Advanced Weight-Loss Surgery at San Antonio’s University Hospital Results in Healthier Patients

By Katy Mena-Berkley
Wednesday, March 11, 2020

Surgeons with University Health System offer a full spectrum of bariatric procedures and complementary programs to help patients achieve their weight-loss goals, improve their overall health and enjoy an enhanced quality of life.

University Hospital bariatric surgeons, Jason Kempenich, MD, Richard M. Peterson, MD, and Kent Van Sickle, MD

For patients living with obesity and related conditions, including coronary heart disease, hypertension and Type 2 diabetes, bariatric surgery can be a powerful resource to manage weight and restore health.

“Bariatric surgery works,” says Kent Van Sickle, MD, Medical Director for the bariatric program at University Health System in San Antonio. He is also Professor of Surgery and the Division Chief for General and Minimally Invasive Surgery at UT Health San Antonio.

“The nice thing about all of these bariatric procedures is that they are all very effective at inducing weight loss and, therefore, resolving — and in some cases outright reversing — the medical problems associated with obesity.”

Dr. Van Sickle works closely with two other specialized surgeons in the University Health System – Jason Kempenich, MD, FACS, general and bariatric surgeon at UT Health San Antonio and Richard M. Peterson, MD, MPH, FACS, FASMBS, Professor of Surgery and Chief of Bariatric and Metabolic Surgery at UT Health San Antonio. As a team, they offer patients the latest, most sophisticated surgical procedures, including the vertical sleeve gastrectomy, often called the sleeve, and Roux-en-Y gastric bypass, considered the gold standard for weight-loss surgery by the American Society for Metabolic and Bariatric Surgery.

One year after her gastric sleeve surgery, Sandra Diaz no longer dreads weighing in at appointments with Dr. Kent Van Sickle. She has lost more than 100 pounds.

Bariatric Team Uses Latest Techniques to Help Higher Risk Patients

The team, which has a wealth of fellowship training in minimally invasive surgery and robotics, also performs a relatively new, advanced procedure known as the SADI-S, which stands for single anastomosis duodeno–ileal bypass with sleeve gastrectomy.

SADI-S is sometimes a better option for patients who have diabetes or a higher body mass index, referred to as BMI.

The SADI-S requires two separate procedures. First, a surgeon removes roughly 80% of the stomach and makes a sleeve with the remaining portion, as they would with a sleeve gastrectomy. This restricts the amount of food a patient can eat. Then the surgeon performs an intestinal bypass, which reroutes a lengthy part of the small intestine and limits the amount of calories a patient can absorb.

The recovery after SADI-S is similar to other minimally invasive surgeries usually requiring a short hospital stay. Patients then follow a liquid diet for about two weeks and a soft diet for several additional weeks before following a high-protein, low-carbohydrate diet.

Sandra Diaz gives a high five to her gastric surgeon Dr. Kent Van Sickle. She says gastric surgery has given her quality of life. Her blood pressure and blood sugar levels are now normal, and she has the stamina to exercise regularly at the gym.

University Health’s Program Provides Important Support Services

To help patients prepare for and adapt to the specialized diets that follow bariatric procedures, University Health System offers nutritional counseling and support, some of the valuable ancillary programs available to bariatric surgery patients.

Dr. Jason Kempenich is a bariatric surgeon practicing at University Hospital and on the faculty at UT Health San Antonio.

“Our nutritionist is very good at following patients long term and even emailing with them, so patients don’t necessarily have to have an appointment to just touch base or get a question answered,” Dr. Kempenich says. “I think checking in with them just creates an extra layer of accountability and assistance.”

In addition to the nutritional support, University Health System offers psychological services that help patients manage emotional issues related to weight loss and medical intervention. A team of nurses and program coordinators follow up with patients about their individual progress. Interventional radiology and endoscopic resources are available should complications such as a sleeve leak occur.

“As an academic facility, University Hospital is empowered with those resources,” Dr. Kempenich says. “We have a team of residents, and we have a teaching conference every week that doubles as a conference for patients who experience difficulties.”

“Obesity is a chronic disease that requires multiple avenues for treatment. Early referrals are important, and so is understanding that obesity is not a choice for people. It is actually a disease, and you need to treat it as such.”
— University Health System Surgeon Richard M. Peterson, MD, MPH, FACS, FASMBS, Professor of Surgery and Chief of Bariatric and Metabolic Surgery at UT Health San Antonio

Dr. Richard M. Peterson is a bariatric surgeon practicing at University Hospital and Chief of Bariatric and Metabolic Surgery at UT Health San Antonio.

