Denis’ Incredible Gastric Bypass Success Story

The following incredible gastric bypass success story is about a patient of mine named Denis, who transformed his life from disaster (>500lbs, heroin addict) to awesome (healthy weight, successful entrepreneur).

I have been fortunate as a bariatric surgeon to have been able to help countless people improve their lives with weight loss surgery. I have seen patients go from not being able to walk without pain to running marathons. I’ve seen a patient go from being confined to a wheelchair to hang gliding in South Africa. Daily I see patients with more energy, more confidence, more happiness, more physical ability, and fewer medical problems. But of the >2300 patients I’ve operated on, I have not seen a more moving story than Denis’ gastric bypass success story.

Generally patients turn to weight loss surgery after a low is reached – a diagnosis of diabetes, a realization that diet and exercise will never work, a realization of what the future will look like with continued obesity, etc.

Denis Hit Rock Bottom

Denis’ low was much lower. The average weight loss surgery patient is about 100 pounds overweight. Denis was 468 pounds overweight at his heaviest – 628 pounds. Being this heavy severely affected every aspect of his life. He was almost incapable of doing things that most of us take for granted – walking, going to the bathroom, standing, showering, dressing, sleeping, etc.

Making his situation even worse, however, was the fact that he had an extremely large apron of skin and fat that hung from his lower abdomen and extended to below his knees. This apron, also known as a pannus, at its heaviest weighed more than 100 pounds. Denis’ weight of 628 pounds was obviously limiting, but this 100+ pound hanging apron of skin and fat made it all much worse. His mobility was limited well beyond where it would have been with his weight alone, and he suffered from continuous and severe pain.

How does a pannus like this develop? The key causal factor is gravity. Over the years gravity can cause an apron of skin and fat to hang lower and lower, and, if it gets severe enough, circulation of blood through the pannus can become compromised. This leads to swelling which causes it to hang even lower, and further compromises circulation. Ultimately permanent and progressive damage in the hanging skin and fat occurs. This damage leads to breakdown of the skin and infection.

Denis was at the end stages of this spiral of progressive damage. Not only was his pannus extremely large and heavy, but it was also chronically infected due to the severely compromised circulation and major swelling. The infections had progressed from an occasional issue to a continuous problem.

Denis unfortunately did not have health insurance. This prevented him from getting the major surgical interventions he needed. This also prevented him from getting treatment for his ongoing issues with both infection and pain.

Denis’ infections in the skin and fat of his pannus progressed to being a continuous issue. The infections would worsen, then improve, then worsen, but never completely resolve. Denis managed these infections the best he could by trying to keep the infected areas clean and dry, and by taking antibiotics when the infections worsened.

Denis treated his pain by using narcotics he bought on the street. For years he took 20-30 or more Norco or oxycontin tablets daily. This was expensive and difficult due to the large number of tablets he had to take every day to control his pain. Eventually he switched to heroin. Smoking heroin every couple hours worked better for pain control, and was cheaper and easier. Ultimately his heroin habit was costing him $150 per day.

At this point in his life things were not going well. Things, unfortunately, got worse before they got better. In 2006 one of Denis’ infections became more severe. He treated himself in the usual way – antibiotics, heroin for pain, and waiting for improvement. The infection, however, progressively worsened and spread throughout his body, making him very sick.

When Denis wasn’t seen for a few days, his friends went looking for him. He was found in his house, lying in a pool of blood and pus, and unconscious. An ambulance was called, but at 628 pounds the EMT’s could not move him. The fire department had to come, break down a wall in his house, and help to move him. It took 8 people to lift him onto an oversized gurney.

Denis Remained Hospitalized for 4.5 Months

Denis almost didn’t make it through the next 24 hours. He had lost a lot of blood, was in septic shock, and was in heroin withdrawal. At one point in the emergency room he stopped breathing and had to be resuscitated by the emergency room physicians.

Denis remained in the hospital for 4.5 months. This was Denis’ wakeup call. He decided to change his life.

During his 4.5 month hospital stay he lost roughly 200 pounds. He still weighed a lot, but he was in much better shape than he was at 628 pounds. He had less pain, his apron of skin/fat was smaller, and it was easier for him to get around. Over the next couple years Denis stayed off all narcotics, started a business, got health insurance, and married his high school sweetheart.

Denis’ weight, however, crept back up over the years. This is not surprising – the body has a biologic “set-point” for weight that it very effectively maintains. The set-point can increase with weight gain, and once it does, it doesn’t go back down (read post about set-point here). Denis’ set-point, unfortunately, was likely close to his maximum weight.

With his weight gain his situation again progressed to where he could barely walk, stand, dress, shower, sleep, etc. His pain again became severe and continuous, and his skin infections started to become more frequent and severe. Despite this Denis continued to manage his business, and stayed off of all pain medications.

