Advances in Bariatric Surgery

Dr. Matthew Gust speaking with a patient

Today’s bariatric surgery is a lot different than it was even a decade ago: more effective and patient-friendly thanks to advancements in techniques and technology, making the minimally invasive procedure a safer option for more people than ever.

Recognizing those gains, insurance companies are increasingly likely to cover its costs to help people improve their overall health and, as a result, cut down or even get off expensive medications.

“The biggest thing I can tell a patient is they have done study after study on bariatric surgery -- we are one of the most-studied fields in medicine -- and every study has come back with the same result: bariatric surgery increases lifespan, decreases the chance of having a cardiac event, of having a stroke, of having cancer,” said Dr. Matthew Gust, who leads PeaceHealth Sacred Heart Medical Center’s bariatric surgery department. “The surgery is giving you the chance to live longer and change your life significantly.”

The procedure itself has moved away from “the band” -- a device that constricts the stomach. Now, sleeve gastrectomy is used in about 70 percent of procedures, followed by gastric bypass (25 percent). Both procedures surgically reduce the size of one’s stomach and alter hormone levels that regulate appetite. The result is patients losing as much as two to four times the weight they’d typically lose via weight-loss drugs and boast longer-lasting results.
 
“People feel like they don’t need to eat as much and feel full sooner rather than the discomfort previously associated with the band,” Gust said. “It leads to better weight loss, and they don’t have a piece of hard plastic in them for rest of their life.”
 

Gust’s colleagues can prescribe weight-loss medications for patients who aren’t candidates for surgery. Those drugs typically require monthly or weekly injections with mixed outcomes and often have limited insurance coverage.

“A lot of insurance plans don’t cover those medicines or will for a couple years and then say you need to find a better plan,” Gust said.

Another advantage of surgery is the opportunity to get off medications for high-blood pressure and diabetes, for example, as the effects from the surgery begin to take hold.

Gust also noted how advancements in technology, such as robotic-assisted surgery, make the procedure accessible to patients who have other ailments that would have previously precluded them from the procedure, including cancer or liver conditions, patients suffering from kidney failure, who are on dialysis or blood thinners, or with high Body Mass Indices.

“If I think there is a benefit from you having surgery, I will make the surgery work,” Gust said. “The most important thing to me is that you have a good result, and for me that means safety.”

PeaceHealth is designated as a comprehensive bariatric facility by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, requiring evaluation every three years.

Gust also emphasized that he and his colleagues are nonjudgemental about anyone who comes to their office.

“The point of coming to see us is to say, Let’s help you get to a place you want to get,” Gust said. “The number on scale is not important. What’s important to me is patients who come and say, Dr. Gust, I’ve never really walked, but I went on a two-mile hike with my kids the other day or was able to play with my grandkids.

“We try to focus on the smaller victories.”