After a battery of medical complications following a surgery last year, the last thing Marc Summers wanted was more surgery.

But when a hernia condition became debilitating for him, another surgery to fix it seemed inevitable. First, however, Summers needed to lose weight. So his doctor, Lee Trotter, began exploring options for him.

Due to Summers' physical limitations from the hernia, losing weight through diet and exercise would have been extremely difficult, Trotter said. Trotter and Summers looked to bariatric surgery instead.

Trotter knew that Summers' previous surgeries and resulting complications made most of the more common bariatric surgeries - lap band and bypass - dangerous. But there was one, an old procedure made new, that made sense for him.

On Oct. 21, Summers underwent a minimally invasive surgery called a sleeve gastrectomy.

The sleeve gastrectomy surgery is a "decades-old surgery," used only in cases where a person needs to lose excessive amounts of weight, Trotter said.

Sleeve gastrectomy first was used as a two-step surgery. During the first step, doctors stapled off about 60 percent of the stomach, which was then removed. That left a banana-shaped portion of the stomach that looked a bit like a sleeve.

Once that portion of the procedure healed, doctors went back in and did an intestinal bypass so a smaller segment of the intestines was allowed to absorb calories and nutrients.

The surgery was considered problematic because patients struggled to absorb adequate amounts of nutrients to remain healthy after the second step, Trotter said. Complication rates were high, he said. Luckily, during the early days of the procedure, doctors began to notice something interesting. Patients were losing weight before even getting to the second procedure, and they were reporting less hunger.

Doctors began to think that "maybe in some patients the intestine portion was way overkill," Trotter said.

Scientists eventually discovered a hormone in the stomach called ghrelin. It's ghrelin's job to tell the brain that the body needs to be fed. The level of ghrelin increases before eating and decreases after.

Ghrelin is produced in the section of the stomach that is removed during the first portion of the sleeve procedure. Doctors speculate that by removing that portion of the stomach, they reduce or eliminate the amount of ghrelin being produced. As a result, patients feel less hungry and are able to lose the weight without the drastic intestinal bypass.

"This is safer. Much less surgery," Trotter said.

The sleeve gastrectomy is becoming more popular again because it can be done laparoscopically and is successful, Trotter said.

Summers knew little about the various bariatric procedures before his surgery, but is happy with the results of the sleeve gastrectomy. Since the procedure, he has lost 30 pounds and is all the closer to getting the hernia operation he needs.

He admits that while he doesn't feel satiated from the liquid diet he will stay on until December, he doesn't necessarily feel hungry.

"It's been difficult. It's a lifestyle change," he said.

That's the most important message of any news about weight loss surgery, Trotter said. The surgery itself won't do it alone.

"Surgery does not cause weight loss. Surgery is a tool in assisting you to live a lifestyle," he said.

Trotter said patients need to learn to feed their bodies what they need rather than just what they want.

Summers is set to start learning that lesson in December, when he adds real food back into his diet.

When Summers had his operation in October, he weighed 379 pounds at

5 foot 11 inches.

Last week, he was already down to 349 pounds. This week, he began incorporating exercise into his routine. His goal is to reach 200 pounds so that he can get the hernia operation.

He sees the hernia operation and the sleeve gastrectomy as the stepping stones to getting his life back to normal.

"I need to get the weight off ... so I have a better life," he said. "So I can lead a normal life and go out and play softball or run around with the kids in the yard."

So far, he thinks he's on the road toward that future.

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com.