Dr. Feng has been asked to participate as a mentor due to his extensive experience in performing this procedure 100% minimally-invasive without the need for large, open incisions from 2001. The surgery can be performed for qualified patients of almost any Body Mass Index with optimal results. The procedure is unique in its versatility and effectiveness.

Dr. John Feng will be participating in the upcoming Laparoscopic Sleeve Gastrectomy course on December 12th 2008. This expert course will be held at Stanford University at the Stanford Cancer Center. The course is attended by experienced laparoscopic bariatric surgeons. Dr. Feng will be performing live surgery education via telesurgery from Sequoia Hospital in Redwood City, California.

The Sleeve Gastrectormy live surgery will be performed by Dr. Feng as part of the overall course agenda. Drs. David Schumacher, Dennis Smith, John Morton are the other course faculty members. Topics include the Evolution of Weight Loss Surgery, Pre-Operative and Post-Operative Considerations with focus on Surgical Techniques. This procedure is considered a standard bariatric procedure by both the American College of Surgeons as well as the American Society for Metabolica and Bariatric Surgery.

Dr. Feng and his practice Crystal Springs Surgical Associates provides a comprehensive, laparoscopic surgical treatment program for severely obese patients. There are 4 minimally invasive procedures offered, including the laparoscopic Lap-Band System placement, Realize Band, Roux-en-Y gastric bypass (or RNY), vertical sleeve gastrectomy and duodenal switch with extensive experience in all these options to provide a tailored treatment plan for individual patients depending on their condition. Crystal Springs Surgical Associates has offices in on the San Francisco Bay Area and Peninsula in San Mateo, San Francisco, Walnut Creek (East Bay), Lodi/Stockton, and Monterey area.

Download the course agenda

Obesity Help, known for its great support for the bariatric community of weight loss surgery patients, asked Dr. Feng to speak because of his expertise in bariatric surgery.

Dr. Feng will speak about the variety of surgical treatments for obesity with a focus on laparoscopic techniques. He will also speak to the key elements of successful and healthy weight loss after surgery.

WHEN: This is an all day event on December 6, 2008
Dr. Feng speaks: 9:55 AM - 10:40 AM
For more information about this event: Click here

More information from: Crystal Springs Surgical Associates

Bariatric or weight loss surgery has been shown to be the gold standard in the treatment of morbid obesity with effective and long-term weight loss as the desired outcome. A recent article in the August 2008 Annals of Surgery, researchers analyzed the data across the United States of over 19,000 patients who underwent gastric bypass surgery in order to determine whether laparoscopic surgery (surgery using incisions less than 1/2 inch) was better than traditional open surgery where the incision was much longer of at lease 6 inches in the upper abdomen.

Previous reports in the surgical literature clearly found that laparoscopic Roux-en-Y gastric bypass when compared to its open, large incision counterpart was associated with shorter recovery time, smaller wounds, and less pain after surgery. Pain is a significant issue since the larger incision in the upper abdomen would force patients to take smaller breaths to minize pain. Taking smaller breaths often can result in fevers and pneumonias after surgey, and thus more complications.

In this current study and analysis, researchers found that over 75% of patients underwent laparoscopic surgery. More importantly, open surgery patients were more likely to require additional surgery, with more complications with the heart and lungs, as well as leaks at connections and septicemia. They also discovered that there were more procedural or technical issues in the open surgery patients. As you would expect, those patients who underwent laparoscopic gastric bypass had a shorter length of stay in the hospital. There were higher costs associated with laparoscopic surgery, most likely related the the very specialized equipment used in the operating room to perform the procedures correctly and efficiently. The hospital costs for care of the patient were less when compared to open surgery patients in past studies.

This is a landmark study in the analysis of outcomes of a large number of patients over the course of a year (2005) in the United States. It confirms past studies that there was significant clinical benefit to the patient who undergoes laparoscopic gastric bypass surgery compared to patients who undergo open, larger incision surgery.

Dr. John Feng, MD, FACS at Crystal Springs Surgical Associates specializes in laparoscopic bariatric surgery. Since his specialty fellowship training, he has not had to perform open surgery using techniques he’s created to achieve this for his patients. There are 4 different procedures used for weight loss and all can be performed laparoscopically. These include the Roux-en-Y gastric bypass, the vertical sleeve gastrectomy or vertical gastroplasty with gastrectomy, the biliopancreatic diversion with duodenal switch (duodenal switch or DS) and placement of an adjustable silicone stomach (gastric) band such as the Lap-Band System or REALIZE Band.

