Centered on Health 1-2-25 - New procedure, Endoscopic sleeve gastrectomy with Dr. Lanny Gore

Centered on Health 1-2-25 - New procedure, Endoscopic sleeve gastrectomy with Dr. Lanny Gore

Episode Transcript

Speaker 1 (00:00):
It's now time for centered On Help with Baptis Help
on US Radio. Wait forty tell me JS. Now, here's
doctor Jeff Tubbler.

Speaker 2 (00:10):
Well, good evening, everybody, and welcome to tonight's episode of
centered On Help with Baptist Help here on news radio
eight forty whas. I'm your host, doctor Jeff Tublin, and
we're host. We're greeted tonight with with our producer mister
Jim Fenn, who is always on standby to take your calls.
Our phone number is five oh two, five seven one

(00:32):
eight four eighty four. We have a great guest tonight
tonight we have doctor Lanny Gore. He's been on our
show before and he's here tonight to talk to us
about bariatric surgery and some new procedures within endoscopics.

Speaker 1 (00:47):
Leave guest, stetiny and other procedures.

Speaker 2 (00:49):
Now, I know that you're out there, and I know
that you have a lot of questions because I do too,
So pick up that phone five oh two, five seven
one eight four eight four and get all your all
your questions since answered. Tonight. We do have doctor Lanny Gore,
who is a bariatric surgeon with active hospitals and in
southern Indiana. He attended the University of Louisville for both
his medical school and residency training. As a bariatric surgeon,

(01:13):
he specializes in lap band ruined why Ste've got strecthany
robotic surgeries, and he's going to touch educate us tonight
about some advancements in the field of bariactric surgery. Welcome
to tonight's show, doctor Gore.

Speaker 1 (01:27):
Thank you very much. I'm happy to be here.

Speaker 2 (01:30):
Well, I'm excited to have you with It's our first
time getting to do this together. And I know that
this is such a huge topic. In fact, I think
for many, many years, I think one of the biggest
healthcare issues facing our community was tobacco, and I think
statistics show that obesity is kind of rivaling tobacco as

(01:51):
a health crisis. What are your thoughts about that in
our community.

Speaker 1 (01:56):
Well, that's true. Morbid obesity is really up there with
cigarette smoking is the biggest cause of preventable death. It
really is at the root of a lot of different
medical problems. And the great thing about mind, joh why
I enjoyed doing what I do. We can really focus
on a lot of different medical problems when we focus
on mobid obesity. We can see people get off the

(02:20):
blood pressure medicine, get off their diabetes medicine. They're able
to get a hip replacement that they weren't allowed to
have because they were overweighthed or they're just more mobile
or have a better quality of life. So mobid obesity,
I hope does get more attention and that it deserves.
I think I remember, you know, growing up, and we

(02:43):
know from long ago, there was a time when you know,
doctors would make rounds with nurses and smoke cigarettes out
in the hospital hallways, right or or a doctor would
recommend this particular type of cigarette because it's safer, And
now we've had a pretty good progremress and know that
it's smoking's pretty harmful. I hope that we can focus

(03:06):
now on morbid obesity in that way, and someday we
will we'll make some similar progress and understand that you know,
the things about our diet, or about our sedentary lifestyle,
or about our own biology that that makes us at
risk of becoming OBEs. I hope we can put that

(03:28):
at the forefront and prioritize it as something to focus
on in order to make patients healthier.

Speaker 2 (03:34):
And from a twenty thousand foot view, what is bariatric surgery?
What I know, we're going to get into a little
bit of details of the individual ones, but in general,
what is that approach taking with a patient?

