LAP-BAND® Surgery and Fills

September 21, 2006

OBGYN.net CoverageFrom the Bandster's Bash 2001 in Tijuana, Mexico

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Roberta Speyer: "This is Roberta Speyer reporting for OBGYN.net Broadcasting. I have the pleasure to be here at the Bandster's Bash in Tijuana, Mexico on the first day of September in 2001. I'm sitting here with Dr. Pedro Kuri who is a bariatric surgeon here in Tijuana and does the procedure that I had called the Adjustable Gastric LAP-BAND®. We're going to ask him a few questions about it and get some insights. Doctor, how long have you been doing this procedure?"

Dr. Pedro Kuri: "For four years and I have already done over 170 procedures, and the results of these are very, very good and they are very similar to the other procedures for bariatric surgery. This is not that aggressive and it's a very good option. The others are good too but this is a very good option for that."

Roberta Speyer: "I noticed when you came into the party there are so many people, especially women. There was a lot of women that had this procedure, about 85% of the people, I believe."

Dr. Pedro Kuri: "I think it's 90%."

Roberta Speyer: "Ninety, and the women are all like myself just so very satisfied; I've lost 90 pounds. I went to Frankfurt, Germany and had it done with Professor Rudolf Weiner. This procedure has just now been approved by the FDA to be done in the United States but you've been doing this procedure for four years here in Tijuana, which is only sixteen miles from the United States. When someone is thinking about having this procedure, if it is paid for by insurance in the United States that's very good but often it is not covered by insurance policies - it becomes an out-of-pocket expense to the person so I have several questions and maybe we'll take them one at a time. First of all, what is the profile for a good patient to have this procedure? What type of obese patient is better served by this procedure than some of the other more invasive procedures?"

Dr. Pedro Kuri: "The basic thing for this is the Body Mass Index - BMI. BMI results from your height and your weight. When it gives you a number between 20 and 25 it's normal, over 25 is overweight, and after 30 is obese, but we consider morbid obesity over 40 of BMI."

Roberta Speyer: "That's exactly where I was when I had the surgery."

Dr. Pedro Kuri: "Yes, and then that's an indication for the surgery. Sometimes we do the procedure in people with a 35 BMI or when they already have any complications like diabetes, high blood pressure, heart problems, or knee problems."

Roberta Speyer: "So that would be called a co-morbidity - something else that's going wrong with the person because of the weight."

Dr. Pedro Kuri: "Yes, those are the indications for surgery for people who've been on several diets for at least three or four years and their weight is like a yo-yo; we call that the yo-yo syndrome. They go down for a while and then they go up and down and this is a health problem. Now in the states and all over the world it's considered a health problem not an aesthetic problem but I know that in the states the National Health Institute bases about two billion dollars for problems related to overweight people."

Roberta Speyer: "It's a big problem."

Dr. Pedro Kuri: "It's a big problem and they're trying to solve it before they come and develop complications that's why it's treated like a health problem."

Roberta Speyer: "Yes, because there's so much more that happens to someone once they become morbidly obese. When you have a profile and you have the right body mass index to qualify to do this, are there certain types of eaters, for example, someone who is fat because they eat a lot of sweets or someone who is overweight because they eat large quantities of food or very rich foods, are there some people that seem to do better with this particular procedure than others?"

Dr. Pedro Kuri: "Yes, some procedures like the gastric bypass is better for the sweet eaters but the main thing here is that the patient that is coming for surgery has to understand that the band is a tool for going down in your weight, it's not a magic wand. Then it's a technical part, a fashion part, and the patient has to be the biggest part of it."

Roberta Speyer: "They have to want to lose the weight."

Dr. Pedro Kuri: "Yes, that's the one who'll lose the weight. You don't cut the arms, you don't cut the head, or the patient because they can think and they can take whatever they want to the mouth and that's going to depend on the patient."

Roberta Speyer: "You can still eat candy bars all day long and liquify them and have them slip down through your stomach if you are so inclined that you want to do that. For myself, I was never a heavy sweet eater but I like to sit down to a big healthy portion and then have seconds and maybe thirds so this tool was remarkably effective for me because I became satiated. I had the feeling of fullness after a much smaller portion and once you feel full you don't eat anymore."

Dr. Pedro Kuri: "That's a change in your eating habits and it will improve. You just put the junk food away and you prefer a healthy dinner rather than junk food and that can change if the person wants and it's going to depend on what you want for the rest of your life because overweight people or the morbidly obese people can reduce the expectancy of life by ten or fifteen years from what it should be normally. It depends on what you want for the rest of your life."

