Friday | July 21, 2017
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Isle center offers bariatric surgery


Stephens Media Hawaii

People considering bariatric surgery to help them lose weight don’t come to the decision lightly, says Maria Oka.

Oka, the surgical bariatric coordinator at Kona Metabolic and Bariatric Surgery Center, which is a part of Alii Health and created with the help of Kona Community Hospital, said the patients she counsels come to her having tried every diet and weight loss trick that exists, without success.

“This is giving them that second chance to finally get their weight down,” Oka said.

The center began performing surgical procedures in September, but Oka, surgeon Nathan Tomita and nurse practitioner April McGeorge, the center’s medical bariatric coordinator, have been working to get the program running since Tomita arrived on island in August 2012. Tomita, who moved to Hawaii Island from Michigan, helped his former clinic qualify as an American College of Surgeons Level 2 Center of Excellence for bariatric surgery, the first in that state.

He implemented those certification guidelines from the start in Kona, in the hopes of eventually qualifying the West Hawaii program for the same designation.

This is the first bariatric surgery program on the Big Island, Tomita said, and he’s seeing patients from all over the island, including Hilo. Previously, people who wanted bariatric surgery had to fly to Oahu, and the only options for follow up appointments were to return to Oahu to see physicians and care providers there.

Stefanie Briseno-Sanchez had been trying to get bariatric surgery for five years. But as a Medicaid patient, she couldn’t find any doctors on Oahu who accepted her insurance.

She was in danger of going blind from intercranial hypertension and suffered from other side effects from her weight.

A little more than a month after her surgery, the 31-year-old Kona resident has lost more than 40 pounds.

“I feel great,” Briseno-Sanchez said. “Less pain, my vision is starting to come back.”

Her weight was impacting her everyday life, she said. She couldn’t tie her shoes, she had a hard time playing with her children. Since the surgery, Briseno-Sanchez, a college student, has been able to sit through classes with less discomfort.

“This procedure has given me a great head start,” she said.

She was also full of praise for the clinic staff.

“I feel supported,” she said. “I feel like I can call them any time, any day. … Because I was looking for so long, I was just ready (for the surgery). They also provided me with so much information, I knew what to expect.”

That support is a selling point for the program, Tomita said.

“It’s the multidisciplinary approach we’re using,” he said. “Come in and step on the scale.”

The patients are monitored for five years after their surgery. Most of those appointments are with McGeorge, who checks the patient’s lungs and heart rate, weighs them and discusses nutrition.

“I make sure they lose the weight safely, without muscle wasting,” she said. “Seventy percent of people (who get bariatric surgery) without medical maintenance regain the weight within two years.”

She checks on their diets, reminding them how many calories they should be consuming, how much protein they need and which supplements they need for vitamins and minerals.

Getting ready for the surgery is a lengthy process. The center offers regular seminars at the hospital and West Hawaii Civic Center explaining the process. Next, patients visit with Oka for an initial evaluation. The seminar and evaluation are free, Tomita said.

If the patient qualifies for surgery, Oka schedules psychological and medical evaluations. The patient also has to complete a medical weight loss program, which typically takes about six months. Patients must lose about 10 percent of their body weight before qualifying for surgery, in part to demonstrate commitment to the lifestyle changes that follow surgery.

The weight lost also shrinks the patient’s liver, which helps with the surgery, Tomita added.

It takes about six months for a patient’s insurance provider to authorize the surgery.

The center offers three types of surgery: Roux-en-Y gastric bypass, gastric sleeve and adjustable gastric banding, all using laparoscopic techniques, which officials said are minimally invasive. About 90 percent of patients select the gastric sleeve, Tomita said.

“They like the fact that there’s no vitamin deficiency, rerouting of the intestines and no foreign body (left in their body),” Tomita said.

Patients must quit smoking and drinking to qualify for the surgery. Tomita said it doesn’t make any sense to give a morbidly obese patient a decade or more of life back, through the surgically assisted weight loss, then have that patient curtail his lifespan with smoking, alcohol or drugs. The surgery also has more risk of failure and complications in smokers, he added.

Some people question why a patient would consider having the surgery in Kona, a relatively rural area, instead of at a major medical center on Oahu, Tomita said.

For one, he said, the program will have good outcomes, especially once it receives its center of excellence designation.

“We’re on the island,” he said. “If you’re in trouble, the surgeon who did your surgery is here. We’re going to see you all the time. It’s a small community.”

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