5 kg (p < .00006). Body mass index
    > decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in
    > body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean
    > body mass did not change (43.8 +/- 3.1 kg to 43.4 +/-
    > 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg
    > (p < .0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5
    > mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and
    > systolic blood pressure
    > (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein
    > cholesterol, plasma triglycerides, and resting energy expenditure values were not
    > significantly altered after liposuction.In conclusion, over a 4-month period, large-volume
    > liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin
    > levels without detrimental effects on lean body mass, bone mass, resting energy expenditure,
    > or lipid profiles. Should these improvements be maintained over time, liposuction may prove
    > to be a valuable tool for reducing the comorbid conditions associated with obesity.
    >
    > ======================================
    >
    > Large-volume liposuction: a review of 631 consecutive cases over 12 years.
    >
    > Commons GW, Halperin B, Chang CC.
    >
    > Department of Plastic Surgery, Stanford University Medical Center, Stanford, CA, USA.
    >
    > Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management
    > techniques, increasingly larger and larger volumes of liposuction aspirations have been reported.
    > Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates
    > of complications have also been reported, with the worst of these resulting in deaths. In a
    > response to the increasing concerns over the safety of large-volume liposuction, a critical review
    > of the senior author's own series has been performed to evaluate risks and benefits and to
    > recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review
    > was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc
    > total aspirate. All procedures were performed by the same senior surgeon between January of 1986
    > and March of 1998. Before September of 1996, traditional liposuction techniques were used. After
    > September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid
    > management was employed for all procedures performed after 1991. The particulars of the surgical
    > and anesthetic techniques used are reviewed in the article. Data collection included preoperative
    > patient demographics, preoperative and postoperative weights and measurements, and preoperative
    > and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were
    > measured, and all complications were tallied. Average follow-up was 1 year.Results showed the
    > majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7
    > percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17
    > liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average
    > of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients
    > experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to
    > 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients
    > experienced minor skin contour irregularities, with most of these patients not requiring any
    > additional surgical procedures. One year after surgery, 80 percent of patients maintained stable
    > postoperative weights. No serious complications were experienced in this series. The majority of
    > the complications consisted of minor skin injuries and burns, allergic reactions to garments, and
    > postoperative seromas. The more serious complications included four patients who developed mild
    > pulmonary edema and one patient who developed pneumonia postoperatively. These patients were
    > treated appropriately and went on to have uneventful recoveries. The results show that large-
    > volume liposuction can be a safe and effective procedure when patients are carefully selected and
    > when anesthetic and surgical techniques are properly performed. Meticulous fluid balance
    > calculations are necessary to avoid volume abnormalities, and experience is mandatory when
    > performing the largest aspirations. Cosmetic benefits are excellent, and overall complication
    > rates are low.
    >
    > ===================================================
    >
    > Large-volume circumferential liposuction with
    > tumescent technique: a sure and viable procedure.
    >
    > Cardenas-Camarena L, Tobar-Losada A, Lacouture AM.
    >
    > Jalisco Institute of Reconstructive Surgery, Guadalajara, Mexico. [email protected]
    >
    > During a 4-year period, 152 female and 9 male patients underwent large-volume liposuction, with
    > ages ranging from 19 to 65 years (mean of 36 years), with a weight previous to surgery between 57
    > and 126 kg (mean of 72 kg). Tumescent liposuction was done simultaneously by two surgeons in
    > several corporal areas according to the necessities of each case. In 28 patients (17 percent), 500
    > ml of whole blood was required previous to the surgery by self donation. By means of liposuction,
    > volumes between 5 and 22.3 liters (mean of 8.7 liters) were obtained with an average relation of
    > 860 cc of fat for 140 cc of liquid. The reduction of hemoglobin and hematocrit at 1 week after
    > surgery was of 3.8 g and 12 percent, respectively. The weight after surgery during the patient's
    > follow-up varied from 54 to 111 kg, with an average of 66 kg. Major complications were not
    > presented. Minor complications consisted of two superficial cutaneous necroses (1.2 percent) and
    > 18 seromas (11.2 percent), which were drained without leaving sequelae; 24 patients (14.9 percent)
    > presented postsurgical palpable irregularities, visible in only 8 patients (5 percent); 148
    > patients (92 percent) expressed important satisfaction with the results of the surgery, with the
    > remaining 13 (8 percent) expressing some disagreement due to persistent irregularities. These
    > complications had a direct relationship to some factors of the surgical technique and some
    > characteristics of the patients. The amount of fat liposuctioned, the ideal height-weight
    > relationship of the patient, the diameter of the cannulas used, and the experience acquired during
    > the time were the most important factors that were associated with the complications. Based on
    > these results, we concluded that large-volume circumferential liposuction with tumescent technique
    > is a viable and sure alternative to achieve improvement of the body contour and weight loss.
    >
    > ========================================================
    > Large-volume liposuction in 181 patients.
    >
    > Albin R, de Campo T.
    >
    > Liposuction is a commonly performed cosmetic surgery procedure that is associated with
    > complications, including fatalities. Many of these have been associated with large-volume
    > liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the
    > Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily
    > defined large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any
    > more than this volume except in specific circumstances such as a hospital-type setting [1]. This
    > study includes 181 patients who have had greater than this amount of total aspirate removed in a
    > single procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only
    > (31 patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic
    > liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150
    > patients). During the last part of the latter series we calculated the blood loss of 45 patients
    > derived from preop and 5-day postop hematocrits. The results show that (1) there is no correlation
    > between the aspirate volume and the calculated blood loss; (2) the majority of the calculated
    > blood loss is not in the cannister; and (3) no deaths occurred, but one patient suffered a deep
    > venous thrombosis and two patients suffered pulmonary emboli. As others have pointed out [2-6] large-
    > volume liposuction can be performed relatively safely if this procedure is treated with the
    > respect it deserves and the practitioner exercises sound surgical judgment, uses appropriate
    > technique, and does not try to cut corners to save money for the patient by performing this
    > surgery in minimal settings.
    > =============================================
    >
    >
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