Speaker 1 (03:50):
Right, Well, we're making changes to the intestine to affect
someone's satiety or their their fullness, the satisfaction with eating.
We are literally making changes in the gut that change
hormones in the body, hormones that has become more popular

(04:13):
now like GLP and other hormones like grilling and others
that really affect our hunger. And there's a lot of
different ones, different parts of the intestines to create different
ones that act on our brain that affect how full
we are, how satiside we are. Well, these operations affect
those hormones and they also literally affect the volume of

(04:36):
food that we can eat. And then how the food
moves through the gut is affected by very action surgery.
So we're trying to achieve weight loss by surgically manipulating
the intestine in different ways. And this can be from
a rather less invasive type of a procedure to a
more invasive type of procedure. So procedures can vary from

(04:59):
simp doing something to make the volume of food you
can hold in your stomach smaller to really causing food
to actually skip over parts of the intestine. And so
that's that's the major strategies. But we're finding that these
changes actually do affect other hormones in the intestine and

(05:20):
so it can have a compounding effect. And that's what
veriatric surgery is.

Speaker 2 (05:27):
That's fantastic, And I know, I mean, we're all familiar
and we're going to talk a little bit, hopefully later
about some of the medications that are out for weight loss.
So when somebody's sitting there, they're listening to this show,
they're hearing me talk and they're hearing you talk, and
they're wondering, how should I am I the right person
to consider a very actic surgery, Like who is the

(05:47):
right person who should be thinking about possibly talking to
their primary care or scheduling at consolation with somebody right here.

Speaker 1 (05:55):
Well, something that maybe a lot of people don't realize
is that many insurance companies will pay for your very
active surgery. Now, you do have to meet some criteria.
So the most common criteria is to have a body
mass index or BMI of forty or greater, and you
can simply google that a BMI calculator, or you may

(06:19):
be able to put one on your iPhone, but you
just simply put in your height in your weight. If
if your BMI is forty or greater, most insurance companies
will pay for your very active surgery. Now those numbers
are going to come down. Many insurance companies will cover
a BMI of thirty five or greater if you have
a particular medical problem that's related to obesity. So some

(06:44):
common types would be type two diabetes, high blood pressure,
sleep at nea, liver disease, some kind of fatty liver
disease for example, and then those numbers may come down
in the future. Some insurance companies are starting to cover
very active surgery with a BMI of thirty if you

(07:07):
have liver disease or type two diabetes. So the American
Society of Metabolic and Bariactric Surgery, that's the society I
belong to, the professional society that makes recommendations regarding bary
actual surgery. They have recommended that these BI numbers be
trended down, so for instance, instead of a BMI forty,

(07:27):
we may see that go down to a thirty five
and from thirty five to thirty and maybe even sometimes
slightly less than thirty in some situations in the future
because and the reason for these numbers, it's just statistically,
this is where people start having health problems related to
their weight. And so when we see that the statistics

(07:49):
are there that show that obesity is causing these health problems,
it makes sense to the insurance companies to pay for
these operations because they're going to be paying less money
for your healthcare actually by paying for your surgery.

Speaker 2 (08:05):
And what are you seeing as far as ages? Is
there a minimum age that somebody could consider this? I mean,
I know we're seeing obesity in all in all of
our age groups. When is it appropriate to consider somebody
being old enough to consider something else?

Speaker 1 (08:21):
That? Yeah, most very act surgeons will treat people at
eighteen years of age illegal adult age. There is some
like pediatric surgeons who do do very actual surgery in
some teenagers. So that is something that is being done
because we're actually seeing that the rate of morbid obesity

(08:42):
and adolescence is actually quadrupled in the last twenty years.
So it is a severe problem. And so because the
problem is causing severe health problems. And we're seeing we're
seeing teenagers with diabetes, We're seeing people in their twenties
with heart disease, significant heart disease. So when when those

(09:05):
kind of severe medical problems are occurring, that's when we
start having, you know, get more aggressive with how to
how to battle this problem. As far as the other end,
how old, I have operated on more than a few
people in their seventies. Uh, And again we have a

(09:25):
we have a variety of different procedures that you know,
have varying degrees of risk and potential complications. And so
you know, it may be that even though someone may
be in their seventies, they can still have very actric
surgery that may still help them lose weight, still help
them be more mobile, and you know, still improve their

(09:48):
health at that point.