For more information, please go to his website at www.GastricBypassSanFrancisco.com.

In a recent study published in September 2008 in the Archives of Surgery, researchers at the University of California San Francisco Department of Surgery published the results of a prospective study that attempted to determine what factors contributed to inadequate or poor weight loss after gastric bypass surgery over a 3 year period.

Although the study did not analyze factors such as exercise level, body composition and fat distribution, they did find that 2 factors did contribute to poor weight loss: the presence of diabetes before surgery and larger stomach pouch size created by the surgeon at the time of the gastric bypass.

Thus, the researchers concluded that changes to the use of diabetes medications may be necessary to help achieve better weight loss. And, of course, careful attention to creating a small stomach pouch at the time of the gastric bypass is critical to maximizing the success of the operation for the obese patient.

At Crystal Springs Surgical Associates, Dr. John Feng, MD, FACS utilizes 4 distinct types of weight loss procedures to tailor to the needs of each patient. These bariatric procedures are all performed laparoscopically (with 1/2 inch incisions) and include the Roux-en-Y gastric bypass, the duodenal switch (DS), the vertical sleeve gastrectomy (vertical gastroplasty), and both the Lap-Band or REALIZE Band systems. Specifically, in the Roux-en-Y gastric bypass, Dr. Feng purposefully creates a stomach pouch that’s no bigger than a “Chapstick.” The pouch essentially is 1/2 inch wide and only 2 - 2 1/2 inches long, or about the size of a finger. He handsews the stomach to the intestine, instead of stapling those 2 parts, specifically to create a small pouch. Even prior to this study, Dr. Feng believed that it’s a small, vertically oriented pouch with a small opening (without the use of foreign objects) that would achieve the greatest success, allowing it to stay smaller for a longer period of time. These principles are carried over to both the gastric band procedures and especially the vertical sleeve gastrectomy where stomach size is important. For longevity of keeping stomach pouch size smaller for a longer period of time, Dr. Feng feels strongly enough about these issues that he used special techniques to achieve these goals.

For more information about weight loss surgery and the various options, optimized for patient outcome, please go to their website at www.GastricBypassSanFrancisco.com.

Metabolic Syndrome is comprised of the following features:

1) High fasting blood sugar levels, or hyperglycemia

2) High blood pressure, or hypertension

3) Obesity

4) Low HDL cholesterol (the “good” cholesterol)

5) High triglyceride levels (one of the “bad” cholesterols)

It has been long known that weight loss surgery, or bariatric surgery, has helped a majority of morbidly obese patients eliminate diabetes, high cholesterol, sleep apnea and high blood pressure after losing much of their excess body weight. A recent study published by a group of scientists in the August 2008 Mayo Clinic Proceedings found that the Roux-en-Y gastric bypass can cure a patient of metabolic syndrome. The researchers studied patients from 1999 to 2003 and compared the patients who underwent surgery to those who didn’t. Everyone had extensive followup with education and instruction about good, healthy dietary and exercise habits. Patients were followed on average for almost 3 and 1/2 years.

They found that of the 180 patients who underwent the Roux-en-Y gastric bypass, the percentage of those who had metabolic syndrome significantly dropped from 79% to only 29%. However, in the control or non-surgery group of 157 patients, the value decreased from 85% to still 75%. Surgery patients lost about 97 pounds while those who didn’t have surgery only lost 1/5 of a pound over that time - a very dramatic difference.

The authors of the study recommend that “Roux-en-Y gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures” in those eligible for bariatric surgery.

Crystal Springs Surgical Associates specializes in the expert and comprehensive care in the treatment of morbid obesity with advanced laparoscopic surgery, including laparoscopic placement of an adjustable gastric band system, such as the Lap-Band System or Realize Band, laparoscopic Roux-en-Y gastric bypass, laparoscopic restrictive vertical gastroplasty (vertical or sleeve gastrectomy) and the laparoscopic duodenal switch (biliopancreatic diversion with duodenal switch, BPD-DS, or DS). Results are optimized using the latest techniques with significant emphasis on followup care and support.

Factors that didn’t seem to make a difference included pre-operative BMI (body mass index), age, number of years taking insulin, number of medications, hemoglobin A1C levels (a marker of diabetes control).

These conclusions are important to the underlying idea that it is the weight loss, not necessarily the type of surgery performed, that plays an important role in helping patients who undergo weight loss (bariatric) surgery improve their overall health, both mentally and physically. Of course, close monitoring is important, probably best performed by the surgeon who operates on the patient. Clearly, both nutritional and exercise regimens that enhance the weight loss after bariatric surgery in a safe manner are important to overall success.

