Meet our Docs: Kevin Helling, M.D., offers advanced laparoscopic and bariatric surgery
By admin Aug 20, 2015
When Kevin Helling, M.D., signed up for medical school through the WWAMI program (an acronym for participating states – Washington, Wyoming, Alaska, Montana and Idaho), he knew he’d be returning to his home state to practice medicine. His colleagues, however, were surprised.
“A lot of people with this kind of training, bariatrics and advanced laparoscopy, typically end up working in a big university hospital. My colleagues thought it was great that I was returning to Wyoming to provide a service that, up until now, has not been available here,” said Dr. Helling, a board-certified general surgeon at Wyoming Medical Center and Wyoming Surgical Associates in Casper.
“It is a special thing to give back to the people who have supported me through medical school, the people who raised me and who I grew up with.”
Dr. Helling completed his subspecialty training in advanced laparoscopic and weight-loss surgery at Harvard University. He also serves as medical director of bariatric surgery at Wyoming Medical Center, which now offers two new surgical options for weight loss. He sat down with The Pulse do discuss these options and the importance of a comprehensive approach to losing weight.
Where did you grow up, and how did you become interested in medicine?
I was born in Laramie when both my parents were at the University of Wyoming. I moved to Casper when I was about 5. I went to Dean Morgan Junior High and graduated from Natrona County High School. After college, I took advantage of the WWAMI program and went to medical school in Washington. I have always been interested in medicine, clear back to second grade.
What did you find so interesting?
From my earliest memories I had wanted to become a doctor. I was always interested in disease, pathology and how people get better. I remember going to the library in elementary school and reading the human body books.
Once I started medical school, I knew that my passion was to be in the operating room. As I progressed through my training, I found that my interests and skills were best suited for general surgery. The diversity of procedures, critical care, and advanced laparoscopy that I get the privilege to do every day continue to drive my interest.
Explain bariatric surgery for those who are not familiar.
Bariatric surgery – or weight-loss surgery – is a field that has developed over the past 20 to 30 years. It involves altering the GI tract in a way that restricts the amount of food that can be eaten as well as altering hormonal pathways responsible for hunger and obesity. These operations are routinely performed laparoscopically and patients recover quickly.
Bariatric surgery is the most powerful tool for the treatment of obesity and health problems related to it. Here at WMC, we combine the surgery with a comprehensive approach to weight loss, which includes dietary and lifestyle changes. By approaching obesity from multiple different techniques, patients benefit the most.
Bariatric surgery is a passion of mine. One of my greatest satisfactions as a bariatric surgeon is to see patients experience dramatic, safe weight loss, and to watch their medical conditions improve. When patients tell me about their new lease on life following weight loss surgery, it makes me feel really good about the choice I made to go into the field.
What surgical weight-loss treatments will you offer at Wyoming Medical Center?
There are two primary operations that we will do. The most extreme, and also the most effective, is the gastric bypass. With the gastric bypass we actually divide the stomach and create a small stomach pouch about the size of an egg. We reconnect that to the small intestine downstream.
There are several mechanisms by which the gastric bypass causes people to lose weight. The first is that the size of the stomach is smaller so you are not able to take in as much food. The second is that we bypass a large portion of the stomach and small intestine, so fewer calories are absorbed. Thirdly, and most interestingly, it alters the hormone balance in the body and down-regulates feelings of hunger.
What other surgical options are available at WMC?
The most common weight-loss operation in the world right now is called the sleeve gastrectomy. We basically remove about 80 percent of the stomach and leave behind just a narrow sleeve, like the sleeve of a shirt. At first glance you would say it works because the stomach is smaller and you cannot eat as much food. That explanation is incomplete, however. The stomach is a very hormonally active organ, and cells responsible for producing hunger hormones are located primarily in the portion of stomach that is removed. By removing the hunger hormone producing cells, appetite is greatly decreased and weight loss results.
How safe are these surgeries?
Weight-loss surgery is major surgery and there are potential complications. Despite this fact, the operations have become much safer in recent years. The mortality rate following bariatric surgery is less than 1/1000 patients, and is similar to the mortality rate for removing the gallbladder. Overall, you have to talk to your doctor about whether the benefits of the operation are outweighed by the risks.
Obviously, this is not for everybody. When is surgery an option?
The National Institutes of Health established criteria to determine who qualifies for weight loss surgery based on the body mass index (BMI). BMI is a calculation based on your height and weight. People with a body mass index over 40, or with a body mass index between 35-40 with a weight-related medical problem like diabetes or high blood pressure, qualify for surgery.
According to the most recent numbers from the Centers for Disease Control and Prevention, 36 percent of Wyoming adults are classified as overweight and 28 percent are obese. That fits along with the national trend of obesity as an epidemic in our country. When you compare that to even a couple of years ago, those percentages have gone up 2 to 3 percent.
Obesity is an epidemic. It is a disease that is caused by multiple factors, and is one that we now have the powerful tools to treat.
How do you see bariatric surgery progressing in the future?
As the field of bariatric surgery continues to evolve, I believe we will see more people getting the operations not just for weight loss, but for treatment of diseases such as type 2 diabetes. This is already being done in some countries and is showing promising results. For now we use the NIH criteria for determining who is a candidate for surgery, but I suspect in the relatively near future those criteria will be revised.
You are also working with the hospital’s Weight Management program. Explain that relationship.
I will be working with Weight Management to provide the surgical care, of course, but also to help facilitate some of the other medical methods of weight management – exercise, diet modification, etc. With that interaction, we will be able to build a nice comprehensive program that can be recognized within the whole state and even the region.
We want to help people approach weight loss in a safe way, avoiding fad diets, avoiding unsafe medications and extreme measures. Most overweight and obese people have tried dieting, but have been unable to experienced prolonged success. We are putting into place all the tools necessary for that. A lot of that is education. For some patients, surgery comes in as it is one of the most powerful tools that can be used to change the behavior.. Ultimately multiple treatment modalities will be used together in the weight loss center to help patients achieve their goals.
You completed a fellowship in advanced laparoscopic surgery. What does that mean?
Laparoscopy is “minimally invasive surgery” in which I create keyhole incisions through which I am able to introduce special instruments into the body that allow me to perform complex operations with minimal incisions.
While most surgeons do some basic operations laparoscopically, I have been trained to do more complex operations, such as hernias and complex stomach and pancreas operations with the laparoscope. These are things that, until recently, were always done through an open incision.
Where did you do your surgical training?
I did my surgical internship at Dartmouth followed by general surgery residency at Stanford, and a fellowship in Advanced Laparoscopic and Bariatric Surgery at Harvard University. I am excited to bring this world class experience back home to Casper and Wyoming.
What are the advantages of laparoscopic surgery?
Laparoscopic surgery can accomplish big operations through small incisions. With the tiny incisions, the recovery time is significantly faster. The risks of complications such as infection and scar tissue formation are lower, and people get back to work more quickly.
There are still some cases when laparoscopic surgery is not appropriate. I approach each patient individually and assess the appropriateness of performing surgery laparoscopically based on individual circumstances.
Dr. Helling is a board-certified general surgeon, completing training in general surgery at Stanford University and subspecialty training in advanced laparoscopic and weight loss surgery at Harvard University. He has authored numerous publications, textbook chapters, and has presented his research at national and local scientific meetings. He practices at Wyoming Surgical Associates in Casper; call (307) 577-4220 for a referral.