Expert Care for Complicated Cases

In the event repairs or revisions are needed following a procedure, the bariatric team at University Health System is equipped to provide surgical solutions.

“The most popular weight-loss operation is the sleeve gastrectomy, followed by gastric bypass, which is a distant second,” Dr. Van Sickle says. “But the third most common is revision surgery, and that makes up a growing percentage of bariatric surgeries in the U.S. This includes revising old weight-loss surgery that didn’t work, or taking out the lap-band, which was a flash-in-the-pan surgery that came and went about 10 years ago.”

To correct lap-band complications, the surgeons utilize more proven procedures. They also have access to University Health System resources and can offer a comprehensive course of care for patients with extreme obesity, some of whom may have a BMI higher than 70. These patients may consult with a physician specializing in obesity and participate in a medical weight-loss program of six months to a year before undergoing bariatric surgery.

“We have patients who really demonstrate commitment to the idea of weight loss,” Dr. Van Sickle explains. “It is more than just a surgery, right? It’s a change in lifestyle. It is a change in how you conduct your life.”

Patients living with comorbidities such as diabetes stand to benefit greatly from the holistic approach to wellness emphasized by this bariatric team.

“I would say that diabetes is one of the biggest reasons to have bariatric surgery,” Dr. Kempenich says. “Those patients stand to gain the most from bariatric surgery because of the diabetes control the surgery can allow. The best thing for their health is to get their diabetes under control, and the weight loss is like a secondary outcome measure.”

And while not everyone with obesity is a candidate for surgery, those who have a BMI greater than 35 with other medical problems, such as diabetes or heart problems, should be referred early before these conditions become so serious bariatric surgery is no longer an option.

Research Raises Hope for Reversing Type 2 Diabetes

Patients living with obesity and Type 2 diabetes may soon have a new surgical option that could reverse insulin resistance and lead to weight loss.

Mesenteric visceral lipectomy, referred to as MVL, is at the center of a clinical trial led by a research team that includes University Health System surgeon Richard M. Peterson, MD, MPH, FACS, FASMBS, Professor of Surgery and Chief of Bariatric and Metabolic Surgery at UT Health San Antonio. Ralph DeFronzo, MD, Chief of the Diabetes Division at UT Health San Antonio and Deputy Director of the Texas Diabetes Institute, is the principal investigator for the study. The Texas Diabetes Institute at University Health System is a partner with UT Health.

The procedure involves Dr. Peterson making a small abdominal incision, then using a special instrument that melts and extracts belly fat surrounding the small intestine.

Researchers have found that performing MVL in obese, insulin-resistant baboons reversed Type 2 diabetes and caused significant weight loss. The findings point to the possible effectiveness of this procedure in humans who have abdominal obesity and diabetes.

“Anything that we can do to enhance opportunities for patients with this disease, we should do,” Dr. Peterson says. “We should be looking at what we are already doing, other things that we can do better and strive to improve.”

Weight-loss Surgery Changing Lives

One of the most satisfying benefits of the bariatric field is seeing your patients achieve goals they may have not have thought possible, and the University Health System surgeons regularly witness those success stories.

Dr. Kempenich remembers one patient who underwent a sleeve gastrectomy in Mexico and experienced a sleeve leak. To repair the defect, the University Health System team performed a procedure that sealed the leak.

“She lost weight, did well and lived her life,” Dr. Kempenich says. “That made a huge difference in the patient’s life.”

Dr. Kempenich also had the pleasure of treating a young woman with endometrial cancer who still wanted the opportunity to have children. Thanks to the multidisciplinary care that he and his colleagues were able to provide, she lost weight, recovered from cancer and was able to plan on becoming a mother.

For Dr. Peterson, some of his job satisfaction comes from witnessing simple improvements in a patient’s life.

“Every day I’m in clinic, I see success stories, and those stories really highlight the quality of life that the patient has after surgery,” Dr. Peterson says. “Whether they have achieved this amazing goal of weight loss they were looking for, or their diabetes is now resolved and they’re not taking insulin, or they are able to get on the ground and play with their grandchildren — little life things make an impact.”

To learn more about bariatric surgery at University Health System, visit or call 210-438-8446.