These findings help confirm the observation that after gastric bypass, vertical sleeve gastrectomy and duodenal switch surgery, and many gastric banding patients, that diabetes can improve even in the first couple of days after surgery. The researchers suggest that gut hormones are affected and thus fixing insulin resistance seen in morbidly obese patients. The amount and speed of weight loss appear important, further complementing data just published 2 months ago that diabetic, obese patients who merely underwent Lap-Band System surgery (76%) were successfully cured of diabetes over a 2 year period.

For more information about gastric bypass, visit www.GastricBypassSanFrancisco.com.

Recent information presented just last month at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons revealed that laparoscopic surgery was linked to a 50% reduction in hospital-acquired infections and a 65% reduction in return admission to the hospital, as compared to open surgery. The study focused on gallbladder, appendix, and uterus surgery.

Results such as these further support the fact that laparoscopic surgery, especially for patients at high risk of infection such as obese patients, will be better for patients than open, or large incision, surgery.

Current laparoscopic, or minimally invasive, techniques that are offered to patients at Crystal Springs Surgical Associates by board-certified surgeon Dr. John J. Feng, FACS, include adjustable gastric band surgery (Lap-Band(R) or REALIZE), restrictive vertical/sleeve gastrectomy/gastroplasty, Roux-en-Y gastric bypass, and duodenal switch. With each procedure, Dr. Feng uses specialized strategies and equipment to optimize healing and recovery.

As discussed in a new article this month in Lancet by Dr. Andrew Renehan, men who gain about 33 pounds and women who gain about 29 pounds over a Body Mass Index (BMI) of 23 kg/m2 are at higher risk for cancers of the esophagus. In women, cancers of the inner lining of the uterus (endometrial), gallbladder and kidneys are at higher risk of occurring with obesity. The risks of thyroid, colon and kidney cancers are higher in obese men.

Other cancers that are also at higher risk of occurring in individuals who are obese but to a smaller degree, include rectal and malignant melanoma in men; postmenopausal breast cancer, pancreatic, thyroid, and colon cancers in women; and leukaemia, multiple myeloma, and non-Hodgkin lymphoma in both men and women.

The conclusions of this paper comes from analyzing over 140 articles, including 282,137 cases of cancer by the British researcher and his colleagues.

In the April 23, 2004 issue of the New England Journal of Medicine, the topic of cancer and obesity was well studied and discussed. Researchers at the American Cancer Society in Atlanta, Georgia studied 900,000 adults who were free of cancer starting in 1982. Sixteen (16)years later, over 57,000 of these people had died from cancer.

People who were morbidly obese (BMI greater than 40 kg/m2 or about 100 pounds overweight) had death rates 52% higher in men and 62% higher in women, compared with normal weight people.

Higher risks of esophagus, colon and rectum, liver, gallbladder, pancreas and kidney, non-Hodgin’s lymphoma and multiple myeloma. In addition, men had a higher trend risk of cancer of the stomach and prostate. In women, it was breast, uterus, cervix and ovaries. Obesity women are 4 times as likely to get kidney cancer and 6 times as likely to get uterine cancer than normal weight women. The researchers estimate that overweight and obesity situation in the United States is probably responsible for 14% of all deaths from cancer in men and 20% of deaths from cancer in women.

In the Lancet article, they discussed also how researchers are not sure why obesity and cancer are so strongly linked. Hormonal, stress and other factors are probably involved. For esophagus cancers, acid reflux in an obese patient may be responsible.

Of course, there have not been large studies about whether or not weight loss surgery or weight loss would reduce the risk of cancer. This would probably turn out to be true since losing weight and keeping it off clearly has been shown to have many health benefits. However, if a person is 100 pounds overweight, it becomes extremely difficult to lose that much weight and keep it off in the long run, unless weight loss surgery is performed. The adjustable gastric band systems (LAP-BAND and REALIZE Band), vertical/sleeve gastroplasty/gastrectomy, Roux-en-Y gastric bypass and Duodenal Switch are the mainstream acceptable methods currently available with only a handful of surgeons trained to offer all 4 procedures, tailored to patients medical needs. There are even a fewer number of surgeons worldwide who offer these procedures laparoscopically with incisions larger than 1 inch, usually 5 or less scars less than 3/4 of an inch with comprehensive understanding of how each of the procedure works. Dr. John Feng at Crystal Springs Surgical Associates is one such expert. In his fellowship specialty training under Drs. Michel Gagner, Alfons Pomp, Daniel Herron and Barry Inabnet in New York, he became a specialist in Advanced Laparoscopic and Minimally Invasive Bariatric Surgery and was the first surgeon to bring the Laparoscopic Vertical/Sleeve Gastrectomy to California and the West Coast.

