Part II - Pre-Op Interview Text

Dr. Marshall Smith: "Here we are back in the pre-operative room for Roberta's surgery. Dr. Weiner has stopped by to do his pre-op visit prior to the surgery, and we'll be heading down in a few minutes. We're fortunate because we've cornered Dr. Weiner to ask him just a couple of questions. Most of you are probably wondering why Roberta came to Germany. Well, first of all it is because the surgery has not yet been approved by the FDA in the United States. Also, Germany is probably one of the best places in the world where this surgery is being performed, and Dr. Weiner is a pioneer in this surgery. What I'd like to do is have him just make a few comments on why he does it laparoscopically and discuss some of the benefits of the procedure as he does it to give you some idea of what Roberta is looking at."

Dr. Weiner: "We are here at the Nordwest Hospital in Frankfurt, Germany. This is a hospital that has had experience for a long time in laparoscopic surgery and also in laparoscopic bariatric surgery. We started with this procedure of adjustable gastric banding in 1995, and we have done several hundred procedures here, and in every case, laparoscopically. We have had no conversions in this technique - the conversion rate was zero."

Roberta Speyer: "What is a conversion rate, for those who are listening to this and might not know what that means?"

Dr. Weiner: "If you start a procedure laparoscopically and you have some problems - technical problems or surgical complications - then you have to convert to open surgery and perform a laparotomy to open the abdomen. With the necessary experience in this laparoscopic technique, we can avoid this laparotomy, and so we have a conversion rate of zero percent. This is because this clinic has long-term experience with laparoscopic surgery. More than 50% of all procedures performed here are laparoscopic procedures - a lot of fundal plications, hernia repairs, lap cholecystectomies (gallbladder removals), and laparoscopic colo-rectal surgery."

Roberta Speyer: "Why is it important to me, as a patient, to have this done laparoscopically?"

Dr. Weiner:  

"The benefits for all patients with laparoscopic surgery are that they have less pain, they have earlier mobilization, and they have few problems with serious or possible complications, especially in obese people who have a higher risk with surgery anyway. If you have a laparotomy, you have to lay down longer, and you have later mobilization and also higher rates of complication, both pulmonary and cardiovascular. Therefore, laparoscopic surgery is very important for obese people. It has a lot of benefits, it's a safe technique with the necessary experience of the surgeon, and you will be able to get up after the procedure this evening and go back to the United States in a couple of days. This is very important, because if you have open surgery, then you have to stay here longer."

Roberta Speyer: "What is the incidence in this? In your particular case, I know there have been no mortalities, and very, very little morbidity, correct?"

Dr. Weiner: "With mortality, less than 0% is not possible in surgery, but it's 0.1% or 0.2%. It is, indeed, caused by general complications, or by complications during surgery."

Roberta Speyer: "Such as?"

Dr. Weiner: Dr. Wiener: "In our clinics, we have never seen these complications, but it is possible to have them."

Roberta Speyer: "What type of complications would cause a problem, and what do you do to avoid those? What should people look for when they're looking for a surgeon?"

Dr. Weiner: "The most common complication is gastric perforation, but this is more common during the learning curve of the surgeon. You can avoid this if the surgeon is experienced in laparoscopic surgery, and especially in this gastric banding procedure. Therefore, it's very important that a surgeon who wants to do laparoscopic surgery does not start with this technique - he or she needs training."

Roberta Speyer: "If I were to recommend to the women on OBGYN.net who might be interested in having this surgery, of course I would recommend they all come to you. But for those who are back in the United States, hopefully this will soon be available there. How many surgeries should the surgeon they choose have done, and how many of these procedures in particular? When a woman or a man goes in to see the doctor - of course, we have mostly women reading this on OBGYN.net - what questions should they ask? What's important for them to know to ensure they are getting someone who's experienced?"

Dr. Weiner: "I believe the learning curve is close to being finished after fifty procedures, and in the United States, laparoscopic operating procedures will start in the year 2000. I believe several surgeons started with this technique, which they've studied, but most of the surgeons will have intermediate training. There are two ways to train - either European surgeons are going to the United States to teach it, or the doctors will come to Europe and train here."

Roberta Speyer: "So fifty would be a good amount?"

Dr. Weiner: "Fifty is a good amount."

Roberta Speyer: "Are there any other things that people should be aware of when they're looking for a surgeon? Any other questions to ask, or any other things? Or is experience is the main thing they should be looking for?"

Dr. Weiner: "Two things. The surgeon must be skilled and have experience in laparoscopic surgery and also perform other laparoscopic techniques, and he or she needs experience in the follow-up of bariatric patients. They also need experience in bariatric surgery."

Roberta Speyer: "What type of follow-up is important and will make this surgery more successful for me and for other patients seeking it? What makes someone a good candidate, and what other types of things do they need to do afterward to ensure success?"

Dr. Weiner: "This procedure will be performed in a clinic, and there are several types of physicians that you need as a team. There must be a surgeon - this is very important. Also, a surgeon should be present around the clock for urgent cases, and you also need a dietician, which must be part of the team in order to give a good follow-up of the patient."

Roberta Speyer: "And the patients themselves? Should they be exercising and increasing physical activity after the procedure? Is that something you encourage?"

Dr. Weiner: "This is important to have weight loss, yes. Obesity is a problem of balance, or balancing the input and output of energy, and if you can increase your output of energy, you are mobilized. This is a very good exercise for this."

Roberta Speyer: "That was also important to me, due to the fact that I come to Germany and Europe about five or six times a year for business. So for me to come and see you for the follow-up will be possible. I don't want people to think that I'm coming and having the surgery and then I'm not going to be doing any follow-up. The follow-up is very important, and we've made some arrangements in the States, but I also intend to come back. I'll be back in January to see Dr. Weiner. I really appreciate you taking the time to tell the people at OBGYN.net about this. I'm ready. What do you think? Do you think this is going to work out for me?"

Dr. Weiner: "Yes."

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At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: http://www.inamed.com/contact/bio_patient.cgi.  Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails.

See Professor Rudolf Weiner's website about Weight Loss Surgery to see if this option is right for you. Visit www.profweiner.com.