Interview: Dr. Michel Gagner – Kuwait

I was invited by AlSeef Hospital Marketing team to get the insider scoop and interview Dr. Michel Gagner, whom I posted about last week. I happily accepted and posted an announcement on my blog, Facebook Page, and Twitter @Ansam518 to allow my readers and followers to ask questions and inquire about the procedure; the endoscope treatment for Diabetes Type 2.

I was greeted by the lovely Ms. Fatima from Marketing, and afterwards by AlSeef Hospital CEO, Dr. Yousef Abu Dahr (gotta love how the whole team was there to greet the media). And then it was my turn to meet Dr. Gagner and Dr. Medhat Farghaly to conduct the interview

The interview was mostly Q&A I had prepared from my own research PLUS questions I got from my readers. Dr. Gagner was kind enough to explain’em all as simple as possible with the aid of some visuals…

 

How is the procedure done/performed? Are there staples used in the procedure? If so, what are they made of?

 

Let’s start with the sleeve gastrectomy (تكميم), it’s mainly a weight loss procedure performed to reduce the stomach size with surgical staples to to attach the opening and prevent leaking… resulting in a thinner stomach (just like banana) which will consequently help in weight loss. The staplers  are made of titanium, and they are mechanical and have cartridges – five or six cartridges are used in each procedure. Those staples stays in the body without interfering with MRI, airport metal detectors, and the rest of the organs. They heal very well and become incorporated in the wall of the stomach, so its well accepted by the body.

 

Will the staples tear out?

 

The staples can move. They are on the outside of the stomach and in certain patients they slowly move from the outside to the inside, though its very slow and may take years to happen and nothing happens really.

 

Why take vitamins?

 

Well in general taking vitamins is a good thing… a lot of people are taking vitamins when they never really had any kind of surgery. It is also recommended that you start taking vitamins at certain age. But after these different types of surgeries (sleeve, bypass… etc) we recommend that all of them take certain kinds of multi-vitamins/supplements – and for the gastric sleeve surgery we recommend that they take multi-vitamins that contains B12 and thiamine. Unlike the gastric bypass, in the gastric sleeve the intestines are left untouched allowing the body to have normal absorption of all the minerals like iron, calcium, and zinc…. so the sleeve is a better option to prevent the decrease of absorption of those minerals specially for women who go through menstruation resulting in blood loss (iron), or others who suffer from lack of calcium and vitamin D deficiency, and the elderly.

 

How different is it from the gastric bypass?

 

With sleeve, we do not have intestinal connection or intestinal surgery/we do not touch the small bowel. One of the complications of the bypass is to have an obstruction in the bowel. There is also the risk of ulcers that can form between the stomach and bowel connections -and then I was shown different pictures of the gastric bypass showing me how food absorption bypass the area where its normally absorbed - The stomach pouch is connected to the intestine, ulcers can form right after the gastric pouch (may bleed and perforate too), we dont see these kind of complications with the sleeve! There are also some vitamins deficiencies like vitamin B12 and folic acid, and folic acid is very important in neuro-development of brain nerves (folic acid important for pregnant women)  – I was told that the problem in Kuwait that there is a lack of food fortified in folic acid, while in the States and North America most food is fortified with folic acid so we rarely see folic acid deficiency… now imagine adding a bypass to that! You really dont want to do a reverse bypass to fix it because its another big/major operation to be performed.

 

Then Dr. Farghaly told me about how important it is to take all those vitamins to make up for the absorption problem – how important is the patients’ own after care, and Dr. Gagner said it is really important to educate ourselves about it… specially for those who get the procedure performed. He stresses on spreading the awareness using all the media tools available, and then he talked about how they have support groups in North America, were patients gather to discuss and share their views, experiences, problems, insight, and more

 

Tell me more about the sleeve procedure used to treat Diabetes Type 2!

 

The sleeve is a universal procedure performed on those with high BMIs. Now Diabetes Type 2 can be associated with obesity so these kinds of surgeries can be performed even for those with lower BMI (30-35) – in fact this kind of surgery work very well for this group of people because it helps them shed of some weight becoming more in the normal weight range

 

Even for those who’ve been diabetic for more than 10 years?