Speaker 2 (09:51):
Fantastic. Well, we are talking with doctor Lanny Gore tonight
bariatric Surgery with Doctors Hospital in Southern Indiana about bariactic
surgery and new procedures including and then just Gotta Shlive,
got sechony and some other newer procedures. I'm doctor Jeff Publin.
You are listening to Center on Help with Baptist Help
here on news radio eight forty wh as our phone

(10:12):
number five oh two five seven one eight four eighty four.

Speaker 1 (10:16):
Give us a colic, you.

Speaker 2 (10:17):
Want to be part of the conversation, We'll be right back, Alana.
Welcome everyone back to Centered on Health with Baptist Help
here on news radio eight forty whas. I'm your host,

(10:41):
doctor Jeff Publin, and tonight we are talking to doctor
Lanny Gore, who is a bariatric surgeon with the Baptist's
Hospital Group and in Southern Indiana who's talking to us
tonight about bariatric surgery and new procedures. So welcome back,
doctor Gore. I'm going to remind our listeners that the
phone number is five oh two five on.

Speaker 1 (11:00):
Eight four a four in.

Speaker 2 (11:01):
Our producer Mischageontint is on stand bias. So doctor Gore,
I just want I'm going to throw this out there
as a question to kind of introduce getting into some
of these techniques that you use. But you know, there's
some shows out there about weight loss procedures and stuff,
and a lot of times patients are asked to lose
weight before they can even be a candidate for surgery.

(11:23):
So if somebody's in a real bind and they need
buriactic surgery. How are we supposed to do that?

Speaker 1 (11:30):
How do they get started? Okay, So in our program,
patients that like are barely meeting the qualifications the bariactual surgery, Like,
they're on the lower end of the of the weight
for a veryfue patient, we're not going to really expect
them to lose a lot of weight. But there are
some patients who have a lot of weight to lose
and it's to the point where their weight may make

(11:54):
the operation very difficult. And some patients their liver can
actually be so big it can make the operation hard
to do, and so we have something called a liver
reduction diet. We do just a couple of weeks before surgery,
but we usually are seeing these patients about six months
before surgery, and we have them see our dietician and

(12:15):
we try to set goals for them and meet with
them once a month for about six months to try
to help them adopt a healthier lifestyle, healthy diet, moving more.
And we understand that the whole reason they're there is
to lose weight, and they've probably tried some things also,
but we still want to make sure that they know
the basics about good diet, about the fact that you know,

(12:38):
moving and try to find out is there some type
of exercise they can do a lot of people can't.
When they reach a high way, it's very difficult for them. So, yes,
it can be very challenging, and we do have situations
where things get really challenging. But the vast majority of time,
I would say over ninety percent of the time, probably

(12:59):
over ninety five percent of the time, we are able
to make some progress. We are able to see some
weight loss through these measures. Because although you know, bear
after surgery is the most effective way to help someone
lose weight, but even these great operations that help, they're
not going to do everything. It does require you to

(13:21):
make some changes. You can't just have one of these
operations and then eat whatever you want and don't worry
about taking a walk or anything like that. That's actually
not true. So we know that, you know, most of
that majority of people can make some changes that's going
to positively influence their life. So then we get some
of the weight off that way, and then after surgery

(13:43):
they're able to keep that weight off and lose a
lot more because now their body is responding the food
much differently, and they're getting fuller by just eating smaller
amounts of food or hormones are different and they're actually
less hungry. I have a lot of patients tell me that, well,
you know, I used to be a sweet soooth, and
now I don't like sweet stuff. I don't like it,

(14:04):
or they want drink because it's too sweet now, And
so we see a lot of changes like that, and
those changes can be very useful to someone trying to lose.

Speaker 2 (14:14):
Weight and for somebody who's thinking about making that step
and calling the office and setting up appointment, tell us
a little bit about what the I think you started
to but what's the pre opt evaluation, like what what
does your team consist of, what should they expect in
sort of that pre surgery phase of.