The Beginning of a New Life

I met Denis in June 2012. At that point he weighed 532 pounds and was in bad shape. His pannus was larger than any I had ever seen; it was extremely heavy, severely swollen, and chronically infected. He could barely walk, could only stand for a short while, couldn’t lie on the exam table, and was in obvious pain. As he told me his story, I was amazed at how successful he had been at making the best of his dire situation.

During that first meeting Denis clearly needed and wanted help, but his level of hope was subdued because he didn’t know if getting help was even possible. Denis had seen many doctors over the years; all declined to get involved because he was deemed too high of a risk.

As we talked, I became excited thinking about how drastically his life would change with weight loss surgery and a panniculectomy. Because of my excitement, Denis’ demeanor changed to one of almost manic excitement and anticipation.

My thought process evolved after Denis left and I had more time to consider his case. I initially thought a panniculectomy followed down the road by a gastric bypass would be the best approach, because his 100 pound apron of skin and fat was his most limiting issue. Denis loved this plan because his pannus was causing him continuous pain and impeding on every aspect of his life. The thought of being rid of it was understandably exciting.

I have done panniculectomies on many patients over the years, but nobody had even close to as severe a problem as Denis’ problem. I looked up the published medical literature on panniculectomies in patients like Denis, and could not find examples of patients with similarly advanced disease. My take away from my research was that the mortality rate for panniculectomy in patients like Denis is very high.

I talked to a colleague of mine who I knew had done a panniculectomy on a patient with a very large, hanging, swollen pannus, and he told me his patient had a series of complications and ultimately died. My initial excitement for operating on Denis waned.

I decided instead that the safer approach would be to first do the gastric bypass laparoscopically, let him lose weight, and then do the panniculectomy after it had shrunken due to the weight loss. The laparoscopic approach for the gastric bypass was important, because a large abdominal incision would almost certainly result in complications. To increase the chances for being able to do the gastric bypass laparoscopically, Denis needed to lose weight before surgery.

I knew this new plan wasn’t going to go over well. Denis left after our first visit thinking that the solution to his problem was within reach. He was ecstatic. I now had to tell him the road would be longer and harder.

When I told Denis the new plan – weight loss (50 pounds minimum), followed by laparoscopic gastric bypass, followed by more weight loss, followed by panniculectomy – his excitement, as expected, disappeared and was replaced by anger and defeat. My strong opinion, however, was that this was the necessary path.

Denis wanted to give up. He tried to give up. Fortunately he has a supportive and influential family, and they convinced him otherwise. Once he accepted the new plan, his hope and excitement returned. He went on a liquid diet, lost 80 pounds in 3 months, and scheduled gastric bypass surgery for October 1, 2012.

Gastric Bypass Surgery

I was a little nervous about his gastric bypass – would the pannus get in the way, or compromise visibility or exposure? Would the weight of his pannus on his legs cause a blood clot? Hard to know, because cases like Denis’ are rare. As it turned out, his operation, because of his preoperative weight loss and despite his large pannus, was very straightforward. He went home two days after surgery and recovered without incident.

As he lost weight after his gastric bypass operation his pannus surprisingly became more problematic rather than less problematic. His weight loss caused it to hang lower, making wearing clothes more difficult. He had a hard time keeping sweat pants around his waist and not around his thighs. Also, as it hung further down, it swung more when he walked, throwing him off balance.

We scheduled the panniculectomy for December 12, 2012. I wanted to wait longer for more weight loss and more shrinkage, and therefore less risk, but Denis could not wait any longer.

Massive Panniculectomy

The panniculectomy was a much more difficult operation than the gastric bypass. The pannus was so heavy that it was hard to maintain exposure of the surgical field, despite using hooks, ropes, and pulleys. The operation had to proceed very slowly to prevent excessive bleeding from the countless large blood vessels that supplied the pannus. In total the operation took more than five hours. We removed a remarkable 52 pounds of skin and fat.

Immediately after surgery Denis felt great. He went home the next day. I think it took me longer to recover than him. His biggest challenge after surgery was learning how to walk without tipping over backwards.

Gastric Bypass Success Story

Now, seven months after his gastric bypass, and five months after his panniculectomy, Denis has lost 300 pounds and is living a remarkably different life. Before, he couldn’t stand without pain. He couldn’t sleep more than an hour or two at a time. He couldn’t walk without getting immediately short of breath. He couldn’t go to the bathroom without first getting into the shower. Now he walks the pier with his wife just for the fun of it. He does karate twice per week. He roller skates twice per week. He rides his motorcycle. Best of all he smiles all the time.

Read more about Dr. Oliak and his Orange County weight loss surgery program at www.OliakCenter.com.