 

Well we wont exclude such patients… it will be less effective, but still doable and there will be noticeable improvements! The patients will take less dosages of insulin and medications – it is still great improvement for them, you know! Keep in mind that each case must be treated individually

 

Is it a treatment or aid to treatment

 

Its a treatment but also a tool! It should be used as a tool. It helps in suppressing hunger and causes hormone change that affects pancreas and also affects the brain, so the person smell, taste, and see food differently. Patients will lose weight and they must work on their eating and exercise habits… basically adapt to a new and better lifestyle changes!

 

The question I got asked by quite a few people: How much weight will I lose?

 

It all depends on their BMI category! The smaller the BMI, the higher percentage of the success you will get… the more fat mass reduction, the less the insulin resistance. At BMI of 30-35, patients may expect to come back to normal weight… BMI in the 40s may come close to normal weight… but if they are very-super-heavy they may require a second surgery. We even performed on patients with BMI of 60+ – they’re categorized as “high risk”.

 

Patients with central obesity (fat at center of the body) are the most affected ones! They are at risk of having metabolic syndrome = high blood pressure, high cholesterol, some degree of coronary diseases, plus type 2 diabetes and with that they may have a fatty liver (with fat deposits) which are very toxic and may cause scar tissue over time in the liver which may develop to sclerosis… its all linked together: Central Obesity + Metabolic Syndrome + Type 2 Diabetes, and again… Gastric Sleeve is a solution here with lower risk of complications

 

What’s the success rate?

 

Its a bit difficult to measure… in the first few years, you will see a lot of publications and very high success rate… problem with such bariatric and metabolic operations is that the success tends to decrease with time… why? Because of the genes! The genes try to get around the modifications done and created by the surgeons. We do not operate nor change the genes which are coding you to be at a certain weight at a certain time – the body realize that this person isn’t at the BMI that I have programmed! So basically the genes try to counteract what the surgeons have created and try to stretch the stomach and get the small bowels to be longer and more efficient!

 

What is the cost of the operation?

 

Between all the tools used, the hospital charges, days spent in the hospital, rooms picked, surgeon fees…etc the cost is around KD4,000 – 5,000 au contraire to USD50,000 when performed in New York!

 

Tell us about your SLS Excel Award 2011 :)

 

Its an American society (Society Laparoscopy Surgeons) that was found when laparoscopic surgeries were being developed, and the award is given once a year to surgeons that have been pioneers and made outstanding contributions to laparoendoscopy in general. A lot of people know me because of bariatric surgeries, metabolic surgeries, and type 2 diabetes which I have been doing for the last 15 years… before that I have developed operations for adrenal removal -I was the first one to do this- beside developing other operations to do with laproendoscopy in pancreas and operations for removal of thyroid glands (almost 20 years ago). Glad to know about all the positive comments I get because us, as patient, we do a lot and try our best with the patients over the years. I worked as surgeon in Miami, New York, Cleveland, Canada (Montreal)… I guess I have patients all over now (plus Qatar and Kuwait)

 

Tell us about the World Congress – 2014 – were you will be the Congress President :)

 

This is the World Congress of Bariatric and Metabolic (diabetes surgery). The World Congress is once a year, it was in Hamburg this year at the end of August and in 2014 it will be in Montreal -where I was born- so I was hoping I could get the congress and competed against many cities. It will be fun.

 

 

All in all, I had a good time and a crash mini course from Dr. Gagner and Dr. Farghaly. They were kind enough to answer all my questions using visual aids and giving examples and more.

 

I thank Dr. Gagner and Dr. Farghaly for their time, Ms. Fatima for being there from the time I got there till I left, Ms. Razan AlRoudhan for arranging this interview for me, and Dr. Yousef Abo Daher for having me in AlSeef Hospital :)

 

I hope I answered all your questions… if not, you can call AlSeef Hospital for reservations/inquiries on 60014054/1881122

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