Dr. Kim Teams up with ESPN Commentator in Dallas

Big Ben has lost a total of 60 pounds, down from his beginning weight of 346 pounds. While he was initially apprehensive about the entire process, Big Ben says he immediately connected with Dr. Kim at the initial consultation: “I felt remarkably comfortable with him in a very short duration.” After a great deal of research and emotional preparation, Big Ben decided to undergo the vertical sleeve procedure to begin the next chapter of his life.
Follow Big Ben’s journey and track his overall weight loss on Dr. Kim’s Dallas bariatric surgery website, then call Dr. Kim’s office to schedule your initial consultation.

My heaviest pre-surgery weigh-in with the great Dr. Kim was a whopping – and embarrassing – 346 lbs.  Yikes.  That number even shocked some of my closest friends and family.  At 6’3” with a closet full of baggy threads, I guess I was able to obscure my sizeable girth fairly well.  But trust me, chairs shuddered in my presence as recently as a month ago.

I’m happy to announce that I’m already 30 lbs lighter and counting.  No, I didn’t lose 30 lbs in two weeks.  For me, the loss process started 3 weeks prior to my surgery as I started an all-liquid diet to prepare for the procedure.

Losing weight is a glorious thing for someone who has battled their weight for years.  When you’re losing weight every day, and working towards an amazing yet very attainable goal, you wake up happy every day.

It’s such a great feeling when you realize that there is no denying that your clothes are getting too big.  I’ve dieted before with some success, but this is different.  In the past, I might have relaxed after losing 30 pounds.  But with the sleeve, I know that this is just the beginning.  Losing 120+ lbs is exceedingly attainable for me with the sleeve if I hold up my end of the bargain by exercising regularly.  But back to how it feels to be heading in the right direction… losing weight on a daily basis is a liberating process to say the least.

I can’t help but get ahead of myself and wonder how much weight I’ll ultimately lose in this process.  I don’t really have a number in mind – I just want to be happy and healthy. Recently, I’ve been doing some thinking about all of the things that I’ll soon be able to do without thinking twice.  Here’s a quick list:

• Air travel. As a big man, catching a simple flight comes with major league anxiety.  Squeezing into a tiny seat, hoping the seat belt click happens without much fanfare and worrying about the poor soul next to me who is folded up into the fetal position have all been flight concerns for me in the past. Soon, that won’t be the case. I can’t wait.  I might even become a Southwest Airlines junkie who flies around for sport.
• Water parks with the kiddos.  My kids love to swim and would love to get their water park on… but truthfully, I just haven’t felt comfortable going. You got the troubling swimshirt decision and the unease that accompanies onlookers pondering your bizarre male pregnancy.  It just hasn’t been a consideration for me.  We swim as a family at home, but not in public.  I can’t wait to hit the water park with my little sea monkeys.  They’re going to love it!
• Playing basketball. I’m not particularly good at it, but I love, love, love to play.  It’s really the only exercise I’ve ever really enjoyed in adulthood.  Unfortunately, I just got too heavy to play at some point.  At 40 years old, I’m not exactly trying to put on a show, get in a competitive league or play with college kids or something.  But I’d really love to be able to get out and run full court with a bunch of fellow 40-year olds for some good, old-fashioned Saturday afternoon roundball cartio. Very soon, that will be a reality for me. I’m stoked!

Those are just a few of the things I’m looking forward to.  For most people, they are just common every day things that folks might even take for granted.  For me, they represent a magnificent light at the end of a tunnel.  Based on the poor direction of my health before my sleeve procedure, that light might as well have been an oncoming freight train.  Now with my sleeve, that light represents a wonderful future that I can’t get to fast enough!  Thanks, Dr. Kim!

