15 Aug 2009
By: Ho Lian-Yi
Last November, Miss Christine Kunasekaran found out she had to take medication for hypertension.
The ITE student, who was 107kg at her heaviest, realised she had to do something drastic.
“I’m quite young to be taking medication for that,” said Miss Kunasekaran, now 23, referring to the condition that is usually associated with people twice her age. She also developed impaired glucose tolerance.
For the 1.65m-tall woman, the solution was surgery – laparoscopic sleeve gastrectomy (LSG).
This is where the stomach is “tubularised” to lose most of its volume so that the patient needs less food to feel full (see graphics).
It has been only four months since the operation but Miss Kunasekaran now weighs just 67kg. Her goal is to reach 62kg.
Her waist shrunk from 99cm to 76cm.
She is among a growing number of people who are turning to this new form of bariatric, or weight loss, surgery.
Others include laparoscopic adjustable gastric banding (commonly called lap-band surgery) and Roux-en-Y gastric bypass.
Dr Shanker Pasupathy, a consultant at the department of general surgery at Singapore General Hospital, performed the surgery on Miss Kunasekaran in April.
He said that the number of reported patients opting for sleeve gastrectomy worldwide has more than tripled from 700 to 2,500.
“The actual number is several times this,” he said.
Miss Kunasekaran had been battling weight problems since her teens. “When I was 14 years old, I was already 60-plus kg,” she said.
She did not lose any weight despite years of compulsory exercise in her school’s Trim and Fit club.
To prepare for the operation, Miss Kunasekaran had to make lifestyle changes. She started doing yoga and eating only healthy food. She also went on a liquid diet for two weeks before the surgery.
Her mother paid for the surgery, which she said cost about $3,000.
She described the recovery period as horrible. “One sip of water (then) and I felt like there is acid going up my oesophagus.”
Nowadays, she feels full a lot faster, and she has to eat slower. “Because my stomach can’t digest if I eat too fast, I’d vomit.”
The weight loss is impressive, but is the procedure safe?
Last year, a driver with a construction company underwent LSG at Alexandra Hospital and, after the operation, his stomach started leaking.
Dr Anton Cheng, deputy director of Weight Management Programme at the Health For Life Centre at Alexandra Hospital, said: “That case was the one and only complication we had from sleeve gastrectomy in 21/2years.”
He pointed out the death rate is no greater than that of a gall bladder operation.
Dr Shanker cited a study published this year which showed that the post-operative mortality rate was 0.19 per cent or five deaths in 2,570 patients.
There were 53 leaks, 28 bleeding episodes requiring re-operation or transfusion and 15 post-operative strictures (abnormal narrowing of tubes or ducts in the body).
But he added: “In the centre where I trained in France, we had almost 100 sleeve gastrectomies with no cases of mortality or leaks.”
Since the Bariatric Surgery Clinic at the Life Centre in SGH opened in February, DrShanker has performed 42 major bariatric surgeries, almost all Roux-en-Y gastric bypass procedures.
SGH has so far done three LSGs. Changi General Hospital (CGH) has seen an increase in the number of people going for bariatric surgery, particularly sleeve gastrectomy.
Dr Andrew Wong, CGH director of upper gastro-intestinal surgery, said that while laparoscopic adjustable gastric banding was popular previously, more people are opting for LSG since doctors started offering it two years ago.
“When performed by trained bariatric surgeons, the bariatric procedures are actually quite safe, and are no more dangerous than other operations for gastro-intestinal cancers,” he said.
But he warned that there are risks, like bleeding and infection.
He said: “It is important for the obese patient considering surgery to understand that bariatric surgery by itself will not result in significant weight-loss.
“It is meant to be an adjunct to the mainstays of weight-loss which are diet restriction and regular exercise. Self-discipline and motivation are important to achieve results.”
Dr Peter Goh, chief surgeon and medical director of Aesthetic Surgical Group, a private practice that also offers bariatric surgery, said: “I think people are afraid of the procedure because there is a chance of dying.
“But because (LSG) is a keyhole procedure, the trauma is much less, and the complication rate is actually very low, less than 1 per cent.
“However, if you are 50kg overweight, you’ll have almost 100 per cent complications from your weight.”
He pointed out that even moderate weight loss is enough to eradicate or improve such complications of obesity as type 2 diabetes and hypertension.
For Miss Kunasekaran, that was the case. “I don’t have to take medication anymore,” she said.
SGH is organising a Public Forum entitled Obesity & Cholesterol Problems: Weighing Your Options at 1pm today at the DBS Auditorium Level 3, DBS Tower 1, 6 Shenton Way. The admission fee is $5.
Laparoscopic adjustable gastric banding: Called AGB for short, It works mainly by lowering food intake. A small bracelet-like band is placed around the top of the stomach to produce a small pouch. A circular balloon controls the size of the outlet. It can be inflated or deflated with saline solution.
Sleeve gastrectomy: The stomach is “tubularised” to resemble the rest of the gastro-intestinal tract. Stomach volume is reduced by 80 per cent or more.
It’s a one-off operation that doesn’t need continual adjustment by a physician, unlike AGB. It also cuts the production of appetite hormone ghrelin, thus reducing hunger pangs more than after AGB.
But patients who don’t change their way of eating within one to two years can experience gastric pouch enlargement and regain weight.
Roux-en-Y gastric bypass: It works by both restricting food intake and lowering food absorption.
Food intake is limited by a small pouch. Food absorption is reduced by routing food directly from the pouch to the small intestine, bypassing most of the stomach, duodenum and upper intestine.
Source: Dr Shanker Pasupathy of SGH and the Weight-control Information Network (WIN) website of the US National Institute of Health.
Click for jpg format
« Back to previous
back to top