Speaker 1 (14:36):
Things, right, So we often will go into detail about
what their diet is, like what what do they eat
on most occasions, maybe what diets they tried in the past,
what efforts they've used in the past to lose weight.
We often will highly recommend a high protein diet because

(14:59):
protein is really the most satisfying of the three macronutrients.
It also is what protects is from muscle loss when
we're losing weight, we do, you know, try to recommend
a efforts to basically put you in a calorie deficit.
Now it can vary for different people, but overall we

(15:20):
tend to go with a higher protein diet, also making
sure you're eating lots of fiber. And what that means
is you're eating fruits and vegetables and you're eating a
lot of food sources with protein. And so we try
to give people, you know, examples even recipes, lists of

(15:40):
food they should choose from that sort of thing. We
try to also figure out some exercise goals for them.
And then most of the time, when someone is preparing
to go through very active surgery, their entrance company requires
a psychiatric evaluation. Now this doesn't mean that if you've
got a psychiatric problem, you absolutely can't have surgery. Not
really what it's about. It's just making sure that if

(16:02):
you do have any psychiatric issues, they're being addressed, either
your in therapy or you're having you're being treated with
medication for it. And just to make sure those things
are being addressed. And then patients have you know, realistic
goals and realistic expectations as well. We're also using this
time to educate them about the surgery, educate them about

(16:25):
what to expect after surgery, and give them support and
encouragement because it is difficult to lose weight. It's very
hard and you need support, and so we try to
provide not only the education, but the moral support and
encouragement that you need because it can be very demeaning.

(16:46):
You can feel kind of down and kind of bad
about yourself when you get in this situation. You can
want to avoid people and avoid relationships and things like that.
So we want to give people, you know, not only
the education that they need, but you know, the moral
encouragement and makes them feel kind of part of our

(17:06):
team and part of our program. And I think that's
very important as you as you're getting ready to go
into surgery.

Speaker 2 (17:13):
No, it sounds well constructed. So what are the most
common surgeries that you perform for weight loss and how
do you make the decision of which one is right
for a particilitation.

Speaker 1 (17:26):
Right, Well, the most common procedure that we do is
called the gastric sleeve or vertical sleeve. Gastrectomy is another
word for it, but anyway, in the gastric sleeve, it's
pretty simple. We're simply making the stomach smaller. So by
removing a portion of the stomach, your stomach goes from
like this large pouch to this narrow tube and you're,

(17:49):
you know, not able to store a lot of food
at once. And it's very safe, very simple, very low
chance of any complication or side effects with gasous sleep.
And so that's why it becomes so popular because by
removing part of the stomach, we're also able to affect
a hormone called grillin, which is a hunger hormone, and

(18:12):
you have less amount of this hormone in your body,
and so you're less hungry, less desire to eat, and
then your stomach smaller. So when you do eat, you
can eat a small amount of food, and a lot
of people it's like about a half a cup to
a cup of food at a time, and you feel full.
And now you know, a person could go ahead and

(18:35):
eat again in four to six hours probably, but a
lot of people don't because their hunger is less. And
this is what helps people maintain that low calorie intake
so that they can lose weight. I think you know
the biggest reason why people fail at diet. It's difficult
to stick to a diet, it's difficult to resist hunger.

(18:56):
That is very hard to do, and so these operations
is what makes it necessary. And so gasri sleet has
become the most commonly performed procedure of the last decade.
Then the next most common procedure that I perform is
called a ruin y gas bypass. That's also one of

(19:18):
the oldest very actric operations. First versions of it were
being done back in the nineteen fifties. With the advent
of laparoscopic surgery in the nineties and early two thousands,
it became more and more popular because now because of
laparoscopic surgery, patients could tolerate these procedures a lot better.
And what I mean by lathroscopic surgery is we're making

(19:39):
small incisions in the abdomen and doing the operation that way,
and so by doing that you can recover faster from
an operation. For both of these operations, it's just one
night in the hospital and you go home the next day.
That means you're going to recover faster and get to
work faster. But anyway, with gastrick sleeve, as I said,
we're making the stomach smaller. With gastric bypass, We're not

