Dr. Harold Kent has had an interesting career in surgery.
He completed his surgical residency at the Naval Hospital in San Diego, California. Later he served as the chief of surgery at the U.S. Naval Hospital in Guantanamo Bay, Cuba, from 1986-1987 and held other key positions there. He joined a surgical practice in Brunswick in 1988 and in 1991 was recalled to active duty in the Navy during the Gulf War. From February to May 1991, Dr. Kent was a staff surgeon at the U.S. Naval Hospital in Jacksonville, Florida.
Dr. Kent has also served as the Chief of the Medical Staff at the Brunswick hospital, as President of the Glynn County Medical Society and as President of the Georgia Society of the American College of Surgeons. He is currently the President-elect of the American Society of General Surgeons.
Dr. Kent and former partner started doing bariatric surgery in Brunswick in 2001. Since that time, almost two thousand patients have had bariatric surgery through the practice. Procedures done have included open and laparoscopic gastric bypass, sleeve gastrectomy and lap banding.
Realizing the need to adopt state of the art technology, Dr. Kent and his former partner started to implant the lap band in 2005. This procedure places a band around the upper portion of a patient’s stomach. The band is connected to a small reservoir placed under the skin into which saline is injected under local anesthesia. The reservoir and a circular balloon inside the band are connected by a long, thin, hollow tube and the injected saline causes the balloon to tighten around the stomach. Combined with diet and exercise, this system can result in substantial weight loss for patients. It is an outpatient procedure for most patients and is completely reversible.
Dr. Kent has been seen good results in most of his patients who are compliant with their aftercare and has now limited the surgical part of his bariatric practice to lap bands only, doing several every month.
Now Dr. Kent is offering patients a new option: the Orbera intragastric balloon. This procedure is gaining popularity because it is a non-surgical procedure and has had good results.
“The new Apollo Endosurgery intragastric balloon was approved by the FDA last year. The balloon surface is very smooth and the risk of injury to the stomach is extremely low. At this point there have been over 220,000 balloons implanted throughout the world.
One of the best thing about the system is the ease of insertion. The patient undergoes an endoscopic exam of the stomach under sedation by Diprivan. No surgery is involved.
“Being put to sleep with Diprivan isn’t like being put to sleep for a major operation. Diprivan is used for sedation with most endoscopic procedures.”
An endoscopic exam is done first to insure that the stomach is completely empty and that there are no contraindications to balloon insertion.
“The balloon comes deflated in a sheath so that it’s about the size of your finger. So, once the endoscopy has been completed, you slide the system down the throat and into the stomach. Once you’ve got the balloon in place, you inject about 600 cc of saline into it,” Kent said.
From there, the delivery system is detached from the balloon and is removed.
“You take a look around with the endoscope after insertion and you’re done. The whole procedure, once it’s refined, should only take about 10 to 15 minutes to complete,” he said.
The patient is treated with medication both before and after the treatment to ensure that all goes smoothly.
“About two weeks before balloon placement, we put the patient on Protonix which is an acid reducing agent. After the procedure the patient has to be on liquids for a period of time then they can move on to mushy foods.”
Throughout the six months that the balloon remains in place, the patient is prescribed Protonix as well as medications to treat possible stomach cramps, nausea, vomiting, and poor emptying of the stomach. The patient must adhere to a dietary program, exercise, and report to the office for frequent follow up, weight checks and counseling.
“A key part to this is having diet and exercise counseling the entire time the patient has the balloon. We will also prescribe a variety of medications that deal with the side effects of the balloon that were observed in the FDA trial,” he said. “We think we will have a fairly small percentage of people with side effects.”
The balloon works by keeping the patient full, thus prompting them to eat less while it is in place.
“If you look at a person’s stomach without the balloon, two hours after they’ve eaten, about 25% of the ingested food is still in the stomach. With the balloon, about 65% of the meal is still in the stomach. So the patient stays full and eats less,” he said.
Keeping the patient’s weight down after the balloon is removed is as much of a goal as losing the initial weight. After the balloon is taken out (also endoscopically), the patients can use their diet and exercise counseling to help them remain on course once the balloon is extracted.
“We give patients tips and tricks to lose weight--just like we’ve been doing with our lap band patients for over ten years,” he said.
While the gastric balloon is relatively new, it has been proved to deliver results. Kent says that people who opt for the procedure lose 3.1 times as much weight as those who only try diet and exercise without the aid of the balloon.
“A BMI (body mass index) of 30 to 40 is the group which qualifies for the procedure. In studies, the average weight loss in patients who receive the balloon is 38% of excess body weight. A person who is 100 pounds overweight would thus be expected to lose approximately 38 pounds,” he said.
The balloon is not covered by insurance programs, although those suffering from morbid obesity can investigate qualifying for financing options through Dr. Kent’s office.
Even with out of pocket expenses, Dr. Kent notes that many patients will end up spending more on their health care if they do not treat their morbid obesity. According to some studies, the average patient with a BMI of 35 or greater spends an average of $15,000/year more than patients whose weight is normal. The health care costs from the diseases associated with morbid obesity is, by various estimates, is over $500 billion/year in the United States.
Between the balloon helping to shuck excess pounds and continued counseling going forward, Kent has seen numerous success stories and many patients who have gone on to lead healthier, happier lives.
“We try to give our patients good habits and then give them that running start to a healthier life,” Kent said.