Maggie McKay (Host): Welcome to FirstHealth and Wellness Podcast from FirstHealth of the Carolinas. I'm your host, Maggie McKay. Joining us today are Dr. David Grantham and Dr. Raymond Washington, surgeons at the Metabolic and Weight Management Center to discuss bariatric revision surgeries and more. Thank you both so much for making the time to be here.

David Grantham, MD: Thanks for having us.

Raymond Washington, MD: A pleasure. Thank you.

Host: Absolutely. Dr. Grantham, let's start with you. What is new in bariatric surgery from robotics to revisions, because I know it's been around a while.

David Grantham, MD: You know, a lot of things that are new for our program. We've started doing our bariatric procedures robotically over the last couple of years, and we have found that it's really made a big difference in patient recovery. They tend to get better faster and be ready to be discharged a little bit earlier than they had been traditionally. And our outcomes have been fantastic over the last couple of years, seeing that benefit for the patients.

Host: Dr. Washington, what's changed the most in bariatric surgery today? And how does that affect patients? What does it mean to them?

Raymond Washington, MD: I think there are a number of factors of change when it comes to weight loss. GLP-1s have really drawn attention to people losing weight. And I think what is really helpful for us is we have a subset of patients that really need surgery. We have those patients that need to lose a hundred pounds and utilizing, like Dr. Grantham talked earlier, the robotic platform. We have those patients usually in the hospital just overnight. So, the recovery's quick. They're back to work in two weeks. And more importantly, the complications are much less than it was 20 years ago when we were doing open procedures. So in terms of good outcomes as well as people getting back to their normal activities as quick as possible, it has really been a game-changer for us using this robotic platform.

Host: Yeah. You said 20 years ago, I remember somebody at work did it and it was a long recovery and a real lifestyle change and kind of a struggle. But now, it's a lot different, which is a good thing, right?

Raymond Washington, MD: You are absolutely right. It's much different. People want to get back to normal activities, and doing it through the smaller incisions, the risk of hernias and infection, all that, is much less. So, it's really a safe procedure. In fact, it's safer than getting your gallbladder out in a lot of studies. So, that's what we want to make patients aware of.

David Grantham, MD: It's interesting now, we'll see a patient the morning after surgery, they're already dressed and they're asking when they can go home. And even five years ago, that was much different—doing the procedures laparoscopically—much less a decade plus ago when they were doing them open. So, it's been a significant step forward.

Host: That is amazing. Dr. Grantham, robotic-assisted surgery is becoming more common across specialties. How have robotics changed bariatric surgery specifically, and what advantages does it offer for patients and surgeons?

David Grantham, MD: Yeah. So, the robotic platform allows for a wristed motion of the instruments inside the belly, which allows for better suturing, and we can work in tighter spaces. So, that more natural move for the surgeon on the inside of the abdominal cavity when we're trying to sew two pieces of intestine together or connect the small intestine to the stomach when we're doing a gastric bypass, that's been real game-changer for us. It allows for increased visibility with a three-dimensional view, and it's a magnified view when we're looking at the structures that we're operating on. So, we get a better view, we get better instrumentation. We have more natural movements with our hands using the robotic platform. And some patients are confused by the word robot. You know, I don't want a robot doing my operation. I want you to do my operation. Well, it is me doing your operation. But it's using the robotic platform, the instrumentation that that provides us to allow it to be as effective as it is.

Host: Dr. Washington, what bariatric procedures are offered at the metabolic and weight management center?

Raymond Washington, MD: We have two major operations that we offer. We do the sleeve gastrectomy, which is essentially done laparoscopic or robotically. It takes a little less than an hour to do, and we're removing about 80% of the stomach. And that's going to allow the patient to lose about 50-70% of their excess body weight over that first nine to 18 months. And that's a purely restrictive procedure. And then, we also have the gastric bypass, which has long been considered the gold standard, where it's both restrictive, meaning we make the stomach smaller, so you take in less calories. And then, we bypass about a hundred centimeters of that intestinal tract. So, you lose more weight because not only are you not taking in less calories, but also you're not absorbing as many calories. Those patients tend to lose a little bit more weight, about 60-80% of the excess body weight. And again, both of those procedures are done robotically and going home the next day, and usually back to work in about two weeks.

Host: That is amazing. Unbelievable. Dr. Grantham, what exactly is bariatric revision surgery? How is it different from someone's first procedure?

David Grantham, MD: Yeah. So like you alluded to, by definition, when someone has a revision, they've already had one operation. And whether they've had a sleeve gastrectomy or whether they've had a gastric bypass or some other variant of a more, I'll say, outdated bariatric procedure, then sometimes they need something changed about their anatomy for symptoms or potentially for improved weight loss as well. And so, a revisional operation is where we operate on someone who has had surgery before and converting that prior procedure to one of the procedures alluded to by Dr. Washington, the sleeve gastrectomy or gastric bypass.

Probably the most common revisions we're seeing now is the gastric banding, which is rarely done in our country anymore. We're removing the bands. And then, those patients are getting their previous banding converted either to a sleeve gastrectomy or to a gastric bypass.

Other considerations for revisions would be a patient who's had a sleeve gastrectomy in the past. And then, they have bad reflux and they want that sleeve converted to a gastric bypass for improved reflux control. So, those are the most common scenarios where someone would undergo a revisional procedure.

Host: Dr. Washington, what are common reasons a patient might need or consider a revision?

Raymond Washington, MD: Well, when we think about revision surgery, it's a couple different reasons. As Dr. Grant mentioned earlier, sometimes patients may have significant reflux after procedures. And the gastric bypass has long been known to not only have significant weight loss for patients, but also it resolves heartburn. And so, for patients that have significant heartburn, and we would really want to convert them to maybe a gastric bypass. And if we know it preoperatively, we'll definitely want to have the gastric bypass.

Host: Dr. Grantham, looking ahead, what excites you most about the future of bariatric surgery, from new technologies to how we support patients before and after surgery?

David Grantham, MD: Yeah. So, there's a lot of excitement about the future of bariatric surgery, and it might not be purely a surgical future. It could be an endoscopic future, it could be a combination of multiple therapies, including medications. So, the future for us is really broad. And that, as a surgeon, we have access to not only the operating room. And we can provide surgeries for patients, but we could do endoscopic procedures and we can also write prescriptions for the medications if that seems to be something that the patients best benefited by.

So, the future for us is pretty wide open. And like we talked about earlier, it's important that we keep patient safety in the forefront of that conversation. Because whatever we do in the future, we want it to be even better than what we are currently doing now. And so, that's what we view as our future in the surgical world moving forward.

Host: Dr. Washington, would you like to add anything?

Raymond Washington, MD: In terms of what's happening now, I think the excitement is not only are we focusing on surgery, but we're also focusing on how we can help our patients maintain that weight loss long-term. So in our program, we really use a multidisciplinary approach, a nutritionist or a behavior person. And we touch our patients immediately after surgery at three months, six months, nine months, a year. But we really have patients for life. And so, it's a lifetime commitment to being healthier. And I'm excited about that. Because what we do, I think differentiates us from a lot of other programs.

Host: Well, thank you both so much for sharing your expertise. It's been a pleasure and I have certainly learned a lot. I appreciate your time.

David Grantham, MD: Very good. Thank you for having us.

Host: Again, that's Dr. David Grantham and Dr. Raymond Washington. To learn more about bariatric surgeries, including revisions, visit firsthealth.org/weight. And if you found this podcast helpful, please share it on your social channels and visit our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to FirstHealth and Wellness Podcast.