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Weight-Loss Surgery, No Cutting Required
“Most people don’t want the risk,” he said, adding that only about 2 percent of those who might be helped by bariatric surgery actually have it.
About 15 million Americans are morbidly obese, meaning their body mass index — a type of weight/height ratio — is at least 40 (overweight begins at 25). Medical guidelines recommend surgery when the index reaches 40, or 35 if there are also complications like diabetes or heart disease.
Dr. Marc Bessler, right, and Dr. Daniel Davis performed a new kind of weight-loss surgery that passes a stapler down the throat to staple the stomach. Credit Josh Haner/The New York Times
Ms. Perez is 5-foot-9 and weighs 289 pounds, for a body mass index of 42 — though her height and generous frame help hide the weight. Her family, friends and boyfriend say she looks just fine.
But she has mixed feelings about her appearance. She weighed 175 or 180 pounds in high school and was comfortable with that weight. But she gained 90 pounds in college and could not take it off. She hopes the operation will help her lose 60 pounds, maybe even in time for her graduation this coming spring from Stony Brook University.
“I don’t feel like it’s a big issue, but of course it is,” she said. “If I go out with my sorority sisters or friends to buy clothes, I probably can’t buy where they do. I’m the one who comes out with accessories. That’s a bummer.”
More important, she said, is her health. She becomes winded too easily, and her blood pressure “is not great,” she said, adding, “I just want to live healthy and not be borderline anything.”
Bariatric operations typically work far better than diet. exercise or drugs, and they often cure diabetes and reduce the risk of dying from heart disease or cancer. But there is also a risk — albeit small, less than 1 percent at experienced centers — of dying from the surgery itself.
The idea behind Toga is to offer something safer and less invasive. Dr. Bessler said he thought it would appeal to many people who feared the other operations.
“It has a lot of promise,” he said. “I deal with a lot of new technologies. This, I’m really excited about.” Dr. Bessler said that he and Dr. Davis had no financial interest in Satiety but that the company did pay for their work on the study.
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Other companies are also developing new devices and minimally invasive operations to cash in on America’s booming obesity epidemic, but Satiety is among the first to start testing its products in people.
A surgeon not involved in the Toga study, Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic, called the new operation very promising and said that so far it seemed to offer “a drastic reduction in side effects and risk.”
Though she wanted surgery, Ms. Perez did not want a gastric bypass, the most common bariatric operation, which shrinks the stomach and rearranges the small intestine. Her aunt had it and lost 150 pounds, but suffered from a hernia, intestinal problems and other serious complications.
So Ms. Perez considered gastric banding, a less extreme and increasingly popular operation that inserts a loop around the top of the stomach and tightens it to form a small pouch.
But Toga, which she discovered on the Internet, seemed less invasive. Also, the price was right: the operation would be free as part of the study. She did not mind if it produced less weight loss than the other methods.
FROM INSIDE Dr. Marc Bessler, above right, and Dr. Daniel Davis of New York-Presbyterian Hospital/Columbia performed a new kind of weight-loss surgery on Karleen Perez that passes a stapler down the throat to staple the stomach. Credit Josh Haner/The New York Times
“To me, it’s not about being completely skinny,” she said. “I’m told I could lose 40 percent of my excess weight.”
If she exercises and diets after the operation, she said, “I’ll probably lose, like, 60 pounds, and that’s realistic to me.”
Temporarily, she kept her plans a secret from most of her friends and impishly told some that she was having her tonsils out. She took down her Facebook page and put a note in MySpace saying that there would be some changes made.
The operation is not as simple as it might sound. To begin, Ms. Perez was given general anesthesia and put on a respirator. Then the surgeons pushed a dilator, a formidable-looking tube about three-quarters of an inch wide, down her throat to stretch her esophagus.
Next came another wide tube, this one about two feet long, containing the stapler. The surgeons inflated her stomach with carbon dioxide to create space in which to work. Dr. Bessler struggled for 5 or 10 minutes to position the stapler properly, and then activated controls that opened it, like a miniature spaceship, inside Ms. Perez’s stomach.
A sail and curving wire emerged from the stapler to help push aside the folds of her stomach. Then Dr. Bessler turned on a vacuum pump to draw parts of the front and back walls of the stomach into the device to be stapled together.
Three rows of staples were needed, but the stapler holds only one row, so the whole apparatus had to be withdrawn, rinsed, reloaded, pushed back down Ms. Perez’s throat and painstakingly repositioned for each row. The Satiety consultants stood close by to coach, at one point warning Dr. Bessler that if he inflated Ms. Perez’s stomach too much, her first row of staples could pop. The surgery took three hours.
“Every operation has its learning curve,” Dr. Bessler said. “We saw a doctor in Brussels who took an hour and a half, but he had done 70.”
The next morning at the hospital, Ms. Perez was in good spirits despite a horrendous sore throat from the operation. She said she had awakened during the night wondering what she had done, and had thought, “This is going to be super life-changing.”
She would be on a liquid diet for several weeks. A nutritionist had given her a pamphlet that commanded, “Don’t Stretch Your Stomach!,” warned that eating too much or too fast could cause vomiting. and advised that the best time to lose weight would be in the next 6 to 12 months, because the body would try to fight the surgery by absorbing more nutrients.
She thought she could do it. She would start slowly, by taking longer and longer walks. She hoped to join a gym, start running, eventually finish a marathon. She wanted to look cool for her graduation.
“My friends are going to be shocked,” she said. “Through struggle comes success.”
A version of this article appears in print on. on Page D1 of the New York edition with the headline: Weight-Loss Surgery, No Cutting Required. Order Reprints | Today’s Paper | Subscribe