In, this operation, I remove approximately 75% of the outside of the stomach (called the greater curve) while maintaining the openings that allow food to enter and exit from the stomach. Please see the animation in our video section of this website. The result is a tube or “Sleeve” in the shape of a banana that will hold about 60-120 cc’s. There is no manipulation of the intestines, and this has specific advantages that I will discuss later. The nerves to the stomach are also preserved, so stomach emptying is not an issue. This operation is performed laparoscopically (or through a scope) so it is minimally invasive and performed through 5-6 small incisions (about 1-2 inches in length). It generally takes less than 1 hour to perform. Because 75% of the stomach is cut out and removed, this operation should be considered not reversible.

There are several advantages to this operation. Because the function of this stomach is preserved, it allows patients to have a more “normal diet” with less restrictions. When I first performed this operation 2 years ago, I wondered how patients would swallow. I find today, patients seem to swallow and digest their food quite well however, requiring far less food. I find that most of my sleeve patients feel quite full with 3-4 ounces of food without difficulty swallowing. Because the intestines are not altered, it does not run the risk of developing ulcers.

A great advantage of this operation is that because there is no re-arrangement of the intestines, there is no significant potential for vitamin and mineral deficiency. VSG then becomes ideal for patients who already suffer from vitamin deficiencies, osteoporosis, anemia, or have medical conditions that can adversely affect digestion in the future (such as Crohn’s disease). Autoimmune diseases such as Lupus are contraindications to the Lap Band procedure. They could still be candidates for gastric sleeve.

This operation is unique in that in our practice, we are seeing weight loss similar to that of gastric bypass. Patients also seem to behave like gastric bypass patients in that it controls hunger quite well in most cases. Removal of the upper, outer portion of the stomach (called the fundus) as is done on this Gastric Sleeve operation, leads to the dramatic reduction in the levels of the hunger hormone, Ghrelin. This hormone is made in the fundus, and probably accounts for the drop in this hormone after Vertical Gastric Sleeve because it is virtually cut out.

Because a stapler is used to perform this procedure, the risks of the operation are inherently associated with the stapler device itself. One such risk is leakage of stomach contents if the staples open up and create a “leak”. This could be life threatening and difficult to heal. Bleeding internally from the staple line can also occur however, to decrease the chances of both leaks and bleeding, I perform endoscopy (also known as an EGD scope) along the inside of the Sleeve itself to examine the staple line both on the inside and the outside. I perform this at the time of the Sleeve operation. The risks of these complications are quite small at 1%. The risks of dying from this procedure have been quoted nationally at .25% which is much less than gastric bypass and slightly higher than the Lap Band. As with all of the bariatric surgeries, complications can consist of pneumonia, pulmonary embolism, injuries to surrounding structures, all of which occur at very low rates of .5% to 1%.

Surgeons will employ this operation as a primary operation or for conditions that I have listed above. They will also use Sleeve Gastrectomy (or Vertical Sleeve Gastrectomy) as the first part of a two part procedure-this is usually reserved for patients with extremely high body weights. It can also be used as an alternative surgical technique (when discussed pre-operatively with the patient) if the surgeon suspects an extremely large liver, or if numerous adhesions may be suspected from multiple prior surgeries.

In summary, Vertical Sleeve Gastrectomy, or the Vertical Gastric Sleeve is becoming rapidly popular in my Dallas-Ft.Worth based practice for many reasons. It appeals to patients who don’t want an implant or the follow-up of a Lap Band, but are concerned about the risks of gastric bypass surgery. It allows patients the ability to lose a significant amount of weight, that approaching gastric bypass without as many risks. In the rare patient who has not lost enough weight with the band, I have been converting this subset of patients who don’t want a bypass, or don’t qualify for a bypass, into a Gastric Sleeve operation. I believe this operation will gain in popularity for years to come.

Some other names for the Vertical Gastric Sleeve: Laparoscopic Vertical Gastric Sleeve, VSG, Gastric Sleeve, Sleeve Gastrectomy, Gastric Sleeve Resection, Greater Curvature Gastrectomy, Gastric Reduction, Partial Gastrectomy, Vertical Gastroplasty

I hope you have enjoyed this article. Please come visit our blog section regularly as we will be posting several interesting topics and adding new columnists who can bring their perspective to the world of bariatric surgery.

David Kim, MD FACS