Roberta Speyer: "I'm just delighted that I had this surgery, and we've interviewed quite a few people here tonight and I know that many of them are also very delighted with the results they've gotten. Now today I did something at Dr. Kuri's office, I had a fill and the way this system works is there's a port underneath the skin and you can inject fluid or take out fluid through a needle. It's not painful at all, first you put a little novocaine or something on there and you don't even feel it. I'm a big sissy so trust me if it hurt I would tell you, it does not hurt, and you were very gentle and kind by the way."

Dr. Pedro Kuri: "Thank you."

Roberta Speyer: "I was at 2 cc's, and this band holds between 0 and 5?"

Dr. Pedro Kuri: "It holds 0 to 5 but I never go that far with the fills. On each patient it's going to work different; with some people 2 cc's and they completely close and some with 3.5 or 3.8."

Roberta Speyer: "Isn't that the beauty of this that it is so adjustable compared to the other methods that were used where someone might be hyperemesis, in other words, throwing up all the time?"

Dr. Pedro Kuri: "Yes, let me tell you the advantage of the band. First, in case you don't want the band, it can be removed, it's reversible."

Roberta Speyer: "Don't try to get mine!"

Dr. Pedro Kuri: "No, but that's one of the main things. The second one is the complication of you just don't want it and then it can be removed. The other procedures are for the rest of your life. The second best advantage of this is it's done by laparoscopy. Laparoscopy means two, three, or four incisions, one inch in diameter and then you're out the next day so just one night in the hospital."

Roberta Speyer: "I was back at my desk within a week."

Dr. Pedro Kuri: "That's it, and then the third advantage of this is that it can be adjusted. Adjusted means you can just close the band or open the band, it depends on the needs of the patient and that will help you a lot. With the other procedures, when they finish the procedure, that's the way you're going to be for the rest of your life, and this can be adjustable."

Roberta Speyer: "You put in 2.6 cc's; I had 2, and when you looked at me through the fluoroscope you didn't like that. You thought that was too restrictive and you put me back down on the table and took a little out. Where did I end up at - about 2.4 or something?"

Dr. Pedro Kuri: "At 2.3 and, yes, sometimes just the smallest amount closes the band very tightly. We want to just restrict your food intake but not to make you suffer, that's the main thing of this."

Roberta Speyer: "Yes, so after that I went out to lunch and I did eat but I didn't eat as much as I had been and I still feel full and it's hours and hours later. That's effective for me."

Dr. Pedro Kuri: "That's the way it works."

Roberta Speyer: "Now that I have you on camera, I hope you'll continue the wonderful work which I'm sure you will. I would love to have you participate in our OBGYN.net Weight Management section that we just launched; we have a million visitors a month to our site. The number one thing that these women requested was more information about weight management, and I think it would be a wonderful addition and I certainly hope you'll join us. I know you're very active on the Internet."

Dr. Pedro Kuri: "Sure, whenever you want I'll be there and you can count on it."

Roberta Speyer: "We have it now, we have Dr. Kuri on our Editorial Advisory Board, and we have it on film. Thank you so much and thank you so much for the wonderful treatment I got at your clinic today, it was very nice. One thing I'd like to hit on before we end is it's very difficult for people to get in it the U.S. because there are only a few doctors that are being trained and proctored by doctors like Dr. Kuri and other doctors from other countries that have the experience to do this procedure. If your insurance does not pay for it, the healthcare in the United States can be very costly so the opportunity for someone from the United States to come down to Tijuana or to some of the other centers that Dr. Rumbaut and some of the other physicians are in is Monterrey and who else is there?"

Dr. Pedro Kuri: "I think Dr. Sanchez is in Mexico City and we have other people that does this."

Roberta Speyer: "Dr. Kuri is also right here and just sixteen miles from the border. It's a beautiful clinic, and I received excellent service there today and it's probably more cost effective for a lot of people that are paying out-of-pocket rather than going into some of the medical centers in the United States so its definitely an option. We'll make sure that we have Dr. Kuri's office e-mail attached to this interview so that people who would like to write to you and contact you about getting the procedure and find out about it can."

Dr. Pedro Kuri: "I will answer any questions that they would like or have doubts about; I'm here to serve you."

Roberta Speyer: "Thank you so much."

Dr. Pedro Kuri: "You're welcome."

Roberta Speyer: "Let's get back to the party."