More turn to obesity surgery

BOSTON — Ken Powers knew the potential dangers of having his stomach stapled, but to a man who had tipped the scales at 475 pounds, those risks didn't much matter.

"I had this thought: If I die on the operating table, having the surgery to try to better my life, I thought it was a better thing to do than to live the way I was living, which, in my opinion, I was kind of waiting to die anyway," he said.

By the tens of thousands, morbidly obese people who have failed at diets, support groups and exercise programs are turning to surgery to lose weight.

In 1998, there were 25,800 obesity-related operations, most of them gastric-bypass procedures commonly known as stomach stapling. This year, the American Society for Bariatric Surgery estimates 103,200 operations.

Questions about the risks and growing use of the procedures surfaced in recent weeks after two patients in New England died during stomach-stapling surgeries. However, obesity specialists say the procedure is safer than it has ever been — and that is contributing to the growing popularity.

And for most patients, the risk of not having the surgery is greater.

"It's an operation that helps cure people of this disease which is life-threatening. People see it as some type of cosmetic surgery, when it's not. More patients die waiting for surgery than die after surgery," said Dr. Janey Pratt, a surgeon at the Massachusetts General Hospital Weight Center in Boston, which does about 300 gastric bypasses a year.

The operation involves using staples or stitches to close off part of the stomach to form a small pouch about the size of an egg, which limits how much food the person can eat. A part of the small intestine also is bypassed to reduce nutrient absorption.

Risks include wound infections, stomach leaks and occasionally life-threatening blood clots.

The International Bariatric Surgery Registry estimates one in 1,000 patients will die within four weeks of the surgery, and three in 1,000 will die within three months. Some surgeons in the field put the fatality rate as high as one in 100 who have the surgery.

Powers, 42, of Worcester, was lucky. Even carrying more than 400 pounds on his 5-foot-11 frame, he had not developed many of the common ailments associated with obesity. Still, sleep was fitful, and walking, particularly upstairs, was exhausting. And he lived in a fourth-floor apartment.