Shant Kiyork struggled with his weight for years. He dieted, exercised, lost weight, and inevitably gained back what he lost and then some.

Fearing that his own attempts to control his ever-greater weight were failing, he chose to have laparoscopic gastric banding surgery, commonly called lap-band surgery, in 2006.

The lap-band was appealing to Shant because it was a less invasive procedure than gastric bypass surgery. But it later proved to be ineffective as a weight loss tool because, much like his yo-yo dieting, he lost a little weight initially and later gained it back. He also began to suffer from abdominal pain and started to have bouts of vomiting, both of which can be side effects of the lap-band.

By the time Shant moved his family to Southern California, his excess weight was also threatening to create problems for him at work. A machinist by trade, Shant was beginning to have severe joint pain and he was concerned his weight would soon interfere with his ability to earn a living. At this point, he turned to Keck Medicine of USC.

Shant’s experience is not uncommon, explains Namir Katkhouda, MD, director of the USC Metabolic and Bariatric Surgery Program at Keck Medicine of USC and USC Verdugo Hills Hospital. “You have to understand that, 10 to 15 years after initial weight loss surgery, you may sometimes have to redo it,” says Dr. Katkhouda. “The lap-band was once popular, but has not withstood the test of time.”

It was clear that Shant’s body was in need of a second operation. But, before he could move forward with his surgery, he was required to go through a number of steps to make sure his heart and his mind were also ready. Weight loss surgery is not a magic pill and requires the patient make lifestyles changes after surgery to stay healthy and free of complications.

All patients of the USC Metabolic and Bariatric Surgery Program must attend a seminar led byDr. Katkhouda and his colleagues during which various surgeries available to bariatric patients and their side effects are discussed. They also get a chance at the seminar to hear from previous patients about their experiences with weight loss and revision surgery.

In addition, patients must attend counseling sessions with a nutritionist and a psychiatrist to make sure the patient understands what is going to happen and assess whether they are prepared to deal with some of the long-term lifestyles changes that come with surgery.

The procedure thatDr. Katkhouda recommended for Shant was first removing the lap-band and then performing a sleeve gastrectomy. Sleeve gastrectomy surgery is relatively new and involves removing about two-thirds of the stomach, including the part that secretes ghrelin, a hormone that signals hunger.

Revising a previous weight loss surgery, says Dr. Katkhouda, is a far more delicate and meticulous operation than initial weight loss surgeries. This type of revision can be tricky because the stomach tissue is often changed by the presence of the lap-band. Because of its difficulty, many doctors remove the band and, after a period of healing, perform the sleeve gastrectomy in a second surgery. Dr. Katkhouda, who has performed hundreds of these surgeries, can do both procedures in one surgery for nearly all of his patients.

“This is one thing that is special about Keck Medicine of USC,” says Dr. Katkhouda. “We do revisions and in 90 percent it is done in one shot and they don’t have to have another surgery three months later.”

Three months after his revision surgery, Shant believes his weight loss is progressing well. He is eating more often, five to six times a day, but smaller portions and has shed 55 of the 180 pounds he needed to lose. His joint pain is gone and he can go to work and get through the day without feeling a lot of discomfort.

Though he expects it will take at least a year to get to his goal weight, he is so confident that he is going to reach it he that has already bought a celebratory Burberry sweater, a brand he has long admired and never been able to fit into. He plans to wear it next winter when he hits his mark.

“It was a great experience and Dr. Katkhouda is a great doctor,” says Shant.

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by Hope Hamashige