(20:00):
only making the stomach smaller, We're then attaching that smaller
stomach to a portion of the intestine which is normally
found further downstream. And so your food literally skiffs over
part of your intestine, and so your intestine is not
absorbing that food as much as it would. It's called malabsorption,

(20:22):
and so that adds to the effects of the weight loss.
And so that so gas to bypass is a little
more complicated procedure. There are some complications associated with gas
with bopass that you don't have to worry about with
gashou sleeve. So gas your bypass, there is the possibility
of someone getting an ulcer. There's about a five percent

(20:42):
chance of that happening, and so we really don't want
people to smoke to have a gas with bypass because
that would further increase your risk of getting one of
these ulcers. And also if someone is heavily dependent on
steroids or insets, which are the drugs a lot of
people say for authritis, saying if you're taking that stuff

(21:02):
like on a daily basis, you'd have to stop that
if you were thinking of having a gas your bot pass.
But even though gas just have more rips and involved.
It can actually be an operation that could cause a
little more weight loss than gaserously, So that's why we
still have it.

Speaker 2 (21:18):
That was going to be my question is does the
amount of weight loss intended to be lost affect the
decision of which of those surgeries you might right?

Speaker 1 (21:27):
Right? So, one of the reasons why a gash with
bot pass may be performed instead of a gaseroously is
because we want to achieve greater weight loss. Also, if
someone is a severe diabetic requiring a lot of insulin,
and they may be better served by having a gas
with bopass. Now, a gasous sleeve can still greatly improve
a lot of people's health, but a gas your boat

(21:48):
pass is probably going to be a little bit more
successful at treating the diabetes. And also, gas through bob
pass can actually be a good operation for someone with
your reflux. So if you're the kind of person that
the reflux is so bad that even medications don't really
control it that well, you might want to think about

(22:09):
a guess sho bipads because it can actually be very
good at reducing that reflex significantly.

Speaker 2 (22:18):
You are listening to doctor Lanny Gore, who is a
bariatric surgeon with Top the Hospital and in Southern Indiana.
He is talking to us tonight about bariatric surgery and
new procedures on Doctor Jeff Colin, you are listening to
sent it on Health with doctor's Health here on news
radio eight forty w h a s our phone number
five oh two, five seven one four eight four.

Speaker 1 (22:39):
If you'd like to call in, you'll be right back.

Speaker 2 (22:58):
Welcome back to cent it on Health with after Help
here on news radio eight forty whas. I'm your host,
doctor Jeff Publin, and we're talking tonight to doctor Lanny Gore,
a bariactor surgeon, about bari actid surgery, some new procedures
and weight loss. So, doctor Gore, I'm going to throw
out a three parter for you, if we could give

(23:18):
us a global view of how much weight should somebody
expect to lose with these surgeries over what period of time?
And when is too When is.

Speaker 1 (23:28):
It too much weight? Okay, well, it's usually a percentage
of your excess weight. And so certainly, you know, if
someone weighs, you know, two hundred and thirty pounds are
not going to lose as much weight as sooney weighs
five hundred pounds, and so it's often a percentage, so
we can see anywhere from about fifty percent to seventy

(23:50):
percent of the excess weight being lost. So, for instance,
if you've ever looked up your ideal weight and you
see that you know, some some number that you didn't
weigh since you were you know, fourteen or fifteen years
old comes up. You know, if an average sized a
woman looks up her ideal weight on one of these

(24:11):
charts and see she should weigh one hundred and forty pounds,
and let's say she's two hundred and forty pounds, she's
one hundred pounds of her weight, and then for her
particular case, she's probably going to lose somewhere around fifty
to seventy pounds, for instance, And so that's what we
can see. Now, different procedures are going to have different results,
so you know, a more aggressive procedure is going to

(24:34):
have more weight loss. So gastric sleeve a very safe procedure,
but the weight loss is going to be closer to
that fifty to sixty percent range, but it could certainly vary.
And then on average gastric bypass, you're going to see
you know, more of a sixty to seventy plus percentage
being lost in a lot of those patients. So certainly

