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- Hello, I'm Doctor Steven Kaster.
I'm the chief medical officer at Menorah Medical Center.
Today, we're launching
our virtual house calls seminar series.
The goal of the series is to introduce our community
to many of the world-class physicians that we have
at Menorah Medical Center.
Our guest today is Dr. Roger de la Torre.
He's a renowned surgeon with bariatric
and metabolic specialist, located in the Overland Park
and Leawood areas.
Dr. De la Torre specializes in helping people regain
their livelihood and their life through weight loss surgery.
He holds more than 60 patents, many of which have helped
his bariatric patients.
We're here to specifically discuss the relationship
between obesity and reflux disease and additionally,
we'll also take questions from the viewers,
regarding surgical weight loss.
So Dr. de la Torre, why is reflux such a problem
for the obese population?
- Well, simply it's a problem of pressure.
Women who've been pregnant know that during their pregnancy,
especially in the latter stages, there's a tremendous amount
of intra-abdominal pressure that can give them GERD,
even if they didn't have
this gastroesophageal reflux previously.
My wife for example had that with our three pregnancies.
With the obese population,
you have increase in visceral fat.
There is fat infiltration to the liver and all of
that increases the pressure in the abdomen and causes things
to want to reflux up towards the esophagus.
- Many people here that reflux is associated
with a hiatal hernia.
Do those always go together in your experience?
- So commonly, the two are equated.
Reflux is often linked to hiatal hernia.
But in fact, you can have a hiatal hernia without reflux
and you can have reflux without a hiatal hernia.
- Do all surgeries that treat morbid obesity
also treat reflux disease?
- No, there are some surgeries in fact,
that although they may help because of the weight loss,
we just talked about the amount of fat and pressure
inside the abdomen.
With weight loss, that should get better.
But some surgeries such as the vertical sleeve gastrectomy,
which has become very popular.
Take a football shaped stomach and then reduce the size
and make a tubular size stomach and so,
the pressure increases.
It's kind of like putting your finger on a hose
and then, the spray comes out much faster
because of the back pressure.
- Can you define what morbid obesity is for the audience?
- So morbid obesity is a specific medical category
and what physicians often use is the term BMI
for body mass index.
As you can imagine, it's quite different to have a woman
who's 5' 1" and weighs 310 pounds and equate that person
to a man who's maybe 6' 5" and ways 310 pounds.
So with BMI, we take not only weight, but the height
and get a better calculation of someone's fat.
So anyone with a BMI greater than 40
is considered morbidly obese.
- For those viewers who have reflux and are overweight,
what would you suggest be their first step
in evaluation or treatment?
- The first step with GERD or reflux usually is medical.
You know and simple things like elevating the head
of the bed, not eating within the two hours
before you go to sleep.
But if reflux is a problem and you are morbidly obese,
then the best operation is one that can treat both.
And the gastric bypass has a 90% effectiveness
or greater when dealing with reflux disease and it's easy
to imagine in creating the small pouch,
stomach during the surgery.
We divide that small pouch from the acid producing,
larger portion of the stomach.
Acid can no longer reflux up into your esophagus
and give you the the problems of GERD.
At the same time, you will lose a lot of
that intra-abdominal fat as well as a tremendous amount
of fat all over.
- Dr. de la Torre, are there any long-term damage
to the body that can occur
when people have acid reflux disease?
- So yes, if you have chronic reflux disease where acid
is constantly regurgitating up into your esophagus,
number one, it can go up so high that
you actually aspirate that.
Some people wake up in the middle of the night coughing
from the acid that has gone up into their esophagus
and down into the trachea or the breathing pipe.
The other thing is that if it stays long enough,
that acid begins to produce changes in the lower esophagus
that can become precancerous, a condition known
as Barrett's esophagusitis and cancer of the esophagus,
which may result from that is a very bad cancer to have.
- All right, now we'll take some questions
from the audience.
If you have any questions, please feel free to submit those
and Dr. de la Torre would be happy
to answer those questions.
- [Man] What are the types of surgeries you offer
at your practice?
- Dr. de la Torre, while we're waiting for questions
to come in, what types of bariatric surgery do you
all provide in your practice?
- So our practice provides three major operations,
which we do commonly.
The gastric bypass is probably the one
that we still perform more so than the others, but gaining
in popularity are the vertical sleeve gastrectomy
and for certain patients, the duodenal switch is one
that used to be reserved for the super morbidly obese,
the people who used to be done, you know,
my 600 pound weight loss, those type of people,
used to be reserved only for them
and the duodenal switch was done more in Europe
before it became popular here.
So we did those three, but we also do things
such as endoscopic treatment for obesity,
where we can alter the stomach endoscopically
without the need for surgery and we also do a things
like the gastric balloon where a balloon can be placed
inside the stomach and give space and give you the sense
of fullness so that you eat less and during a time period,
usually six months, we can modify how you eat,
go through dietetic counseling and things like that.
- [Man] How quickly can a person
see weight loss after surgery?
- How quickly can a patient see weight loss after a surgery?
- So it depends on the surgery, but if you choose one
of the main three, it's not unusual to lose a pound a day,
immediately after surgery for the first month to six weeks.
- [Man] What are the steps I have to do to take
to get ready for a surgery?
- So can you define the steps that a patient
has to go through to qualify for surgery?
- Sure, of course, you need to see one of the surgeons
if you're interested in surgery and then,
a lot of people want to know how long
after I see the surgeon can I get
on the operating room table?
Well, a lot of that depends on whether or not
you have comorbidities.
Things such as diabetes, heart disease, things that
often are equated go hand-in-hand with obesity.
So that may take some time to get cleared, you know,
go see a cardiologist.
Have the cardiologist confirm that you're healthy enough
to undergo an operation and then, sadly,
insurance company still mandate some of the delay.
Many insurance companies will ask for three or six months
of a physician supervised weight loss before they
will consider surgery for the insured.
- [Man] I'm only about 50 pounds over weight.
Do I qualify for surgery?
- Next question is, the viewer
is only 50 pounds over weight.
Would he or she qualify for bariatric surgery?
- At 50 pounds it's unlikely.
Roughly someone whose BMI is 40
is usually around a hundred pounds
over their ideal body weight.
If you are less than hundred pounds
over your ideal body weight and you have diabetes,
high blood pressure, sleep apnea, joint disease
and things like that, then that can push you to an area
where you would be considered a candidate.
- [Man] I'm only in my early 20's, do I qualify?
- So one of the questions from a viewer was he or she
is in their early 20s.
Do you have any age requirements as far as who qualifies
for bariatric surgery?
- So yes, we still don't do a pediatrics here.
But if you are 18, up to we've done patients in their 70s,
then then you can still be a candidate for surgery,
being 20 does not prevent you from an operation
by any means.
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- All right, Well, thank you de la Torre for meeting
with us today.
We appreciate all your ideas
and comments regarding bariatric surgery.
For more information about the weight loss program
at Menorah Medical Center, please check out our website
at MenorahMedicalCenter.com/weightloss
or you can call our bariatric coordinator at 913-498-7367.
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