Novel Weight-Loss Surgery Changes Teen’s Life
San Jose native Megan Acaccia is riding her bike three miles a day, climbing the steepest Bay Area hills, and shopping for a new swimsuit. She’s full of excitement about her high school graduation in June—a milestone that didn’t look very bright until she received lifesaving weight-loss surgery at Lucile Packard Children’s Hospital at Stanford.Just nine months ago, the eighteen-year-old was regularly missing school. She was always sick—vomiting, diarrhea, night sweats—and gulping down seven different medications daily. Standing 5'3" and weighing more than 300 pounds, Megan had a Body Mass Index (BMI) of 54; she was morbidly obese. And her extra weight caused an even heavier load of secondary diseases: hypertension, arthritis, acid reflux, polycystic ovary syndrome, and obstructive sleep apnea.
“I would go on a short hike and then not be able to walk for three days,” remembers Megan, who tried every diet in the world. “The pain in my back and ankles was so bad.”
Bullied since elementary school, by junior year the stress and anxiety became too much; she stayed home for a month. “Here was a very dedicated girl who was sad and didn’t want to go to school,” said Susan Farrales, RN, nurse practitioner, who met Megan in Packard’s pediatric weight control clinic at age 15.
At that point, Megan’s pediatrician suggested she look into bariatric surgery. “A good candidate is someone who has failed every other treatment,” said Matias Bruzoni, MD, pediatric general surgeon at Packard Children’s. “It’s a last resort.”
Megan had access to one of the top adolescent bariatric surgery programs in the country at Packard Children’s, which became the first children’s hospital in California to offer bariatric surgery for adolescents in 2004.
Packard is also the only children’s hospital on the West Coast to offer the sleeve gastrectomy, a newer bariatric surgery procedure for adolescents that is less invasive than other types of weight-loss surgery.
The sleeve gastrectomy dramatically shrinks the size of the stomach, removes the part of the stomach that generates the hunger hormone, and delays gastric emptying. This results in patients feeling fuller longer, even after eating a very small amount of food.
Drawing on a collaborative relationship with Stanford Hospital & Clinics, Packard introduced the sleeve gastrectomy in 2010. While too early to see long-term outcome data, “in many ways, the sleeve is the ideal operation for adolescents. It doesn’t require a foreign body like the gastric band procedure, and it doesn’t require rerouting of the intestine, or cause potential vitamin deficiencies,” said John Morton, MD, director of bariatric surgery at Stanford Hospital & Clinics and co-director of the program at Packard. Sleeve gastrectomies also carry fewer post-operative complications than alternative surgeries.
 Megan, before her bariatric surgery |
The Packard team also looks for the dedication required to meaningfully change old habits—essential for long-term success. “We can give them the physical restriction of shrinking their stomach, but if it’s not in their head—if they’re not willing or able to follow through—they may not triumph,” Bruzoni reflects.
On June 13, 2011 Megan was ready for surgery. Bruzoni and his team, including Craig Albanese, MD, chief of pediatric general surgery, made five small incisions in Megan’s abdomen, and, with the help of a tiny camera inserted laproscopically, removed about two-thirds of her stomach using a vertical line of staples. “Imagine the stomach is a bag. We transform it into a long tube the size of a banana,” described Bruzoni. The procedure takes about two hours, and Megan was home two days later.
Carefully following her new eating and activity guidelines, Megan lost weight immediately. Two weeks later, she dropped 11 pounds and felt a surge of new energy. “I could walk around the block faster and my ankles didn’t hurt afterward,” she remembers.
Melting away with the extra pounds were secondary illnesses. Three months post-surgery, she no longer needed a positive airway pressure mask to sleep. Soon after, handfuls of medication were replaced with a single vitamin. And, she was starting to enjoy herself with new clothes and outdoor activities. After a recent run-in with a former middle school bully who hardly recognized her, Megan’s confidence soared. As of publication, she has lost 114 pounds—a record loss for sleeve gastrectomy patients at Packard—and is still counting.
Megan’s new healthy lifestyle has also had a major impact on her entire family. Her mother, sister and brother have all shed more than 150 pounds combined. “It takes us forever to grocery shop; we all stand around reading every label,” laughs mom Annie.
With her graduation in June, Megan has a lot to celebrate, including her first job, plus enrolling in West Valley College in the fall. Her family could not be prouder, and neither could her Packard family.
“Her self-determination and dedication have given her the power to beat this disease,” said Farrales. “It’s obvious that when Megan sets a goal for herself, she achieves it.”