(24:54):
your lifestyle, you know, your activity affects that. You know,
if you're a relatively young patient who then after surgery
also gets very strict about their diet and also begins
to exercise, they're going to you know, have a lot
more success compared to maybe an older patient who has
bad needs and back back and can't really do a

(25:16):
lot of aggressive exercise. So the results are going to
vary based on that. As far as time, most of
the weight that is lost is going to be lost
during that first year after surgery. It's usually around a year,
although that can vary too by a few months. Anywhere
from eight months to eighteen months is where we're going

(25:38):
to see a lot of the weight being lost. And
then the third component, too much weight loss. Well, fortunately
I don't see that very often. It's rare that I
see that. In some of the times I've seen that
it's someone who's had a gas with bob pass maybe

(26:00):
many years ago, and they may have actually developed some
kind of other problem, whether it be a ballotstruction or
some other complication of the procedure that's affecting their diet
and inability to eat. So the weight gets very low,
their BMI actually gets very lower, their overall weight, their
muscle is very low as well, and so they're starting

(26:23):
to even have maybe things like bottomin deficiencies and things
like that, and so we may have to intervene in
some way to correct that. But fortunately that's very rare
to see that. I don't think I've ever seen it
with a gash of sleeve before, and I've only seen
it maybe a couple of times. Who guest should back pens.

Speaker 2 (26:42):
Good to know well As a gastroenterologist, the word end
of stopic always gets my attention, and so I know
there's talk about an end of stopic sleevestrectomy, and tell
us about that procedure. Is that surgery trained or GI

(27:02):
doing that, who's doing it?

Speaker 1 (27:04):
And what is it?

Speaker 2 (27:05):
Why is it beneficial?

Speaker 1 (27:06):
Yeah? So, first of all, indoscopic means that we're putting
a scope in the mouth and we're getting down into
the stomach that way, and so we're not making any
incisions on the abdemens. So both surgeons and gas genurologists
are doing this procedure. I have been trained to do
the procedure. I've actually used the device that is used

(27:28):
to do this procedure. I've been using it for years
to make small changes in people that have already had
some type of bar asci surgery. So if someone in
for instance, of someone's catagasic bypass, I can use the
device to make part of their stomach just a little
bit smaller, or make an opening in the stomach to
the intestine a little bit smaller that can kickstart their

(27:50):
weight loss again. The same device is developed by the
company called Apollo. This device can be used to makes
this is in the stomach so that we basically sew
the stomach to itself on the inside, so that the
stomach cannot fully expand and it stays in this contracted state. So,

(28:13):
because it kind of resembled our gastric sleeve operation that
we do, it's called the endoscopic sleeve. Gastroplasty is the
name for it, or ESG. So the ESG or endoscopic
sleeve is a pretty new procedure, and we're now offering
anti patients at Baptistel Floyd and I'm hoping we can

(28:36):
get some people interested in that now. It is a
new procedure, so we don't really have a lot of
long term data on that, but the new data is promising.
We're seeing a significant weight loss with sleeve gas strectomy,
so we've seen anywhere from twenty five percent to forty

(28:56):
percent excess weight loss within endoscopic sleeve. There was actually
a report just two months ago and Jamma that actually
compared endos gopicsly with the hot drug osimpic or seema
glue tide because a lot of people are losing weight
on that medication. The endoscopics was superior to seema glue tide.

(29:18):
So there may be some patients out there who may
be life the idea of having a procedure that's less invasive,
it doesn't require any incisions. Also, there may be people
out there whose entrance company does not cover very actually
surgery and may be paying for this out of pocket.
And this is going to be probably about half the

(29:38):
cause of some of these surgeries that you may also
in other advantages, you can you can go home often
the same day after having this procedure done, and so
those are a lot of the advantage of it. Now disadvantage, well,
it's a new procedure we don't know a lot of
the long term results of this procedure. An obvious concern

(29:59):
would be how long these stitches going to remain in place?
Are these stitches going to break? Are they going to
come loose eventually? So that is, I guess a concern
that people are wondering about. But they are permanent features.
They're designed to stay there and keep the stomach closed down.
It's just we simply don't know yet how long they're

(30:21):
going to last. But the recent study that looked at
it versus sema glue tide was a five year study
and at least at five years, they did show some
consistent weight loss with ESG.