In a recent study earlier this month in the Annals of Family Medicine, researchers examined several past studies that involved just pedometer-based walking programs without dietary intervention. They concluded that pedometer-based walking programs resulted in modest weight loss and that the longer the program, the more the weight loss. Imagine with the dietary control that weight loss patients achieve, such programs would probably show even better results.

Another study from Stanford University was published in the Journal of the American Medical Association late last year in November 2007 by Dr. Dena Bravata, a colleague of mine. Dr. Bravata and her colleagues found that just using a pedometer increases activity significantly, by over 2000 steps in her study. The daily recommended walking goal is 10,000 steps or at least increase steps each day to this goal. Using the pedometer, by increasing activity, help both weight loss and blood pressure.

Using a pedometer to measure walking is very smart since it gives a person the ability to objectively monitor their own progress. Monitoring and even recording this progress helps the individual to plan on improvement that can also be measured.

After weight loss surgery, use your pedometer. You’ll be suprised how much (or how little) you walk. So you can decide to walk that much more the next day. Eventually, it will be come natural, especially as your own cardiovascular health and your weight loss goals improve.

Sixty obese patients with type 2 diabetes were entered into the study which lasted for 2 years. In the conventional group, standard treatment with dieting, exercise, medical and lifestyle changes methods were used. In the weight loss surgery, or bariatric surgery treatment group, patients underwent uncomplicated placement of an adjustable gastric band system. The research group involved in this study historically uses the Lap-BAND System from Allergan which has been FDA approved in the United States for surgical treatment of obesity since June 2001.

Patients were followed on a regular basis and compared at the end of the study. The average BMI in both groups were approximately 37 kg/m2 at the beginning of the study with an average age of 47 years. At the end of the study there were 26 conventionally treated patients and 29 surgery patients.

Overall, 76% of all the surgery patients who had undergone adjustable gastric band surgery were cured of diabetes. This result was much lower than the non-surgery patients where only 15% of the patients experienced diabetes remission. Surgery patients lost over 62% of their excess body weight compared to only about 4% weight loss in the conventionally-treated patients. Curing diabetes was directly related to the success in losing a significant amount of weight. With gastric band surgery, BMI decreased from 36.9 kg/m2 to 29.5 kg/m2. Without surgery and the best available nutritional, exercise and appropriate medical treatment, the average BMI only went from 37.1 kg/m2 to 36.6 kg/m2.

As stated in the conclusions, it is important to realize that this study is the first one to document how diabetes can be cured effectively with adjustable gastric band surgery with minimal complications in patients with a BMI of 30-35 kg/m2, as well as in BMI 35-40 kg/m2. Bariatric surgery currently is the best way to successfully achieve significant and long-lasting weight loss in severely obese patients. Currently, NIH criteria state that patients with a BMI of 40 kg/m2 without obesity-related illnesses are appropriate candidates for surgery, along with other criteria, such as failed prior attempts at supervised weight loss and psychological clearance. In addition, if a patient has a BMI from 35-40 kg/m2, that patients must have obesity-related conditions that would qualify him or her for bariatric, or weight loss, surgery. This study emphasizes that perhaps lowering the BMI criteria would also help patients that have diabetes, but only if the risks of surgery have been decreased. In the United States, the Allergan Lap-BAND System procesure and the more recently FDA-approved, REALIZE Band System from Ethicon are probably the types of procedures that should be used in these instances. Undergoing surgery of any type must involve weight the risk to benefit ratio. Future, larger studies will probably better answer these questions.

Today, there are 4 commonly accepted types of bariatric surgery procedures used to treat obesity. These include the Roux-en-Y gastric bypass, the Duodenal Switch, the Vertical/Sleeve Gastroplasty/Gastrectomy, and the adjustable gastric band procedures such as Lap-BAND or Realize Band. Surgeons, such as Dr. John Feng, MD, FACS, at Crystal Springs Surgical Associates, are probably best at discussing the appropriate options for each patient in an individualized manner since Dr. Feng performs all 4 procedures in his practice laparoscopically. It is important in choosing not the right surgery but also the right surgeon who can provide optimal care for the patient.