University Health System Blog

Dr. Shawn Tsuda answers the question: “I have acid reflux. How do I know if I’m a good candidate for surgery?”

Gastroesophageal reflux disease, also known as GERD, is a common problem and can affect people’s lives from occasional mild discomfort to severe, disruptive pain. The potential complications include erosive esophagitis, increased risk for esophageal cancer, strictures impairing swallowing and the cost of medications used over years.

The majority of patients can control their symptoms with lifestyle changes, such as avoiding foods that cause reflux, not eating too close to going to bed, sleeping with one’s head up, as well as, medications, primarily H2 blockers and proton pump inhibitors.

However, some patients may have already developed complications from GERD or are refractory to even the most aggressive medication regimens. In other cases, a hernia of the stomach through the diaphragm, called a hiatal hernia, may be a contributing factor. For these patients, surgery may be the best option.

After appropriate studies that involve examining the acidic levels of the stomach and the function of the esophagus, a laparoscopic procedure called a Nissen fundoplication can be performed.  This involves wrapping the top of the stomach around the esophagus, preventing acid reflux.

This procedure can be successful up to 90 percent of cases.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery and consults patients at the school’s Patient Care Center in Las Vegas.

Have a health question? University Health System doctors answer select questions from readers like you.

Robin Morello, bariatric surgery nurse coordinator at the University of Nevada School of Medicine’s weight loss surgery center in Las Vegas, was featured in the Las Vegas Review-Journal yesterday. It chronicles Morello’s first-hand experience with battling obesity and how weight loss surgery changed her life, helping her shed more than 100 pounds. Today, Morello has dedicated her nursing career to helping patients overcome obesity. The weight loss surgery center at the medical school is a collaboration between the University of Nevada School of Medicine and University Medical Center. The center is led by bariatric surgeon, Shawn Tsuda, M.D.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: Is pregnancy safe after weight loss surgery such as gastric bypass or lap band?

Many women who suffer from severe obesity also suffer from hormonal problems that make it difficult for them to conceive children. Even for women who are not trying to conceive, menstrual irregularities related to obesity can be a significant burden.

After a patient undergoes surgery such as gastric bypass, sleeve gastrectomy or laparoscopic adjustable gastric band to lose weight, a period of hormonal and menstrual irregularity can continue. However, it is also commonplace for women to regain their ability to conceive after weight loss. Rapid weight loss, however, can come with relative nutritional deficiencies. Therefore, it is imperative that patients take vitamin and mineral supplements guided by their physician.

Most patients after weight loss surgery reach their goal between 18 and 24 months. At the University Weight Loss Surgery Program, it’s our practice to encourage nutritional supplementation and appropriate birth control until at least 18 months after bariatric surgery. Only after the patient is deemed nutritionally robust by their doctor should they consider bearing a child.

However, if these criteria are met, the ability to conceive can be a positive life-changing event in patients who were otherwise limited by their severe obesity to have children.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What are some general guidelines that make me a good candidate for weight-loss surgery?”

Obesity remains one of the most significant health epidemics in the U.S.

There are more than 60 health problems that have been linked to obesity, including diabetes mellitus type II, hypertension, arthritis, and obstructive sleep apnea.

The current recommendations for weight-loss surgery is based on the body mass index (BMI), which is a person’s weight in kilograms divided by their height in meters squared.

If your BMI is greater than 40 kg/m2, or 35 kg/m2 with significant obesity-related health problems, you are a candidate for weight loss surgery. Your BMI can easily be calculated from a number of free online calculators. (Here’s the Centers for Disease Control BMI calculator.)

The most common operations considered are the Roux-en-Y gastric bypass, adjustable gastric band or sleeve gastrectomy. For the most part, these procedures are performed laparoscopically. The operation is not a quick fix, but rather a tool to help with weight loss.

For patients who are severly obese, traditional diets and exercise can often be frustrating and unsuccessful. Weight-loss surgery may be the best option for prevention of medical problems and risk of early death, and consultation with a weight loss surgeon for more information is the next best step.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What happens if I regain the weight I lose after gastric bypass surgery? Can the surgery be redone?”

Weight re-gain following bariatric surgery remains a concern for many patients who have had, or are considering, surgery for weight loss.

While weight-loss procedures – whether the gastric bypass, adjustable gastric band, or the sleeve gastrectomy – remain the best option for durable weight loss in patients with morbid obesity, regain of most or all of one’s preoperative weight is possible.

While the primary cause of weight re-gain can be from a gastric pouch that is stretched, a gradual re-connection between the remant stomach and “new” stomach, or a band that is too loose or malfunctioning, the most common reasons are poor behavioral choices.

Grazing for food, snacking, eating too close to bed time, lack of exercise, and lack of portion control are the common culprits.

This emphasizes the importance of having weight loss surgery-when indicated-in the context of a comprehensive program that has support groups, personal follow-up with the surgeon, and a committment to life-long care.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Is the new way of using ultrasound to blast fat without surgery looking promising?”

Methods of reducing areas of fat in the body without the use of incisions, but instead with ultrasonic energy through the skin, holds promise as a cosmetic procedure for patients concerned with “probem areas” on their body.

This procedure, now starting to see use in the U.S., is akin to liposuction, but minus the incisions. Doctors are quick to note that this is not a weight-loss procedure, but purely a cosmetic one.

It’s important for patients to recognize when obesity is better served by methods of weight reduction rathar than targeted fat reduction, for which liposuction or ultrasonic methods may be useful.

Occasionally, obesity can be accompanied by serious health problems—morbid obesity—that has more to do with extra fat on conspicuous areas on your body.

Your physician can identify the relationship between your height and body surface area known as the body mass index, or BMI, which tells doctors whether you are overweight, obese, or severely obese.

In some cases, lifestyle changes and a tailored diet and activity plan may be warranted to help reduce your risks for heart disease, diabetes mellitus, hypertension, and numerous other obesity-related health problems.

In cases of severe obesity, surgical management options such as laparoscopic gastric bypass or gastric banding may be the best option for weight reduction.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.