Speaker 2 (30:36):
You know, I hope people are listening and that they
heard a couple of really important things that I heard
you say, which is that these surgeries tend to be
the most effective way to lose weight. And for those
that might be out there and might be on the
fence about having surgery and being opened up for even laparosophically,

(30:58):
I hope they're hearing this because that it sounds like
there's some real advantages to the less invasiveness of this
type of approach. But on the other hand, I know
that there's some newer techniques that are are on the
more aggressive for more weight loss, but are making improvements
in some of the bypass area. When we come back,

(31:19):
I want to hear a little bit about about that
to kind of balance out that that spectrum for us. Right,
we're going to take take our final break here. You're
listening to Send It on Help with Baptist Health here
on news radio A forty w h A S. I'm
your host, doctor Jeff Helvin. We're talking tonight to doctor
Lanny Gore, buryatic surgeon. Download the iHeartRadio app to listen

(31:39):
to tonight's SOHO in its entirety. We will be right
back after this. Welcome back to Send It on Health
with Baptist Help here on news radio at age forty

(32:02):
wh as. I'm your host, doctor Jeff Covlin. We're talking
tonight to doctor Lanny Gore about Bury accid surgery. He's
a very active surgery with Doctor Hospital and in southern Indiana.
The number to download the iHeartRadio app to re listen
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app has to offer. So doctor go right before we

(32:23):
went to break, we had talked a little bit about
one of the newer, lesser invasive surgeries. There's some newer,
more aggressive surgeries that are out there. Could you tell
us what those are? And why do we want more
and more aggressive surgeries?

Speaker 1 (32:39):
Okay, So a procedure that we're also now offering is
called the SADIE procedure as SADI are also known as
sadie s. It stands for single and asthmosis. Do I
to know illeal bypass with sleeve? Oh? So, this particular
procedure does involve creating a gastric sleeve, but then then

(33:02):
connecting the lower portion of that sleeve stomach to the intestine.
And so it has some aspects of sleeve, some aspects
of gastric bypass, and it can cause even more weight
loss than a gas roop bypass. And I guess saying

(33:22):
it's more aggressive, Well that's yes and no. Yes, it
can cause more weight loss and potentially lead to you know,
malabsorption in a small percentage of cases, but by and large,
there's promising results with SADIE and it may even be

(33:42):
safer than gastric bypass because there's no there's much less
risk of the ulcer that I mentioned earlier that you
give a gasp bypass, and there's a type of battle
obstruction that some people with gastric bypass can get called
an internal hernia, and we're not seeing that with a
SAD procedure. So it may in some ways have an
advantage over gastry fivepass in that it actually has some

(34:05):
less risk in some regarding some of the complications. So
this procedure has been endorsed by the American Society of
Metabolic and Very Active Surgeon. It's actually the newest procedure
just basically recommended in the last couple of years by them,
and so I think we're going to see it perform

(34:25):
more and more frequently. And it also may be a
good procedure for someone who's had a gas with sleeve
and is now looking to lose more weight, or maybe
they've had some weight regain and want to try a
different procedure because the sleeve portion of the procedure and
them has already been done and so it becomes a
shorter procedure and maybe even easier to perform in a

(34:47):
gastry FIVEPAS. And so that's why I think we're going
to see this procedure perform more and more frequently. Now
hopefully insurance companies will start covering it a little better
than they are. There are some insurance companies that are
not mentioning it as one of the bari actual procedures
that they cover, and so we're having to kind of
work around that and and and so that's kind of

(35:08):
our challenge right now is trying to you know, figure
out if insurance companies are going to cover this operation
for a lot of people. But it is, you know,
an operation that it's more aggressive than a gasroous sleep,
probably on par with with how complicated it is with

(35:29):
gastric bypass, but it might actually be a little safer
in some ways than a gastric bypass, and so therefore
I think we'll likely see it performed more may It
has an advantage also, I mentioned affecting the hormones and
hunger definitely affects those things. It's even more successful at

(35:49):
treating diabetes than gas with bypass, and so it's going
to have a lot of advantages for people that have
you know, severe health problems related to their obesity diabetes,
and it's going to help them, you know, basically cure
their diabetes and other medical problems it's related to obesity.

Speaker 2 (36:08):
Well, we'll definitely have to have you back when that's
being done more and.

Speaker 1 (36:12):
See where we're getting with that.

Speaker 2 (36:14):
And now have a little bit of a loaded question
for you, because if you actually know the answer to this,
you might be the only one who does. But you
mentioned these weight loss medications earlier. How do they fit
in this landscape of bariactric surgery. Who should get the medicine,
who should get surgery? And are they ever used together?

Speaker 1 (36:35):
What do we know in twenty twenty four about this? Well,
I think obesity treatment needs to be a combination of
all these techniques. I mean, we want our patients to
lose weight however they can. So we may be using
these drugs preoperatively to help people lose weight before surgery.
We may be using it after surgery and those people

(36:56):
that maybe aren't losing as much weight as they'd like to,
or maybe it's been a few years since their surgery
and they're starting to regain a little bit of weight,
so we're using it in both situations. We actually are
offering a pure medical program also right now, so for
people not even interested in surgery, but they want good
dietary counseling, they want the opportunity to be prescribed these medications.

(37:22):
We do offer that, and so we feel that these
drugs are successful. Now statistically they don't achieve the weight
loss that very actric surgery does, but they certainly are
the most successful weight loss medications that have been designed
so far. And I think we're going to see more

(37:45):
drugs like these come out in the future. In fact,
just attended a conference and there are more types of
these medications coming through, and there's new studies all the
time about maybe them having other benefits on even other
organists and other types of health problems. That's going to
be interesting to hear more about. But I think we

(38:05):
want to use these medications along with surgery, much like
cancer is treat you know, we treat cancer with a
combination of surgery and medications, and and so it's going
to be that type of approach, and we really need
to do everything we can a lifestyle change, diet, medicine, surgery,

(38:27):
whatever it takes to really treat this disease that is
you know, now as big as smoking as are preventable
cause of death. Well, I hope that but again another
thing I'd like to say, these medications are new. We
don't know the long term effects. You know that that's

(38:48):
something to keep in mind. These medications are expensive, it's
hard for a lot of patients to get these medications,
and supposedly you have to be on these medications for
the rest of your life. Stuff medic you're likely to
regain your weight, so that's something to think about. And
there are actually people who don't respond very well to

(39:08):
these medicines, and even they can't handle the side effects,
so it's not going to be It's not a cure
all yet. It's certainly the best medicines that they've developed,
but it's not a total fix yet.

Speaker 2 (39:21):
Well, it's great to have all these gobses, doctor Gore.
We are definitely going to have to have you back.
I mean, this is just a hot topic, a lot
of information. Thank you so much for explaining all of
this to us. I hope our listeners got so much
out of this. That'll do it for tonight's segment of
Send It On Health with Factors Health, I'm your host,
doctor Jeff Publin. I want to thank our guest doctor
Laney Gore for sharing all of his expertise with us.

Speaker 1 (39:42):
I want to thank our producer and this.

Speaker 2 (39:44):
Is Jim Fen and you the listener, join us every
Thursday night for another segment. We will talk to you next.

Speaker 1 (39:50):
Week and have a great end, safe weekend.

Speaker 2 (39:56):
This program is for informational purposes only. It should not
be really upon his medical advice.

Speaker 1 (40:01):
The content of this program is not intended to be
a substitute for professional medical advice, diagnosis, or treatment. This
show is not designed to replace a physician's medical assessment
and medical judgment.

Speaker 2 (40:13):
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
or regarding specific medical conditions.

Speaker 1 (40:21):
To find a Baptist health provider, please visit Baptistealth dot com.